Abnormal synovium in the frozen shoulder: A preliminary report with dynamic magnetic resonance imaging

We studied 16 patients (18 shoulders) with frozen shoulders, 8 patients with subacromial impingement syndrome, and 3 healthy volunteers with dynamic magnetic resonance imaging enhanced with gadolinium diethylenetriaminepentaacetic acid. After intravenous contrast was administered, gradient-recalled echo images were obtained in the oblique coronal plane every 11 to 13 seconds for a total period of 4 to 5 minutes. The signal intensity was measured at the periphery of the glenohumeral joint and in the subacromial bursa. The coefficient of enhancement (percent signal increase per second) in the frozen shoulders was 1.33±0.43 (mean ± SD) for the glenohumeral joint and 0.89±0.47 for the subacromial bursa. These values were far greater than those in subacromial impingement syndrome or in the control group, indicating increased blood flow to the synovium in the frozen shoulders. No previous reports have shown a clinical measure related to the pathophysiology of this disease.     

Clinical investigation of carbohydrate antigen CA-50

The CA-50 enzyme immunoassay kit (EIA kit) that has been developed with the use of C-50 monoclonal antibody prepared by L. Lindholm et al. was evaluated for diagnosis of human cancer. The levels of CA-50 in the sera were determined using this kit supplied from Mitsui Pharmaceuticals, Inc. Co. in 759 healthy donors, 728 patients with benign disease and 1,263 untreated patients with cancer. A CA-50 concentration of 40 U/ml of serum was used as the cut-off value. Patients with pancreatic cancer and patients with bile duct cancer had high positive incidence of 75% and 68%, respectively, compared with a low positive incidence of under 40% in patients with other cancers. On the other hand, positive rates in patients with benign disease were as low as 13%. Comparison of the serum levels of CA-50 with CA19-9 in the same samples did not exhibit complete positive correlation in patients with pancreatic cancer, patients with bile duct cancer and patients with liver cancer. These findings indicated that C-50 antibody reacted with two epitopes of CA19-9 and sialosyllactotetraose. From the above results, the usefulness of CA-50 as a tumor marker for pancreatic cancer and bile duct cancer was recognized with this EIA kit.     

Synthesis and antitumor activity of tropolone derivatives. 7. Bistropolones containing connecting methylene chains.

Bistropolone derivatives (4-12) containing differing lengths of linkage between the two tropolone rings were prepared and examined for their antitumor activity in in vitro (KB cell) and in vivo (leukemia P388 in mice) systems. Parent compound 3, related compounds previously prepared, and the new compounds 4-12 were evaluated for inhibitory activity against ribonucleotide reductase by indirect means to measure their effects on the dNTP pool imbalance. Present structure-activity relationship results would suggest that potently active bistropolones in vivo inhibit intracellular ribonucleotide reductase through chelating with the two irons at the two active sites of the enzyme.     

Malignant fibrous histiocytoma arising from a calcifying enchondroma – a case report

Summary. A man, 79 years of age, developed a malignant fibrous histiocytoma which arose in relation to a calcifying enchondroma of the distal femur. Radiographs showed a fracture through an intensely calcified bony tumour with no bony destruction. The clinical diagnosis was a dedifferentiated chondrosarcoma. Histology showed an anaplastic sarcoma with calcified tissue showing extensive areas of necrosis and degeneration. No chondrosarcomatous foci were found.

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Resumé. Nous rapportons le cas d’un homme de 79 ans, qui a développé un histiocytofibrome malin à partir d’un enchodrome calcifié du fémur distal. L’examen radiologique a montré une fracture au sein d’une tumeur très calcifiée sans association de destruction osseuse. Cette lésion apparaissait cliniquement être un chondrosarcome dédifférencié. Mais l’étude histologique a montré un sarcome anaplasique avec un tissu cartilagineux calcifié présentant des plages étendues de nécrose et de dégénérescence. Il n’y avait pas de foyer chondrosarcomateux visible.

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Accepted: 9 November 1996     

Significance of fiberoptic bronchoscopy after pulmonary resection of lung cancer for early detection in second lung cancer

By the end of 1988, seventy five cases after pulmonary resection for lung cancer and one case after pulmonary resection for basal cell hyperplasia were examined with fiberoptic bronchoscopy as postoperative follow up. Endobronchial tumor was detected in 14 cases. In seven cases, endobronchial tumor was located at site far from the surgical bronchial anastomosis. These tumors were suspected as second lung cancer as long as examined by fiberoptic bronchoscopy. Histological type of all of these was squamous cell carcinoma. Re-operations were performed in five cases and two of them were early lung cancer. In 6 cases (13.6%) among 44 cases examined with fiberoptic bronchoscopy after pulmonary resection for central type squamous cell carcinoma, second lung cancer was detected. In the case of central type squamous cell carcinoma, usually the tumor appears to be of same histological type and at same location. Among those cases those who smoke heavily should be separated as high risk group. If this group is followed with fiberoptic bronchoscopy or sputum cytological examination, it is more possible to detect second lung cancer at an early stage.     

Possible relationship between low birth weight and magnesium status: from the standpoint of "fetal origin" hypothesis.

Magnesium deficiency in pregnant women is frequently seen because of inadequate or low intake of magnesium. Magnesium deficiency during pregnancy can induce not only maternal and fetal nutritional problems, but also consequences that might last in offspring throughout life. Many epidemiological studies have shown that restricted fetal growth, i.e. intrauterine growth retardation (IUGR), is associated with an increased risk of insulin resistance in adult life. We previously postulated that the intracellular magnesium of cord blood platelets is lower in the small for gestational age group than in the appropriate for gestational age group, suggesting that intrauterine magnesium deficiency may result in IUGR. Taken together, intrauterine magnesium deficiency in the fetus may lead to or program the insulin resistance after birth. We hypothesize that intrauterine magnesium deficiency may induce a metabolic syndrome in later life. Prospective studies will further clarify whether infants with IUGR induced by magnesium deficiency are at higher risk for metabolic syndromes in childhood or adulthood.     

Long-term survival after removal of a malignant peripheral nerve sheath tumor originating in the anterior mediastinum

Malignant peripheral nerve sheath tumors (MPNSTs; malignant schwannomas) rarely occur in the anterior mediastinum, and their prognosis is poor. A 75-year-old man was referred to our hospital for examination of an anterior mediastinal tumor. A computed tomography-guided percutaneous needle biopsy revealed only fibrosis. The tumor was completely excised via a median sternotomy with partial resection of the pericardium and right upper lobe of the lung. Thereafter, the tumor was diagnosed as a storiform-pleomorphic type of malignant fibrous histiocytoma. At 1 year after the surgery, a distant metastasis was found in the interlobular space between the right middle and lower lobes. The tumor was completely excised via a right posterolateral thoracotomy. Reexamination of the primary and secondary tumors revealed an MPNST. No recurrence was found up to 5 years after the second surgery without adjuvant chemotherapy or radiation therapy. However, he died from multiple lung metastases after 6 years.     

Experimental study of patch reconstruction of tracheal defects with Marlex mesh]

Animal experiments of the patch reconstruction of tracheal defects using Marlex mesh were performed on 41 mongrel and beagle dogs. They were consisted of four groups. In group I, cervical tracheal defects were reconstructed with simple Marlex mesh patches. In group II, cervical tracheal defects were reconstructed with Marlex mesh patches which were reinforced by three polyacetal-resin half rings. In group III, thoracic tracheal defects were reconstructed with Marlex mesh patches which were reinforced by half rings, and were covered with omental pedicle flaps. In group IV, a pedicled rectus abdominis muscle flap was prepared, and the inner side of Marlex mesh was covered by anterior sheath of the rectus abdominis and the external surface of the mesh was reinforced by rings and rectus muscle. Accordingly, in this group, thoracic tracheal defects were reconstructed by this combined Marlex mesh and pedicled muscle flap. In group I, Marlex mesh patches protruded into the tracheal lumen a large number of cases. On the contrary, in group II, in which meshes were reinforced by half rings, no protrusion of Marlex mesh patches was recognized. But granulation and abscess formation was observed in a large number of this group. In group III (omentopexy group), in spite of few granulation and abscess formation, complete epithelialization were obtained in only three of twelve dogs. In group IV (muscle flap group), few granulation and abscess formation was observed, and complete epithelialization were obtained in seven of twelve dogs. In conclusion, 1: Reinforcement of Marlex mesh by polyacetal-resin half rings was effective to maintain the tracheal lumen. 2: Using of omental pedicle flap or rectus abdominis muscle flap was effective to prevent the abscess and granulation formation. 3: Use of rectus abdominis muscle flap resulted in good epithelialization. 4: The inner surface of patches was covered with the flattened epithelium 2-3 months after surgery, and then covered with ciliated cells almost completely except central area of patches 6-12 months after surgery. The reconstruction of tracheal defect with combined Marlex mesh and rectus abdominis muscle flap may be ready for clinical use, however further investigation is necessary to develop tubular reconstruction of trachea in future.     

MRI of patellar tendon anterior cruciate ligament autografts.

Twenty-one MR examinations were performed in 15 patients with clinically stable knees after arthroscopic anterior cruciate ligament (ACL) reconstruction with patellar bone-tendon-tibial bone autografts. The postoperative interval ranged from 3 months to 3 years 3 months (average 9.5 months). Proton- and T2-weighted sagittal images with axial and oblique sagittal T1-weighted images were obtained. The MR appearance of the autografts was categorized depending on distribution of dark signal band into type 1 (continuous, two patients), type 2 (proximal half, eight patients), type 3 (distal half, two patients), and type 4 (nonvisualization, three patients). There was no change in appearance of the grafts in those who had a second imaging within 1 year postoperatively. We conclude that the normal ACL autograft has a variable appearance and that criteria used in evaluating the native ligament is inadequate to assess the autografts.