Clinical significance of soluble form of HLA class I molecule in Japanese patients with pancreatic cancer.

In recent studies a soluble form of human leukocyte antigen class I (sHLA-I) has been found in blood, urine, ascitic fluid, and various other tissues. Research has been focused on the role of sHLA-I in the induction of immunotolerance in organ transplantation. To examine the role of sHLA-I in the immune system of patients with malignancy, we examined serum sHLA-I levels in patients with pancreatic, biliary, hepatic malignancy, and other diseases. We examined sHLA-I levels in the sera of patients with pancreatic cancer (n = 19), benign biliary disease and chronic pancreatitis (n = 20), hepatocellular carcinoma (n = 51), gallbladder cancer (n = 6), cholangiocellular carcinoma (n = 6), and in normal controls (n = 22), using enzyme-linked immunosorbent assay (ELISA). In patients with pancreatic cancer we also analyzed the relationship between sHLA-I and CA19-9, and the specificity and sensitivity of sHLA-I. When patients with acute or chronic hepatitis were excluded from analysis, the mean sHLA-I level in patients with pancreatic cancer was significantly higher than that of normal controls (p < 0.01) and patients with benign disease (p < 0.01), hepatocellular carcinoma (p < 0.01), gallbladder cancer (p < 0.05), and cholangiocarcinoma (p < 0.05). We determined a serum sHLA-I cutoff level for normal controls of 2000 ng/ml; serum levels of sHLA-I were higher than the cutoff in ten patients with pancreatic cancer, and serum levels of CA19-9 were lower than 37 IU/l in 9 of 14 patients; sensitivity and specificity were 88.2% and 85.5%, respectively. Serum levels of sHLA-I in pancreatic cancer patients were higher than in the other diseases, although we found that pancreatic cancer cell lines did not produce the sHLA-I. The evaluation of serum sHLA-I levels could have clinical significance in pancreatic cancer.

A possible mechanism of primary ciliary dyskinesia: a case of a segmental defect in ciliary microtubules.

We report here a 13-year-old woman with cough, sputum and fever. The patient had both chronic sinusitis and bronchitis. Chest X-ray and computed tomographic scan of the chest revealed mucous bronchial filling and bronchiectasia in bronchi of bilateral lower lobes, right middle lobe and left upper lobe. Aerosol inhalation scintigraphy with 99mTechnetium demonstrated delays of the discharged tracer. On the basis of these findings, primary ciliary dyskinesia was suggested. This was confirmed by the findings from nasal biopsy with transmission electron microscopy where all of the microtubules were segmentally defected near the basal body in the cilia. On the basis of these findings, we diagnosed the patient with primary ciliary dyskinesia which may be due, at least in part, to segmental defect of ciliary microtubules.

[Clinical statistics of the patients admitted to the Department of Urology Shizuoka Red Cross Hospital between 1981 and 1990].

A statistic survey was made on the patients, diseases and operations experienced at the Urological ward of Shizuoka Red Cross Hospital between 1981 and 1991. The total number of inpatients was 2,830 and the male to female ratio was 3.5 to 1. The most frequent diseases among the inpatients were obstructive uropathy (25.5%), malignant neoplasia (23.7%), non-specific infection (16.4%) urolithiasis (16.1%). The number of operations was 1922. Endoscopic surgery was the most frequent form of operation (55.2%).

[A case of Fournier's gangrene].

A 59-year-old man was admitted to our hospital complaining of perineal pain and scrotal redness. He was diagnosed with diabetes mellitus 12-years ago but had not received treatment. The scrotum soon showed necrosis and pus discharge. A culture study revealed Clostridium, Bacteroides and many other bacteria. Antibiotics chemotherapy (CMZ, AMK, MINO) was done but because necrotizing fasciitis progressed, we performed surgical treatment of necrosis. The skin defect was closed naturally with wound irrigation. The patient is doing well and his diabetes is under control. We found 13 other cases of Fournier's gangrene in the Japanese literature and their age, culture study and complications are discussed.

[Clinical studies on Suncefal (cefpiramide) concentration in prostatic tissue and bladder wall].

The cefpiramide (CPM) concentration in prostatic tissue of 19 patients with benign prostatic hypertrophy and bladder wall of 2 patients with bladder tumors was measured, after 2 g of CPM was administered intravenously by bolus technique prior to operation. Prostatic tissue level was 28.4 to 131 micrograms/g and tissue to serum ratio 0.15 to 0.63 at 12 min. to 220 min. after administration. The T1/2 of CPM in prostatic tissue was 3.29 hours. The bladder wall level was high at both determinations. CPM level in prostatic tissue and bladder wall covered the minimum inhibitory concentration of many bacteria detected from the infected sites. Therefore, CPM which has a strong antimicrobial activity can be considered as a highly useful antibiotic for the treatment of postoperative infections.

[A case of bilateral testicular tumors--a review of 115 cases in Japanese literature].

A case of bilateral testicular tumours of germ cell origin is reported. A 35-year-old man with bilateral testicular swelling visited our clinic. Bilateral high orchiectomy was performed. Histological examination of both resected testis revealed typical seminoma. Postoperative irradiation was performed. The patient is doing well after one year of postoperative follow-up without any sign of metastasis. Besides this case, we found 115 cases of bilateral testicular germ cell tumours in the Japanese literature. There were 39 cases with different and 76 cases with similar histology between the left and right testis. The age distribution, location of testis, time of onset and histological classification of these cases is discussed.