DETECTION OF ANTIRIBOSOMAL P PROTEIN ANTIBODIES IN PATIENTS WITH SYSTEMIC SCLEROSIS

This study investigated the prevalence and clinical significanceof anti-ribosomal P protein (anti-P) antibodies in patientswith systemic sclerosis (SSc). Serum samples from 150 patientswith SSc were examined by indirect immunofluorescence, ELISAand immunoblotting. Anti-P antibodies were detected in four(3%) patients with SSc. Three of the four patients showed SSc/SLE(systemic lupus erythematosus) overlap syndrome, but psychiatricdisorders were not observed in these patients. By longitudinalimmunoblotting analysis one patient, who was initially diagnosedwith SSc, later developed anti-P antibodies along with clinicalmanifestations of SLE. Our data suggest that anti-P antibodiesare uncommon in SSc and that the presence of anti-P antibodiesin patients with SSc indicates an overlap with SLE. KEY WORDS: Anti-ribosomal P protein antibodies, Systemic sclerosis, Systemic lupus erythematosus     

A Study of Malignant Bile Duct Stenosis Using Percutaneous Transhepatic Cholangioscopy

Abstract: From June, 1987 to November, 1989, 11 patients with malignant bile duct stenosis, which was later confirmed by surgery or autopsy, were examined by percutaneous transhepatic cholangioscopy (PTCS) and by an endoscopic biopsy. The endoscopic findings obtained with the usual observation methods and methylene blue staining and the histological findings of the biopsy specimens were compared. A fine vascular proliferation was seen in all of the patients and a granular appearance was noted in patients with carcinoma of the major papilla. The papillary appearance was noted in one case each of pancreatic carcinoma, bile duct carcinoma and carcinoma of the major papilla. Marginal protrusion was not noted in patients with pancreatic carcinoma. A distorted narrow segment was seen only in cases of pancreatic carcinoma. The presence of a granular appearance indicated that the carcinoma was exposed on the surface. A high degree of fine vascular proliferation and a papillary appearance tended to indicate a carcinoma which invaded mainly into the fibromuscular layer without invasion of the mucosa. The methylene blue staining method was simple and effective for better visualization of the surface structure of the abnormal area, normal mucosa and the border zone.     

Three-dimensional analysis of occlusal curvature in healthy Japanese young adults

Summary  Knowledge of the standard value of the occlusal curvature would be helpful when providing oral rehabilitation for patients with or without occlusal derangement. Dentists often use a 4-inch radii arc as the standard based on Monson spherical theory. However, the validity of application of this theory in Japanese has not yet been verified. The objective of this study was to determine the typical shape of the occlusal curvature in Japanese adults and investigate the relative contribution of each factor to the depth of the curvature, as the initial phase, to prove the validity of determination of occlusal curvature. Seventy-nine Japanese adults (42 males and 37 females, aged 18 to 37 years) with intact dental arches were recruited, and the occlusal curvature was estimated by calculating the radius and center position of the approximate sphere. Besides, the relative contribution of gender, age, dental arch length and width, overjet, overbite for the radii was calculated. The median radius of the sphere was 110·6 mm, larger than the 4-inch value advocated by Monson. This indicates the necessity to reconsider the application of the method of occlusal plane analysis in Japanese individuals. Median position of the centre was 64·6 mm anterior to and 68·5 mm above the mid-point between condyles. Relative contribution of overbite for the radii was 10·9%, the highest amongst the factors. Therefore, a typical shape of the occlusal curvature was observed in Japanese subjects. Overbite is considered as one of the principal factors correlated to the depth of the occlusal curvature.     

Synaptic Development and Related Disturbances*

Abstract Characteristics of synaptic development are as follows: 1) an increase-decrease in the number of synapses consisting of an over-production followed by elimination, the end product being the maturing form; 2) with maturation, there is a transformation from the axo-dendritic shaft synapses to the axo-dendritic spine ones. In early development, synaptogenesis probably proceeds simultaneously with myelination. A suggestion that the critical period giving definitive impairments in the organization of synapses exists may be raised. Quantitative analyses of the mitochondrial number in. the presynapse, determined using conventional osmium tetroxide staining and the number of synaptic junction determined using the EPTA preferential procedure reveal the synaptic changes, both in normal development or in response to nutritional and pharmacological factors.     

Hybrid Therapy of Radiofrequency Catheter Ablation and Percutaneous Transvenous Mitral Commissurotomy in Patients With Atrial Fibrillation and Mitral Stenosis

AF Ablation and PTMC. Background: The rhythm control of atrial fibrillation (AF) associated with mitral stenosis (MS) is often difficult using antiarrhythmic drugs (AADs), even after a percutaneous transvenous mitral commissurotomy (PTMC). Few studies have examined the efficacy and safety of simultaneously performing radiofrequency catheter ablation (RFCA) and a PTMC in patients with MS and AF. Methods: Twenty consecutive patients with drug‐resistant AF and rheumatic MS underwent RFCA combined with a PTMC (n = 10; persistent AF‐8, long‐lasting [>1 year] persistent AF‐2; RFCA group) or transthoracic direct cardioversion (DC) following a PTMC (n = 10; persistent AF‐7, long‐lasting persistent AF‐3; DC group). In all patients, the mitral valve morphology was amenable to a PTMC, and more than 2 AADs had been ineffective in maintaining sinus rhythm (SR). In the RFCA group, a segmental pulmonary vein isolation (PVI) was performed in the initial 5 patients, and an extensive PVI was performed in the remaining 5. Results: During a mean follow‐up period of 4.0 ± 2.7 years, 8 patients (80%) in the RFCA group were maintained in SR, as compared to 1 (10%) in the DC group (hazard ratio, 0.16; 95% confidence interval, 0.03 to 0.75; P = 0.008 by the log‐rank test). The prevalence of the concomitant use of class I and/or class III AADs was comparable between the 2 groups (P = 0.70). No complications occurred during the procedure or follow‐up period in either group. Conclusions: The hybrid therapy using RFCA and a PTMC was safe and feasible, and significantly improved the AF free survival rate compared to DC following a PTMC. (J Cardiovasc Electrophysiol, Vol. 21, pp. 284–289, March 2010)     

The usefulness of ureterorenoscopic examination in evaluation of upper tract disease

AIM: The objective of the present study was to clarify the indications, usefulness and limitations of ureterorenoscopy. MATERIAL AND METHODS: From January 1998 to June 2004, 72 consecutive patients (48 men and 24 women) with a mean age of 66 years (range, 27-83 years) underwent ureterorenoscopy to diagnose upper urinary tract tumors (UUT). Median follow-up was 24 months (range, 1-73 months). Patients were divided into four subgroups by voided urine cytology and preoperative radiographic findings. Group A (n=11, 15.3%), positive voided urine cytology and positive preoperative radiographic findings; group B (n=5, 6.9%), positive cytology and negative radiographic findings; group C (n=48, 66.7%), negative cytology and positive radiographic findings and group D (n=8, 11.1%), frank hematuria originating from the UUT but negative cytology and negative radiographic findings. We compared the findings of ureterorenoscopic examination and biopsy with the results of retrograde pyelography and cytology of upper tract urine. For each examination, the following diagnostic indices were assessed: sensitivity, specificity, positive-predictive-value (PPV) and negative-predictive-value (NPV) and accuracy. Statistical analysis was performed using McNemar's test. RESULTS: For ureterorenoscopy, sensitivity was 94%, specificity 59%, PPV 72%, NPV 92% and accuracy 76%. For biopsy, sensitivity was 77%, specificity 100%, PPV 100%, NPV 80% and accuracy 88%. Accuracy of ureterorenoscopy tended to be superior to that of retrograde pyelography. Ureterorenoscopy was most useful in the group which consisted of 48 patients (66.7%) with negative voided urine cytology and positive preoperative radiographic findings. This group was the only group in which accuracy of ureterorenoscopic biopsy was superior to that of urine cytology, significantly (P=0.03). CONCLUSION: Results indicated that ureterorenoscopy is most suitable and gives superior accuracy in patients with positive radiographic findings and negative voiding cytology. Ureterorenoscopic biopsy of the upper urinary tract would provide useful information when considering therapeutic strategies, such as nephron-sparing management.     

ULTRASOUND MEASUREMENT OF SKIN THICKNESS IN SYSTEMIC SCLEROSIS

Sclerotic skin change in systemic sclerosis (SSc) usually accompaniesincreased skin thickness. In order to quantify the cutaneouschanges and to clarify the changes in the ‘uninvolved’skin in systemic sclerosis (SSc), we measured the skin thicknesson the chest, the forearms and the hands of 79 patients withSSc and 81 healthy controls with a B-mode ultrasound (30 MHz)apparatus. The thickness of the ‘uninvolved’, aswell as the ‘involved’ skin in patients with SScwas significantly greater than that of healthy controls. Increasedskin thickness on the forearms and/or the hands showed a 64.6%sensitivity and a 100% specificity for SSc. These results indicatedthat the skin which appears to be ‘uninvolved’ inpatients with SSc is already pathologic, as shown by increasedthickness. Moreover, measurement of skin thickness may be beneficialin the diagnosis of this disease at an early stage. KEY WORDS: Systemic sclerosis, Skin thickness, ‘Uninvolved’ skin, Ultrasound measurement