Risk factors for small for gestational age

BACKGROUND: The purpose of the paper was to determine the risk factors for small-for-gestational-age (SGA) infants at full term, in Japan. METHODS: The study was conducted at four hospitals and clinics in the Tokyo metropolitan area. A retrospective review of 2972 mothers and their infants born from singleton pregnancies at any time during the years 2002 and 2003 was conducted. RESULTS: Of these women, 8.4% gave birth to SGA infants. The proportion of SGA infants was significantly higher among heavy smokers (>10 cigarettes/day; 13.7%, P < 0.01). The odds ratio (OR) for SGA decreased significantly in proportion to the pregnancy body mass index (OR, 0.89; 95% confidence interval [CI]: 0.84-0.94, P < 0.001). The OR of SGA for stratified maternal weight gain was 1.79 (95%CI: 1.24-2.58, P 12 kg. CONCLUSION: The present study clearly confirms the detrimental effect of a low prepregnancy body mass index, low maternal weight gain and maternal smoking during pregnancy on the incidence of SGA infants.     

AP-811, a novel ANP-C receptor selective agonist

AP-811 is a derivative of the Phe8-Ile15 region of atrial natriuretic peptide (ANP) and is one of the smallest linear ligands for ANP receptors. The binding and agonist activities of AP-811 have been compared with those of other ANP analogs for the ANP-A and ANP-C receptors. AP–811 binds with a high binding affinity to and is a strong agonist for the ANP-C receptor, indicating that the binding and agonist sites for this receptor are the same or near each other in the ANP sequence. In contrast, AP-811 showed no agonistic effect for the ANP-A receptor, although it could bind to this receptor. Comparing the biological activities of AP-811 with those of other ANP analogs, we propose that the binding and agonist sites for the ANP-A receptor may consist of separate regions of ANP. In conclusion, AP-811 is the smallest C-receptor-selective agonist.     

White blood cell count,C-reactive protein and erythrocyte sedimentation rate in respiratory syncytial virus infection of the lower respiratory tract

Laboratory findings such as white blood cell (WBC) count, C-reactive protein (CRP) concentration and erythrocyte sedimentation rate (ESR) level in patients with bronchiolitis, bronchopneumonia and lobar pneumonia caused by respiratory syncytial virus (RSV) were studied. The diagnosis of having RSV infection of the lower respiratory tract was made on the presence of RSV antigen in nasopharyngeal specimens by means of enzyme immunoassay, on chest X-ray appearances and clinical manifestations. The WBC counts in the lobar pneumonia cases (n = 25, 12 288 ± 6296/mm³) were significantly greater than those for the bronchiolitis (n = 52, 9562 ± 2720/mm³) and bronchopneumonia (n = 43, 8369 ± 3714/mm³) cases. The concentrations of CRP in lobar pneumonia cases (n = 25, 6.5 ± 7.3 mg/dL) were significantly greater than those in the bronchiolitis (n = 52, 1.9 ± 2.0 mg/dL) and bronchopneumonia (n = 43, 2.1 ± 2.4 mg/dL) cases. The ESR levels in the lobar pneumonia cases (n = 24, 43.8 ± 29. mm/h) were also significantly higher than those in the bronchiolitis (n = 34, 20.1 ± 12.3 mm/h) and bronchopneumonia (n = 40, 24.7 ± 15.9 mm/h) cases. There were no significant differences in the WBC counts, the CRP concentrations and ESR levels between the bronchiolitis and bronchopneumonia cases. These results suggest that the RSV lobar pneumonia cases are coinfected with some bacterial organisms more heavily than in the RSV bronchiolitis and bronchopneumonia cases.     

Usefulness of contrast-enhanced ultrasound for the diagnosis of recurrent renal cell carcinoma in contralateral kidney

We studied contrast-enhanced ultrasound (CEU) for recurrence of renal cell carcinoma (RCC) at the contralateral kidney during postoperative follow up of localized renal cell carcinoma. CEU successfully detected all recurring cases, despite the fact that 5/6 cases were observed using conventional ultrasound; the remaining one case was not detected using conventional ultrasound. CEU using Levovisto successfully revealed renal tumors as RCC. Lesions were diagnosed as cystic renal tumors by Bosniac classification, and pathological findings demonstrated RCC, in accordance with the prior tumor.     

Successful Stent Implantation in Acute Myocardial Infarction and Successful Directional Coronary Atherectomy of a Stenotic Lesion Involving an Aneurysm in a Woman with Kawasaki Disease of Adult Onset

Our patient was a woman who suffered from Kawasaki disease at the age of 20. Coronary aneurysms were confirmed in the left main trunk and proximal sites of the left anterior descending artery and the circumflex artery by coronary angiography at the age of 21. When she suffered an inferior acute myocardial infarction at the age of 24, two Palmaz-Schatz stents were successfully implanted in the right coronary lesion in order to prevent acute closure. One month later, directional coronary atherectomy was successfully performed to the left anterior descending artery lesion which had a rapid progression of the stenosis, and the pathological examination revealed that the cause of the stenosis was thrombus. She has remained well during the following 2 years.     

Histopathological analysis of angiogenic factors in renal cell carcinoma

AIM: The present study was carried out to clarify whether a histopathological analysis of vascular endothelial growth factor (VEGF), transforming growth factor-beta1 (TGF-beta1) and matrix metalloproteinase 2 (MMP-2) can help predict the outcome of renal cell carcinoma (RCC). We examined the expression of VEGF, TGF-beta1 and MMP-2 in a large series of RCC with a long follow-up, based on histopathological factors and survival. METHODS: Immunostaining for VEGF, TGF-beta1 and MMP-2 was performed on formalin-fixed, paraffin-embedded tissue sections from 84 patients with RCC who underwent nephrectomy at our institution between 1985 to 2000. The microvessel density (MVD) of tumor tissue was measured after it immunohistochemically stained with CD105 (Endoglin) monoclonal antibody. RESULTS: A significant association was observed in the expression of VEGF and TGF-beta1 regarding the stage (P < 0.01, P < 0.01), nuclear grade (P < 0.01, P < 0.01) and MVD (P < 0.001, P < 0.001), respectively. However, no correlation was found among the results of MMP-2, nuclear grade and MVD. A multivariate analysis demonstrated both the nuclear grade and MVD to be independent prognostic factors. CONCLUSION: Our results suggested that the expression of both VEGF and/or TGF-beta1 can be useful predictive prognostic factors RCC. In addition, a multivariate analysis demonstrated MVD to be an independent prognostic factor of RCC.     

Gastric Emptying and Gastroesophageal Reflux in Patients Fed via Percutaneous Endoscopic Gastrostomy: Effects of Erythromycin

Abstract: Percutaneous endoscopic gastrostomy (PEG) has been suggested to affect gastric emptying. The aims of this prospective study were to examine the effects of erythromycin, known to act as a motilin agonist, on gastroesophageal motility in nine patients fed via PEG tubes and nine fed via nasogastric tubes. The gastric emptying time and gastroesophageal reflux index were simultaneously measured in each patient after the intravenous administration of erythromycin (200 mg) or a placebo on different days, using a radioisotopic method. The alteration of gastric emptying time produced by intravenous erythromycin in the PEG group was smaller than that in the nasogastric group (p<0.05). However, gastroesophageal reflux indices in the two groups were similar. We conclude that PEG may impair gastric emptying subclinically without affecting gastroesophageal reflux.     

Multicentric liposarcoma

Abstract A 72-year-old man complaining of upper abdominal discomfort was diagnosed as having retroperitoneal liposarcoma by means of diagnostic imaging. He then underwent an operation. One mass existed on the curvatura ventriculi major, extending to the hilum splenicum and pressing back the pancreal head and body. There was another mass to the left of the first, situated on the ventral side of the left kidney. Also, another mass was intramurally found adjacent to the curvatura ventriculi major. Histologically, the mass on the curvatura ventriculi major ranged from the peritoneal cavity to the retroperitoneum Its intraperitoneal portion was classified as a differentiated lipoma-like type and the retroperitoneal mass was of mucous type. The mass on the left kidney was of a differentiated fibrosing type. The intramural mass in the gastric curvature was found to be a differentiated lipoma-like type. The patient has been under observation for 12 months and has shown no recurrence.     

SUCCESSFUL TREATMENT OF VITILIGO WITH PUVA-PIGMENTED AUTOLOGOUS EPIDERMAL GRAFTING

Background. The methoxypsoralen-ultraviolet A-light (PUVA)-induced pigmented epidermal grafting procedure appears to be a more effective treatment for vitiligo than similar treatments presently available. This finding was based on: 1) a more vigorous and completely homogeneous repigmentation was observed in the vitiliginous area and 2) that the treatment was safe, easy, inexpensive, and not time-consuming (approximately 3–4 hours), thus making it a suitable outpatient clinic treatment procedure for vitiligo patients. Patients and Methods. Twenty-eight patients with amelanotic depigmented lesions that had been refractory to conventional therapy were treated using suction blisters from autologous epidermal sheets. These had 8-methoxypsoralen (8-MOP) solution applied and had been exposed to ultraviolet A light (topical PUVA) in order to stimulate melanogenesis. Results. Successful repigmentation was obtained after transplantation in all patients with segmental and localized vitiligo. The most homogeneous repigmentation was obtained within 3 months after grafting. Conclusions. This novel procedure is an excellent tool by which to treat segmental and localized vitiligo lesions that have failed to respond to other therapies.     

Long-term survival following radical prostatectomy in Japanese men with clinically localized prostate cancer: A single institutional study

BACKGROUND: We evaluated the outcome of radical prostatectomy to provide information about long-term survival following this procedure. METHODS: One hundred and twenty-three otherwise healthy Japanese patients with clinically localized tumors underwent radical prostatectomy. Treatment outcomes were measured in terms of clinical progression-free survival, prostate cancer-specific survival and overall survival. Overall survival was compared with expected survival of age-matched Japanese men. RESULTS: For these 123 patients, clinical progression-free survival and prostate cancer-specific survival at 10 years were 72.5% and 86.4%, respectively. Results of Cox multivariate analysis showed that only pathological stage (P = 0.047) and tumor grade (P = 0.009) were independent predictors of clinical progression. Only tumor grade was a statistically significant independent predictor (P = 0.048) in terms of prostate cancer death. Both the 10 and 15-year overall survival rates for these 123 patients were 58.6%, whereas the expected survival of age-matched Japanese men was 65.0% at the 10-year follow up, and 43.8% at the 15-year follow up. CONCLUSIONS: The long-term overall survival in this surgically treated group is comparable to the expected survival rate of age-matched Japanese men. These results might be useful in counselling patients with clinically localized prostate cancer.