11C-choline positron emission tomography in bladder cancer: Report of four cases

Little work has been done with positive emission tomography (PET) in bladder tumors because high urinary excretion of (18)F-FDG makes visualization of the bladder tumor difficult. (11)C-choline has recently been reported as a new tracer which lacks urinary radioactivity. We report the result of (11)C-choline PET in four patients with invasive bladder tumors. In one case, (11)C-choline PET could detect bladder tumor effectively without urinary activity and bone metastasis despite negative bone scintigraphy. On the other hand, an intense accumulation of the tracer in the bladder hampered the interpretation on PET scanning in three patients. The mechanisms of the (11)C-choline accumulation in the bladder were reported to be due to inflammatory and proliferative changes in the mucosa of the bladder from previous catheterization or other factors. Further study is necessary to prove the value of (11)C-choline PET for detecting primary bladder cancer and bone metastasis.     

A case report of Stevens-Johnson syndrome with Mycoplasma pneumoniae infection

We encountered an 8 year old boy who suffered from Stevens-Johnson syndrome with Mycoplasma pneumoniae infection. He had multiple erythema with vesicles in oral mucosa, and on his palms and feet, trunk and genital regions. We treated him with prednisolone (1 mg/kg per day) and antibiotics. His skin lesions improved dramatically, and a persistent fever and toxic general condition also showed dramatic improvement. Although the use of corticosteroids for Stevens-Johnson syndrome has recently been controversial, we thought that administration of corticosteroids was an effective treatment for some selective cases of Stevens-Johnson syndrome. The patient reported in this study had many beneficial effects in response to corticosteroid treatment.     

Immunogenicity and reactogenicity of the component acellular pertussis vaccine produced by a combination of column purified pertussis toxin and filamentous haemagglutinin

This is the report on a prospective, single blind, comparative study of a component acellular pertussis vaccine produced by a combination of detoxified, column purified pertussis toxin (PT) and filamentous hemagglutinin (FHA) combined with diphtheria and tetanus toxoids (DTcaP) and the traditional acellular pertussis vaccine produced with essentially the same method as described by Sato with DT (DTaP) of the same manufacturer. A total of 616 infants and children received DTcaP and a total of 289 received DTaP. In all age groups for both vaccines values of serum antibodies to PT and FHA after two doses of the vaccines were comparable to those of convalescent sera. Incidences of systemic and local reactions were, in general, not greatly different between DTcaP and DTaP recipients. In Japan the use of traditional acellular vaccines replaced whole cell vaccines in 1981. Protective antigens of Bordetella pertussis have now been specified and thus component vaccines have become theoretically possible. This is the first component vaccine which has been developed in Japan. Several other component vaccines are now under investigation in the world.     

Assessment of body composition measured by bioelectrical impedance in children

Bioelectorical impedance methods have been found to be a valid and reliable way of estimating per cent body fat (%BF) in adults. We applied them to healthy children and compared them with conventional anthropometry methods. One thousand two hundred and sixteen children participated in this study. Impedance and skinfold thickness were measured, and %BF was estimated using these values. Bodyweight and height were measured, and per cent obesity (%OB) and body mass index (BMI) were obtained. The values of %BF by the bioelectrical impedance method (%BFi) were 8.6 ± 4.0% in the junior male group, 14.2±2.8% in the junior female group, 7.9±4.7% in the senior male group and 16.1 ±2.9% in the senior female group. The % BFi correlated strongly with skinfold thickness, %OB and BMI. Thus %BFi correlated strongly with variables from conventional methods. It was concluded that it is a reliable way of assessing lipid storage in children.     

A Case of Multiple Ectopic Pheochromocytomas Occurring in the Urinary Bladder and the Para-Aortic Region

A patient with urinary bladder pheochromocytoma and anotherpheo-chromocytoma in the para-aortic region is presented. Also,nine cases which have already been reported in Japan are reviewed. The following conclusions are made: bladder pheochromocytomacan appear at any age in either sex. The clinical triad consistingof hypertension, gross intermittent or transient painless hematuriaand micturitional attacks typical of pheochromocytoma are seenin most cases. Attention is called to such urinary bladder     

Persistence of anti-HBs and protective efficacy after administration of hepatitis B vaccine

To evaluate the effect of hepatitis B vaccine on the persistence of anti-HBs and its efficacy in preventing hepatitis type B, anti-HBs and anti-HBc levels were studied over a period of 5.5 years. Plasma-derived hepatitis B vaccine, containing 20 micrograms of HBsAg protein, was injected subcutaneously in 122 healthy medical staff members, followed by two identical injections 1 and 6 months later. Anti-HBs and anti-HBc levels were then measured by radio-immunoassay. The anti-HBs titres were expressed as the sample/negative (S/N) ratios, and an S/N ratio of more than 2.1 was considered positive. The mean (and s.d.) anti-HBs titre peaked 7 months after the first vaccination with an S/N ratio of 153.6 +/- 149.8, after which it decreased with time. The mean anti-HBs titre dropped to an S/N ratio of 8.0 +/- 5.1 5.5 years after the first vaccination. The percentage of vaccinees who were anti-HBs positive also gradually decreased with time after a peak of 84.2% at 7 months following the first vaccination. The percentage of vaccinees who were anti-HBs positive was 38.9% 5.5 years after the first vaccination. The anti-HBc level was not positive in all subjects during the observation period. Five vaccinated volunteers who had developed anti-HBs after the basic vaccination, but whose acquired antibody level became negative within 4.5 years following the first vaccination, were administered a booster dose of 20 micrograms of HBsAg 4.5 years after the first vaccination. Only one of these subjects did not respond to the booster vaccination.(ABSTRACT TRUNCATED AT 250 WORDS)     

Laparoscopic treatment of colonic stenosis due to perforation in crohn’s disease

A 23‐year‐old woman was admitted to the Teikyo University Hospital with symptoms of watery diarrhea and left lower abdominal pain. A painful mass was palpated in the left lower abdomen. Abdominal computed tomography demonstrated an inflammatory mass associated with gas accumulation. Abscess formation and perforation of the intestine was strongly suspected. Considering her general condition, antibiotic therapy was adopted first. The size of the mass decreased markedly with antibiotic administration. Upper gastrointestinal series showed no abnormalities in the small intestine. Barium enema showed complete obstruction of the descending colon. Colonoscopy revealed the granular change of the mucosa and stenosis at the descending colon. Non‐caseous granuloma was histopathologically noted. The condition of the patient was diagnosed as colonic stenosis due to the perforation at the descending colon as a complication of Crohn’s disease and laparoscopic resection of the colon was performed. Although marked adhesion was noted around the lesion, surgery was successfully completed. Crohn’s disease is a chronic, potentially panintestinal, incurable affliction. Colonic perforation in Crohn’s disease is a relatively rare complication. Surgical management should be as minimal as possible. Laparoscopic surgery for this particular patient was considered to be an adequate choice of treatment.     

"Beak"-Plasty: A New Effective Modification of Z-Plasty

BACKGROUND: Because the "lateral limbs" resulting from conventional Z-plasty form a steep angle against the relaxation skin tension line (RSTL), they often develop hypertrophic change, whereas the "central limbs" become inconspicuous after being realigned parallel to the RSTL. OBJECTIVE: To alleviate the above-mentioned hypertrophic change of the lateral limbs, we modified the conventional Z-plasty and invented a new technique. Because the shape of the flap resembles a bird's beak, we call the technique "beak-plasty." The purpose of this study is to present the new technique. METHODS: The technique is described and effectiveness of the technique is reviewed on 21 patients. In particular, three representative cases are presented with photographs. RESULTS: In all patients, the lateral limbs of the flaps did not become hypertrophic after a minimum follow-up period of 9 months. CONCLUSIONS: Our technique can effectively reduce Z-plasty's risk of postoperative hypertrophy in the lateral limb. Therefore, it can make the scar less conspicuous than in conventional Z-plasty. For this advantage, we recommend our technique as an effective armament for scar revision. The authors have indicated no significant interest with commercial supporters.