Low-Dose-Rate and High-Dose-Rate Brachytherapy for Localized Prostate Cancer in ABO-Incompatible Renal Transplant Recipients.

BACKGROUND: Brachytherapy is one of the standard treatments for localized prostate cancer (CaP). However, the feasibility of brachytherapy for renal transplant recipients (RTRs) is still uncertain. MATERIALS AND METHODS: Between August 2007 and March 2018, all patients who had undergone low-dose-rate (LDR) brachytherapy or high-dose-rate (HDR) brachytherapy for clinically localized CaP at our institution were retrospectively identified (n = 394). Of these patients, 3 had a history of renal transplantation. We reviewed all available clinical data retrospectively. RESULTS: All of the RTRs received ABO-incompatible renal grafts from their spouses and had stable renal graft function before the diagnosis of CaP. The median age at diagnosis of CaP was 65 years (range, 60-67 years). The median time between transplantation and brachytherapy was 7 years (range, 4-10 years). In all of the patients, clinical stage was cT1cN0M0. Two patients received 125I LDR-brachytherapy (dose, 145 Gy) and 1 patient was treated by 192Ir HDR brachytherapy (dose, 19 Gy in 2 fractions) combined with external beam radiation therapy of 39 Gy in 13 fractions. The median follow-up period after brachytherapy was 44 months (range, 34-50 months). During the follow-up period, none of the patients developed disease progression including biochemical recurrence or clinically significant adverse events associated with radiation therapy. CONCLUSIONS: LDR brachytherapy and HDR brachytherapy are safe and technically feasible in RTRs with CaP, and oncological outcomes in RTRs do not appear to be inferior to those of patients who did not receive renal transplant.

Effects of long-term treatment with low-dose pravastatin on biliary lipid and bile acid composition in patients with nonfamilial hyperlipoproteinemia.

We tested the possibility that pravastatin, a competitive inhibitor of hepatic hydroxymethyl glutaryl coenzyme A (HMG CoA) reductase, would alter cholesterol saturation of gallbladder bile by decreasing its cholesterol saturation index and/or degree of fatty acyl chain unsaturation in lecithin. Eighteen patients with type IIa hyperlipoproteinemia were treated with pravastatin 10 mg/d for 12 months. Gallbladder bile samples were aspirated with a duodenal tube by stimulating gallbladder contraction with intramuscular administration of cerulein before and after treatment. Serum cholesterol level was significantly reduced by 20% after 3 months, and this level was maintained after 12 months. In contrast, the cholesterol saturation index of gallbladder bile was not altered after 3 months (1.52 +/- 0.20 v 1.70 +/- 0.24), but it decreased significantly after 12 months (0.95 +/- 0.11, P < .01). The degree of fatty acyl chain unsaturation tended to decrease, although this was not statistically significant except for the decrease in molar percent of linoleate after 3 months. These findings suggest that long-term treatment with an inhibitor of HMG CoA reductase improves bile lithogenicity even at a comparatively low dose, and can decrease the incidence and complications of cholesterol gallstones.

Effects of fluvastatin on human biliary lipids.

The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have rapidly become widespread in the treatment of hypercholesterolemia and are known to be variable in efficacy. To investigate the effect on biliary lipids, a 3-month study using fluvastatin was devised. A total of 19 patients were enrolled in this study: all had hypercholesterolemia (7 men, 12 women; 13 with type IIa, 6 with type IIb). After an observation period of 4-6 weeks with placebo, fluvastatin at a daily dose of 30 mg was administered for 3 months. Fasting blood samples were taken early in the morning, before, and once a month during 3 months of fluvastatin treatment, for measurement of serum lipids. Cerulein-stimulated bile in the gallbladder was sampled using a duodenal tube, and the changes in biliary lipids were assessed. There was a marked decrease in serum total cholesterol after 12 weeks of treatment (21%; p < 0.001). However, there was no significant difference in the bile cholesterol saturation index (CSI): values before and after 3 months of drug administration were 0.93 and 0.99, respectively (Admirand-Small method). There were no significant changes in either the fatty acid composition of biliary lecithin or in the bile acid composition of bile. In conclusion, on the basis of these results, short-term (3 months) administration of fluvastatin does not appear to affect CSI.

Mediastinal lymph node metastasis from lung cancer: evaluation with Tl-201 SPECT--comparison with CT.

PURPOSE: To assess the usefulness of thallium-201 single photon emission computed tomography (SPECT) in detection of mediastinal lymph node metastasis from lung cancer. MATERIALS AND METHODS: Computed tomography (CT) and Tl-201 SPECT were performed in 113 patients with lung cancer. Surgical staging was performed in all patients, and the results of the two modalities were compared with the pathologic findings in 364 node stations. RESULTS: Cancerous nodes were found in 32.7% of the patients. The sensitivity of CT in detecting mediastinal node metastasis was 62%; specificity was 80%. These rates were higher for Tl-201 SPECT (76% and 92%, respectively). Furthermore, these rates were excellent in patients with enlarged mediastinal nodes at CT (87% and 93%, respectively). However, Tl-201 SPECT had more limited spatial resolution than did CT. CONCLUSION: Tl-201 SPECT is useful in evaluation of mediastinal node metastasis in lung cancer, especially for patients with enlarged nodes at CT.

Effects of pravastatin (CS-514) on biliary lipid metabolism in patients with hyperlipidemia.

Pravastatin was administered to 20 patients with hyperlipidemia type IIa and IIb, for a period of 8 to 16 weeks at a daily dose of 10 to 20 mg, to investigate the effects on serum and biliary lipids. At the end of the treatment with pravastatin, the serum cholesterol level was significantly reduced, by 20%, compared with the control level. On the other hand, no significant differences were observed in serum high-density lipoprotein (HDL) cholesterol and triglyceride levels. Additionally, the administration of pravastatin did not change mode % compositions of biliary lipids, such as cholesterol, phospholipids, and total bile acids, as well as individual biliary bile acids. Consequently, there was not any significant change of the cholesterol saturation index. Based on the above results, our findings suggest that, for the treatment of hyperlipidemia, pravastatin is a highly effective cholesterol-lowering drug that does not affect biliary lipid metabolism.

Polymyositis and toxoplasmosis.

Extensive severe polymyositis in a patient with toxoplasmosis was presented. Toxoplasmosis was serologically substantiated by a serial two tube rise in a toxoplasma-antibody titer by a hemagglutination test. When appeared to be toxoplasma gondii was detected in areas of myositis. Toxoplasma gondii was found in a single small area of hepatic necrosis, but no other organ or tissue was involved. Thus, the present case was peculiar in respect that skeletal muscles were the major target of toxoplasmosis. A causal relationship between toxoplasmosis and polymyositis was discussed and the literatures were reviewed. Serological investigation and histopathological search for toxoplasma gondii should be done in every case of polymyositis not only for the appropriate therapy but also for the further elucidation of the relationship between toxoplasmosis and polymyositis.

Localized hepatic necrosis related to cytomegalovirus and Toxoplasma gondii.

An unusual hepatic lesion due to both cytomegalovirus and Toxoplasma gondii was described in a patient with angio-immunoblastic lymphadenopathy treated by predonin. The lesion was a single well-defined area measuring 1.5 x 1.0 x 0.5 cm of confluent severe hepatic necrosis with multiple cytomegalic inclusion cells and numerous tokoplasmas. The remaining liver had no liver cell necrosis, inflammatory cell infiltration, or evidence of either cytomegalovirus infection or toxoplasmosis. These findings suggested us the possibility of symbiosis and synergism of cytomegalovirus and toxoplasma gondii in the liver. Additionally, this was the first demonstration of cytomegalovirus in liver cells by electron microscopy.

Suppressor T cell dysfunction and depressed immunoglobulin production by B cells in vitro in patients with SLE.

Peripheral blood lymphocytes or T and B cells from systemic lupus erythematosus (SLE) patients and normal individuals were stimulated with pokeweed mitogen and the intracytoplasmic immunoglobulin positive cells were observed. From the results of coculture of normal and SLE cells, it was postulated that SLE patients had not only a loss of suppressor T cell activity but abnormal B cell function. Further experiments showed that these abnormalities in SLE lymphocytes remained in spite of corticosteroid treatment or inactive disease.

Treatment of sick sinus syndrome with permanent cardiac pacemaker. (Sick sinus syndrome and artificial pacemaker).

Twenty nine patients with sick sinus syndrome were treated from November, 1972 through July, 1976. Six cases had sinus bradycardia, 14 cases had sinoatrial block/sinus arrest and 9 cases had bradycardia-tachycardia syndrome. Twenty five patients received the implantation pacemaker with good result. There was found that an adequate pacing of the heart was effective for the control of the attack of tachyarrhythmia in the case with bradycardia-tachycardia syndrome.

Effect of isometric handgrip exercise on left ventricular function in the patient with artificial cardiac pacemaker.

The cardiovascular effects of isometric handgrip exercise were determined with a nonivasive method in the patient with artificial pacemaker. The arterial blood pressure was measured with mercury manometer as well as cardiac output by the dye dilution method with Indocyanin green before and after handgrip exercise. Isometric handgrip exercise produced a significant increase in the left ventricular ejection time, the left ventricular ejection time/the preejection period, the ejection time index/the isometric contraction time, the arterial blood pressure and cardiac output and a significant decrease in the preejection time and the isometric contraction time. Cardiac output was increased more remarkably in the negative Master two step test group than in the positive Master two step test group. There was found a significant positive relationship between the increase in cardiac output and P wave rate upon handgrip exercise.