Effective multidisciplinary treatment for ovarian granulosa cell tumor with multiple metastases--a case report.

Ovarian granulosa cell tumor (GCT) is among the ovarian sex-cord stromal tumors that are classified as borderline malignancies. We report a case of GCT with multiple metastases for which multidisciplinary treatment including surgery, chemotherapy and radiotherapy was effective. A 41-year-old woman underwent left salpingo-oophorectomy because of an ovarian tumor in 2004. Final pathology confirmed a granulosa cell tumor adult type, FIGO Stage IC. In 2008, tumorectomy of the lower abdominal wall metastases was also performed. After three cycles of BEP chemotherapy for metastases of the right lung, liver, paraaortic lymph node and rectus, surgical resection was performed in 2009. In 2010, local radiation was performed for the first lumbar vertebral metastasis. Ovarian GCTs exhibit slow growth but if the surgical stage is IC or higher, there is the possibility of recurrence. It is important to treat recurrent tumors with the combination of surgery, chemotherapy, and radiation therapy.

Genetic influences on the difference in variability of height, weight and body mass index between Caucasian and East Asian adolescent twins.

OBJECTIVE: Twin studies are useful for investigating the causes of trait variation between as well as within a population. The goals of the present study were two-fold: First, we aimed to compare the total phenotypic, genetic and environmental variances of height, weight and BMI between Caucasians and East Asians using twins. Secondly, we intended to estimate the extent to which genetic and environmental factors contribute to differences in variability of height, weight and BMI between Caucasians and East Asians. DESIGN: Height and weight data from 3735 Caucasian and 1584 East Asian twin pairs (age: 13-15 years) from Australia, China, Finland, Japan, the Netherlands, South Korea, Taiwan and the United States were used for analyses. Maximum likelihood twin correlations and variance components model-fitting analyses were conducted to fulfill the goals of the present study. RESULTS: The absolute genetic variances for height, weight and BMI were consistently greater in Caucasians than in East Asians with corresponding differences in total variances for all three body measures. In all 80 to 100% of the differences in total variances of height, weight and BMI between the two population groups were associated with genetic differences. CONCLUSION: Height, weight and BMI were more variable in Caucasian than in East Asian adolescents. Genetic variances for these three body measures were also larger in Caucasians than in East Asians. Variance components model-fitting analyses indicated that genetic factors contributed to the difference in variability of height, weight and BMI between the two population groups. Association studies for these body measures should take account of our findings of differences in genetic variances between the two population groups.

Correlation of immunohistochemical p53 labeling index with inhibition rate in chemosensitivity test in gastric and colon cancer.

To determine whether the expression of p53, p21, bcl-2 or Ki-67 in cancer cells is predictive of chemosensitivity, immunohistochemical examination of these factors and chemosensitivity assays were performed on colon and gastric cancer specimens. Chemosensitivity tests were performed using CDDP, 5-FU, MMC, or ADR and inhibition rate (IR) was calculated by MTT assay. Before exposure to anticancer drugs, the samples were investigated immunohistochemically for expression of the above factors and after anticancer drug exposure by TUNNEL staining, for the presence of apoptotic cells. With 5-FU and MMC, the apoptotic index was well correlated with IR, so their effects were related to apoptosis. Moreover, with these two agents, the p53 labeling index (LI) was inversely correlated with IR and p21-LI showed a good correlation with IR. We therefore concluded that immunohistochemical studies for p53 and p21 were useful for predicting the chemosensitivities of colon and gastric cancer to MMC and 5-FU.

[Statistical genetic analysis of some problem behaviors during sleep in childhood--estimation of genetic and environmental factors influencing multiple health phenomena simultaneously].

This study was conducted to clarify the genetic and environmental factors for some problem behaviors during sleep in childhood, namely sleep talking, half-sleeping, night terrors and nocturnal enuresis. The subjects were 881 pairs of twins, consisting of 609 monozygotic (279 male-male, 330 female-female) and 272 dizygotic (86 male-male, 84 female-female, 102 opposite-sexed). They were all applicants to the junior high school affiliated with Tokyo University from 1981 to 1998. The twins' mothers had previously completed a medical questionnaire and had been interviewed by three to five interviewers. With regard to the above mentioned four traits, they selected one answer from the choices 'often', 'sometimes' 'never' and 'unknown' for each twin. The interviewer checked the answers and, where necessary, explained the meaning of any terms such as "night terrors". Genetic analysis was performed as follows. First the answers were summarized in the form of a 2 x 2 contingency table; 'often' and 'sometimes' were included in one category. Then, tetrachoric correlations of the contingency table were calculated according to zygosity using the program package PRELIS2. Furthermore, covariance structure analysis was performed for several genetic models using the program package LISREL8. The results were as follows. Univariate genetic analysis showed that all four traits were under genetic control. Sleep talking, half-sleeping and night terrors were under strong or moderate genetic control. As to nocturnal enuresis, the genetic effect was moderate and shared environmental factors played an important role. Sex difference was observed in the case of half-sleeping and enuresis. Moreover these traits tended to occur together, and sleep talking, half-sleeping and night terrors shared common genetic and environmental factors in addition to specific genetic and environmental factors.

[MRSA septicemia caused by an infected pacemaker lead: a case report with a review of Japanese literatures].

A 50-year-old woman was admitted to our hospital because of MRSA septicemia caused by a contaminated permanent pacemaker lead. A pacemaker system was successfully removed under cardiopulmonary bypass support. Postoperative antibiotics was administered for 7 weeks. Total removal of a pacemaker system under cardiopulmonary bypass support is the treatment of choice in a case with pacemaker infection associated with MRSA septicemia.

[Analysis of microsatellite alteration in colorectal cancer].

We investigated the possible correlation between the microsatellite alterations (replication error: RER, and loss of heterozygosity: LOH) and clinicopathologic factors and survival in colorectal cancer. A total of 78 colorectal cancers was examined for microsatellite alteration at three microsatellite loci containing D2S123, D18S58 and C117-703. RER is considered positive when at least one microsatellite locus is detected. RER was positive in 28.2%, and the respective positivity was 12.8%, 15.3% and 11.5%. The positivity of LOH was 6.4%, 10.3% and 19.2%, in that order. RER-positive cancers were more significantly found in the proximal colon than the distal colorectum. Node-negative colorectal cancers were more noted in RER (+)-positive cancers. Multivariate analysis showed that LOH in D18S58 locus and RER in CI17-703 locus were independent prognostic factors.

[Long-term observation of sensorineural hearing-impaired children with hearing aids].

In the long-term observation (9-22 years) of 45 hearing-impaired children, using our own "Hearing Test Progress Table", 36(80.0%) showed fluctuation of the hearing threshold. Twenty-nine of the 36 patients had acute progression of hearing loss. Three peaks of onset of the acute loss were observed: at age 6, 10, 16 years in girls, 7, 11 and 16 years in boys. Twenty-three of the 45 (51.1%) have been able to maintain their good thresholds throughout these periods, with 14 cases of hearing loss restored by our successful treatment of acute sensorineural hearing losses (1-6 times). Twenty-two of the 45 children (48.9%) could not maintain their initial thresholds: gradual hearing deterioration in 7 of the 22, and acute hearing loss (1-10 times) in the remaining 15 cases. Although these 15 patients could not maintain their initial hearing thresholds until the end of the observation period, active treatments for their acute losses were successful in the early period, and almost all patients were able to maintain their initial hearing thresholds until graduation from elementary school. Our "Hearing Test Progress Table" is based on the results of pure tone audiometry for each frequency on every audiometry test. The management (including guidance and treatment) using the table is very effective.

Thoracoscopic lung resection for lung metastasis of colorectal cancer.

We performed thoracoscopic lung resection seven times in four patients with lung metastases from colorectal cancer. This procedure allowed a short operation time, minimal blood loss, and a short hospital stay. Thoracoscopic lung resection was chosen for resection of lung metastases from colorectal cancer because it allowed simultaneous bilateral lung resection and early postoperative adjuvant chemotherapy.

Laser labyrinthectomy.

Concepts and methods of laser labyrinthectomy have been proposed based on experimental studies in which the macula utriculi was irradiated with an argon laser beam through the oval window. In our previous reports, a single application of the beam (1.5 W, 0.5 s) eradicated the guinea pig macula within 5 weeks. The contour of the membranous labyrinth was normal and intact. The human macula utriculi was approached after stapedectomy and irradiated with an argon laser in a patient who developed persistent positional vertigo after closure of a perilymph fistula. Laser singular neurectomy was also done. Hearing remained unchanged, and the patient's vertigo disappeared. The human macula sacculi, however, cannot be irradiated, because of the presence of pigment in the saccular wall. In guinea pigs, the semicircular canals were irradiated from the outside. The lateral and posterior canals were approached through the middle ear, whereas the anterior canal was approached through the posterior fossa. Argon laser irradiation (1-1.5 W, 0.5 s) to the bony canal produced a charred area with or without perforation. The semicircular duct showed shrinkage and tearing of the trabecular meshwork immediately after irradiation. Several weeks later, the canal had been obliterated by ossification. Although laser labyrinthectomy can destroy the function of individual otolithic organs and eliminate dynamic impulses of the semicircular canals, hearing can be preserved.

[A case of superior vena cava syndrome caused by adenocarcinoma of the mediastinum--the significance of pulsed Doppler echocardiography in the SVC reconstruction].

We report a case of SVC syndrome caused by adenocarcinoma of the mediastinum, in which brachiocephalic vein flow was recorded by pulsed Doppler echocardiography before and after the SVC reconstruction. A 46-year-old man was admitted to the hospital with the chief complaints of edema of the face and the upper extremities. Although chest X-ray film showed no abnormalities, chest CT and SVC-graph demonstrated the obstruction of SVC and bilateral brachiocephalic veins. It was found that bilateral brachiocephalic vein flow displayed characteristic one-peak shaped pattern and the peak flow velocity was decreased. We removed SVC and bilateral brachiocephalic veins with the surrounding tissue, and SVC and tributaries were reconstructed with 10 mm ringed ePTFE grafts. Histological examination revealed carcinoma cell infiltration in the wall of SVC. Postoperative phlebography showed well patent grafts, and bilateral brachiocephalic vein flow pattern normalized and the peak flow velocity remarkably increased.

Physical growth of Japanese twins.

The present study aimed at clarifying the characteristics of twins' physical growth. First, 557 pairs of normal Japanese twins were analyzed according to the following three life stages: (1) intrauterine growth, (2) body weight and height from birth to 6 years, and (3) body weight and height at school age (from 6 to 11 years). The following results were obtained. 1. Intrauterine growth of twins was very different from that of singletons, especially as regards weight, so twins should be estimated by twin standards. 2. Size deficit at birth was appropriately recovered over the first 6 years. 3. No size deficit was observed by school age. Second, the similarity of bodyweight and height according to zygosity was analyzed using 605 pairs of normal Japanese twins, 427 monozygotic (MZ), 113 same-sexed dizygotic (DZ) and 65 opposite-sexed DZ pairs. The similarity between MZ and DZ pairs was almost the same at birth. However, MZ pairs became increasingly more similar with age, whereas DZ pairs became more dissimilar. This tendency was very clearly seen through early infancy, thus suggesting that genetic factors became more apparent during this life stage.

Rapidly growing mural thrombus in an abdominal aortic aneurysm.

While mural thrombus accompanied by an abdominal aortic aneurysm (AAA) is not rare, the growth rate of such a thrombus has not yet been adequately documented. We present here a very rare case of a 62-year-old female patient with an AAA in whom the mural thrombus in the aneurysm grew very rapidly over a short period. We could follow the growth of the mural thrombus in the AAA by two-dimensional (2-D) abdominal echography. Patients with an AAA must be closely monitored by this technique which is able to detect the presence of the thrombus and allow evaluation of its growth.

Zygosity diagnosis of twins by questionnaire for twins' mothers.

Subjects were 74 twin pairs, 61 MZs and 13 same-sexed DZs who entered the High School affiliated with Tokyo University, Japan. Their mothers also participated. The twins' zygosity was previously identified by many genetic markers. This study aimed at clarifying the effectiveness of zygosity diagnosis by questionnaires distributed to twins' mothers. The questionnaire consisted of three questions concerning the degree of similarity of twins at one year of age; whether they were confused, and if so, by whom. It was slightly modified from that reported earlier by Ooki et al [11] for twins themselves. According to the degree of similarity of the twins, points were allotted thus: from 1 to 3 points for answers to questions (1) and (2) and from 1 to 4 points for answers to questions (3). The sum of the points was calculated, then ranged from 3 to 10. Zygosity was determined by the sum of these points. If the sum was 3-6, the twin pairs were considered MZ and if the sum was 7-10 DZ. It was revealed that more than 90% of twins were identified correctly as MZ or DZ by applying this cutting point and this result was in accordance with that obtained by use of discriminant function analysis. Moreover, the accuracy of the mothers' responses was nearly the same as that obtained by the questionnaire for twins themselves. It was concluded, therefore, that the information from twins' mothers is as correct as that from twins themselves. This questionnaire is simple, practical and especially useful when twins are still too young to participate personally.

[Management of infective endocarditis].

Clinical manifestations and the results of management of infective endocarditis were reported. Of 46 patients, 17 cases received medical treatment alone (group A), and 29 cases underwent surgical interventions (group B). Affected valves were aortic in 29, and mitral in 24. In group B, however, infection occurred on the aortic valve in 22, and on the mitral valve in 11. Aortic valve was more often affected in group B than in group A (p less than 0.05). Embolic complications were observed in 5 of group A, 4 of whom had involvement of cerebral vessels, and in 4 of group B, all of whom had cerebral emboli. Of 8 cerebral embolic episodes, 6 emboli originated from mitral valvular lesions. In group A, 6 (35.3%) died of cerebral accidents or acute heart failure within 30 days after the onset of illness. In group B, 20 cases were operated on at chronic stage, and 9 cases underwent operation at active stage. Various procedures, alleged to be the most favorable, were selected to the individual patient. No mortality was found in the former group, but one patient (11.1%) in the latter group died of multiple organ failure 31 days after surgery. All patients, who were operated on at active stage, received intravenous administration of antibiotics for 6 to 8 weeks after the operation. Comparing the actuarial survival rate of group A and group B, group B was superior to group A for initial 4 years, but no significant difference was discernible thereafter.

Macrophage migration inhibitory factor (MIF) produced by a human T cell hybridoma clone.

A human T cell hybridoma clone, F5, producing high levels of macrophage migration inhibitory factor (MIF) was established by the emetine-actinomycin D selection method. This clone produced two species of MIF which were separated on a Phenyl Sepharose column. We purified MIF-2 (the more hydrophobic species of the two) to homogeneity from the conditioned medium of stimulated F5 cells by a series of steps that included hydrophobic chromatography, ion-exchange chromatography. Ricinus communis lectin affinity chromatography, and high-performance liquid chromatography on anion exchange and reverse-phase columns. Purified MIF was digested with endoproteinase Lys-C and Asp-N. The amino acid sequences of the generated peptides were determined. No sequence similarity with any other protein was found. The molecular weight of MIF-2 was estimated to be 45 kDa from sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of immunoprecipitates with anti-peptide antibodies. These results show that F5MIF-2 is a novel cytokine.

Zygosity diagnosis of twins by questionnaire.

Subjects were 189 twin pairs, 165 MZ and 24 same-sexed DZ, who entered the junior high school affiliated to Tokyo University (sample T), and 93 twin pairs, 71 MZ and 22 same-sexed DZ, who were registered at Kinki University (sample K). The zygosity was previously identified by many genetic markers, and this study aimed at zygosity diagnosis by questionnaire. The latter included three questions: "How are you alike?", "How often are you mistaken?", and "By whom are you mistaken?". According to the degree, 1-3 points, 1-3 points, and 1-4 points were given for each question, and the sum of the points of each pair of twins was calculated. Zygosity was determined by the sum of points, distributed from 6 to 20. Namely, if the sum was 6-13, the twin pair was considered MZ, and if the sum was 14-20, DZ. More than 90% of twins were diagnosed correctly by use of this cutting point. This result was in accordance with that obtained by use of discriminated function analysis. It is concluded that zygosity diagnosis by questionnaire is convenient and useful, in particular for epidemiological research.

Relationship between blood uric acid level and personality traits.

The present study deals with the relationship between blood uric acid level and human behavior. Subjects were 37 MZ and 7 DZ twins aged from 18 to 45 years. In males, blood uric acid level increased with age, while it decreased with age in females. Blood uric acid level was corrected and standardized using regression lines separately for males and females. The distribution of standardized uric acid level corresponded well with the theoretical curve of normal distribution. The intraclass correlation coefficient for standardized uric acid level was r = 0.370 (P less than 0.05) for the 37 MZ twins, but not significant for the 7 DZ twins. These findings suggest that blood uric acid level is genetically controlled. By the analysis of 12 personality traits in YG (Yatabe-Guilford) character test, it was revealed that "General activity" was more controlled by genetically than environmentally. In the evaluation of the correlation between standardized uric acid level and the YG 12 personality traits, significant correlation was observed in "Lack of agreeableness" and "Rhathymia". Since these two personality traits include the factor of "activity", it is concluded that the plasma uric acid level and activity in a broader sense are under genetic control. This conclusion is consistent with the generally accepted view that persons with high uric acid level are more active and energetic than those with low level.

The influence of birth injuries in first-born and second-born twins.

This study showed that biological handicap with many complications at birth was much more recognized in the second-born than in the first-born twins. One of the most prominent intrapair differences was, for example, the weight at birth. However, intrapair differences, which were observed also in other physical measurements, diminished gradually with age. Moreover, as for intellectual ability, which was represented by the scores of the entrance examination test or standard achievement test, no remarkable influences due to handicap of the second-born were identified. Thus, it was concluded that the biological handicap seen in the second-born twin at birth did not give any significant effect on later development.