[Lung cancer associated with bulla found during an operation of pneumothorax; report of a case].

A 50-year-old man was admitted to our hospital because of dyspnea. His chest X-ray and computed tomography (CT) showed right pneumothorax and multiple bullae. His pneumothorax was drained with a chest tube, however, because of a persistent air leak, bullectomy was performed 18 days after the occurrence of pneumothorax. Intraoperatively, we found a palpable tumor in the bulla approximately 10 mm in diameter and resected it with the bullae. Histologically, the tumor was diagnosed as a large cell carcinoma.

[Successful removal of aberrant needles in the pericardium and lung].

A 28-year-old woman who had been diagnosed as schizophrenia was admitted to our hospital, complaining of chest pain. Her chest X-ray demonstrated 9 foreign bodies in the pericardium, lung and others. Her chest computed tomography (CT) confirmed needle-like shadows in the pericardium and lung. They were diagnosed as aberrant needles, and surgically removed. The intrapulmonary aberrant needle was removed with video-assisted thoracoscopic surgery. Aberrant needle in pericardium or lung should be removed surgically, because it is very dangerous. Intraoperative chest X-ray is always necessary before closing the wound to avoid leaving the residual fragments.

Anti-tumour effects of nobiletin, a citrus flavonoid, on gastric cancer include: antiproliferative effects, induction of apoptosis and cell cycle deregulation.

AIM: To demonstrate the antitumour effects of nobiletin (5,6,7,8,3',4'-hexamethoxyflavone), a citrus flavonoid extracted from Citrus depressa Hayata, on human gastric cancer cell lines TMK-1, MKN-45, MKN-74 and KATO-III. MATERIALS AND METHODS: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, the TdT-mediated dUTP biotin nick-end labelling (TUNEL) method and cell-cycle analysis revealed that nobiletin acted on these cells in several ways, namely by direct cytotoxicity, induction of apoptosis and modulation of cell cycle. The efficacy of combined treatment of nobiletin with a conventional anticancer drug, CDDP, was also examined. Treatment with nobiletin 24 h prior to CDDP administration showed a synergistic effect compared to the control. CONCLUSIONS: Although the effective dose and administration route of nobiletin require further investigation, our study represents a potential successful linking of this compound with the treatment of gastric cancer.

A mutation in plasma platelet-activating factor acetylhydrolase (Val279Phe) is a genetic risk factor for cerebral hemorrhage but not for hypertension.

Platelet-activating factor (PAF) acetylhydrolase is an enzyme that inactivates PAF. Deficiency of this enzyme is caused by a missense mutation in the gene. We previously found a higher prevalence of this mutation in patients with ischemic stroke. This fact suggests that the mutation might enhance the risk for stroke through its association with hypertension. We have addressed this hypothesis by analyzing the prevalence of the mutation in hypertension. We studied 138 patients with essential hypertension, 99 patients with brain hemorrhage, and 270 healthy controls. Genomic DNA was analyzed for the mutant allele by the polymerase-chain reaction. The prevalence of the mutation was 29.3% (27.4% heterozygotes and 1.9% homozygotes) in controls and 36.2% in hypertensives and the difference was not significant. The prevalence in patients with brain hemorrhage was significantly higher than the control: 32.6% heterozygotes and 6.1% homozygotes (p <0.05). PAF acetylhydrolase deficiency may be a genetic risk factor for vascular diseases.

A mutation in plasma platelet-activating factor acetylhydrolase (Val279-->Phe) is a genetic risk factor for stroke.

BACKGROUND AND PURPOSE: Platelet-activating factor (PAF) is a phospholipid with multiple actions that include thrombosis and inflammation. It is inactivated by a plasma enzyme, PAF acetylhydrolase. Deficiency of this enzyme in plasma is caused by a missense mutation in the gene (Val279-->Phe). We have studied a possible association of this mutation with the risk of stroke. SUBJECTS AND METHODS: We studied 120 consecutive patients with cerebral thrombosis. The control group consisted of 134 patients matched for age and sex with minor complaints but without stroke. Genomic DNA was analyzed for the mutant allele by a specific polymerase-chain reaction. Plasma PAF acetylhydrolase activity was determined by the method of Stafforini et al. RESULTS: The prevalence of the mutant gene was 43.4% in stroke patients (39.2% heterozygotes and 4.2% homozygotes), which was significantly higher than the 25.4% in control subjects (22.4% heterozygotes and 3.0% homozygotes) (chi 2 = 9.22, P < .01). The prevalence was slightly higher in stroke patients without hypertension than those with hypertension, but the difference was not significant. The patients with family histories of stroke had a slightly higher but not a significant prevalence of the mutant gene as compared with those without family histories of stroke. Plasma PAF acetylhydrolase activity was higher in patients than in control subjects, in normal subjects, or patients with a heterozygous genotype. CONCLUSIONS: These results suggest that plasma PAF acetylhydrolase deficiency may be a risk factor for stroke. This may explain the relatively high prevalence of stroke in Japan, as the mutation is more common among Japanese than Caucasians.

Rapidly growing histologically benign meningiomas: cell kinetic and deoxyribonucleic acid ploidy features: report of three cases.

We present three cases of histologically benign meningiomas with a rapid and known time course to the development of symptoms. Tumor doubling time calculated from sequential computed tomographic scans and computer-assisted image analysis of proliferating cell nuclear antigen reactivity suggested rapid growth. Feulgen staining indicated deoxyribonucleic acid aneuploidy. Tests for progesterone and estrogen receptor immunoreactivity were negative. These cases are noteworthy for their uncharacteristically rapid growth in the absence of histological evidence of atypia.

Effect of aminophylline injection on the pituitary-thyroid axis in asthmatics.

We investigated the effect of aminophylline on the pituitary-thyroid axis in 13 asthmatics (21-71 yr). Aminophylline (250 mg), dissolved in 100 ml of saline, was given intravenously for 30 min. Blood was collected, before and 30, 60 and 120 min after beginning the injection. Serum TSH was significantly increased from the 2.2 +/- 1.6 microU/ml baseline to 2.7 +/- 1.9 microU/ml at 60 min (p less than 0.01), and to 2.8 +/- 2.1 microU/ml at 120 min (p less than 0.05). Serum T4 also rose from the 8.8 +/- 1.2 micrograms/dl baseline to 9.6 +/- 1.5 micrograms/dl at 120 min (p less than 0.05). There were no changes in serum T3 and rT3 levels. Correlations between increase of theophylline and TSH levels, and between increases in TSH and T4 concentrations, were observed. Since aminophylline stimulates the secretions of catecholamine from the sympathetic nerve endings and the adrenal medulla, we assumed that TRH was released from the hypothalamus by a beta-2-receptor mechanism because TSH secretion had been stimulated. These findings suggested that aminophylline-induced T4 release from the thyroid is mediated by released TSH and by the direct stimulatory effects of raised endogenous catecholamine on the thyroid.

[Prediction of avascular necrosis in the femoral head following fracture dislocation--using the electrochemically generated hydrogen clearance method].

In order to predict necrosis of the femoral head following fracture-dislocation, the blood flow in the femoral heads in twenty-five hips was measured immediately after reduction and three, six, nine and twelve months thereafter. Twenty hips were followed up for more than one year (average 26.3 months) radiographically. Seven out of twenty hips had very low blood flow in the weight bearing areas three months after reduction. Five of seven had very low blood flow six and nine months after reduction and resulted in necrosis which was determined radiographically. The other two of seven recovered the blood flow and have not resulted in necrosis. Thirteen hips with normal blood flow three months after reduction also did not undergo necrosis. It is possible to predict the incidence of necrosis after fracture-dislocation by measuring the blood flow of the femoral head with the electrochemically generated hydrogen clearance method.

[Experimental study on the measurement of bone marrow blood flow using electrochemically generated hydrogen].

There are two problems in clinical application of the blood flow measurement by the electrochemically generated hydrogen method: one is to determine the diffusion transport value (DTV) in the absence of blood flow; the other is the variability of DTV among the individual electrodes. In order to solve these problems, I developed a technique to estimate DTV in vivo based on the DTV measured in in vitro experiments. Significant correlation between the DTV of human bone marrow without blood flow (y) and the DTV in 0.5% agar gel dissolved in physiological saline at 0 degrees C (x) was obtained: y = 0.980x + 0.494, r = 0.984, p less than 0.005. It is therefore possible to determine DTV in human bone marrow without blood flow from the DTV measured in vitro. The present technique to estimate DTV in bone marrow via DTV measured in vitro is useful clinically in monitoring blood flow of free vascularized bone graft and of femoral head after fracture-dislocation of the hip.

A new method for monitoring circulation of grafted bone by use of electrochemically generated hydrogen.

The patency of the anastomosed blood vessels in a free vascularized bone graft is difficult to ascertain during the early postoperative stage. For this purpose, the local blood flow was measured by means of electrochemically generated hydrogen. Although only three cases have been tested thus far, the method proves to be a simple and useful monitor of the blood flow in a free vascularized bone graft.

Ultrastructure of disseminated choroid plexus papilloma.

A disseminated choroid plexus papilloma (DCPP) with a malignant change in the cervico-spinal leptomeninges observed 4 years after the removal of choroid plexus papilloma (CPP), originating from the fourth ventricle, was studied under the electron microscope. Although the ultrastructure of intracranial CPP has been reported by several authors, there are just a few reports on DCPP. The present tumor was ultrastructurally very similar to normal choroid plexus, but the lack of the capillary fenestration and of invaginations of the epithelial basal plasmalemmas suggested that the epithelium was deprived of secretory function.

Determination of dose-plasma concentration relationship of phenobarbital in epileptic patients by a new specific radioimmunoassay.

A new phenobarbital hapten, 1-(4-carboxybutyl)-phenobarbital (CBP) was synthesized. Antiserum obtained from a rabbit immunized with CBP-bovine serum albumin conjugates is specific for phenobarbital and does not substantially cross-react with a major metabolite, p-hydroxyphenobarbital. The antiserum was used to develop a sensitive radioimmunoassay which could determine as little as 100 pg of phenobarbital. The radioimmunoassay was applied to the determination of plasma phenobarbital concentrations in epileptic patients and the results were compared with those obtained by a spectrophotometric technique (r = 0.950, P < 0.01). A significant dose-plasma concentration relationship for phenobarbital was observed in epileptic patients treated with phenobarbital for more than a month.

[Tentorial dural arteriovenous malformation--a case report (author's transl)].

UNLABELLED: A case of tentorial dural AVM was reported. A 52 years old man came to the Jichi Medical School hospital on July 29, 1974, with the chief complaints of intermittent left exophthalmos, diplopia and left blepharoptosis, which had been noted since March of 1974. He had episodes of severe headache attack since 3 years prior to the hospital visit. Angiography done at the out-patient department demonstrated the dural AVM with the nidus in the left tentorium. The nidus was fed by the left posterior middle meningeal artery, the dural branch of the left occipital artery, the left posterior cerebral artery, the left superior cerebellar artery and the dural branches of vertebral artery. It was drained to the vein of Labbé and the two cortical veins of the occipital lobe. He was appointing admission under the diagnosis of dural AVM, but he had an apopleptic attack three days before the appointed date, so was admitted in emergency. Neurological examination on admission: The patient was in drowsy state, papilledema on the both sides and right hemiparesis including the face were noted. The bruit was not audible. Left CAG revealed intracerebral hematoma in the left tempotal lobe, so that the removal of the intracerebral hematoma and the middle meningeal artery ligation were carried out after his general condition improved, on October 18, 1974. On October 30, 1974, the second operation was performed in an attempt of the radical excision of the AVM nidud. But, unfortunately, the patient fell into the shock state so that the operation had to be stopped at the stage of the ligation of the feeders running in the dura of the posterior fossa. The third operation was done on February 19, 1975. The AVM nidus was removed with the left transverse sinus and a part of tentorium. He was discharged on March 3, 1975, with only the right homonymous hemianopsia. Nine months after his discharge, there was no sign of recurrence of AVM. PATHOLOGICAL FINDINGS: The left transverse sinus was almost occupied with AVM tissue. The endothelium of arteries were hypertrophied and the internal elastic bnadles were partly defected. Veins showed also hspertrophy of the endothelium and the thrombus formation. The dural AVM of the posterior fossa is not a rare malady, especially in the recent years, probably due to the technical advances in the roentgenology, such as magnification techniques as well as selective arterial catheterization. The most common signs and symptoms of this disease picked up from the reports of 112 cases in the literature are: bruit 47%, headache 44%, papilledema 26% and SAH 24%. The extra cranial ligation of feeders were reportedly carried out on 39 cases, but only 9 cases (23%) were effective. Therefore, the radical excision of the nidus would be the most desirable method for the complete treatment of the dural AVM.