Cardiac tamponade due to intrapericardial rupture of an amebic liver abscess

Pericardial abscess is rare in healthy individuals, especially the amebic type. We report a case of pericardial abscess and cardiac tamponade due to intrapericardial rupture of an amebic liver abscess. A 31-year old Japanese male complained of fever to a local hospital. A liver mass was discovered in his left hepatic lobe by an abdominal echogram. He was referred to the internal department of our hospital and was treated with quinolone antibiotics. Two weeks after medication, he suddenly complained of epigastralgia and severe orthopnea and was admitted. Abdominal computed tomographic scan showed an enlarged liver mass, and massive pericardial effusion suggested cardiac tamponade. He underwent an emergency subxiphoid partial pericardiectomy under local anesthesia. 1,000 ml of light brownish fluid was removed and his condition improved. Although no ameba was cultivated from the pus, the amebic serological test was positive. Metronidazole was administered and the patients was discharged 31 days after surgery.     

Clinical classification of the patterns of mandibular movements during mastication in subjects with TMJ disorders.

To investigate the chewing patterns of patients with TMJ disorders, analysis of mandibular movement was performed in 25 normal subjects and 150 patients with stomatognathic dysfunction using the Sirognathograph analyzing system. Patients with TMJ disorders demonstrated different chewing patterns than those of normal subjects. Chewing patterns in the frontal, horizontal, and sagittal projections were classified into four, two, and two different patterns, respectively, and each distinct chewing pattern appeared to be associated with a specific TMJ disorder.     

Surgical treatment of renal cell carcinoma with bone metastasis

Eighty-six patients with renal cell carcinoma underwent radical nephrectomy in Chiba Cancer Center Hospital. Fifteen of the 86 patients developed bone metastases. Seven of the 15 patients with bone metastases had received chemotherapy and radiotherapy. Six of the 15 patients underwent surgical treatment and two received radiotherapy alone. Of the six patients treated surgically for bone metastases, two patients were treated with wide resection and the remaining four patients underwent excision of the metastatic lesions in combination with radiotherapy, chemotherapy or immunotherapy. One of the two patients who underwent wide resection of a pelvic bone lesion is alive without evidence of disease for 6 years and 4 months. Another patient who underwent wide resection of femoral bone lesion survived for 14 years and 2 months but died of recurrent cancer. Pathologic findings of renal cell carcinoma in the long-time survivors showed adenocarcinoma of alveolar type of clear cell subtype and in grade 1. Wide resection of bone metastases of renal cell carcinoma can significantly prolong the survival time and improve the quality of life of the patients.     

Morphological characteristics, especially the malignant features, of chordoma in comparison with the notochord

Twelve cases of the chordoma, including 4 cases with metastases, have been examined by light and electron microscopy for a comparison with 5 cases of the human notochord. Observed similarities in the histological and ultrastructural characteristics of the chordoma with those of the notochord suggested the histogenetic origin of the chordoma from the remnant of notochord. A "diffuse pattern" that was seen in the histological appearance of 4 cases of the chordoma, including 2 cases with metastases, was not observed in the notochord and was considered to indicate the malignant nature of such chordoma. Electron microscopy of the physaliphorous cells characteristic of the chordoma demonstrated intracytoplasmic large vacuoles containing glycogen.     

Membrane-limited hepatic transport of the conjugative metabolites of 4-methylumbelliferone in rats

The hepatic transports of 4-methylumbelliferone (4-MU) and its conjugative metabolites, the glucuronide (4-MUG) and sulfate (4-MUS), were investigated in rats with various methods. The extraction ratio (E) was estimated with the multiple indicator dilution (MID) method using isolated perfused rat liver. The values of E for 4-MUG and 4-MUS were much lower (less than 0.2) than that for the parent compound, 4-MU (0.89). In addition, we examined the simulation of the outflow curves of conjugates based on the "distributed" model in which we varied the permeability between the blood and hepatocytes. When the permeability was much smaller relative to the hepatic blood flow, the simulated curve was superimposed on the dilution curve. These results suggest that the influx permeabilities of these conjugates are so low that little extraction occurs during the passage through the liver. Measuring the unidirectional uptake of these conjugates into the liver with the in vitro centrifugal filtration method using isolated hepatocytes, we determined the influx permeabilities (PSinf(total] for the total ligands. The value of PSinf(total) determined with the in vitro method was extrapolated to that per gram of liver, assuming 1 g of liver has 1.3 X 10(8) cells. The values of PSinf(total) for 4-MU, 4-MUG, and 4-MUS were 4.8, 0.06, and 0.11 mL/min/g liver, respectively. Thus, the influx permeabilities for 4-MUG and 4-MUS were much smaller than the hepatic blood flow (1.6 mL/min/g liver), confirming the results of MID method.     

Alleviation of gallbladder complications by treatment of hepatic arterial embolization with caerulein

Transcatheter arterial embolization (TAE) with the concurrent use of caerulein was assessed for the purpose of preventing gallbladder complications often seen after TAE of hepatic carcinoma. Ninety-six cases with primary hepatic carcinoma, who had undergone TAE in the right hepatic arterial region over the past 4 years, were divided into three groups: 22 cases for which embolization was possible on a selective basis by passing the catheter to the peripheral side beyond the bifurcated region of the cystic artery; 40 cases who had undergone TAE in which caerulein was not administered, from the central side of the bifurcated region of the cystic artery; and 34 cases given 20 g caerulein 15–30 min before TAE. A comparison was made using the abdominal pain, pyrexia, rate of leukocytosis and the US findings of the gallbladder as the indices of the gallbladder complications. As a result, it become evident that it was possible to prevent or alleviate gallbladder complications if caerulein were administered before TAE in cases where the embolizing substances were infused in the right hepatic artery from the central side of the bifurcated region of the cystic artery. It was conclusively shown that the gallbladder blood flow decreases if the organ is contracted by caerulein, which in turn causes a decrease in the inflow of the embolizing substances whereby complications are alleviated.     

Expression of Jun activation domain-binding protein 1 and p27 (Kip1) in thyroid medullary carcinoma

AIMS: p27 is a prominent regulator of cell proliferation by universally inhibiting the cell cycle, while Jun activation domain-binding protein 1 (Jab1), a multifunctional cell signaling protein, contributes to carcinoma progression by degrading p27. In this study, we investigated the expression of these proteins in medullary thyroid carcinoma. METHODS: We immunohistochemically examined Jab1 and p27 expression in 64 medullary thyroid carcinomas. RESULTS: Of the 64 cases examined, decreased p27 expression was observed in 38 cases (59.4%). The p27 expression level was inversely linked to tumour size as well as plasma calcitonin level. Jab1 expression level was generally high, and 46 cases (71.9%) were classified as overexpressing Jab1. The incidence was higher than those in papillary and follicular carcinomas, which were previously reported. Jab1 expression level was inversely linked to that of p27, and all five cases with only cytoplasmic but not nuclear staining of p27 overexpressed Jab1. CONCLUSIONS: These findings suggest that (1) decrease in p27 expression may contribute to local tumour growth; (2) Jab1 expression is related to the progression of medullary carcinoma by decreasing the amount of p27 in the cell and accelerating its degradation; and (3) Jab1 may play a more vital role in the pathogenesis of medullary carcinoma than papillary and follicular carcinomas.