A solid cystic tumor of the pancreas with ossification and possible malignancy, coexisting nonfusion of the pancreatic ducts.

We report the case of a 34-year-old woman with a solid cystic tumor (SCT) of the pancreas accompanied by ossification and possible malignancy, coexisting nonfusion of the pancreatic ducts. There was a 24 x 29 x 33-mm mass with a prominent calcified lesion in the tail of the pancreas detected by abdominal ultrasonography, computed tomography, and magnetic resonance imaging. There were no distal metastases detected. Endoscopic retrograde pancreatography revealed nonfusion of the pancreatic ducts. The resected tumor consisted of solid and cystic components. The tumor was not encapsulated and included a severely ossified lesion inside. On microscopy, the tumor cells were small, eosinophilic, and proliferated in a solid or pseudo-papillary pattern. The tumor cells infiltrated into the surrounding normal pancreas parenchyma and invaded part of the mesentery. The immunostaining was positive for alpha-1-antitrypsin, neuron-specific enolase, vimentin, and chromogranin A. In the literature, only a few cases of SCT of the pancreas described ossification. As far as we know, only three cases of SCT of the pancreas, which demonstrated nonfusion of the pancreatic ducts, have been reported. Thus, SCT of the pancreas with ossification, possible malignancy, and coexisting nonfusion of the pancreatic ducts is extremely rare.

[Clinical efficacy of cefpirome sulfate against Bacteroides species, Prevotella species and Porphyromonas species. Society of Anaerobic Bacterial Infections in the fields of obstetrics and gynecology in Gifu].

The injectable cephalosporin cefpirome (CPR) was launched in Japan in 1993. It has widely been used in the various infectious diseases. We therefore studied the clinical and bacteriological efficacy of CPR against infections caused by Bacteroides species, Prevotella species and Porphyromonas species frequently isolated from the obstetric and gynecologic infections. Thirteen institutions were involved in this study which ran from March 1994 to January 1999. The administration dosage of CPR was 2 to 4 gram per day administered by drip infusion or intravenous infusion. The duration of treatment was from 3 to 15 days. The evaluations were performed before and after the treatment. CPR was administered to 194 patients with obstetric and gynecologic infections, and 146 of 194 cases were acceptable for the evaluation of drug efficacy. Bacteroides species were identified in 102 patients. Clinical efficacy in 146 cases was excellent in 12 patients, good in 110, fair in 9 and poor in 15 patients. The eradication rate for Bacteroides species could be in 37 cases out of 54 evaluable cases; Prevotella species in 38 out of 49; and Porphyromonas species in 5 out of 5. The overall assessment of bacteriological efficacy was "eradicated" in 91 cases out of 133 (68.4%). Adverse reactions including abnormal findings in laboratory tests were seen in 8 patients (4.76%). Based on these results, CPR promises efficacy and safety in the treatment of obstetric and gynecologic infections due to Bacteroides species.

Differential efficacy of gonadotropin-releasing hormone (GnRH) agonist treatment on pedunculated and degenerated myomas: a retrospective study of 630 women.

This study was designed to compare the anatomical location of myomas (submucous, intramural, subserous, or cervical), whether pedunculated or non-pedunculated if degenerated or undegenerated and relating these findings to myoma volume reduction in women treated with gonadotropin-releasing hormone agonist (GnRHa). Our retrospective study group included 630 patients with symptoms attributed to fibroids. They were treated with a single GnRH agonist for 20 weeks and the size of the myoma was monitored by magnetic resonance imaging and/or ultrasonographic scan. During a 20 week-treatment, submucous, intramural, or subserous fibroids showed an overall reduction of 63% (P<0.01) with little variation between these types. No reduction in size was seen in cases of pedunculated, degenerated, or cervical myomas. These data suggest that GnRH agonist therapy might be used primarily for non-pedunculated and undegenerated myomas.

Retroperitoneal malignant fibrous histiocytoma causing variegated colonic lesions.

A 68-year-old man visited our hospital because of heartburn. A firm mass was palpated in the left upper abdominal quadrant. Ultrasonography and computed tomography revealed a large left sided retroperitoneal tumor. A barium enema examination showed shallow irregularly depressed or elevated lesions. Colonoscopy revealed an irregularly shaped ulcer and multiple submucosal masses suggesting invasion by an extrinsic malignant tumor. Although colonoscopic biopsy was negative, a resected tumor was histologically diagnosed as a malignant fibrous histiocytoma (MFH). When such varigated lesions are detected in the colon, MFH should be considered, and an attempt to sample the submucosal layer may be necessary.

Economic costs of anxiety disorders.

Anxiety disorders are estimated to affect 26.9 million individuals in the United States at some point during their lives. This study used the human capital approach to estimate the direct and indirect costs of these highly prevalent disorders. In 1990, costs associated with anxiety disorders were $46.6 billion, 31.5% of total expenditures for mental illness. Less than one-quarter of costs associated with anxiety disorders were for direct medical treatment; over three-quarters were attributable to lost or reduced productivity. Most of these indirect costs were associated with morbidity, as mortality accounted for just 2.7% of the total. Greater availability of effective, relatively low-cost outpatient treatment could substantially reduce the economic and social burden of these common and often crippling disorders.

Economic costs of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD), classified as a severe mental illness by the National Advisory Mental Health Council, affects 2.1% of the population annually, as shown by the Epidemiological Catchment Area surveys. This study, using the human capital approach, estimated the direct and indirect costs of OCD. The total costs of OCD were estimated to be $8.4 billion in 1990, 5.7% of the estimated $147.8 billion cost of all mental illness, and 18.0% of the costs of all anxiety disorders, estimated to be $46.6 billion. The indirect costs of OCD, reflecting lost productivity of individuals suffering from or dying from the disorder, were estimated at $6.2 billion.

Random drug tests at work: the probability of identifying frequent and infrequent users of illicit drugs.

Random drug testing in the workplace has become more common since federal guidelines were issued in 1988, despite the criticism that most positive tests are the result of occasional use of illicit drugs. In order to determine the relative probabilities of detecting frequent versus infrequent users of illicit drugs, a survey of 15 experts in the drug abuse field was conducted. Based on the responses, it was estimated that 55% of employed people who used any illicit drugs in the prior year were annual drug users, 37% were monthly users, and 8% were daily users. Analysis using probability theory indicated that among workplace drug users who test positive, 52% will be daily users, 41% will be monthly users, and only 7% will be annual users. At a 50% testing rate, random drug tests identify 40% of daily users, 8% of monthly users and only 1% of annual users during the course of a year. The estimated rate of illicit drug use among employees is approximately eight times the average random testing positive rate. Random drug tests in the workplace are effective in identifying near daily users of illicit drugs, but they are less effective at identifying infrequent drug users. Employers have found that random drug testing is a deterrent to both frequent and occasional use of illicit drugs.

[Gallstone classification and analysis of their constituents].

Macroscopic classification of gallstones as proposed by the Japanese Society of Gastroenterology is based on the presence of characteristic structures on the cut surface. According to this classification, gallstones can be broadly divided into three types: cholesterol gallstones, pigment gallstones and rare gallstones. This classification is widely accepted in Japan because of its clinical applicability. A more accurate classification requires analysis of the constituents of gallstone. In particular, infrared absorption spectroscopy has been utilized for this purpose because it enables a rapid and easy analysis, requiring only small amounts of sample. In the selection of patients with gallstones for non-surgical treatment, such as ESWL and dissolution therapy, qualitative diagnosis is necessary. With this in mind, we have attempted to produce CT-Profile curves of individual gallstones, depicting changes in CT values assessed along cross-sectional lines passing from the center of the stone to their maximum diameters. This method allowed qualitative diagnosis almost of all gallstones.

[Staging of rectal cancer: assessment with Gd-DTPA enhanced MR imaging].

This study was designed to assess the value of Gd-DTPA enhanced imaging in the staging of rectal carcinoma. Twenty-five patients were prospectively evaluated with MR imaging using a 1.5 Tesla unit. Based on the results of a barium study and/or digital examination, a balloon catheter was inserted to the level of the lesion before examination. Both T1- and T2-weighted images and Gd-DTPA enhanced images were obtained in all patients, and Gd-DTPA enhanced fat-saturation images were obtained in 11 patients. When both T1- and T2-weighted images were used, 24% of tumors were ill defined. However, when Gd-DTPA and Gd-DTPA enhanced fat-saturation imaging was added, all tumors were well defined and the quality of the images increased. There was no significant difference between images in the detection of muscular invasion. In the detection of perirectal fat invasion, however Gd-DTPA fat-saturation imaging showed increased sensitivity. Nevertheless, it also decreased specificity, so there was no significant difference between images. In the detection of metastatic lymph nodes, Gd-DTPA enhanced and Gd-DTPA enhanced fat-saturation imaging were not useful. Tumor detection using Gd-DTPA enhanced fat-saturation images was excellent. However, the accuracy of staging was not improved by supplemental Gd-DTPA enhancement.

A good outcome pregnancy in a patient with paroxysmal nocturnal hemoglobinuria.

In this report, the maternal and fetal risks in a patient with paroxysmal nocturnal hemoglobinuria (PNH) were evaluated. A patient with PNH carried a pregnancy to successful delivery, with a healthy male infant, and suffered from postpartum cerebral subcortical, but not hepatic, thrombosis followed by recovery. An elevation of serum levels of lactate dehydrogenase isoenzyme, alpha-hydroxybutyrate dehydrogenase, was observed during pregnancy. The level was ameliorated to the non-pregnant level by delivery. However, hemoglobin concentrations during pregnancy and post-partum were at least 8 g/dl. This is a first report that shows tight coupling between an onset of intravenous hemolysis and pregnancy. The management of pregnancies in such patients is also discussed.

Successful pregnancy in a patient with paroxysmal nocturnal hemoglobinuria: case report.

In this report, the maternal and fetal risks in a patient with paroxysmal nocturnal hemoglobinuria (PNH) were evaluated. A patient with PNH carried a pregnancy to successful delivery, with a healthy male infant, and suffered from postpartum cerebral subcortical thrombosis followed by recovery. An elevated level of serum lactate dehydrogenase isoenzyme (alpha-hydroxybutyrate dehydrogenase) was observed during pregnancy; the level returned to normal by delivery. However, the hemoglobin concentration during pregnancy and post-partum was kept at 8 g/dl. This is the first report of a relation between the onset of hemolysis and pregnancy. The management of pregnancy in such patients is discussed.

Measurement of portal blood flow by an ultrasonic "duplex" system composed of a pulsed Doppler flowmeter and a linear-type real time B mode electroscanner.

The portal vein hemodynamics of patients with various liver diseases were investigated by means of a duplex system consisting of a linear electroscanner and a pulsed Doppler flowmeter. In cases of chronic liver disease, the cross-sectional area of the portal vein trunk became greater as the liver injury proceeded, while the maximum velocity tended to decrease. However, blood flow volume was no different between the controls and the chronic liver disease group. On the other hand, the splenic venous flow volume tended to increase as the liver injury advanced, suggesting that the increase in splenic venous flow volume is closely related to the formation of esophageal varices. This method permits non-invasive observation of changes during the course of various types of liver disease.

[Studies on the enhancement of anti-tumor activity in patients with cervical cancer by local administration of OK-432].

In order to investigate an effective administration method for OK-432, a potent biological response modifier (BRM), in patients with cervical cancer, preoperative local administration was conducted and the following results obtained: Immunohistochemical examination using monoclonal antibodies indicated that the group given local injection of OK-432 showed a marked increase in Ia antigen-positive T4 cells, Ia antigen-positive macrophages and NK cells in the tissue of the area surrounding the cervical cancer and in regional lymph nodes compared with the non-injection group. The responsiveness of regional lymph-node lymphocytes to interleukin 2 and NK activity, which were investigated at the same time, was increased significantly by local injection. From the above results, it was suggested that local administration of OK-432 could be a useful measure for enhancing anti-tumor activity in patients with cervical cancer.