Search

A patient with nasopharyngeal carcinoma developed atypical parapharyngeal-lesion syncope syndrome associated with stereotypical cycles of heart rate variation, which occurred only when he was drowsy before falling asleep. Vagal tone fluctuation is implicated.

The relationship between family history of gastric carcinoma and gastric carcinoma in Japanese under 40 years of age was analyzed. The subjects were 108 gastric carcinoma patients (86% were diffuse type) at 9 hospitals in the Kanto area of Japan. Firstly, incidence of gastric carcinoma among the parents of the subjects were compared with that in the general population. Observed/expected (O/E) ratios (P-value) were 1.8 (0.06) for all subjects, 1.3 (0.62) for male subjects, 2.1 (0.04) for female subjects, 0.5 (0.41) for early carcinoma, 2.6 (P<0.01) for advanced carcinoma, 2.3 (0.22) for intestinal-type carcinoma and 1.7 (0.13) for diffuse-type carcinoma. Association between gastric carcinoma and parents' history of gastric carcinoma was strong among women and regarding advanced carcinoma, and the difference in O/E ratios between early and advanced carcinoma was remarkable. Secondly, factors related to advanced-stage gastric carcinoma were analyzed. Histological type (diffuse and intestinal types) was not related, but family history of gastric carcinoma among parents and grandparents was related to advanced stage, and the relationship was independent of other factors. The odds ratio (95% confidence interval) was 3.3 (1.1-9.9). Family history may be related to stage of gastric carcinoma through its relationship to the manner or speed of the tumor's progression. We hypothesis that some genetic factor exists which is involved both in progression from early to advanced stage and in occurrence of gastric carcinoma.

A giant isolated extracardiac unruptured aneurysm of the right coronary sinus of Valsalva was detected incidentally in a 24-year-old man with clinical findings of Ehlers-Danlos syndrome. The right coronary artery was occluded at its ostial resion. Surgical correction was performed by obliterating the orifice of the aneurysm with a Dacron patch. Microscopic examination of the diseased aortic wall revealed absence of medial elastic fibers. Collective review of 19 reported similar cases revealed that reports concerning unruptured, isolated giant sinus of Valsalva aneurysm were rare, especially in young patients, and that the aneurysm of this patient was the largest.

A previously well 66-year-old woman was admitted to our hospital because of severe abdominal pain, oliguria, jaundice and hemoglobinuria. At admission, the following values were obtained: red blood cell count 261 x 10(4)/mm3, serum creatinine 2.8mg/100ml, total bilirubin 8.0mg/ml, indirect bilirubin 5.7mg/100ml, LDH 13886 WU, negative direct and indirect Coomb's test and peripheral blood smear showing schistocytosis. She was diagnosed as hemolytic uremic syndrome and was successfully treated with plasma infusion, plasma exchange and hemodialysis. The results of the tests for verotoxin titer of E. coli O157: H7 and circulating anticoagulant were positive. The test result for anticoagulant eventually became negative during her clinical course. In this case, circulating anticoagulant might have contributed to the pathogenesis of hemolytic uremic syndrome.

We investigated the effect of multimodal therapy in 187 patients with esophageal cancer. All patients were followed up over a period of 5 years. Among the 187 patients, 174 (93.1%) eligible patients with biopsy-proved esophageal squamous cell carcinoma underwent esophagectomy and were randomly assigned to receive radiotherapy (RT) with or without protein-bound polysaccharide (PSK), or RT plus chemotherapy (CT) with or without PSK. The 5-year survival rates of patients with RT, RT+PSK, RT+CT and RT+CT+PSK were 40.0%, 42.3%, 29.1% and 37.2%, respectively. There was a tendency for longer survival on PSK, but statistical significance was not reached (RT+CT group versus RT+CT+PSK group: log-rank and generalized Wilcoxon tests, P = .1930, P = .1034). However, Cox multivariate regression analysis indicated that postoperative therapy with or without PSK was the most significant prognostic factor for patients receiving RT+CT and for the eligible patients. These results indicate that PSK may have a beneficial effect on esophageal carcinoma when given in combination with CT+RT.

The aim of this report is to evaluate retrospectively the data from a prospective randomized study of 158 esophageal cancer patients who actually completed therapy with protein-bound polysaccharide P (PSK) and the 5-year survivals with and without raised alpha 1-antichymotrypsin and sialic acid levels to determine the value of these parameters in predicting effectiveness of immunotherapy. There was a significant difference in survival between the patients with and without PSK therapy. The survival of the radiochemotherapy plus PSK group treated for > 3 months was significantly better than that of the radiochemotherapy group. Among the patients with abnormal levels of alpha 1-antichymotrypsin and sialic acid, those who received PSK may have a significantly better survival than those without PSK. These results indicate that the preoperative serum levels of alpha 1-antichymotrypsin and sialic acid may possibly predict the effectiveness of immunotherapy using PSK.

A 64-year-old male was admitted to our division because of fever. After admission, the patient was given beta-lactam antibiotics intravenously because he had no eruption and eschar. However, the fever continued, and he became unconsciousness and DIC appeared. We diagnosed the patient as Tsutsugamushi disease from indirect fluorescent antibody technique. Minocycline was excellently effective. Several reports of Tsutsugamushi disease without eruption have been given, so we must always be careful of Tsutsugamushi disease.

We studied the relationships of renal lesions with clinical features and renal prognosis in 128 Japanese patients with noninsulin-dependent diabetes mellitus (NIDDM). Diabetic glomerulosclerosis (DMGS) was found in 108 cases (84.4%), and DM-associated glomerulonephritis (GN), IgA nephropathy and membranous nephropathy, was in 20 cases (15.6%). There was no significant difference in age at renal biopsy, age at DM onset, DM duration, glomerular filtration rate (GFR), urine protein and serum IgA level between patients with DMGS and DM-associated GN. With respect to histological parameters, the increase in mesangial matrix was more closely related to DM duration, GFR and urine protein than to the degree of glomerular sclerosis. The index of glomerular lesion (IGL), which was calculated by combining these two lesions, had a more significant correlation with the clinical features than the tubulo-interstitial lesions. We suggested that the mesangial change was an initiating reaction, and the interstitial one was secondary in NIDDM patients. The prognosis of renal function after renal biopsy of the patients whose serum creatinine level was less than 1.2 mg/dl, was poorer in cases with nodular lesion than in those with diffuse lesion. The grade of tubulo-interstitial lesion was also more severe in these patients with nodular lesion. However, the controls of blood glucose, blood pressure, serum total cholesterol were not different among the two groups. On the other hand, serum creatinine level of most patients with associated GN did not change for a long period, up to 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

The effective renal plasma flow (ERPF) of patients with renal-urinary disorders were estimated employing 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) and a newly-developed clearance method which needs no blood sampling and is based on two-compartment fitting of the cardiac time-activity curves. In comparison with 123I-ortho-iodohippurate (123I-OIH) (n = 9), the disappearance rate constants and ERPF values estimated by the clearance method and the ERPF values by Schlegel's method showed a good correlation between the two agents (r = 0.88, r = 0.83 and r = 0.85, respectively). The ERPF values evaluated using 99mTc-MAG3 and the clearance method correlated well with those by Schlegel's method (n = 11, r = 0.95). These results suggest that 99mTc-MAG3 shows pharmacokinetics which are similar to those of 123I-OIH and that it might be a useful diagnostic tool for estimating the ERPF in patients with renal disorders.

A 58-year-old healthy woman was admitted to our hospital on 8th October, 1991 for detailed investigation of an abnormal shadow on chest roentgenogram, which was detected by mass survey. The chest roentgenogram showed a cloudy shadow of the right upper lobe, and retrospectively, this abnormal shadow had been present since 1986. Flexible fiberoptic bronchoscopy showed complete obstruction of right B1b bronchus by regenerated bronchial mucosa. Aseptic pus was detected in the obstructed bronchus by means of transbronchial aspiration cytology (TBAC) and chronic lung abscess was diagnosed. The chest roentgenograms of this case is very unusual, and we were unable to find a similar case of chronic lung abscess diagnosed by means of TBAC.

Scintigraphic appearance of left anterior descending artery (LAD) lesion in stress 201Tl myocardial SPECT was studied in 43 patients (pts) with midportion lesion in LAD confirmed by coronary angiography. Right margin of ischemic region in the basal short axial image was -36 +/- 17 degrees and left margin was -128 +/- 75 degrees. In 28 pts of 43 pts left margin lied beyond -120 degrees. From the results it was concluded that in most cases basal inferior wall was perfused by septal branches from LAD. In 6 pts with midportion lesion situated proximal to the first diagonal branch and in 12 pts with midportion lesion situated proximal to the second diagonal branch ischemic region in the apical portion was noted at both septum and anterolateral wall. Critical short axial image, in which right margin of ischemic region shifted from plus to minus area, was the 3.2nd short axial image in the former group and the 5.2nd in the latter group (p < 0.01). In 10 pts with midportion lesion situated distal to the large first diagonal branch, ischemic region was noted in septal wall and not in anterolateral wall. It was concluded that right margin of ischemic region in the basal coronal image was the most useful sign for predicting midportion lesion and left margin for dominance between LAD and right coronary artery and that apical anterolateral ischemia was sign for LAD lesion involving diagonal branch. Critical short axial image was useful for determining whether the lesion was situated proximal or distal to the first diagonal branch and whether the lesion was situated proximal to the second diagonal branch.

A new cell line, designated TMCC-2, has been established from operation material from a woman with endometrial clear cell carcinoma. TMCC-2 was successively subcultured 40 times in about 1 year. The monolayer culture cell showed a pavement-like arrangement of polygonal and short spindle-shaped cells, and had a tendency to pile-up without contact inhibition. Since PAS positive and Alcian-Blue negative substance could be seen in the cytoplasm, the cells were found to produce glycogen. The population doubling time, the saturation density and plating efficiency of the 25th passage cells were 24 hours, 1.8 x 10(5) and 23%, respectively. The nuclear DNA histogram obtained by flow cytometry showed two peaks at 2.1C and 4.1C. Therefore, the DNA index was 1.05. A tumor maker assay of the culture medium revealed significantly high values for TPA, CA125, CA19-9, and SLX compared with the control medium. The TMCC-2 cells produced the tumors in nude mice after subcutaneous transplantation. In addition, the histological findings were similar to those in the original tumor. As mentioned above, the TMCC-2 cell line derived from endometrial clear cell carcinoma will be very valuable in basic research on clear cell carcinoma of the endometrium.

A patient with stenosis of the internal carotid artery and occlusion of the external carotid artery associated with an unusual extracranial collateral pathway is presented. A 63-year-old man was hospitalized for sudden onset of black-out after urination. He was alert, and no neurological deficit was found. MRI showed multiple lacunae in the bilateral putamens. Cerebral angiogram demonstrated severe stenosis of the left internal carotid artery at its cervical segment and complete occlusion of the left external carotid artery at its origin. The ascending pharyngeal artery originated from the left internal carotid artery above its stenotic lesion and the superior thyroid artery originated from the left common carotid artery. The sternocleidomastoid branch from the left superior thyroid artery and the muscular branch from the left vertebral artery anastomosed with the muscular branch of the ascending pharyngeal artery. The ascending pharyngeal artery maintained patency of the internal carotid artery. It is important to perform vertebral angiography when there is proximal occlusion and severe stenosis of the internal carotid artery, and when the ascending pharyngeal artery has not been clearly identified as a branch from the ipsilateral external carotid artery on the common carotid angiogram.

Cases which present abnormality in water-electrolyte before and after operation of pituitary adenoma are occasionally reported. The authors have encountered a case in which neurological symptoms became aggravated abruptly with pituitary apoplexy after admission, hyponatremia was noted before operation and polyuria, not hypotonic urine was observed after operation. As a result of an endocrinological examination which may have an influence on water-electrolyte (ADH, aldosterone, ANP, etc.) the ADH level in hyponatremia before operation was high at 6.8 pg/ml; so, it was taken as SIADH. According to a study at the time of polyuria after operation, the ADH level was normal at 2.4 pg/ml, the ANP level was abnormally high at 140 pg/ml and the specific gravity of the urine was kept at 1.010 or more. So, polyuria was considered due to abnormally increased content of serum ANP. In polyuria due to abnormally increased content of serum ANP, the osmotic pressure of the urine is maintained relatively well, which is a clinical feature evidently different from diabetes insipidus. After operation for pituitary adenoma, water-electrolyte should be controlled with polyuria due to abnormally increased content of serum ANP in addition to diabetes insipidus taken into consideration.

A free floating thrombus in the left atrium is a rare complication of the mitral valvular disease. A 56-year-old woman with mitral stenosis was admitted for cerebral infarction and abdominal pain. A free floating ball thrombus was detected in the left atrium by echocardiography. We performed the emergent open heart surgery for removal of ball thrombus and mitral commissurotomy successfully. The size of thrombus was 4 x 3 x 2 cm. Postoperative course was uneventful.

A 24-year-old female was diagnosed as having membranoproliferative glomerulonephritis type II (or dense deposit disease), 11 years prior to becoming pregnant. The patient's first renal biopsy was performed 5 years after the onset of her renal symptoms. This biopsy was compared to a second renal biopsy taken just before the patient became pregnant. The second renal biopsy only showed a slight progression in the disease process. During the course of pregnancy, neither renal insufficiency nor hypertension were clinically evident. However, both an increase in proteinuria and a transient hypoalbuminemia were observed. The pregnancy, labor and delivery, and postpartum course for both the mother and child were without complications. Cases of membranoproliferative glomerulonephritis type I and pregnancy have been reported. However, to our knowledge, there are few reports documenting the outcome of pregnancy when a patient has membranoproliferative glomerulonephritis type II. We suggest that it is possible for a patient with membranoproliferative glomerulonephritis type II to have an uneventful pregnancy if she has neither hypertension nor renal insufficiency.

Sunrabim for injection (BH-AC), one of the antitumor agents available for acute leukemia, has considerable activity against a variety of transplanted solid tumors in rats and mice. A comparative clinical study was performed by randomized controlled trial on two different combined chemotherapies of MMC, 5-FU (MF group), and MMC, 5-FU, BH-AC (MF . BH-AC group) for 64 patients with a variety of solid cancers. Among 64 patients, 47 were evaluable for response (MF group: 23/32, MF . BH-AC group: 24/32). The partial response rate of the MF group was 4.3% (1/23), and that of the MF . BH-AC group was 33.3% (8/24). MF . BH-AC therapy was found to be more effective than MF therapy. The toxicity rates of the two therapies were similar (MF group: 46.7%, MF . BH-AC group: 50.0%). This study suggests that combined chemotherapy of MF plus BH-AC is more effective on a variety of solid cancers in comparison to MF therapy.

The electrophysiological effects of intravenous administration of disopyramide (1.5 mg/kg) were studied in 26 patients with sinus node dysfunction (SND). Disopyramide shortened spontaneous cycle length (SCL) in 12 patients and lengthened it in 4. Maximum sinus node recovery time (max SRT) was prolonged in 9 patients and shortened in 6. Estimated sinoatrial conduction time (SACT) was prolonged in 4 and shortened in 4 out of 10 patients in whom this measurement was possible. However, these changes were not statistically significant. Neither were there any significant changes in PA and AH intervals nor refractory periods of the AV node. HV intervals and refractory periods of the atrium at matched cycle length were significantly lengthened. Atrial echo beats and atrial premature beats disappeared in 7 of 12 patients treated with disopyramide. In all of these 7 patients atrial refractory period were increased. Thus, the disappearance of atrial echo beats and atrial premature beats was thought to be due to a prolonged atrial refractoriness. In 4 patients who had supraventricular arrhythmias without having either marked prolongation of max SRT or episodes of syncope, disopyramide was administered orally for a long term, during which these arrhythmias and symptoms disappeared and sinus rate increased. These results suggest that disopyramide is useful in patients with SND and supraventricular arrhythmias.

Syrian golden hamsters were administered 8-nitroquinoline, at a concentration of 0.05%, in a 10% ethanol solution as drinking water for 104 weeks. The animals were kept under observation until 112 weeks of age when the experiment was terminated. Both control and treated groups developed tumors in a pattern indistinguishable from that usually observed in Syrian golden hamsters. Thus the result of this experiment indicates that 8-nitroquinoline given orally at a concentration of 0.05% is not carcinogenic in Syrian golden hamsters.