Effect of ankle joint stiffness during eccentric phase in rebound jumps on ankle joint torque at midpoint.

The purposes of this study were to investigate firstly, the ankle joint stiffness during the eccentric phase in rebound jumps, and secondly, the effect of ankle joint stiffness during the eccentric phase on ankle joint torque at midpoint. Nine active males executed rebound drop jumps from a height of 30 cm (RDJ30) and 50 cm (RDJ50), and 5-repetition rebound jumps (5RJ). Force plate data, limb position and electromyogram (EMG) of the medial head of gastrocnemius (GAS), soleus (SOL), and tibialis anterior (TA) muscles were recorded simultaneously during all jumps. When compared with RDJ30 and RDJ50, 5RJ displayed significantly higher jumping height, ankle joint torque at midpoint, ankle joint stiffness during the eccentric phase, and integrated EMG (IEMG) of GAS and SOL. Furthermore, 5RJ displayed significantly lower contact time and IEMG of TA than RDJ30 and RDJ50 did. The ankle joint torque at midpoint showed a significant positive correlation with jumping height but a significant negative correlation with contact time in rebound jumps. There was a significant positive correlation between the ankle joint stiffness during the eccentric phase and ankle joint torque at midpoint in rebound jumps. These results suggested that for the rebound jumps to be effective, it may be important to enhance the ankle joint torque at midpoint by greater ankle joint stiffness during the eccentric phase. These results also suggested that compared to 5RJ, RDJ30 and RDJ50 may reduce ankle joint stiffness in order to protect the tendomuscular system from the stretch load. However, ankle joint stiffness is possibly increased in 5RJ because the restraint to defend the tendomuscular system is reduced by prediction or adaptation to the stretch load because it is a continuous jump.

[Off-pump coronary artery bypass for old myocardial infarction associated with jejunotomy for obstructive ileus due to gall bladder stone; report of a case].

In non-cardiac operative cases with inflammatory digestive organ disease, bacterial translocation (BT) often results from non-enteral nutrition postoperatively. If coronary artery bypass grafting (CABG) is performed in the case having old myocardial infarction (OMI) and inflammatory digestive organ disease at first before non-cardiac operation, he seems vulnerable to have severe complications such as multiple organ failure due to systemic inflammatory response syndrome (SIRS) and preexisting BT postoperatively. We performed a off-pump CABG (OPCAB) for OMI associated with jejunotomy for obstructive ileus due to gall bladder stone. No complication was found in the postoperative course. We conclude that combined operation, non-cardiac surgery after OPCAB is worth considering in those cases. And we think OPCAB is better than conventional CABG in such cases, because cardiopulmonary bypass is known to ponder comparable damages to immune system, coagulation system and others.

[Quality control for MHTS region and possibility of the standardization].

There is a final purpose of the standardization of the external quality control for the resolution of the difference between facilities. Two solutions are promoted in order to unify the evaluation level. They are that it unifies the reference value and common evaluation method used common display. However, it is the prior settlement that there is some a problem on both method and that absolute value is made to agree using standard substance.

Obstructive jaundice facilitates hepatic metastasis of B16F1 mouse melanoma cells: participation of increased VCAM-1 expression in the liver.

Obstructive jaundice facilitates experimental liver metastasis in the rat model, but the detailed mechanisms of this facilitation remain unclear. This study aimed to evaluate the contribution of vascular cell adhesive molecules-1 (VCAM-1) to augmented hepatic metastasis in cases of obstructive jaundice. Obstructive jaundice was induced in male C57BL/6 mice by common bile duct obstruction for 5 days using a Surgiclip. For the biliary decompression, obstructive jaundice was induced for 5 days, followed by removal of the Surgiclip. Liver specimens and blood samples were obtained from animals 5 days after biliary obstruction (OJ5) or sham operation and 2, 5, 11, 14 days after biliary decompression. The expression of VCAM-1 mRNA was increased in the livers from the OJ5 group. Western blot analysis demonstrated increased expression of VCAM-1 protein in the livers of the OJ5 group, in contrast with low VCAM-1 expression in the sham group. The expression of VCAM-1 protein was sustained at high levels at 2 days and decreased at 5 days after biliary decompression (BD5). For the induction of experimental hepatic metastasis, male C57BL/6 mice were randomized to three groups (sham, OJ5, BD5) of six animals each. B16F1 melanoma cells were introduced into the animals by an intraportal injection. Metastatic colonies in the livers were investigated 13 days after inoculation. The mean number of metastatic colonies was significantly increased in the OJ5 group (70.5+/-51.2) compared to that of the sham group (7.2+/-7.9) (p<0.05). This augmentation of hepatic metastasis was abrogated in the BD5 group (16.8+/-20.3). In conclusion, our results suggest that augmented hepatic metastasis in cases of obstructive jaundice are partly mediated through VCAM-1/VLA-4 interaction.

Caveolin-2 is targeted to lipid droplets, a new "membrane domain" in the cell.

Caveolin-1 and -2 constitute a framework of caveolae in nonmuscle cells. In the present study, we showed that caveolin-2, especially its beta isoform, is targeted to the surface of lipid droplets (LD) by immunofluorescence and immunoelectron microscopy, and by subcellular fractionation. Brefeldin A treatment induced further accumulation of caveolin-2 along with caveolin-1 in LD. Analysis of mouse caveolin-2 deletion mutants revealed that the central hydrophobic domain (residues 87-119) and the NH(2)-terminal (residues 70-86) and COOH-terminal (residues 120-150) hydrophilic domains are all necessary for the localization in LD. The NH(2)- and COOH-terminal domains appeared to be related to membrane binding and exit from ER, respectively, implying that caveolin-2 is synthesized and transported to LD as a membrane protein. In conjunction with recent findings that LD contain unesterified cholesterol and raft proteins, the result implies that the LD surface may function as a membrane domain. It also suggests that LD is related to trafficking of lipid molecules mediated by caveolins.

Non-Hodgkin's lymphoma of the ascending colon in a patient with becker muscular dystrophy: report of a case.

We herein present the findings of a 10-year-old boy with non-Hodgkin's lymphoma of the ascending colon which caused intussusception and intestinal bleeding. He had a history of Becker muscular dystrophy. However, he had neither hypertrophic calves nor cardiomyopathy, and his serum creatine kinase (CK) level always exceeded 2000 IU/l. Preoperatively, a laboratory examination revealed high serum levels of CK (2038IU/l), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH), and the blood hemoglobin level was 7.0g/dl. A barium enema examination revealed an intussusception in his ascending colon, which was found to be a highly vascular tumor on Doppler ultrasound scans. A right hemicolectomy was performed. Macroscopically, the 5 x 6 x 8-cm solid tumor of the ascending colon resembled a submucosal tumor and had two ulcerous lesions at the tip. The tumor was histologically diagnosed to be a diffuse large B-cell lymphoma of the ascending colon. General examinations revealed no involvement of lymphoma postoperatively. At 13 months after surgery, the CK (37861U/l), AST (110lU/l), ALT (1381U/ l), and LDH (420lU/l) levels are still high, and the patient is doing well without any signs of recurrence.

Predication of axillary lymph node metastasis by intravenous digital subtraction angiography in breast cancer, its correlation with microvascular density.

Accurate predication of axillary node status by non-invasive diagnostic method would be of great value in cases of breast cancer. There have been few reports advocating digital subtraction angiography (DSA) as specifically advantageous for the detection of lymph node metastasis. IV (intravenous)-DSA was carried out on 42 patients with breast carcinoma using a DSA system with a matrix of 1024 x 1024 pixels. When a mass became stained in the axilla, it was considered to be metastatic. An immunohistochemical technique with JC70 antibody to platelet/endothelial cell adhesion molecules was used to evaluate the microvascular density (MVD) of the axillary lymph nodes. IV-DSA achieved a 76.2% sensitivity, 85.7% specificity, and 81.0% accuracy. The average MVD with JC70 antibody was 97.7 +/- 44.4 in metastatic and 62.9 +/- 23.6 in nonmetastatic nodes. MVD was significantly higher in the cancerous than in the noncancerous regions within lymph nodes. The MVD was 105 +/- 38.4 in DSA-N(+) cases and was 57.8 +/- 21.9 in DSA-N(-) cases, and the difference was statistically significant. In conclusion, IV-DSA is a useful diagnostic modality for detection of axillary lymph node metastasis. This new modality predicts lymph node status by assessing the neovascularization of the lymph node.

Ovarian actinomycosis complicated by diabetes mellitus simulating an advanced ovarian carcinoma.

A patient presented with a pelvic tumor which mimicked an advanced ovarian carcinoma with invasion into urinary bladder, rectum and uterus, as detected by MR imaging. After surgery, however, actinomycosis of the left ovary was diagnosed by pathological examination. Ovarian actinomycosis in this patient was complicated by diabetes mellitus.

Recurrent clear cell carcinoma of the ovary changing into producing parathyroid hormone-related protein (PTH-rP) with hypercalcemia.

We experienced the case of a clear cell carcinoma of the ovary arising from an endometrial cyst, which started to produce parathyroid hormone-related protein (PTH-rP) in a recurrent tumor, thus inducing hypercalcemia. Using immunohistochemical analysis, we demonstrated that the primary carcinoma was immunonegative for PTH-rP, but that the recurrent carcinoma was strongly immunopositive for PTH-rP.

Expression of multidrug resistance-associated protein in endometrial carcinomas: correlation with clinicopathology and prognosis.

The objective of the study reported here was to investigate the expression of multidrug resistance-associated protein (MRP) in endometrial carcinomas and to evaluate the relationship between its expression and clinical data. Using immunohistochemistry, we examined MRP expression in 15 normal endometria, 10 cases of endometrial hyperplasia, and 64 cases of endometrial carcinoma. The normal endometrial glands were weakly immunopositive throughout the menstrual cycle. In addition, we found a progressive increase in the MRP expression of the endometrial hyperplasias. Of the 64 cases of endometrial carcinoma, 62 (97%) expressed MRP. Of these 62 cases, 34 (55%) showed strong immunostaining (>/=50%) and 28 (45%) showed weak immunostaining (<50%). In particular, the intensity of the immunostaining was very strong in 25 (71%) of the 35 grade 1 carcinomas. There was a significant difference in MRP expression between the grade 1 carcinomas and the more poorly differentiated carcinomas (grade 2 or grade 3) (P <.01), especially at stages 1a and 1b (P <.001). However, beyond stage 1c, there was no significant difference in MRP immunoreactivity between the histologic differentiations. Furthermore, beyond stage 1c, those patients with strongly MRP-positive carcinomas had a relatively poorer survival rate than those with weakly MRP-positive carcinomas (P <.05). We concluded that MRP immunoreactivity was already present in normal endometrium and showed a progressive increase from endometrial hyperplasia to well-differentiated carcinoma. Beyond stage 1c, strongly MRP-positive carcinoma indicated a poorer survival rate.

Ovarian dysgerminoma showing high serum levels and positive immunostaining of placental alkaline phosphatase and neuron-specific enolase associated with elevation of serum prolactin level.

We report a 35-year-old Japanese female patient with ovarian dysgerminoma showing elevated serum levels of placental alkaline phosphatase (PLAP), neuron-specific enolase (NSE) and prolactin (PRL). All elevated tumor markers improved dramatically after the removal of the tumor. Immunohistochemically examined, the tumor was stained positive for PLAP and NSE and negative for PRL. Our present case is the first report of dysgerminoma showing positive immunostaining for PLAP and NSE, and the association of high serum level of PRL followed by decrease accompanied by the tumor debulking.

Expression of the anti-metastatic effect induced by Juzen-taiho-to is based on the content of Shimotsu-to constituents.

We investigated the inhibitory effect of oral administration of Juzen-taiho-to, a Kampo Japanese herbal medicine, and its related formulations on the experimental liver and lung metastasis of tumor cells in vivo. Oral administration of Juzen-taiho-to for 7 d before tumor inoculation significantly reduced the number of liver metastatic colonies of colon 26-L5 carcinoma cells and attenuated the increase of liver weight in a dose-dependent manner ranging from 4 to 40 mg/d. Its oral administration for this same period before tumor inoculation also significantly inhibited lung metastasis of B16-BL6 melanoma cells. Juzen-taiho-to originally consisted of 8 crude drugs derived from Shimotsu-to and Shikunshi-to prescriptions together with two crude drugs (Cinnamomi Cortex and Astragali Radix). Oral administration of Shimotsu-to as well as Juzen-taiho-to for 7 d before tumor inoculation resulted in a significant reduction in the number of metastatic colonies and the liver weight as compared with the control, whereas Shikunshi-to did not exhibit such an inhibitory effect. Unsei-in containing four Shimotsu-to constituents was also active in inhibiting liver metastasis. Toki-shakuyaku-san and Ninjin-yoei-to, which include all Shimotsu-to constituents except Rehmanniae Radix and Cnidii Rhizoma, respectively, did not show a significant anti-metastatic effect. Rikkunshi-to and Ninjin-yoei-to, which contain Shikunshi-to constituents, did not affect the inhibition of liver metastasis. Hochu-ekki-to treatment before tumor inoculation also led to a significant inhibition of liver metastasis, probably through an inhibitory mechanism different from Juzen-taiho-to. These results suggest that the anti-metastatic effect of Juzen-taiho-to is partly associated with its Shimotsu-to-derived constituents.

Effects of levofolinate calcium on subacute intravenous toxicity of 5-fluorouracil in rats.

To clarify whether levofolinate calcium (1-LV) enhances 5-fluorouracil (5-FU) toxicity, a 4-week toxicity study of 5-FU (10 mg/kg/day) in combination with 1-LV (6, 20 or 60 mg/kg/day) was conducted in rats. In the 5-FU alone group, a decrease in body weight gain, food consumption, RBC parameter and WBC counts were detected. Histopathologically, lymphoid depletion of lymphatic organs, hematopoiesis enhancement of the spleen and myelosuppression were observed. In the group for which 5-FU was combined with 1-LV, the RBC counts decreased, extramedullary hematopoiesis increased and the suppression of lymphatic organs was enhanced. Changes in the lymphatic organs were observed at 20 mg/kg/day of 1-LV and above. In monitoring of blood drug concentrations of 1-LV, 5-methyl tetrahydrofolic acid, a metabolite of 1-LV, and 5-FU after the 1st and 14th dosings, there was no apparent difference between 5-FU alone and 5-FU combined with 1-LV in Cmax and AUC0-infinity. The potentiation induced by 1-LV in the toxicity of 5-FU appeared to be mainly immuno-suppression and myelosuppression, which were related to the anti-tumor activity of 5-FU. Plasma concentrations of 5-FU and 1-LV in this study overwhelmed the concentrations that enhancement of thymidylate synthetase (TS) inhibition due to 5-FU was observed by addition of 1-LV in vitro. Therefore toxic potentiation of 5-FU due to simultaneous 1-LV dosing is presumed to be concerned with an increased ternary complex (FdUMP-TS-5,10-methylenetetrahydrofolate) formation and a greater extent of TS inhibition.

Management of malignant ovarian tumors in young women. 21 nulliparous cases.

To evaluate the management of malignant ovarian tumors in young women who wish to maintain fertility, we retrospectively reviewed ovarian malignancies in 21 young women who were both nulliparous and under 40 years of age. With stage 1a disease, all 9 patients were treated with conservative surgical therapies, and all of them are still alive, irrespective of histological type. With stage 1c disease, 5 (83%) of 6 patients were treated with conservative surgical therapies. Among them, 2 patients with epithelial tumors, who were treated with conservative surgical therapies and potent cis-diamminedichloroplatinum (CDDP)-based combined chemotherapies, are still alive. Furthermore, one of them had a successful pregnancy. On the other hand, 3 out of 4 patients with nonepithelial tumors were treated with conservative surgical therapies. However, 2 (67%) out of 3 died; both of them were treated with non-CDDP-based chemotherapy. In 6 patients with disease beyond stage 2, 4 (67%) were treated with radical surgical therapies, but 2 (33%) were treated with conservative surgery and CDDP-based combined chemotherapy, one of which was followed by a successful pregnancy in spite of nonepithelial tumor. As above, we could obtain some successful pregnancies in cases beyond stage 1c after conservative surgery by adding definite CDDP-based combined chemotherapy. However, we must carefully select the patients with nonepithelial tumors for conservative therapy by adding definite CDDP-based combined chemotherapy and inform them of the risks of therapy.

A one-month repeated oral dose toxicity study of methotrexate in unilaterally nephrectomized rats.

A repeated oral dose toxicity study of methotrexate (MTX) was conducted in order to examine whether the enhancement of MTX toxicity would occur in unilaterally nephrectomized (UNX) rats. UNX rats or sham-treated (SHAM) rats received dosages of 0, 0.06, 0.2 or 0.6 mg/kg/day (control animals received physiological saline). Toxic effects of MTX observed in this study were not different from studies already conducted, i.e., myelo- and lympho-toxicity, gastrointestinal toxicity, hepatotoxicity, pulmonary toxicity and renal toxicity were evident in the animals given MTX. Toxic effects of MTX in the UNX rats were more severe than those in the SHAM rats; a higher number of dead and moribund animals was observed among the UNX rats, and abnormal clinical signs appeared a few days earlier in the UNX rats. In the hematological examination, a decreased number of the blood cells in the UNX rats was observed at the lower dose level as compared to SHAM rats. The nontoxic dose of MTX in SHAM rats and UNX rats was 0.06 mg/kg/day and below 0.06 mg/kg/day, respectively. According to the results of a toxicokinetic examination conducted in the animals receiving 0.2 mg/kg/day, AUC and T 1/2terminal of MTX in the UNX rats were higher than those of SHAM rats. It was considered that the enhancement of the MTX toxicity in UNX rats was caused by the longer exposure of MTX in UNX rats. Serum UN and Cr of the UNX rats receiving physiological saline were higher than those of the corresponding SHAM rats, which suggested a slightly decreased GFR had been induced in UNX rats in this study. However, decreased PSP excretion was not observed in the UNX rats and urine volume of the UNX rats was equivalent to that of SHAM rats. Thus, it was considered that vicarious hypertrophy occurred in the residual kidney and decreased renal function was not evident in the UNX rats. This study demonstrated that the enhancement of toxicity of MTX had occurred even though a decreased renal function was not evident.

Endoscopic fenestration of pseudo cyst in acute pancreatitis.

We report a case of pseudo cyst accompanied by acute pancreatitis which was successfully treated by endoscopic cyst-gastrostomy. It had been enlarged recurrently after twice simple needle aspiration under ultrasonic monitoring. Because of the infection of the cyst, rapid and complete drainage was needed. Upper gastro-intestinal endoscopy showed a large bulge of the stomach which was compressed by paragastric pancreatic cyst. Endoscopic ultrasonography revealed that the cyst wall was attached hard with the stomach and there was no vessels between them. Endoscopic fenestration of the bulge was created using papillotome and diathermic snare. The drainage was effective and cyst was decompressed rapidly. The fenestration was closed after the cyst was diminished. Recently the endoscopic cyst-gastrostomy made by cutting linearly or inserting catheter have been reported, however, these treatments sometimes resulted in infection and relapse because of the quick closure of the fistula. When the bulge is large and endoscopic ultrasonogram revealed low bleeding risk, the fenestration may be advisable for effective drainage of longer duration without infection.

Expression of pS2 protein in endometrial carcinomas: correlation with clinicopathologic features and sex steroid receptor status.

Using immunohistochemistry, we examined pS2 expression in 64 samples of endometrial carcinoma, 11 samples of endometrial hyperplasia and 15 samples of normal endometrium, and compared them with clinicopathological data, estrogen receptor (ER) expression and progesterone receptor (PR) expression. Of the 64 samples of endometrial carcinoma, 45 (70%) expressed the pS2 protein. The average age of the patients with pS2-positive carcinomas (54.8 +/- 8.6 years) was significantly lower than that of the patients with pS2-negative carcinomas, and all premenopausal patients were positive for the pS2 protein. Among histological types, pS2 expression was observed in 33 (92%) of the 36 G1 carcinomas, but in none of the 5 nonendometrioid carcinomas. Of the 48 ER-positive carcinomas, 43 (90%) were pS2-positive and 5 were pS2-negative. Of the 40 PR-positive carcinomas, 37 (93%) were positive for pS2. There were significant associations between pS2 expression and ER/PR expression (p < 0.001). Staining of the pS2 protein was also observed in the samples of normal endometrium. We found a progressive increase in immunoreactivity of pS2 protein from normal endometrium to endometrial hyperplasia and still more in well-differentiated carcinoma. All 11 cases of endometrial hyperplasia were strongly positive for pS2. Furthermore, patients with pS2-positive carcinomas had a better survival rate than those with pS2-negative carcinomas (p < 0.05). Our data suggest that pS2 expression is likely correlated with estrogen-related endometrial carcinoma and is possibly involved in early disease progression.

Free ileocolon transfer after hypopharyngo-laryngo-cervical esophagectomy for speech rehabilitation.

Patients with carcinoma of the hypopharynx or the cervical esophagus usually undergo total laryngectomy with hypopharyngo-esophagectomy and, consequently, lose the power of speech. Therefore, a reconstruction method which would enable speech rehabilitation is desirable following this type of procedure. Free ileocolon transfer consists of colo-esophagostomy, pharyngo-colostomy, ileo-tracheotomy, vascular anastomosis under a microscope, and permanent tracheostomy. In this method, the colon functions as the alimentary tract, while the ileum and ileocecal valve can produce sounds. We evaluated the results in live patients with free ileocolon transfer following hypopharyngo-laryngo-cervical esophagectomy. Although there was no case of direct operative death, one patient died from cancer progression. Four patients are still alive at from 18 to 36 months after operation. Postoperatively, stenosis of the colo-esophaogostomy appeared in two patients, but there was no case of anastomotic breakdown or any other major complication. Speech rehabilitation was good, and there was no misswallowing into the airway. We think that free ileocolon graft is one of the more preferable procedures following hypopharyngo-laryngo-cervical esophagectomy.

Parametrial involvement in endometrial carcinomas: its incidence and correlation with other histological parameters.

To identify the incidence and spread pattern of parametrial involvement in endometrial carcinomas, resected parametria in 91 patients who underwent radical or modified radical hysterectomy with pelvic lymphadenectomy were histologically examined. The relationship between parametrial involvement and other histopathological features including histological type, tumor grade, depth of myometrial invasion, lymph-vascular space invasion, cervical involvement, adnexal metastasis, and lymph node metastasis was studied. Parametrial involvement was histologically demonstrated in 12 (13.2%) of the 91 cases. There were 2 patterns of spread: direct invasion of cancer cells to the parametrial connective tissue (5 cases) and lymphatic involvement within the parametrium (7 cases). According to the FIGO surgical stage, parametrial involvement was found in none (0%) of 48 patients in Stage I, 3 (11.5%) of 26 in Stage II, and 9 (52.9%) of 17 in Stage III. Among histopathological variables, the presence of parametrial involvement was significantly correlated with deep myometrial invasion and lymph-vascular space invasion in the myometrium. Multivariate analysis revealed that parametrial involvement significantly contributed to the poor prognosis in Stage II and III patients.

Immunohistochemical analysis of distribution of estrogen receptors and progesterone receptors in the postmenopausal endometrium.

OBJECTIVE: To examine the expression of sex steroid receptors (ER: estrogen receptor; PR: progesterone receptor) in the postmenopausal endometrium (PMEM) and the relationship to clinical data for studying its characters. METHODS: The immunohistochemical reactivity of the PMEM was studied using monoclonal antibodies against ER and PR, in 33 postmenopausal patients. RESULTS: The endometrium was thicker in patients who were postmenopausal for 1 to 10 years (1.48 +/- 1.31 mm) than in patients who were postmenopausal for more than 10 years (0.79 +/- 0.37 mm)(p < 0.05). Among the 33 postmenopausal endometrial samples, ER positivity was found in the glands in 26 cases (78.8%) and PR positivity was detected in 18 cases (54.5%). The average age of the patients with ER positive reactivity in the glands (61.69 +/- 7.26 years) was significantly lower than that of the patients with ER negative reactivity (66.00 +/- 3.56 years)(p < 0.05). Furthermore, the endometrial thickness of the patients with ER or PR positive reactivity in the glands (1.24 +/- 1.09 mm and 1.47 +/- 1.20 mm, respectively) was significantly greater than that of the patients with ER or PR negative reactivity (0.67 +/- 0.26 mm and 0.70 +/- 0.40 mm, respectively)(p < 0.05). CONCLUSION: ER in the glands of the PMEM was determined to decrease gradually with increased aging. The presence of ER and PR in the gland cells seemed likely to determine the thickness of the PMEM.