Facet joint injection versus epidural steroid injection for lumbar spinal stenosis: intra-individual study.

AIM: To evaluate the efficacy of facet joint injection (FJI) for patients with lumbar central canal stenosis (LCS) in comparison with epidural steroid injection (ESI) in the same individuals. MATERIAL AND METHODS: Two hundred and fifty-two patients who underwent both FJI and ESI for LCS between January 2014 and December 2014 were considered for enrolment in the study. A radiologist retrospectively conducted a chart review and recorded which injection was chosen as the third injection after sequential injections of FJI and ESI, and why clinicians chose the particular injection method. The response was measured via the use of a five-point satisfaction scale. RESULTS: Among 252 patients, only 73 patients were included in the study (the remaining patients did not fulfil the inclusion criteria). Out of 73 patients (mean age, 69.7 years; range, 49∼87 years), 50 patients had received a third injection, 33 patients (66%) underwent FJIs as a third injection. Out of 19 patients who had experienced an ineffective first ESI, 13 (68.4%) patients reported the second FJI as effective. Out of six patients for whom the first FJI had been ineffective, three (50%) patients reported the second ESI as effective. CONCLUSION: FJIs can be administered as an alternative to ESIs in cases of LCS.

The RNA stability regulator HuR regulates L1 protein expression in vivo in differentiating cervical epithelial cells.

Human papillomavirus (HPV) L1 and L2 capsid protein expression is restricted to the granular layer of infected, stratified epithelia and is regulated at least partly at post-transcriptional levels. For HPV16, a 79 nt late regulatory element (LRE) is involved in this control. Using W12 cells as a model for HPV16-infected differentiating cervical epithelial cells we show that HuR, a key cellular protein that controls mRNA stability, binds the LRE most efficiently in nuclear and cytoplasmic extracts of differentiated cells. Further, HuR binds the 3' U-rich portion of the LRE directly in vitro. Overexpression of HuR in undifferentiated W12 cells results in an increase in L1 mRNA and protein levels while siRNA knock-down of HuR in differentiated W12 cells depletes L1 expression. In differentiated cervical epithelial cells HuR may bind and stabilise L1 mRNAs aiding translation of L1 protein.

Comparison of manikin versus porcine models in cricothyrotomy procedure training.

OBJECTIVE: To compare the usefulness for training of a porcine model (larynx, trachea, and pig skin) and a manikin model using a Portex cricothyrotomy kit (PCK). METHODS: In a prospective randomised crossover trial, participants in the airway workshop performed crico-thyrotomy using a PCK on the porcine and manikin models (Tracheostomy Trainer and Case). The porcine model was made with larynxes and trachea from freshly slaughtered pigs and covered with a piece of thinned pigskin stapled to a wooden board. Participants were asked to assess the following: reality of skin turgor; difficulty with skin penetration, landmark recognition and procedure; reality of the model; and preference for each model using a visual analogue scale (VAS) of 0-10 cm. The VAS scores for each model were compared. RESULTS: 49 participants were included in the study. Mean (SD) VAS scores for the reality of skin turgor, degree of difficulty with skin penetration and landmark recognition were higher with the porcine model than with the manikin model (7.0 (2.1) vs 4.7 (2.0), 6.4 (2.4) vs 3.6 (2.2), 5.1 (2.2) vs 4.2 (2.5), respectively). There was no difference between the models in the difficulty of the procedure (5.0 (2.4) vs 4.7 (3.2)). The porcine model had a higher VAS score for overall reality and preference of the model (7.1 (2.0) vs 4.8 (2.3) and 7.1 (2.0) vs 4.8 (2.2), respectively). CONCLUSION: The porcine model is a more useful training tool than the manikin model for cricothyrotomy with PCK because of its reality and similarity to human anatomy.

Visual method of measuring reflection-type characteristics of holographic optical elements.

A highly diverging laser beam is used to measure angular and spectral selectivities and grating vector direction for reflection-type holographic optical elements (HOE's). The intensity distribution of the beam transmitted from the HOE's reveals dark, ring-shaped patterns. Since these ring patterns are formed as a result of the beam diffracted by the HOE's, the thicknesses and the diameters of the ring patterns convey information on both the angular and the spectral selectivities of the HOE's. In addition the deviation of the ring centers relative to the center of the intensity distribution reveals the grating vector direction. Determination of values related to the ring patterns permits highly accurate measurement of HOE characteristics, such as the upper limit of the diffraction wavelength, the angular and the spectral selectivities, and the grating vector direction. This is proved experimentally.

Treatment with cytosine arabinoside and granulocyte colony-stimulating factor in patients with myelodysplastic syndrome and its leukemic phase.

Twenty-one patients with myelodysplastic syndrome (MDS) or overt leukemia resulting from MDS were treated with recombinant human granulocyte colony-stimulating factor (rhG-CSF) and cytosine arabinoside (Ara-C). Ara-C was administered in a dose of 20 mg/m2 every 12 h for 5 days and after 2 days 125 micrograms of rhG-CSF was administered for 10 days. After recovery of the leukocyte count the therapy was repeated, doubling the dose of Ara-C serially when possible. Of 13 patients with MDS, four achieved complete remission (CR), two good response (GR), two minor response (MR), and five no response (NR). Of eight patients with overt leukemia from MDS, only one with hyperplastic bone marrow achieved a partial response (PR) and the remaining seven achieved NR. The efficacy of the combination of rhG-CSF and Ara-C in the treatment of MDS and its leukemic phase is discussed, including at which time rhG-CSF should be administered: before, after or concomitantly with Ara-C. Multicenter randomized studies are needed in the evaluation of this combination therapy.

Transplantation of allogeneic peripheral blood stem cells after myeloablative treatment of a patient in blastic crisis of chronic myelocytic leukemia.

A 48-year-old man in blastic crisis of chronic myelocytic leukemia received a transplant of allogeneic peripheral blood stem cells. The donor was his HLA-identical sister, who refused to donate bone marrow cells, but agreed to donate peripheral blood stem cells. The patient received standard transplant conditioning with cyclophosphamide (120 mg/kg) and busulfan (16 mg/kg). Peripheral blood stem cells were mobilized with granulocyte colony stimulating factor and collected by apheresis. After transplantation, the white blood cell count and the result of microscopic analysis of the bone marrow became normal, and the leukocyte karyotype became 46XX. DNA fingerprinting showed complete chimerism. Graft-versus-host disease was suppressed with cyclosporine and methyl-prednisolone. The patient died of recurrence of leukemia on day 102+.

Cell kinetic effects of granulocyte colony-stimulating factor on the sensitivity of nonlymphocytic leukemia cells to cytosine arabinoside.

We measured the percentage of proliferating cells in peripheral blood and bone marrow of patients with nonlymphocytic leukemia by flow cytometry and immunostaining with antibodies to proliferating cell nuclear antigen (PCNA) and Ki-67. We evaluated the effects of granulocyte colony-stimulating factor (G-CSF) on nonlymphocytic leukemia cells. The S phase cell ratio, PCNA positive cell ratio, and Ki-67 positive cell ratio were higher after culture with G-CSF than culture without G-CSF. The ratio of viable cells was lower after culture with G-CSF followed by cytosine arabinoside (Ara-C) than culture with Ara-C alone. The number of clonogenic leukemic cells in methylcellulose was also smaller after culture with G-CSF followed by Ara-C than Ara-C alone. Our results suggest that the administration of G-CSF before induction chemotherapy enhances the sensitivity of antitumor agents against leukemic cells.

Evaluation of proliferating cells in acute leukemia with antibodies to proliferating cell nuclear antigen and Ki-67 monoclonal antibodies.

The percentage of proliferating leukemic cells was evaluated in 32 patients with acute leukemia; this percentage was measured by flow cytometry and immunostaining with antibodies to proliferating cell nuclear antigen and Ki-67 monoclonal antibodies. In the peripheral blood samples, the mean proportion of cells that stained for proliferating cell nuclear antigen was 10%, the mean proportion of cells that stained for Ki-67 was 12%, and the mean proportion of cells in the S phase was 5.9%; in the bone marrow samples, these means were 15%, 15%, and 10.1%, respectively, all of which were higher than in the peripheral blood samples. There was a correlation between the proportion of cells that stained for proliferating cell nuclear antigen and cells that stained for Ki-67, and there was no correlation between the proportion of cells that stained for proliferating cell nuclear antigen or Ki-67 and the proportion of cells in the S phase.

Flow cytometric analysis of G-CSF receptors on normal white cells and leukemic cells.

In treatment of leukemia with granulocyte colony stimulating factor (G-CSF), the possibility is that G-CSF receptors on leukemic cells lead to activate its proliferation in response to G-CSF. Therefore, it is useful to know the proportions of leukemic cells with receptors for G-CSF. We used flow cytometry to estimate the proportion of such cells and normal granulocytes with G-CSF binding activity. Recombinant human G-CSF was labeled with fluorescein isothiocyanate. Granulocytes showed higher binding to the G-CSF than lymphocytes. Leukemic cells obtained from 17 to 21 patients with AML bound specifically to G-CSF, but leukemic cells with lymphoid malignancies did not. Our results showed positive correlation with date obtained by the isotopic G-CSF receptor assay. With this method, leukemic cells need not be isolated; they can be distinguished from lymphocytes or granulocytes on the cytometry screen. Radioisotopes are not needed. It is judged to be practical for the clinical laboratory.

[CSF in laboratory medicine].

The effect of granulocyte-colony stimulating factor (G-CSF) or macrophage-colony stimulating factor (M-CSF) on patients with malignant lymphoma was analyzed. G-CSF was administered for ten days after conventional chemotherapy causing an increase in the granulocyte and monocyte counts. The increase in these cells shortened the duration of a leukocyte count lower than 2000 or 3000/mm3. There were no detectable effects from G-CSF on other blood cells. M-CSF had no effect on any of these cells. Receptors of these cytokines on various types of leukemic cells were also analyzed by flow-cytometry using fluorescent isothianate-labelled G-CSF or M-CSF. With this simplified method, G-CSF receptors were detected on almost all of the myeloid acute leukemia cells, but not on the nonmyeloid leukemic cells. M-CSF receptors were also detected on all of the monocytic acute leukemic cells, but not on myelocytic or lymphocytic leukemic cells.

Secondary T-cell lymphoma presenting as a giant ulcer.

Secondary cutaneous T-cell lymphoma may present with various types of skin lesions, but rarely produces ulceration in contrast to primary cutaneous T-cell lymphoma. We report a case of malignant lymphoma of the tonsil that recurred as a giant cutaneous ulcer on the back of a 45-year-old man. Biopsy of the ulcer revealed a malignant lymphoma of diffuse, mixed-cell type. Surface marker analysis of the tumour cells showed suppressor/cytotoxic T-cell characteristics. The skin lesions were treated by electron beam therapy.

[Therapeutic effects of cefclidin against severe infections in patients with hematopoietic disorders. Hanshin Infection Study Group].

One hundred thirty-eight patients with severe infections associated with hematopoietic disorders were treated with cefclidin (CFCL), and the efficacy and the safety of the drug were evaluated. The results obtained are summarized below. 1. Of the 126 patients in whom the efficacies were evaluable, 22 (17.5%) responded markedly well and 48 (38.1%) moderately, and the overall efficacy rate was 55.6%. 2. Efficacy rates for different infections were: 20.0% in septicemia, 61.2% in suspected septicemia, 46.7% in respiratory tract infection and 25.0% in others. 3. Significantly different efficacy ratings were observed between a group of patients with neutrophil counts of less than 100/mm3 and that with neutrophil counts of higher than 501/mm3. 4. Out of 138 patients in whom the safety was evaluable, side effects were observed in 5 patients (3.6%) and abnormal laboratory test values in 9 (6.5%). None was serious, however.

Positive effect of granulocyte-colony stimulating factor on erythropoiesis in humans.

We studied the effects of granulocyte-colony stimulating factor (G-CSF) on human erythropoiesis in vivo. Changes in the peripheral blood were analyzed in 9 subjects; 3 healthy volunteers, 3 patients with pancytopenia and hypersplenism and 3 patients with chronic renal failure and severe anemia being treated with hemodialysis. We monitored erythropoiesis according to the number of highly fluorescent cells (HFC) present in the peripheral blood after staining with Auramine 0. These cells are relatively immature reticulocytes that contain much RNA. All subjects received recombinant human G-CSF at a daily dose of 100 micrograms/m2 administered intravenously for 3 to 5 days. Plasma erythropoietin was measured in patients receiving dialysis before and several times after its administration. The number of HFC increased significantly in all subjects. In 1 of 3 patients receiving dialysis, the plasma erythropoietin increased transiently but insignificantly. These findings show that G-CSF affects human erythropoiesis in vivo, but that the mechanism of its effect did not involve an increase in plasma erythropoietin.

[Effects of maintenance treatment after high-dose intravenous gamma-globulin for idiopathic thrombocytopenic purpura].

High-dose intravenous immunoglobulin (IVIG) for idiopathic thrombocytopenic purpura (ITP) produces a dramatic and substantial increase in platelet count, but the increased count tends to return rapidly to its pretreatment level. We studied the effects of immunosuppressive treatment aimed at the maintenance of platelet counts following the IVIG administration in ITP. Thirty-five patients with ITP were treated with IVIG, and then thirty-two of them with an immunosuppressant (azathioprine) and a glucocorticoid (prednisolone). After IVIG, the platelet count increased significantly. With immunosuppressive therapy after IVIG, most patients had a tendency to maintain the counts. In particular, this maintaining effect was remarkable in those patients who had been responsive to the standard prednisolone therapy while non-responders to the prior prednisolone failed to maintain the counts. When prednisolone was given after IVIG, the effect of maintaining platelet counts was dose-dependent. The treatment with azathioprine and prednisolone after IVIG appears to be effective in maintenance of platelet counts.

Therapy with mitoxantrone, ifosfamide, vindesine, and prednisolone for malignant lymphoma with adjustable doses and timing of courses.

Thirty-seven patients with malignant lymphoma were treated with mitoxantrone, ifosfamide, vindesine, and prednisolone. The time among courses was not fixed, being decided by the time for recovery from the leukopenia caused by the treatment. The drug dose was adjusted after the initial course. Of the 12 patients treated for the first time, eight had a complete remission and two had a partial response. Of the 18 patients who relapsed after another drug regimen, six had a complete remission and seven had a partial response. The SD of the leukocyte nadirs decreased after the first course, and time needed for recovery from leukopenia tended to shorten during treatment. Side effects seemed mild, and we can use many drugs safely in a short term without long drug-free intervals. Response rates were satisfactory, compared with other report, so this method of timing the start of courses with adjustment of the dose seems useful.

Effects of ubenimex, a biological response modifier, on myelodysplastic syndrome and chronic leukemia.

Twenty cases of myelodysplastic syndrome (MDS) were treated with ubenimex. Seventeen cases were treated with the drug over 90 d. Among these, 10 showed improvement of anemia, 12 an increase in platelet count which had decreased before treatment and 10 an increase in neutrophil count; however, 14 showed an increase in blast percentage in bone marrow aspirate. CD4/CD8 ratio was increased in 4 cases and shifted to a normal from an abnormal range in 6 cases. When the MDS cases were observed in refractory anemia (RA) and refractory anemia with excess blasts (RAEB), great improvement was seen, but in RAEB increase in blast percentage was also observed. CD4 increased mostly in RA and CD8 increased in RAEB. Ten cases of chronic myelocytic leukemia (CML) were first treated with ubenimex and cytostatics, then with ubenimex only. Six cases attained partial remission within 3 months, but one case showed a marked increase in white cell count and blast count and in another case a progression of splenomegaly associated with increase in white cell count. From these findings we conclude that ubenimex could be utilized in MDS or CML if the patient was at risk for strong chemotherapy.