Incidence of and risk factors for incisional hernia after closure of temporary ileostomy for colorectal malignancy.

PURPOSE: Incisional hernia is a major complication after stoma closure and can cause uncomfortable symptoms. In this study, we evaluated the risk factors for hernia formation with the aim of reducing the incidence of incisional hernia. METHODS: A total of 134 oncology patients underwent closure of a temporary loop ileostomy between May 2004 and December 2013. The incidence of incisional hernia was determined by routine follow-up computed tomography scanning every 6 months. The relationships between patients' characteristics, including age, sex, obesity, diabetes mellitus, surgical site infection, chronic obstructive pulmonary disease, hypertension, hypoalbuminemia, smoking, and presence of a midline hernia and the occurrence of incisional hernia were retrospectively evaluated. RESULTS: The median follow-up time was 47 months (range 8-130). Hernias occurred in 23.9% of patients (32/134). The median time to detection of hernias was 8 months (range 2-39). The Chi-squared test revealed significant differences in obesity (P = 0.0003), hypertension (P = 0.0057), and incisional hernia history (P = 0.0000) between patients with and without incisional hernia. Multivariable analysis and univariate analysis revealed that hypertension and the presence of midline incisional hernia were risk factors for incisional hernia. CONCLUSIONS: Hypertension and the presence of a midline incisional hernia were the major risk factors for incisional hernia after loop ileostomy closure. These risk factors can be addressed before planning surgery.

[A study on the risk factors for tuberculosis epidemics observed from the results of extraordinary health examinations].

In recent years, tuberculosis (tbc) epidemics have been increasing, and have become a social problem in Japan. This study was carried out to clarify the current risk factors on tbc epidemics. The original reports of a total of 254 tbc patients whose contacts were examined for possible tbc infection (extraordinary health examinations) during 1992-97, were investigated and compared with all new pulmonary tbc cases registered during the same period in Aichi prefecture. In addition, from registration cards in each public health center, the risk factors for 19 cases of both tbc epidemics (infecting more than 20 contacts) and microepidemics infecting 10-19 contacts were further examined. The results obtained were as follows; 1. Extraordinary health examinations were carried out in 3.2% of total pulmonary tbc cases, and were carried out at higher rates among contacts with younger patients and with those having severer tbc by radiographical (p < 0.01) and bacteriological findings (p < 0.01). 2. 11 tbc epidemics (3.4%) and 34 microepidemics (14.3%) were identified among 254 examinations over 6 years. They were frequently observed in groups with abundant bacilli discharge and long lasting cough, and also in young age groups. 3. All of the 19 cases causing epidemics or microepidemics had multiple risk factors; the main factors being late diagnosis, inadequate health managements in schools and offices and poor quality of patients' living environments. Therefore, it is necessary for public health centers to work more closely with schools and industrial circles for the prevention of tbc epidemics.

Low risk of TT virus (TTV) infection in medical workers.

The rate of infection with TT virus (TTV), a novel single-strand DNA virus was evaluated and the clinical and laboratory features in affected Japanese medical workers were analysed. TTV DNA was measured in 356 medical workers and in 150 age-matched controls using a seminested polymerase chain reaction. TTV DNA was detected in 62 of 356 medical workers (17.4%). There were no differences in the prevalence of TTV infection between medical workers and controls (18.9%) and in the characteristics of medical workers with TTV infection and medical workers without it, except that the mean age of patients with TTV infection was higher than that of patients without TTV. The medical workers were drawn from three groups: medical doctors, nurses and clinical laboratory technicians. There was no statistically significant difference between the rate of TTV infection in the three groups. These findings suggest that the risk of TTV infection in medical workers is low and not related to liver dysfunction.

[Effective treatment of AFP-producing lung cancer with UFT].

The main form of chemotherapy for non small cell lung cancer is a multiple combination therapy centered on cisplatin (CDDP). We herein report a case in which a favorable course was obtained for a patient with extremely rare AFP-producing lung cancer by single oral administrations of UFT, following extirpation of brain metastasis. The patient was an 80-year-old male whose main complaints were headache and aphasia. Following close examination, a diagnosis was made of moderately differentiated adenocarcinoma with the primary lesion in S6 of the right lung. A metastatic lesion was found in the left occipital lobe. Blood AFP was an abnormally high 17,000 ng/ml. No tumorous lesions were found in the liver. The brain metastasis were extirpated to alleviate cranial nerve symptoms, and the tissue was found to be the same as that of the primary lesion. AFP staining of the tumor tissue revealed positive cells. Because there was proliferation in the primary tumor following surgery, administration of UFT (300 mg/day Tegafur) was begun. Four weeks later the tumor had begun to shrink, and at 15 weeks was judged to be a partial response. A reduction in AFP was also seen. The patient showed absolutely no side effects from UFT, thus enabling outpatient treatment. Good results were obtained both in reducing the tumor and in maintaining the patient's quality of life.

Rehabilitation of patients with anosognosia for hemiplegia due to intracerebral haemorrhage.

We have studied the differences in the lesions, concomitant symptoms and ADL levels in patients in acute-stage cerebral-haemorrhage and manifesting anosognosia. Twelve of 50 patients (24.0%) presented with anosognosia. The (+) group had longer intervals between onset and the first evaluation than did the (-) group, demonstrating severe sensory disturbance. The volume of haemorrhage was significantly larger in the (+) group. Anosognosia disappeared within 3 months in all cases. In the (+) group the time until discharge was long, with the ADL level at the time of discharge being low. Therefore, it was considered that anosognosia was important as an inhibitory factor hampering rehabilitation.

[An immunohistochemical study of the relationship between p53 expression and the DNA ploidy pattern using image cytometry in colorectal carcinoma].

We studied p53 expression in 46 colorectal carcinomas by immunohistochemistry. We examined the relationship between p53 expression and the pathological findings, the prognosis and tumor proliferative activity by Ki-67 staining or DNA ploidy pattern using an image cytometer. Expression of p53 was observed in 41.3% of carcinomas. No correlation was found between p53 expression and the depth of invasion, lymph node metastasis or Dukes' stage. No difference in survival was found between p53 positive and negative patients after curative surgery. We also studied the DNA ploidy pattern using an image cytometer in 28 carcinomas. Aneuploidy was found more frequently in the p53 positive areas than in the negative ones, but there was no significant difference. The DNA index showed no difference between the p53 positive and negative areas. We examined proliferating activity using Ki-67. There was no difference in the Ki-67 labeling index between p53 positive and negative areas. In the present study, there was no correlation between p53 expression and pathological findings, prognosis, tumor proliferative activity using Ki-67 staining or DNA ploidy pattern. Thus, p53 expression was suggested to have little relationship to grade of malignancy.

[Identification of motor area by transcranial magnetic stimulation using an "eight-figure" coil in patients with motor paralysis].

In patients with motor paralysis, we tried to identify the functional motor area by transcranial magnetic stimulation using an "eight-figure" coil designed by Ueno. Motor evoked potentials (MEPs) were recorded in 7 patients from 50 to 64 years old, and in 5 normal volunteers 26 to 45 years old. They were stimulated at 49 points over an unilateral hand motor area, and at 21 points over a foot motor area, and surface MEPs were recorded on their contralateral thenar muscle and abductor hallucis brevis muscle. In normal volunteers, the optimal eddy current for stimulating the hand motor area was directed anteriorly parallel to the midline, and for stimulating the foot motor area, it was postero-laterally directed with an angle of 45 degrees towards the midline. MEPs could be induced at their muscle contractions during which their thumbs and middle fingers softly touched each other, and their halluxes slightly flexed. In five patients two kinds of amplitude mappings reconstructed from MEPs were obtained at rest or at muscle contraction. A line connecting these two peaks on an amplitude mapping was regarded as an "MEP-motor area". A geographical difference between the MEP-motor area and MRI-motor area (identified by an MRI surface image) was studied at muscle contraction and at rest. In normal subjects the sites of the MEP-motor area and of the MRI-motor area coincided, whereas, in patients with space-occupying lesions near the central sulcus, the MEP-motor areas were located 1 to 2cm posterior to MRI-motor areas.(ABSTRACT TRUNCATED AT 250 WORDS)

[Study on relationship between intratumoral DNA heterogeneity and clinicopathological findings in colorectal cancer].

We studied the relationship between intratumoral DNA heterogeneity and clinicopathological findings in 85 colorectal cancers. DNA ploidy was analyzed in 5 specimens from different sites of each tumor. When the difference in the DNA index (D.I) between several peaks in the same tumor was more than 0.1, the tumor was considered to consist of heterogeneous subpopulations with different DNA clones. DNA heterogeneity was found in 34 cases (40.0%). There was no relationship between DNA heterogeneity and depth of tumor invasion, lymph node metastasis or stage. The incidence of heterogeneity was significantly higher in the tumor with lower differentiation, liver metastasis or vessel invasion.

[Histological analysis of craniopharyngiomas--with special reference to their histological origin and differentiation].

The histogenesis of craniopharyngiomas was immunohistochemically studied on the basis of cytokeratins (CK) expression, with special reference to histological subtype, i.e., the squamous type (Sq) and adamantinomatous type (Ad). Alcian-Blue staining and immunohistochemical expression of secretory component were also studied to assess secretory activity. Although combined expression of simple-, stratified-, and skin-type CK was detected in both Sq and Ad, the pattern of expression in Sq and Ad was different. Sq displayed epidermal differentiation of CK, and secretory activity was limited to the apical cells of Sq. Based on these findings, the histogenesis of Sq appeared to be from Rathke's pouch, but that of Ad remained obscure.

Cell adhesion activity of a 30-kDa major secreted protein from human bladder carcinoma cells.

Human bladder carcinoma cell line EJ-1 secreted a protein of 30 kDa as a major component. This protein was purified from the serum-free conditioned medium of EJ-1. Its N-terminal amino acid sequence was identical to that of fibroblast-derived endothelial cell growth factor (f-ECGF), but there were differences in their amino acid compositions and isoelectric points. The 30-kDa protein showed no effect on the growth of bovine capillary endothelial cells, but it promoted the attachment and spreading of rat liver cell line BRL and human umbilical vein endothelial cell line ECV-304. These results suggest that the 30-kDa protein, tentatively named "tumor-derived adhesion factor (TAF)", may be related with the aberrant cell adhesion of cancer cells.

Computed topographic electroencephalographic study in left hemiplegic patients with higher cortical dysfunction.

Computed topographic electroencephalography (EEG) was performed on patients with right hemispheric injury due to cerebral infarction to investigate the relationship of wave form pattern with neurologic and neuropsychologic data and activities of daily living (ADL). Neurologic signs, unilateral spatial neglect, motor impersistence, and constructional apraxia were found to have no relation to the wave form pattern of computed topographic EEG. In patients with abnormalities detected by the "Mini-Mental State" examination (MMSE) or the "Kanahiroi" test, and in patients with abnormalities in word fluency, extensive slowing of EEG frequency was commonly observed ipsilateral to the side of the lesion or bilaterally, and the ADL were frequently poor. In contrast, among the patients with slow waves and retained alpha waves, the MMSE, "Kana-hiroi" test, word fluency, and ADL were less abnormal. Computed topographic EEG may thus be a useful tool to evaluate neuropsychological status in rehabilitation patients with cerebral infarction.

Unilateral spatial neglect due to right frontal lobe haematoma.

Two patients with unilateral spatial neglect caused by right frontal lobe lesions underwent cerebral blood flow studies. A 54-year-old, right-handed woman developed left hemiplegia and frontal lobe neglect associated with cerebral haemorrhage after surgical excision of a frontal tumour. A 66-year-old, right-handed woman developed a haemorrhage in the right frontal lobe caused by rupture of an aneurysm. This was followed by left hemiplegia and frontal lobe neglect. In both cases, 123I-iodoamphetamine single photon emission CT disclosed a reduction in regional cerebral blood flow localised along the circumference of the haematoma in the frontal lobe, but did not reveal any lesions in the parieto-occipital junction. These findings suggest that, in these two cases, the frontal lobe neglect was caused by lesions confined to the frontal lobe.

Immunohistochemical demonstration of membrane cofactor protein (MCP) of complement in normal and diseased kidney tissues.

The immunohistochemically stained membrane cofactor protein of complement (MCP/CD46), one of the complement regulatory proteins, was up-regulated in some diseased kidney tissues. MCP in diseased kidneys was strongly concentrated along the glomerular capillary walls as well as in the mesangial regions, while MCP in normal kidneys was weakly detected in all glomerular structural cells and in the epithelial cells of tubules. Since the enhanced staining was noted in those areas where depositions of C3b/C3c occurred, ongoing complement reaction might be responsible for the up-regulation of MCP expression. MCP expression may be up-regulated by complement fragments generated during complement activation in glomerulonephritis. Furthermore, anti-MCP staining was stronger in intensity in patients with moderate to massive proteinuria, indicating that up-regulation of MCP expression could be directly correlated to the kidney damage.

Purification and characterization of a two-chain form of tissue inhibitor of metalloproteinases (TIMP) type 2 and a low molecular weight TIMP-like protein.

Multiple forms of metalloproteinase inhibitors were found in the serum-free conditioned medium of the EJ-1 human bladder carcinoma cell line by reverse zymography assay with gelatinase A as the indicator enzyme. Two novel forms of inhibitor with apparent molecular masses of 18 and 22 kDa on nonreducing SDS-polyacrylamide gel electrophoresis (PAGE), together with tissue inhibitor of metalloproteinases (TIMP) and TIMP-2, were purified from the conditioned medium by a series of chromatographic steps. Structural analysis showed that the 18-kDa inhibitor is a two-chain form of TIMP-2 (tc-TIMP-2) produced by proteolytic processing, and the 22-kDa inhibitor may be a partially glycosylated form of TIMP. The purified tc-TIMP-2 was separated into a 17-kDa peptide and a small peptide of about 2.5 kDa by reducing SDS-PAGE and into four isoforms with pI 7.6, 7.3, 7.2, and 6.8 by isoelectric focusing. tc-TIMP-2 has essentially the same inhibitory activity as TIMP-2 toward gelatinase A, collagenase, stromelysin, and matrilysin. Unlike TIMP-2, however, tc-TIMP-2 does not bind to the latent precursor fo gelatinase A. Similar two-chain forms of TIMP-2 were produced by its partial digestion with trypsin or less effectively with plasmin. These results suggest that proteolytic processing of TIMP-2 plays a role in the regulation of gelatinase A activity in the extracellular matrix.

A metalloproteinase inhibitor domain in Alzheimer amyloid protein precursor.

Extracellular deposition of amyloid beta-protein (beta-AP), or A4 protein (M(r) 4,000), is associated with Alzheimer's disease and with Down's syndrome (trisomy for chromosome 21). The large membrane-bound precursor protein (APP) of beta-AP is normally cleaved within the beta-AP region by a putative proteinase (APP secretase) to release its extracellular portion; beta-AP is produced by an alternative proteolytic processing. Here we demonstrate that APP contains a proteinase inhibitor domain for the matrix metalloproteinase gelatinase A, which is located in the C-terminal glycosylated region of the secretory forms of APP. In addition, we show that the gelatinase has an APP secretase-like activity, which hydrolyses the Lys16-Leu17 bond in the beta-AP sequence. Our results indicate that the proteinase inhibitor domain of APP and gelatinase A may be involved in the formation of beta-AP.

Influence of regional cerebral blood flow on event-related potential (P300).

The relationships between event-related potential (P300), higher brain functions, and regional cerebral blood flow (rCBF) were examined in 31 neurosurgical patients. The P300 latency, evaluated by an acoustic "odd-ball" paradigm, was normal in 14 and prolonged in 17 patients. Fourteen of 17 prolonged P300 patients had reduced rCBF in the right cerebral hemisphere, especially the frontal lobe and/or thalamus. There was a significant inverse relationship between P300 latency and laterality index (rt rCBF/lt rCBF) in the frontal lobe. Prolonged P300 patients revealed significant abnormalities in psychological tests compared to normal P300 patients. There were significant inverse relationships between the P300 latency and "orientation" and "memory" test scores. Decreased rCBF in the right cerebral hemisphere, especially the frontal lobe and/or thalamus, is associated with prolonged P300 latency, suggesting that the right cerebral hemisphere is important in human cognitive processes.

Postauricular response in motor paresis with intracranial lesions.

The clinical usefulness of the postauricular response (PAR) in the evaluation of motor paresis was studied in 105 patients with intracranial lesions and 25 normal volunteers. Click stimuli at 90 dB hearing level were delivered in each ear, and PARs recorded from bilateral posterior auricular muscles with reference to the vertex (Cz). No volunteer demonstrated PAR in the relaxed posture, but in tensed postures increasing muscle tone PARs were elicited with a latency of 11.5 +/- 0.7 msec and an amplitude of 6.2 +/- 2.8 muV. Sixty-two patients (59%) had high-amplitude PARs in the relaxed posture. PARs were enhanced more frequently in paretic patients than in non-paretic patients (p less than 0.01). In subcortical lesions, the PAR latency had a significant correlation with the degree of motor paresis (p less than 0.005). In patients, the enhanced PAR amplitude suggested the presence of motor paresis associated with deep-seated mass lesions. The enhanced response is thought to be associated with dysfunction of the pyramidal and extrapyramidal tracts.

Activation of TIMP-2/progelatinase A complex by stromelysin.

Progelatinase A was purified as a complex with TIMP-2 from the conditioned medium of a human glioblastoma cell line. The TIMP-2/progelatinase complex was resistant to the activation by p-aminophenylmercuric acetic acid (APMA), and showed less than 10% of the activity of the TIMP-2-free active enzyme. When the complex was incubated with stromelysin in the presence of APMA, the 64-kDa progelatinase was effectively converted to the 57-kDa mature enzyme, increasing its gelatinolytic activity about 8-fold. These results suggest that stromelysin is a natural activator of TIMP-2-bound progelatinase A.

[Three dimensional display of cerebral vessels using a personal computer].

A new method for a 3-D reconstruction of angiographic cerebral vessels was developed. This system was constructed from inexpensive equipment such as a personal computer, a video camera, a video display, and a digitizer. The input of the vessel images on anteroposterior and lateral angiograms was performed using a video camera with a personal computer and an image processing program (FDM 98-4; Fotoron Co.). These processed images were modified with our original editorial method. This can contribute a lot to the erasing of "non-vessel" images such as skull bone and other noise. It also adds concerning vessels which cannot be clearly taken from angiograms with the video camera. The most beneficial point of the editorial method was to reduce the time consumed in the reconstruction. The spatial points of X-ray discharging boxes against the AP and lateral films were calculated from the length and width of the radiated images of metal bars. These bars were attached to the 3 planes of the lucent box in which the patient's head was inserted to take the angiograms. The 3-D points of the vessels were calculated as follows; one point of a vessel on the lateral image and the spatial point of the X-ray discharging box against the image were linked by a line on which a point moved within a Z range. When the extended line which linked the point and the position of the X-ray discharging box against the AP view crossed the AP image, the Z value of the point was adopted and X and Y values were gained.(ABSTRACT TRUNCATED AT 250 WORDS)