Plasma urokinase-type plasminogen activator in patients with leukemias

Plasma levels of urokinase-type plasminogen activator (u-PA) were measured with an enzyme-linked immunosorbent assay in patients with leukemias. As compared with healthy subjects (0.73 +/- SD 0.17 ng/ml), plasma u-PA antigen level was markedly elevated in patients with acute promyelocytic leukemia (APL) (1.76 +/- 0.89 ng/ml) at disease onset. Mean u-PA concentrations in patients with other acute nonlymphoblastic leukemia (0.57 +/- 0.51 ng/ml), acute lymphoblastic leukemia (0.77 +/- 0.82 ng/ml) and chronic myelocytic leukemia in blastic crisis (1.30 +/- 1.35 ng/ml) were not significantly elevated, but some of them showed an elevation of plasma u-PA. Plasma u-PA values were correlated with some of the fibrinolytic parameters such as FDP and D-dimer. Plasma u-PA antigen was decreased after the administration of antileukemic drugs in patients with APL. These results suggest that the coagulopathy in patients with various leukemias may in part be associated with u-PA release from the leukemic cells, especially in patients with APL.

Dural arteriovenous malformations in the anterior cranial fossa

Two cases of dural arteriovenous malformation (DAVM) fed by the anterior ethmoidal artery in the anterior cranial fossa are reported, one of them examined by magnet resonance imaging (MRI). Only one other case with MRI findings so far has been published. Fourty-eight previously reported cases are reviewed. One of our patients presented with subdural haematoma (SDH) without subarachnoid or intracerebral haemorrhage. The other patient had a nasal bleed without any neurological manifestations. In comparison with previously reported cases, the clinical manifestation of our cases is infrequent (1 patient with nasal bleed, and 2 patients with pure SDH that is 2 and 4%, respectively, in the literature). Feeder was the anterior ethmoidal artery either unilateral or bilateral. Drainage of DAVMs was through a markedly dilated vascular sac into the superior sagittal sinus (SSS). The high incidence of haemorrhage from DAVM in the anterior fossa is related to this vascular sac. Magnetic resonance imaging (MRI) showed a flow void area in the left frontal region on T 1-weighted images in one case. These cases were treated by surgical excision of the malformation with good results. Aetiology, clinical presentation, and treatment of these rare DAVMs in the anterior cranial fossa is discussed.

[Clinical study of cyclic intra-arterial chemotherapy using mitoxantrone for advanced hepatocellular carcinoma]

Cyclic intra-arterial infusion chemotherapy using Mitoxantrone via reservoir system was prescribed for 8 patients with advanced hepatocellular carcinoma. According to the clinical staging system, two patients were in Stage III and the other six patients in Stage IV-A. Vp-3 portal invasion was observed in six out of the eight patients. Mitoxantrone (5-8 mg/body) was administered intra-arterially via port-a-cath device every 4 weeks. For tumor response, there were two PR cases, four NC cases, and two PD cases. Thus, the response rate was 25%. The mean survival period was 6.5 months, and 1-year survival rate was 13%. In one of two PR cases, the survival time has been more than two years so far. Gastrointestinal toxicities such as nausea and vomiting were not severe. Critical myelosuppression requiring medication was not observed. Although a temporary increase of serum bilirubin was found in two cases, no severe damage to hepatic function was observed. From our preliminary data, this arterial infusion chemotherapy using Mitoxantrone via reservoir system can be safely performed on non-hospitalized patients with advanced hepatocellular carcinoma, and may be a useful treatment modality.

Tissue factor in plasma of patients with disseminated intravascular coagulation

Recently it has been shown that tissue factor (TF), an important trigger for initiating blood coagulation, is present in the circulating plasma. In order to assess the clinical implications of TF in plasma, plasma concentration of TF was quantitated in 65 patients with disseminated intravascular coagulation (DIC). The mean concentration of plasma TF was elevated in patients with DIC at presentation as compared with healthy subjects (446 +/- SD 536 pg/ml vs. 138 +/- 51 pg/ml, P < 0.001). Abnormally high levels were found only in 46.2% of the patients, predominantly in patients with non-hematological solid tumors and acute leukemia. Plasma TF did not correlate with hemostatic markers of DIC such as thrombin-antithrombin III complex, prothrombin fragment 1 + 2, plasma-alpha 2-plasmin inhibitor complex, FDP, D-dimer, or fibrinogen. Serial determinations of plasma TF demonstrated that plasma TF changes roughly in parallel with the course of DIC in most patients with elevated TF at presentation of DIC. These findings suggest that plasma TF is potentially valuable for monitoring the progress of DIC in a limited population of patients.

Immaturity of the myenteric plexus is the aetiology of meconium ileus without mucoviscidosis: a histopathologic study

The most common aetiology of meconium ileus is a deficiency in trypsin activity caused by cystic fibrosis. The pathogenesis of meconium ileus without mucoviscidosis is less well understood, although a number of causative factors have been suggested. The symptoms and clinical course of nine patients with meconium ileus without mucoviscidosis were reviewed, and the myenteric plexus of a surgical specimen of intestine was examined histologically and cytometrically. The nuclei of the intramural ganglion cells were much smaller than were seen in normal newborn infants. The nuclear areas resembled those seen in fetuses of 5-6 months gestational age, but the number of ganglion cells approached normal. This immaturity of the ganglia was observed both in the contracted distal ileum and dilated proximal ileum. Patients with an ileostomy passed solid faeces for about 1 to 2 months postoperatively, after which time the faeces became watery. The intramural ganglia were mature at the time of ileostomy closure. We conclude that immaturity of the myenteric plexus in the ileum and colon seems to be the main aetiologic factor in meconium ileus without mucoviscidosis.

Extensive dissection at the porta hepatis for biliary atresia

Dissection at the porta hepatis is the crucial step in surgery for biliary atresia. The authors describe their procedure for extensively dissecting the porta hepatis. The technique is based on an anatomic cast corrosion of the human liver, and the portal vein serves as the landmark for dissection. Lateral dissection at the hepatic hilus is critical to the procedure. On the right side, the anterior portal branches are dissected to the bifurcation of the S5 and S7 segmental portal branches, over the bifurcation of the anterior and posterior portal branches. On the left side, the liver parenchyma, which bridges the umbilical point, is sectioned, and the left portal branch is dissected to the umbilical point over the pars transversalis and taped. The fibrous mass that lies within the confines of the portal branches, including the dorsal aspect, is transected completely. This procedure was performed in 16 infants; the jaundice cleared in 93.7%.

Fatal thromboembolism in acute promyelocytic leukemia during all-trans retinoic acid therapy combined with antifibrinolytic therapy for prophylaxis of hemorrhage

In contrast to patients with disseminated intravascular coagulation (DIC) due to other causes, patients with acute promyelocytic leukemia (APL) receiving standard cytotoxic chemotherapy can be treated safely with antifibrinolytic drugs for prophylaxis of hemorrhage, without the occurrence of thromboembolic complications. However, such drugs should be used cautiously in APL patients who are receiving all-trans retinoic acid (ATRA) differentiation therapy. We report here a patient with APL who had fatal thromboembolism after receiving ATRA and tranexamic acid therapy.

Bilateral periorbital eccrine hidrocystoma

We saw four patients showing identical features as cystic lesions on the bilateral external canthi. Histological examination showed cystic cavities in the dermis. Histological and enzyme histochemical findings suggest that these cystic tumors are of eccrine origin. Thus we diagnosed these cystic tumors as eccrine hidrocystoma with characteristic clinical feature. The recognition of this feature would help to correctly diagnose these eccrine hidrocystoma.

Cough variant asthma: a case study with antigen, histamine and methacholine inhalation challenge tests

This paper presents a 7 year old girl with cough variant asthma, in which house dust challenge test provoked fine crackles on auscultation without any changes of lung function test. Pretreatment with DL-chlorpheniramine maleate for 7 days inhibited the appearance of fine crackles. On histamine inhalation test, fine crackles and rhonchi appeared on auscultation without bronchoconstriction (% fall of one-second forced expiratory volume < 10%). These data suggest that the cause of cough variant asthma is mainly an immunoglobulin E-mediated allergic reaction in the mucus secreting system.

[Medical examination of workers exposed to lead in the Philippines]

The medical examination of workers exposed to lead was conducted as part of the activity of the Occupational Safety and Health Center (OSHC) Project in the Philippines (JICA Project). The subjects of the medical examination were 21 male and 193 female workers of a semi-conductor plant (abbreviated A company), 59 male and 6 female workers of a refrigerator manufacture (B company); 199 male workers of a storage battery manufacturer (C company); and 107 male and 6 female workers of a lead smelter (D company). Among the examination items were questions regarding occupational history, subjective complaints and objective signs, determination of blood lead levels, urine delta aminolevulinic acid levels, and examination for anemia. The survey was conducted from June to September in 1990. The following results were obtained: 1) The mean age of the workers ranged from 21.8 to 33.8 years. Those of companies A and B were younger than those of companies C and D. The mean employment duration of males at C company was 10.7 yr, and the longest among the four companies. That in both sexes for A company was 1.8 yr and the shortest among the above mentioned companies. 2) The blood lead geometric mean levels of companies C and D showed the highest concentration. The level in males of C company was 64.5 micrograms/dl and that of D company was 80.8 micrograms/dl. The level in females of A company was 9.9 micrograms/dl and the lowest in concentration. The urine delta aminolevulinic acid geometric mean levels were less than 6.0 mg/l in the four companies. There was no company having hemoglobin mean values less than 14.0 g/dl in males or less than 12.0 g/dl in females. 3) The proportion of blood lead levels of 60 micrograms/dl or more was 67.3% in males of C company, and 89.7% in males and 16.7% in females of D company. The proportion of urine delta aminolevulinic acid levels of 6 mg/l or more was 1.0% in females of A company, 20.1% in males of C company, and 43.0% in males of D company. The proportion of hemoglobin values less than 14.0 g/dl in males or less than 12.0 g/dl in females was 4.7% in females of A company, 1.7% in males of B company, 3.5% in males of C company, and 12.1% in males of D company.(ABSTRACT TRUNCATED AT 400 WORDS)

Purification of two types of TNF inhibitors in the urine of the patient with chronic glomerulonephritis

In order to clarify whether TNF inhibitory activity in the urine of glomerulonephritis (GN) patients depends on the existence of TNF inhibitors/soluble TNF receptors, we purified two types of TNF inhibitors from the urine of chronic renal failure (CRF) with GN patient. Using four steps of chromatography (anion exchange chromatography, preparative reverse phase chromatography, TNF affinity chromatography, analytical reverse phase chromatography), two types of 99% pure TNF inhibitors were purified. Amino terminal amino acid sequence revealed that one inhibitor was identical to soluble TNF receptor, p55, however, the other was homologous but not identical to soluble TNF receptor, p75. Our experiments demonstrated that TNF inhibitory activity in the urine of CRF patients depended partly on the existence of soluble TNF receptors in the urine.

Reversed-phase high-performance liquid chromatography for analysis of urinary proteins: diagnostic significance of alpha 1-acid glycoprotein

In order to analyze urinary proteins from patients with various renal diseases, a reversed-phase high-performance liquid chromatography with IPG PACK ODS column packed with polyporous glass was employed. The peak areas of alpha 1-acid glycoprotein (alpha 1-AGP), beta 2-microglobulin (beta 2-MG) and albumin were measured by a chromato-integrator. The alpha 1-AGP/albumin ratio was regarded as the marker of glomerular damage, while the beta 2-MG/albumin ratio indicated tubular dysfunction. As a result, the alpha 1-AGP/albumin ratio in the urine from patients with either various glomerulonephritis (GN) or idiopathic nephrotic syndrome was significantly higher than that from either patients with postural proteinuria or healthy children. However, the beta 2-MG/albumin ratio in the urine from patients with GN was the same level as controls. The beta 2-MG/albumin ratio was elevated only in urine from patients with tubular dysfunctions. These data suggest that the urinary alpha 1-AGP/albumin ratio could be a beneficial indicator in locating patients with GN from among children with asymptomatic proteinuria.

[Anatomical study on the right bronchial artery for operation of esophageal cancer through right thoracotomy with special reference to the intercostobronchial arteries]

In view of the operative field of esophageal cancer, anatomical findings of the right bronchial arteries were studied in specimens of 71 cadavers. Intercostobronchial arteries were absent only in 3 cadavers (4.2%; group A). As 22.6% of the cadavers had only one intercostobronchial artery supplied as the right bronchial artery (group B), it was considered to be important to preserve this artery. Cadavers both with the intercostobronchial artery and with the other right bronchial-arteries were observed in 70.4% (group C). Right bronchial arteries deriving from the aorta to course similarly to intercostobronchial arteries were present in small number (group D). Further, right bronchial arteries were classified into three types according to the deriving arteries as follows: (I) intercostobronchial arteries, (II) bronchial arteries deriving from the aorta, (III) other right bronchial arteries deriving from right subclavian artery, right inferior thyroid artery or right interthoracic artery. Considering difficulty of the approach from the operative field with right thoracotomy and the anatomical relationship with neighboring organs, it was thought that preserving the type (I) arteries is easy, the type (III) has a possibility to be preserved, and (II) is hard to be preserved. We concluded that preserving intercostobronchial arteries is important in esophageal cancer surgery approached through right thoracotomy because of small number of cadavers without these arteries and ease of preservation.

Successful Kasai operation for biliary atresia in a 9 month old

A rare case of a successful Kasai operation for biliary atresia in a 9 month old is described. For infants over 6 months of age, there had been no reports of long-term survival after this procedure.

Aneurysm arising from the petrous portion of the internal carotid artery: case report

A 21-year-old man with hearing loss and recurrent otorrhagia was shown angiographically to have an aneurysm arising from the intrapetrous internal carotid artery (ICA). Endovascular balloon occlusion of the aneurysm with preservation of the parent ICA was attempted twice, but each time the balloon deflated and the aneurysm reappeared two weeks and three months, respectively, following the endovascular procedures. The patient was then successfully treated with a surgical trapping procedure combined with superficial temporal artery-middle cerebral artery bypass.

[Determination of synephrine in Oriental pharmaceutical decoctions containing aurantii nobilis pericarpium by ion-pair high-performance liquid chromatography. II]

A simple method using ion-pair high-performance liquid chromatography was established for the rapid and precise determination of synephrine in thirty three species of oriental pharmaceutical decoctions containing Aurantii Nobilis Pericarpium. An ODS column and a mixed solvent system of water, acetonitrile, sodium dodecyl sulfate and phosphoric acid as a mobile phase were used for the separation. Synephrine was eluted without interference of other coexisting components within 15 min.

Possible role of metallothionein on the gastrointestinal absorption and distribution of cadmium

Although the role of metallothionein (MT) has been suggested by many researchers, the exact biological or physiological roles of MT are still unclear. Up to the present, the role of this ubiquitous low molecular weight protein has variously been reported as 1) the regulation of the normal absorption and homeostasis of essential metals such as zinc (Zn), copper (Cu), 2) the chelation and detoxification of toxic metals such as cadmium (Cd) or mercury (Hg). The mechanisms of Cd uptake from gastrointestinal lumen and its consecutive transport from the intestinal mucosa into blood circulation and tissue are not well known. The chemical form of Cd is an important factor on its gastrointestinal absorption. It has been reported that Cd in foods such as meat, seafoods, and vegetable is existing mainly as Cd-MT or MT-like Cd binding proteins. Also it is well known that MT is induced in the intestinal tissue by oral Cd administration. Until today, the mechanism of gastrointestinal absorption has been mainly discussed about Cd ion. However, it needs the consideration including the chemical form of Cd such as Cd-MT in foods or Cd bound by MT induced in the intestinal tissue. Namely, it is important to assess the possible role of MT on gastrointestinal absorption and its consecutive tissue distribution of Cd.

Fatal pulmonary haemorrhage and crescentic glomerulonephritis without autoantibodies: a paediatric case report

The case of an 8-year-old girl who had a fatal pulmonary haemorrhage and crescentic glomerulonephritis without autoantibodies is presented. Circulating anti-glomerular basement membrane antibodies, circulating immune complexes and anti-neutrophil cytoplasmic autoantibodies were not detected. To our knowledge this is the youngest reported case of the disease.

Circulating thrombomodulin as a novel endothelial cell marker: comparison of its behavior with von Willebrand factor and tissue-type plasminogen activator

Circulating thrombomodulin is a novel endothelial cell marker, which may reflect the endothelial injury. Plasma levels of thrombomodulin were quantitated by an enzyme-linked immunosorbent assay (ELISA) in patients with hematological malignancies, liver disease, diabetes mellitus, collagen disease, thrombotic disease, and disseminated intravascular coagulation (DIC), and the thrombomodulin values were compared with those of von Willebrand factor antigen (vWf:Ag) and tissue-type plasminogen activator (t-PA) which are released from stimulated or damaged endothelial cells. The mean plasma concentrations of thrombomodulin in these disease states were elevated as compared with healthy subjects. A relatively high mean thrombomodulin level was observed in DIC, liver disease, and collagen disease. Abnormally high thrombomodulin values (greater than normal mean value + 3 SD) were found in 32.3% of patients with hematological malignancies, 57.7% of patients with liver disease, 39.3% of patients with diabetes mellitus, 30.0% of patients with collagen disease, 23.1% of patients with thrombotic disease, and 69.0% of patients with DIC. Plasma concentrations of both vWf:Ag and t-PA were also elevated in these patients. On the whole, the plasma thrombomodulin concentration was positively correlated with vWf:Ag (r = 0.441, P less than 0.001) and t-PA (r = 0.398, P less than 0.001). These findings indicate that the elevation of plasma thrombomodulin is frequently seen in a variety of diseases and circulating thrombomodulin is possibly useful for evaluating the endothelial damage in selected disease states.

Accumulation of vanadium during embryogenesis in the vanadium-rich ascidian, Ascidia gemmata

It is a remarkable and previously unrecognized fact that ascidians, which are known to contain high levels of vanadium in their blood cells, begin to accumulate vanadium during embryogenesis. This study revealed that the accumulation starts quite dramatically 2 wk after fertilization, and 2 mo later, the amount of vanadium in larvae is 600,000 times higher than that in the unfertilized egg. These results were obtained by neutron activation analysis, a highly sensitive method for determining levels of vanadium, in the Ascidia gemmata, the ascidian that contains the highest known levels of vanadium and accumulates vanadium at 150 mM in its blood cells, a concentration that corresponds to 4,000,000 times the concentration in seawater.