Intraarterial chemotherapy or chemoembolization for locally advanced and/or recurrent hepatic tumors: evaluation of the feeding artery with an interventional CT system.

PURPOSE: To evaluate the utility of an interventional CT system for intraarterial chemotherapy or chemoembolization for locally advanced and/or recurrent hepatic tumors. METHODS: Thirty-eight patients with locally advanced or recurrent hepatic tumors underwent 73 intraarterial contrast-enhanced CT (IA-CECT) examinations immediately before chemotherapy or chemoembolization. The degree of tumor vascularity on angiography and enhancement on IA-CECT was classified into three grades: no, mild, or marked vascularity. The IA-CECT grades were compared with the angiographic grades. RESULTS: Twenty-nine (69%) of 42 examinations that were interpreted as having no or mild vascularity on angiography were classified as marked enhancement on IA-CECT. Based on IA-CECT findings, the position of the catheter was changed in 14 (19%) of 73 CT examinations. The reasons for the reposition were as follows: weak or no enhancement of the tumor (n = 11) or strong enhancement of the gallbladder wall (n = 3). The treatment strategy was changed in three patients (8%). No major complications relating to the interventional procedures were observed. CONCLUSIONS: IA-CECT is a reliable method when evaluating the perfusion of the tumor and adjacent normal tissues. The interventional CT system is useful for performing safe and effective intraarterial chemotherapy or chemoembolization in patients with locally advanced and/or recurrent hepatic tumors.

Distinct advantage of the in situ generation of quaternary ammonium fluorides under phase-transfer conditions toward catalytic asymmetric synthesis.

[structure in text] Quaternary ammonium fluorides were found to be efficiently generated in situ from the corresponding ammonium hydrogensulfates by treatment with commercially available potassium fluoride dihydrate (KF.2H(2)O) in THF and directly used as a fluoride source for the generation of carbon nucleophiles from organosilicon compounds. This method can be successfully applied to the preparation of structurally well-defined, C(2)-symmetric chiral quaternary ammonium fluorides of type 1 (X = F), thereby allowing catalytic enantioselective Mukaiyama-type aldol reactions under mild conditions.

Unique synthetic utility of BF(3).OEt(2) in the highly diastereoselective reduction of hydroxy carbonyl and dicarbonyl substrates

A new aspect of commonly used BF(3).OEt(2) has been illuminated by successfully demonstrating the unique but highly stereoselective reactions of hydroxy carbonyl and dicarbonyl substrates. For example, treatment of gamma-hydroxy ketone 1c with BF(3).OEt(2)/Bu(3)SnH in CH(2)Cl(2) at -78 to -40 degrees C afforded the corresponding 1, 4-diol 2c with virtually complete diastereoselection, while use of TiCl(4) as a Lewis acid under similar reaction conditions caused a total lack of diol yield and selectivity (17%; 2c/3c = 1.2:1), accompanied by a significant formation of 2,3-disubstituted tetrahydrofuran 4 (44%).

"Amphiphilic" Cleavage of gamma-Stannyl Ketones with ATPH/RLi: Application to Enone Fragmentation by the Conjugate Addition - Cleavage Sequence.

The use of a combined Lewis acid/base system consisting of aluminum tris(2,6-diphenylphenoxide) (ATPH) and MeLi has allowed the electrophilically activated nucleophilic ("amphiphilic") cleavage of C(alpha)-C(beta) bonds in gamma-stannyl ketones. Through combination with the conjugate addition of alpha-stannyl carbanion to enone, this approach constitutes a novel two-step conjugate addition - cleavage sequence that leads to functionalized ketones (see reaction).

Risk factors for low birthweight in Japanese infants.

The purpose of our study was to identify risk factors for low birthweight (LBW; birthweight < 2500 g) in Japanese infants. The data was collected from questionnaires completed by the parents of 23132 infants who underwent a standardized well baby check-up for 1-month-old infants, conducted by the Fukuoka City Medical Association from 1987 to 1995. The following eight factors and their second-order interaction terms were examined as potential risk factors for LBW: maternal age at delivery, history of live-born LBW infant, history of abortion in previous pregnancies, maternal smoking, coffee and alcohol consumption during pregnancy, prenatal training and live birth order. The results of multiple logistic regression analysis showed that the following three factors and one interaction term significantly contributed to LBW: history of live born LBW infant, maternal smoking, live birth order and the interaction between maternal smoking and live birth order. The smoker-related risk for LBW was quite different in each of the three groups stratified by live birth order. Efforts should be made, for example, to increase the accessibility of early, high-quality prenatal care for the high-risk groups with previous LBW babies and to implement smoking intervention, ranging from specific medical procedures to broad-scale public health and health-related educational programs in schools.

[Clinical significance of determination of serum RNase activities in patients with eosinophilia--II. Measurements using polyuridylic acid and polycytidylic acid as substrates].

The activities of RNase (RNase-U and RNase-C) were determined in the serum and leukocytes of 277 patients with 14 cases of various kinds of eosinophilia (not less than 10(3)/microliters), 28 cases of chronic myelocytic leukemia (CML), using polyuridylic acid and polycytidylic acid as synthetic substrates according to the method of Raddi et al. Serum RNase-U activity, serum RNase-C activity and the activity ratio (U/C x 10(-3)) were 55 +/- 14 U, 1,280 +/- 235 U and 44 +/- 11 (mean +/- SD), 196 +/- 137, 1,992 +/- 1,134 U and 97 +/- 38, and 110 +/- 50 U, 1,854 +/- 625 U and 65 +/- 13 for normal subjects, eosinophilia and CML (untreated), respectively. U/C ratio in eosinophilia and CML (untreated) showed a highly significant positive correlation (p less than 0.001) with peripheral eosinophil count; the activity of serum RNase-U per cells in the supernatant of eosinophil homogenate rose significantly (p less than 0.001) compared with that of lymphocytes or granulocytes. Besides, serum and eosinophil RNase-U had a similar optimal pH. These results suggested that serum RNase-U in eosinophilia originated mostly from eosinophils and its rise was correlated strongly with the increase in eosinophils.

[Classification and surgical repair of congenital ear lobe anomalies].

We encountered 21 cases of congenital ear lobe anomalies at our clinic during the past seven years. This report presents our system for classification of these cases and describes some typical cases. We divided ear lobe anomalies into four groups according to the type of lobe as follows; large, adhesive, defective and cleft ear lobe type. In the large lobe type, the ear lobe is characteristically large. For the adhesive lobe type, no angle is formed between the ear lobe and the face, i.e. the helix is elongated in a straight line towards the face. The cleft ear lobe type is classified into two surgical categories, viz. the cleft and appendage types. The former is recognized by a cleft on the lobe which continues from the helix, whereas the latter type has an appendage on the lobe. Combinations of these two types are included in the cleft type because a cleft in the lobe is more significant in terms of the shape of the repaired ear lobe. As regards the surgical repair of these anomalies, careful consideration is required in order to accomplish tridimensional reconstruction and create the natural curve of the lobe using z-plasty and other local flaps.

[Changes in serum RNase activities in chronic phase and acute crisis of chronic myelocytic leukemia].

We investigated serum acid and alkaline RNase activities in 16 cases of acute crisis of chronic myelocytic leukemia (CML), 21 cases of untreated CML, and 13 cases of treated CML, to clarify clinical significance of the determination of RNase activities in acute crisis of CML. We obtained results as follows; the ratio of acid to alkaline Rnase activities (Ac/Al ratio) of chronic phase of CML was 1.64 +/- 0.47 (mean +/- SD) in the untreated cases, and was 1.32 +/- 0.16 in the treated cases. The Ac/Al ratio always indicated over 1.0 in the chronic phase of CML without any relationship to treatments. On the other hand, in the cases of acute crisis, the Ac/Al ratio was significantly lowered (0.94 +/- 0.22) as compared to the chronic phase of CML (p less than 0.001), and was similar to that of acute leukemia. The acid and alkaline RNase activities of the blast from the patients with acute crisis of CML showed remarkably lower value than those of leukemic cells from patients with chronic phase of CML. Therefore, it was Suggested that the return to normal range of Ac/Al ratio in acute crisis of CML depended on marked decrease of RNase activities of blasts. Thus, serial determinations of the enzyme activities are considered to be one of useful tools for prediction of acute crisis of CML.

Enhancing effect of cetyl lactate on the percutaneous absorption of indomethacin in rats.

The enhancing effect of cetyl lactate (CL) on the percutaneous absorption of indomethacin (ID) from test solutions in propylene glycol (PG) was investigated by using the abdominal skin of rats in vivo. The percutaneous absorption rate of ID from 1 or 3% CL-PG test solution through the intact skin of rats was observed to be faster than that from the control solution (without CL). The bioavailability of ID was about 0.04% for the control solution, 2.2% for 1% CL-PG and 6.8% for 3% CL-PG test solutions. These results suggest that CL functions as an enhancer for the percutaneous absorption of ID. Furthermore, marked enhancing effects on percutaneous absorption of ID were obtained at a concentration greater than 1% CL in PG. In order to elucidate the mode of action of CL as an absorption enhancer, the percutaneous absorption of ID from the control solution and 3% CL-PG test solution through damaged skin from which the stratum corneum had been stripped was additionally investigated. It was confirmed that CL acts on the stratum corneum to produce its effect.

[Clinical significance of serum ribonuclease (RNase) assay in acute leukemia].

The clinical significance of serum ribonuclease (RNase) assay in acute leukemia was studied. Serum RNases were assayed by the method of Akagi et al. with slight modifications in the serum samples obtained from 50 cases of healthy subjects, 55 cases of acute leukemia before therapy, 18 chronic myelocytic leukemia before therapy, 13 chronic myelocytic leukemia under treatment and 20 reactive leukocytosis. The ratio of acid RNase to alkaline RNase activities (Ac/Al ratio) was statistically increased in acute promyelocytic leukemia, acute myeloblastic leukemia [M2], acute myelocytic leukemia and erythroleukemia (leukemic stage) compared with those in healthy subjects (P less than 0.001). All cases of acute promyelocytic leukemia and most of the acute myeloblastic leukemia [M2], acute myelomonocytic leukemia and erythroleukemia cases had an Ac/Al ratio of above 1.0. In remission of acute leukemia, it is noteworthy that acid and alkaline activities showed no substantial difference from those of healthy subjects. While, on relapse of acute leukemia cases, showing Ac/Al ratio above 1.0 in pretreatment state, Ac/Al ratio increased to above 1.0. Thus, the assay of serum RNases and the calculation of Ac/Al ratio might be an additional method for diagnosing acute leukemia and for assessing their remission and recurrence in some type of acute leukemia.

Light and electron microscopic studies of a case with simultaneous Mondini and Michel deformities of the inner ears.

We performed light and electron microscopic studies on the temporal bones of a patient with genetic aplastic deafness, in which the right ear had a Mondini-type defect and the left ear a Michel-type anomaly. The round window of each ear was absent. The stapedial foot plate of the right ear was depressed at its central part and was covered by thin membrane. The course of the internal auditory meatus of the left ear was deviated ventrally. There was total aplasia of the cochlea in the left ear, while that of the right ear showed only three-quarters of a turn. In this ear, three sites of spherical bulging were found and were believed to represent outer hair cells. Other structures of the normal cochlear duct were not present. The modiolus of the left ear was round and dome-shaped, contained sparse nerve fibers and a primitive spiral ganglion. The saccule, utricle and semicircular canals of each ear were missing, so that a common cavity of the vestibular system was present. Several otoliths could be seen under the surface of the membrane covering the common cavity. No sensory cells or their related tissues could be found in either ear.

Tape attachment therapy for correction of congenital malformations of the auricle: clinical and experimental studies.

After the auricular cartilage of 5-week-old rabbits was bent and fixed by suture, the cartilage increased in thickness in a short period of time. The thickness was maximal 6 weeks later and slightly greater than that of the control cartilage 12 weeks later. At this stage, the auricle was fixed in curved form. There was no difference in the morphology of cartilage cells between the bent group and the control. Tape attachment therapy is very simple. We propose that surgical treatment should be designed after a few months of tape attachment therapy. In the present work, the effect of taping was graded good in 4 cases of Stahl ear, 1 case of atypical cryptotia, and 2 other cases. In 2 cases of cup ear the result was fair, but this deformity with marked auricular aplasia was not curable by this conservative treatment.

Topical immunology of nasal allergy and mucosal IgE antibodies.

In the present study, the in vitro tissue-radioallergosorbent test (t-RAST) was performed in two groups of patients: one with perennial attacks of sneezing, serous hypersecretion and nasal congestion, the other with nasal congestion only. The results obtained were compared with those obtained by a series of conventional allergy tests. We then found that t-RAST provided objective data comparable to those obtained with serum-RAST and that the t-RAST is a reliable means of quantitatively detecting specific IgE antibodies in the nasal mucosa. t-RAST is of special value to diagnosticians because it is able to discern unequivocally and easily those patients with localized nasal allergy.