[A MULTICENTER CLINICAL SURVEY ABOUT THE PREVALENCE OF JAPANESE CYPRESS POLLINOSIS AND THE EFFICACY OF SUBLINGUAL IMMUNOTHERAPY WITH JAPANESE CEDAR POLLEN EXTRACT DURING JAPANESE CYPRESS POLLEN DISPERSAL PERIOD]

BACKGROUND

Little is known whether sublingual immunotherapy using Japanese cedar pollen extract (cedar SLIT) is effective for not only Japanese cedar pollinosis but also Japanese cypress pollinosis. We investigated the prevalence rate of Japanese cypress pollinosis, efficacy of cedar SLIT on cypress pollinosis and patients' wish to receive cypress SLIT.

METHODS

We investigated a multi-center (31 institutions), cross-sectional survey using a self-administrated questionnaire with four questions for patients received cedar SLIT aged from 5 to 69 years old.

RESULTS

2523 subjects were enrolled for analysis. 83.4% of them had pollinosis symptoms during cypress season before cedar SLIT. In such patients, 37.4% experienced lessened efficacy of cedar SLIT during cypress season. Both the prevalence of cypress pollinosis and the lessened efficacy of cedar SLIT on cypress pollinosis were significantly seen in western Japan as compared to eastern Japan. 76.1% of the subject having cypress pollinosis before SLIT wished to receive cypress SLIT if it is available.

CONCLUSION

A lessened efficacy of cedar SLIT during cypress season was broadly seen in Japan, and further showed a regional difference. Together with the finding of high wish by patients, these results suggest a development of cypress SLIT is desirable.

Development of high-order harmonic focusing system based on ellipsoidal mirror

We have developed a focusing system for extreme ultraviolet light produced by high-order harmonic generation. An ellipsoidal mirror with a precise surface shape was fabricated and installed into the focusing system. A rigid mirror manipulator and a beam profiler were employed to perform precise and stable mirror alignment. As a demonstration of the focusing performance, high-order harmonics in the wavelength range of 13.5-19.5 nm were successfully focused into a 2.4 × 2.3 μm(2) spot.

Measurement of z-direction component of electron spins field-emitted from a single-crystal magnetite whisker

A 90° sector type spin rotator was developed for measurement of the z-direction component of a spin polarization, which is parallel to the emitter axis. The rotator enables us to measure all components of electron spins field-emitted from a single crystalline magnetite. In-plane component of spin polarization dominated of field-emitted electrons from single crystalline magnetite whisker, thus it is suggested that the magnetization of the magnetite whisker results from the anisotropy of crystalline structure rather than its shape.

Percutaneous radiofrequency ablation therapy as a first choice for renal tumor in patients with von Hippel-Lindau disease

375

Background: Forty percent of patients with von Hippel-Lindau (VHL) disease have multifocal, bilateral renal cell carcinoma (RCC). The advent of ablative therapy has allowed many of these tumors to be approached percutaneously. Probe-based radiofrequency ablation (RFA) have recently been shown to be feasible nephron-sparing therapies for RCC, and have been proposed as first-line treatments for patients with VHL. We evaluated the feasibility, safety and therapeutic effects of RFA for VHL patients.

Methods: We reviewed the outcomes of VHL patients with RCC treated by RFA from 2003 to 2010. Follow-up consisted of serum creatinine measurement, physical examination and serial contrast enhanced computerized tomography or magnetic resonance imaging.

Results: The 42 tumors of 15 patients (23-70 years old, median 40) received a total of 43 RFA treatments to a 7 to 28 mm renal tumor (median 16). Seven of the patients had bilateral renal tumors. Tumor enhancement was eliminated and the renal function was preserved after the treatment in all tumors. There were no major complications related to the procedures though eight of small subcapsular hematomas, one of hematuria, one of small urine overflow, and one of nausea were seen after RFA. There was no recurrence after RFA during a mean follow-up period of 28.9 months (range 4.0-89.0, median 20.0 months). The overall recurrence-free survival rate was 100%. There was also a 100% metastasis-free and disease specific survival rate in the cohort.

Conclusions: The result of the present study showed percutaneous RFA was a feasible, safe, and promising therapy for the treatment of VHL patients with RCC.

No significant financial relationships to disclose.

Blue and Green Electroluminescence from Porous Materials

In applying porous Si (PS) to color display technology, it is important to fabricate light emitting devices with three primary colors. However, there have been few reports on blue and green electroluminescence (EL), and its mechanism (even the relationship between PL and EL spectra) is unclear. To obtain blue and green EL and to investigate its mechanism, we have formed PS anodized under UV illumination (UV-PS) with green photoluminescence (PL) and porous SiC with blue PL. Consequently, green and blue light emitting devices were successfully fabricated by using these materials. The observed spectra are from 350 to 750 nm with a peak of, 520 nm for ITO / UV-PS junctions and from 300 to 600 nm with a peak of 470 nm for ITO / porous SiC junctions. The EL mechanism is also discussed by reference to experimental results of comparing PL and EL spectra and of investigating the dependence of EL intensity on current.

Visible Electroluminescence from Pn Junction Type μc-Sic/ Porous Si / c-Si Structures

We have fabricated two kinds of n-type microcrystalline silicon carbon (μc-SiC) / porous silicon (PS) / p-type crystalline silicon (c-Si) pn junctions and demonstrated a visible light emission from them. We have observed three types of visible light emission; an uniform red light emission at a forward current above 12mA/cm2 for the pn junction using a 0.2–0.4 Qcm c-Si substrate, and a very weak white light emission at a forward current of about 90 mA/mm2 and a strong orange-red light emission at a forward current from 200 to 619 mA/mm2for the pn junction using a 3.5–4.5 Ωcm c-Si substrate.

Picosecond Decay Dynamics in Porous Silicon

Picosecond decay dynamics of luminescent porous silicon has been studied using the second harmonics (SH) of a cw modelocked YLF laser and a synchroscan streak camera. Picosecond luminescence decay shows nonexponential behavior that becomes large with decreasing emission energy. When increasing hydrogen termination on the surface of a Si microcrystal occurs, this picosecond luminescence decay becomes faster. Our experimental results indicate that there are two luminescent states in porous Si : a weak luminescent quantum confinement state and a strong luminescent surface localized state.

Visible Photoluminescence From Porous Silicon Carbide

We have fabricated porous silicon carbide using single crystal 6H–SiC that has a wider indirect bandgap than silicon crystal prepared by electrochemical anodization. We have observed intense blue–green luminescence with the peak wavelength of around 500 nm at room temperature. The luminescence intensity is about five hundred times stronger than that of free electron to acceptor recombination in 6H–SiC crystal. This porous SiC offers an intense blue–green luminescent material. The results of structural analysis (secondary electron microscope analysis) and optical measurements (photoluminescence spectrum, Raman spectrum, and picosecond luminescence decay) suggest that the origin of the intense blue–green luminescence is the same as that of the intense red luminescence of porous silicon.

Visible Photoluminescence From Rapid-Thermal-Oxidized Porous Silicon

We have studied the origin of the visible photoluminescence (PL) from oxidized porous Si. The hydrogen–passivated surface of porous Si prepared by electrochemical etching is converted to stable silicon oxides by rapid–thermal–oxidization processes. At low oxidation temperature (Tox), the PL spectrum with a peak near 700 nm is observed. At high Tox above 800 °C, a strong blue PL is observed near 400 nm. We discuss the origin of blue and red PL by employing the results of ab initio electronic structure calculations of silicon–oxygen compounds.

A High Speed Contact-Type Image Sensor using Amorphous Silicon Alloy Pin Diodes

A new A4-size contact-type image sensor with 8 elements per millimeter (1,728 elements) was developed by using amorphous silicon alloy pin photodiodes as the light receiving elements. The matrix switching method is employed for signal reading. This method can read the signals from all of the 1,728 photodiodes using a 54 (54-channel input) x 32 (32.channel output) matrix switching scheme. It is advantageous in that the required input and output external circuits can be simplified. To prevent signal crosstalk between the diodes in the matrix, amorphous silicon alloy pin diodes, which are made in the same process as the photodiodes for maintaining a low cost, are connected in series to each photodiode in reverse polarity as blocking diodes.

To achieve superior signal-to-noise ratio and response at the same time, amorphous silicon alloy pin diodes are optimized to satisfy both a high photo-to-dark ratio and a high rectification ratio. The image sensor can operate at up to 2 MHz signal reading clock, maintaining a signal-to-noise ratio of over 24 dB under 0. 1–1x sec exposure.

One-dimensional Wolter optics with a sub-50 nm spatial resolution

We studied an imaging system consisting of an elliptical mirror and a hyperbolic mirror [i.e., one-dimensional (1D) Wolter optics] to realize an achromatic full-field hard x-ray microscopy with a resolution better than 50 nm. We report the performance of this 1D Wolter optical system when the mirrors were ultraprecisely figured by elastic emission machining. Experiments to form a demagnified image (demagnification factor of 385) of a 10 μm slit were conducted at an x-ray energy of 11.5 keV at BL29XUL of SPring-8. The system could form a demagnified image with a resolution better than 50 nm over a 12.1 μm field.

Formation of nanocrystalline copolymer thin film PVDF-TrFE and its ferroelectric electron emission property

Ferroelectric copolymer thin film PVDF-TrFE was deposited by spin coating method, and then annealed for the improved crystallization. The XRD and AFM measurements showed that as-formed PVDF-TrFE thin film was composed of the nanocrystallines with 50-80 nm in size and some amorphous phases. Meanwhile, as-formed PVDF-TrFE thin films also show a good polarization inversion property with a switch current of approximately 2.0 microA at a coercive field 40 MV/m. Electron emission testing results showed that under a continuous excitation of applied voltage pulses, PVDF-TrFE thin films exhibited an expected electron emission ability with emission current range of 0.08-0.52 microA, and the related electron emission mechanism was discussed.

Physiochemical properties of generic formulations of tacrolimus in Mexico

Tacrolimus is an important immunosuppressive agent used to prevent allograft rejection after transplantation. Tacrolimus has a narrow therapeutic index; therefore, it is essential that the physicochemical properties of generic formulations be identical to the brand-name formulation, Prograf. In this study, the physicochemical properties of generic tacrolimus formulations were compared with Prograf. The drug dissolution profiles of generic formulations of tacrolimus were different from that of Prograf. Tacrobell and T-Inmun exhibited faster dissolution than Prograf, and Tenacrine, Framebin, and Talgraf showed slower and incomplete drug dissolution, releasing 24% to 51% of tacrolimus within 2 hours. Generic formulations of tacrolimus demonstrated decreased solubility compared with Prograf. The solubility of Prograf was 35.7 microg/mL at 2 hours and 29.5 microg/mL at 24 hours. The solubility of Tenacrine, Framebin, and Talgraf at 2 hours was 5.5, 12.6, and 7.8 microg/mL, respectively, and the solubility decreased to 0.5, 2.3, and 2.1 microg/mL, respectively, at 24 hours. Whereas Prograf demonstrated content uniformity, the content of the generic tacrolimus formulations varied widely. The standard deviation of content for Tenacrine, Tacrobell, and T-Inmun were high at 29.3, 6.9, and 5.6, respectively. Furthermore, the mean percentage of labeled amount of T-Inmun was 84.2% with a relative standard deviation of 6.7% (minimum value; 72.7%; maximum value; 100.7%). These results indicate that generic formulations of tacrolimus tested in this study are not bioequivalent to Prograf, which suggests that their use may be of potential risk to transplant patients.

Transcatheter Embolization of Pulmonary Artery False Aneurysm Associated with Primary Pulmonary Hypertension

A 29-year-old woman with primary pulmonary hypertension presented with recurrent hemoptysis. Contrast-enhanced CT of the chest demonstrated the enhanced mass surrounded by consolidation related to parenchymal hemorrhage. Pulmonary angiography suggested that the mass was a pulmonary artery false aneurysm. After a microcatheter was superselectively inserted into the parent artery of the false aneurysm, the false aneurysm was successfully treated by transcatheter embolization with coils. Her hemoptysis has never recurred.

Recanalization 24 months after endovascular repair of a large internal iliac artery aneurysm with use of stent-graft

An 83-year-old man with a large internal iliac artery aneurysm (IIAA) was treated with the use of stent-graft, suggesting successful results at 3, 6, and 12 months after treatment. However, 24-month follow-up computed tomography showed minor peripheral opacification of the IIAA. The patient underwent surgical endoaneurysmorrhaphy. No previous report of long-term recanalization of a satisfactorily thrombosed iliac artery aneurysm at 2 years or more after stent-grafting has been previously reported. Further follow-up studies need to be performed on the present procedure before anyone can confidently recommend it in regard to its long-term safety.

Altered hepatic hemodynamics caused by temporary occlusion of the right hepatic vein: evaluation with Doppler US in 14 patients

PURPOSE

To evaluate with Doppler ultrasonography (US) the altered hepatic hemodynamics caused by temporary occlusion of the right hepatic vein.

MATERIALS AND METHODS

The study group consisted of 14 patients being considered for hepatic arterial infusion or transarterial embolization. In all patients, maximum peak velocity of the blood flow in the right portal vein was measured with Doppler US before and during the occlusion of the right hepatic vein. In 13 patients, color Doppler US was performed to evaluate Doppler signal in the portal venous branch in the occluded area before and during occlusion. Average peak velocity in the right hepatic artery in eight patients was measured by using a transducer-tipped guide wire before and during occlusion.

RESULTS

Maximum peak velocity of the right portal vein significantly decreased with occlusion (P <.01). Hepatic venous occlusion changed the Doppler signal in the portal venous branch in the occluded area from hepatopetal to no signal in 10 patients; to weakened hepatopetal in two; and to hepatofugal in one. Average peak velocity of the right hepatic artery showed a decrease or plateau for 15-30 seconds after the start of occlusion and then a rapid increase to reach a plateau at around 75-90 seconds, with 1.5-2 times as much velocity as that before occlusion.

CONCLUSION

Increase in hepatic arterial velocity is accompanied by a decrease in the portal velocity with temporary occlusion of the right hepatic vein; the expected increased drainage through the portal vein was almost undetectable.

Evaluation of hepatic functional reserve in rats with obstructive jaundice by asyaloglycoprotein receptor

BACKGROUND/AIMS

Until now, there has been no adequate means of evaluating the liver functional reserve in cases with obstructive jaundice. 99mTC-GSA (99mTechnetium-DTPA-Galactosyl-human serum albumin) is a new liver-imaging agent which binds specifically to the asyaloglycoprotein-receptor on the membrane of hepatocytes. So, the liver imaging by GSA excludes the influence of the reticuloendothelial system. Therefore, the uptake of 99mTC-GSA is considered to be a useful method for the estimation of liver functional reserve in cases with obstructive jaundice.

METHODOLOGY

In this study, we examined the uptake rate and specific binding capacities of 99mTC-GSA to receptors on the membrane of hepatocytes following 1, and 2 weeks of bile-duct ligation and 1 week after reduction of jaundice using the rat model.

RESULTS

The hepatic uptake rate decreased as the period of jaundice was prolonged and returned to nearly normal by the reduction of jaundice. The value of specific binding capacities at 2 weeks after bile-duct ligation decreased significantly compared to the value of the control and the reduced group (P < 0.05). The cause of decrease in specific binding capacities was indicated as the decrease of affinity constant especially in the high affinity part. These results coincide with the change of binding capacities of insulin and glucagon receptors with obstructive jaundice, which accurately reflect the severity of hepatocyte injury.

CONCLUSIONS

Taking together these results, 99mTC-GSA liver scintigraphy is thought to be a useful method to evaluate the liver functional reserve in cases with jaundice.

p48 subunit of mouse PTF1 binds to RBP-Jkappa/CBF-1, the intracellular mediator of Notch signalling, and is expressed in the neural tube of early stage embryos

BACKGROUND

Development of the pancreas and the nervous tissues is regulated by common transcription factors. A basic helix-loop-helix protein, p48 of pancreas transcription factor 1 (PTF1), is essential for differentiation of the exocrine acinar cells.

RESULTS

We isolated PTF1 p48 from 9.5-day mouse embryos as a binding protein of RBP-Jkappa, a mediator of Notch signalling. p48 bound to RBP-Jkappa more strongly than and in a distinct way from Notch1. In 9.5-12.5 day embryos, p48 was expressed in the dorsal part of the neural tube as well as in the pancreatic buds. Two lines of evidence suggested functions of p48 in neurogenesis: (i) expression of p48 was induced in P19 cells when they committed to neural fate upon retinoic acid treatment, and (ii) p48 over-expressed in Xenopus embryos repressed the development of neuronal precursors. p48 inhibited the MASH1-activated transcription from the E-box, while p48 stimulated transcription from the PTF1 motif synergistically with E47. The p48/E47-activated transcription from the PTF1 motif was stimulated further by RBP-Jkappa and RBP-Jkappa derivatives that mimicked the active RBP-Jkappa/Notch complex.

CONCLUSIONS

In developing embryos, p48 is expressed in both the nervous system and the pancreas. p48 inhibits neuronal differentiation. We propose possible mechanisms for this inhibition.

Substrate-binding clusters of the K+-transporting Kdp ATPase of Escherichia coli investigated by amber suppression scanning mutagenesis

The Kdp-ATPase of Escherichia coli is a four-subunit P-type ATPase that accumulates K(+) with high affinity and specificity. Residues clustered in four regions of the KdpA subunit of Kdp were implicated as critical for K(+) binding from the analysis of mutants with reduced affinity for K(+) (Buurman, E., Kim, K.-T., and Epstein, W. (1995) J. Biol. Chem. 270, 6678-6685). K(+) binding by this pump has been analyzed in detail by site-directed mutagenesis. We have examined 83 of the 557 residues in KdpA, from 11 to 34 residues in each of four binding clusters known to affect K(+) binding. Amber mutations were constructed in a plasmid carrying the kdpFABC structural genes. Transferring these plasmids to 12 suppressor strains, each inserting a different amino acid at amber codons, created 12 different substitutions at the mutated sites. This study delineates the four clusters and confirms that they are important for K(+) affinity but have little effect on the rate of transport. At only 21 of the residues studied did at least three substitutions alter affinity for K(+), an indication that a residue is in or very near a K(+) binding site. At many residues lysine was the only substitution that altered its affinity. The effect of lysine is most likely a repulsive effect of this cationic residue on K(+) and thus reflects the effective distance between a residue and the site of binding or passage of K(+) in KdpA. Once a crystallographic structure of Kdp is available, this measure of effective distance will help identify the path of K(+) as it moves through the KdpA subunit to cross the membrane.

Antagonistic Actions in Vivo of (23S)-25-Dehydro-1alpha-Hydroxyvitamin D(3-)26,23-Lactone on Calcium Metabolism Induced by 1alpha,25-Dihydroxyvitamin D(3)

The vitamin D analog, (23S)-25-dehydro-1alpha-hydroxyvitamin D(3)-26,23-lactone (TEI-9647), is an antagonist of the 1alpha,25-dihydroxyvitamin D(3) [1alpha,25(OH)(2)D(3)] nuclear receptor (VDR)-mediated differentiation of human leukemia (HL-60) cells. To clarify whether TEI-9647 could function as an antagonist of 1alpha,25(OH)(2)D(3) in vivo, we investigated in vitamin D-deficient (-D) rats the effects of single doses of TEI-9647 on several parameters of calcium metabolism modulated by 1alpha,25(OH)(2)D(3). TEI-9647 (50 microgram/kg iv) acting alone slightly, but significantly, stimulated intestinal calcium transport (ICA) and bone calcium mobilization (BCM) only at 8 h, but not at 24 h. In contrast, TEI-9647 dose-dependently inhibited ICA and BCM stimulated by an iv dose of 0.25 microgram/kg 1alpha,25(OH)(2)D(3) after 24 h, but not after 8 h. With respect to serum PTH levels, the administration of either TEI-9647, 50 microgram/kg, or 1alpha,25(OH)(2)D(3), 0.25 microgram/kg, began to decrease the circulating levels by 4 h, which reached a nadir 24 h after administration. But, when TEI-9647 and 1alpha,25(OH)(2)D(3) were simultaneously administered to -D rats, the TEI-9647 dose-dependently reversed the inhibition of PTH secretion caused by 1alpha,25(OH)(2)D(3), 0.25 microgram/kg, at 8 and 24 h after the treatment. In separate experiments, the daily iv administration of 20 microgram/kg of TEI-9647 alone to +D rats for 2 weeks resulted in no significant changes in the prevailing serum Ca(2+) concentration. But doses of 1-20 microgram/kg of TEI-9647 in combination with 0.5 microgram/kg of 1alpha,25(OH)(2)D(3), for 2 weeks, dose-dependently and significantly suppressed the serum calcium concentration increase caused by the 1alpha,25(OH)(2)D(3). Collectively, these results show that TEI-9647 acting alone displays in vivo weak agonistic actions, but when administered in combination with 1alpha,25(OH)(2)D(3), is a potent antagonist of three genomic-mediated calcium metabolism parameters. We conclude that TEI-9647 can also function as an antagonist of 1alpha,25(OH)(2)D(3) in vivo in the rat.

[Biopsy]

We reviewed the current devices, techniques, guiding images, indications and complications of needle biopsy with CT guidance. The development of new devices such as automated cutting needle has enabled radiologists to obtain tissue specimens of good quality at biopsy. Techniques such as the tandem or coaxial method ensure more a more accurate biopsy route. And helical CT and CT fluoroscopy have markedly shortened the time required for needle biopsy. However, we sometimes encounter minor complications, and rarely major ones, during and after needle biopsy. Some of these complications may be caused by malpractice. Therefore it is important always to pay attention to the possibility of complications of needle biopsy and to minimize radiation exposures from CT fluoroscopy.

Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: report of a case

We report a rare case of generalized peritonitis due to a ruptured pyometra in an 86-year-old woman, and also conduct a review of the previous Japanese literature. The patient presented with muscle guarding and rebound tenderness. Computed tomography (CT) disclosed a cystic mass in the peritoneal cavity, in which an air-fluid level was noted. Pneumoperitoneum around the uterus due to gas production of anaerobic bacteria was noted on a CT. At laparotomy, the uterus was markedly enlarged with a necrotic area on the uterine fundus, which was found to be perforated. A supravaginal hysterectomy and drainage were performed. We found only eight cases of a ruptured pyometra presenting as pneumoperitoneum in the Japanese literature between 1977 and 1999. The most common cause of pneumoperitoneum is a perforation of the gastrointestinal tract. However, other possible causes, as seen in our patient, should also be taken into consideration. Although it is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.

Water extract of Helicobacter pylori stimulates interleukin-8 secretion by a human gastric epithelial cell line (JR-St) through protein tyrosine phosphorylation

BACKGROUND

Infection by Helicobacter pylori induces cytokine production in gastric mucosal cells. Production of interleukin-8 (IL-8) is known to be markedly increased and is believed to play an important role in gastric mucosal inflammation. The aim of this study was to elucidate the effects of soluble factors of H. pylori on IL-8 production in a gastric epithelial cell line, JR-St.

METHODS

JR-St cells were cocultured with a H. pylori water extract, live H. pylori or culture medium supernatant for 24 h, then the IL-8 secreted into the culture medium was assayed. The effects of three different inhibitors; (i) an inhibitor of protein kinase C (PKC); (ii) an inhibitor of PKC and protein kinase A (PKA); and (iii) an inhibitor of protein tyrosine kinase (PTK) were also compared. Specific induction of IL-8 mRNA was also examined.

RESULTS

Water extract of H. pylori increased IL-8 secretion 7.72-fold, more than the control. The increase was concentration dependent. Live bacteria, supernatant and water extract significantly stimulated IL-8 secretion. Addition of live bacteria increased IL-8 secretion most strongly, while the effect of water extract was small (22% that of live bacteria). Secretion was not inhibited by the PKC inhibitor staurosporine or the inhibitors of PKA and PKC H7. However, secretion was significantly reduced by the PTK inhibitor herbimycin in a dose-dependent manner. Furthermore, 24 h exposure to water extract increased IL-8 mRNA expression, suggesting water extract increased production of IL-8.

CONCLUSIONS

Some soluble factors of H. pylori can stimulate IL-8 production by JR-St cells. Stimulation was not dependent on PKA or PKC but was, at least partially, dependent on protein tyrosine phosphorylation. This suggests that soluble factors of H. pylori can play an important role in mediating the inflammatory response of H. pylori gastritis.

[Usefulness of 67Ga scintigraphy in deciding surgical indication in secondary hyperparathyroidism]

In order to evaluate the usefulness in deciding surgical indication in secondary hyperparathyroidism (SHP), 67Ga scintigraphy was performed in 37 patients of SHP before parathyroidectomy (PTx). The radionuclide accumulation in skull and submandible was classified into 4 patterns (skull-submandibular pattern, skull pattern, submandibular pattern and normal pattern). Serum alkaline phosphatase levels were significantly elevated in patients of skull-submandibular pattern (13 cases) compared with skull pattern (6 cases), submandibular pattern (6 cases) and normal pattern (12 cases). Serum intact parathyroid hormone levels were significantly elevated in patients of skull-submandibular and skull patterns compared with normal pattern. No significant difference was observed among the weight of resected parathyroid glands. In 4 of 6 patients of normal pattern on 67Ga scintigram, bone scintigraphy showed a characteristic pattern of SHP including an increased accumulation in the skull and submandible. Bone mineral density (BMD) in the distal radius was increased within six to twelve months after PTx in 10 of 11 patients of skull-submandibular pattern on 67Ga scintigram, whereas only one patient showed an increase in BMD in 9 patients of normal pattern. In summary, it was concluded that 67Ga scintigraphy could provide a useful information in deciding the indication for PTx in secondary hyperparathyroidism.

[Chronological study for solitary bone metastasis in the sternum from breast cancer with bone scintigraphy]

Since breast cancer is frequently associated with bone metastasis, bone scintigraphies have been performed to determine pre-operative staging and to survey postoperative bone metastasis. The sternum, in particular, is a site at which is difficult to differentiate between benign bone disease and bone metastasis, because of varied uptake and wide individual variations. In this study, chronological bone images were scintigraphied in six cases with solitary sternal metastasis and three cases with benign bone disease including two fracture cases and one arthritis case. On bone scintigrams in which solitary sternal metastasis appeared, increased uptake was found in five cases, and photon deficiency was observed in one case. During follow-up scintigraphies, abnormal accumulations, such as hot spots and cold lesions, increased in the bone metastasis while abnormal uptake disappeared or was unchanged in the benign bone disease cases. On CT, four cases showed osteolytic change, and one exhibited osteosclerotic change. These findings indicate that sternal metastasis usually shows osteolytic change, even if a hot lesion is recognized on bone scintigraphy. In solitary sternal metastasis, for which early diagnosis is difficult, both an integrated diagnosis using other imaging techniques and chronological bone scintigraphy are important.

[Development of a simple method for the washout correction of 123I-IMP SPECT and its application to a quantitative rCBF method]

We have developed a simple method to correct the washout of tracer from the brain based on the two-compartment model in brain early SPECT using N-isopropyl-p-[123I]iodoamphetamine (123I-IMP). This correction was applied to a new quantitative method of regional cerebral blood flow (rCBF) in combination with the microsphere method by continuous arterial sampling previously reported. Data acquisition of 123I-IMP early SPECT was started from 35 min after 123I-IMP i.v. injection, and the time activity curve of whole brain on anterior head planar images was monitored immediately after 123I-IMP i.v. injection for the correction of washout of tracer from the brain. The usefulness of this method was evaluated in 12 patients with various brain diseases by comparison with the results obtained from the super-early SPECT at 7-10 min after 123I-IMP i.v. injection. The washout rates in cases of early SPECT corrected by this method ranged from 16.91% to 39.34% with a mean +/- SD of 27.72 +/- 5.44%. The contrast of hypo- to hyperperfusion regions on early SPECT was improved by the correction of the washout, and its intracerebral distribution was similar to the simultaneously obtained super-early SPECT images. These results indicated that the present correction method for the washout was useful for more correct quantification of rCBF.

Mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid: report of a case

The patient was 59-year-old Japanese woman who presented with a neck swelling. Ultrasonography and computed tomography demonstrated a round tumor in the thyroid right lobe measuring 2.5 x 1.5 cm in size. A right hemithyroidectomy with lymph node dissection was performed. Histopathological findings demonstrated low-grade B cell lymphoma of the mucosa-associated lymphoid tissue (MALT) associated papillary microcarcinoma. A previous report showed an excellent prognosis of MALT lymphoma of the thyroid without capsular invasion or lymph node involvement. We also describe the concept of MALT lymphoma as a primary lesion in which lymphoid tissue is not present in the normal state.

Case report KY: functional analysis of a follow-up chin cup patient with TMJ pain

At 19 years 1 month, the patient returned to the clinic for a follow-up screening of chin-cup patients. She was the only TMJ dysfunction patient who agreed to undergo further treatment. Mandibular kinesiograph, computer-aided axiograph, and electromyograph records were gathered to aid in evaluating function. Splint therapy and orthodontic retreatment relieved the TMJ pain associated with balanced muscular activity and helped to achieve more normal movement of the mandible.

Interleukin-8 enhances tetragastrin-stimulated acid secretion in vivo

Recent studies have demonstrated a relationship between cytokines and gastric acid secretion. However, details of the mechanism underlying that relationship have not been elucidated. For this study, an in vivo experiment was undertaken to investigate the possibility that IL-8 would be involved in the mechanism of gastric acid secretion. Gastric lumen-perfused rats were prepared and the stomachs were perfused with a saline solution. The effluent was collected at 15-min intervals and assayed for titratable acid against 0.01 M NaOH. IL-8 (200 ng/rat) given intravenously did not influence basal acid output in rats. However, when IL-8 was administered by injection during continuous tetragastrin infusion (4 microg/kg/hr) acid output increased significantly (P < 0.01). The acid output during the first hour following IL-8 injection was 43.6% higher than prior to the injection. Acid output during the second hour was lower than during the first hour. However, successive injection of IL-8 again increased tetragastrin-stimulated acid output by 23.4% (P < 0.05). IL-8 injection did not change histamine-stimulated acid output. The results indicate that IL-8 has the effect of enhancing gastrin-stimulated acid secretion and might have an important role in the pathophysiology of gastric acid secretion in vivo.

Experimental evaluation of hepatic functional reserve using 111In colloid for clinical application

We have postulated that reduced hepatic blood flow is the primary factor responsible for postoperative hepatic insufficiency, and have shown the usefulness of the hepatic blood flow index (KL) estimated by 198Au colloid. However, 198Au colloid has became unavailable due to its intense exposure activity. Therefore, we prepared 111In colloid as a substitute for 198Au colloid to evaluate hepatic functional reserve. In the present study, a 111In colloid was administered to rats to investigate the possibility of clinical application. First, liver cirrhosis was induced in rats using CCl4 Changes in KL and hepatic tissue blood flow were measured by hydrogen gas clearance (HL) after CCl4 injection, and was shown to correlates well with it. The correlation between KL and HL, together with normal and cirrhotic liver, was significant (r = 0.83, p < 0.01) Second, reticuloendothelial function was modulated with Zymosan A (stimulation) and Silica (suppression). The KL value remained unchanged in spite of the addition of an activator or suppressor to the reticuloendothelial system. Third, 30% and 70% hepatectomy models were studied according to the method of Higgins-Anderson. KL and HL was measured before and 1, 3 and 7 days after hepatectomy. KL and HL after 30% and 70% hepatectomy showed similar changes. These results indicate that the clearance of 111In colloid can be used clinically as an index of the hepatic blood flow.

Clinical evaluation of temporomandibular joint disorders (TMD) in patients treated with chin cup

The purpose of this manuscript was twofold: (1) to provide more information on the incidence of temporomandibular joint disorders (TMD) in chin cup-treated patients during and after active treatment; and (2) to evaluate results of functional analysis for one orthodontically treated chin cup patient with temporomandibular joint (TMJ) pain and difficulty of maximum mouth opening. Eighty-six out of a total of 160 chin cup patients responded to our questionnaire and were checked for pain, clicking, and maximum mouth opening. Twenty-eight of the chin cup subjects showed one or more symptom(s) of TMD. Spontaneous pain was found most often during active treatment but clicking (sound) occurred more often during the retention phase. One retreated patient showed remarkable improvement of TMD symptoms.

[Comparative study on the tumor accumulation of 99mTc-tetrofosmin and 99mTc-MIBI in rabbits bearing VX-2 cancer]

Each of myocardial blood flow imaging agents has a potential usefulness as an agent for tumor scintigraphy. The tumor accumulation and washout of 99mTc-tetrofosmin and 99mTc-MIBI were comparatively studied using rabbits bearing VX-2 cancer. From seventeen to twenty days after the implantation of VX-2 cancer into the femoral region of seven rabbits, tumor to soft tissue accumulation ratio (T/S ratio) of each agent was calculated in early images (5 min after injection) and in late images (50 min after injection). Compared with 99mTc-tetrofosmin, the T/S ratio of 99mTc-MIBI was higher and, moreover, the washout was delayed. These results suggest that there is a difference in tumor accumulation property between these two agents.

[Compartment analysis of 123I-iomazenil brain on early and delayed SPECT]

We investigated the characteristics of 123I-Iomazenil (IMZ) SPECT images in 12 adults (six males and six females, with a mean age of 56.1 years). The washout rate of 123I-IMZ from the brain was estimated from two SPECTs done 15 min and 3 hr after injection. Although the washout was relatively slow, the rates differed in each intracerebral region, suggesting that the distribution of 123I-IMZ was gradually changing. Furthermore, assuming 123I-IMZ kinetics in the brain for the three-compartment, two-parameter model, the transition rate constant (K1) from the blood to the brain and the binding potentials (BP) of benzodiazepine to the receptor were calculated. The BP and K1 values were compared with 123I-IMZ SPECT counts and CBF values by 123I-IMP. The BP values correlated more closely with the counts on the delayed SPECT than those on the early SPECT. It was confirmed that delayed SPECT images reflect better the distribution of the benzodiazepine receptor than early images do. On the other hand, the K1 values correlated highly with CBF obtained by 123I-IMP, and this finding suggested that super-early SPECT images might be remarkably influenced by the distribution of CBF.

Morphologic adaptation of temporomandibular joint after chincup therapy

The purpose of this study was to clarify the morphologic changes of the temporomandibular joint (TMJ) after chincup application, with longitudinal TMJ cephalometric laminagraphs. The subjects were 19 prepubertal patients with true, mild skeletal Class III malocclusions with anterior crossbite. All underwent chincup therapy from the beginning of treatment. The control subjects were 16 patients with functional anterior crossbite, with normal jaw relationships. Cephalometric laminagraphs and lateral cephalograms were obtained before and after treatment. Statistical analysis of the data revealed the results as follows: (1) The chincup therapy changed the direction of growth of the mandible, especially, the ramus swing-back. (2) The chincup group showed a relatively more slender mandibular neck compared with the control group. (3) The condylar heads were bent forward after the chincup application, and the glenoid fossa was deepened and widened. The clearance between condyles and fossae was decreased by the orthopedic force of the chincup appliance.

Laparoscopic cholecystectomy: a multicenter study of 17 hospitals

A study of 1,254 laparoscopic cholecystectomies performed at 17 hospitals affiliated with the Liver, Gallbladder, and Pancreas Research Group of the First Department of Surgery at Okayama University was undertaken to assess the current status and safety of this procedure. The data for 336 patients, comprising the initial 20 laparoscopic cholecystectomies performed at each institution, were compared with the data from the remaining 918 patients. Comparison of the two groups revealed the following: 1. the rates of intraoperative conversion to open cholecystectomy were 11.3% and 5.1% (P < 0.05), 2. the complication rates were 5.7% and 3.4%, and 3. the rates of bile duct injury were 2.4% and 1.1%, respectively. Compared with the first group, the bile duct injuries resulting from a lack of experience decreased in the second group, however, the incidence of these injuries occurring during avulsion of the gallbladder in difficult cases increased. These results suggest that the experience acquired during the initial 20 laparoscopic cholecystectomies led to a reduction in the rate of intraoperative conversion to open cholecystectomy, but it did not reduce the rate of complications, and that the risk of bile duct injury was always present.