Retroperitoneal leiomyosarcoma: a case report.

Retroperitoneal leiomyosarcoma is a relatively rare and aggressive tumor. Because of its rarity, it is difficult to arrive at a definite diagnosis preoperatively and to design an effective strategy. Here the authors report a case of peritoneal leiomyosarcoma in which diagnosis was difficult because the clinical course resembled that of ovarian cancer. A 77-year-old woman diagnosed with ovarian cancer underwent laparotomy. The excised tumor contained a necrotic polypoid mass that histologically displayed the features of leiomyosarcoma. The patient received adjuvant chemotherapy with a combination of gemcitabine and docetaxel but died two months after surgery owing to the aggressive behavior of the tumor. Because the preoperative diagnosis in this case was ovarian cancer, arriving at a treatment strategy assuming peritoneal leiomyosarcoma was difficult. If complete surgical resection of tumor is not performed, as in the present case, the prognosis can be extremely poor.

Relationship between the Peripheral Lymphocyte Response to Mycophenolic Acid in vitro and the Level of ATP in Peripheral CD4+ Lymphocytes before and after Renal Transplantation.

OBJECTIVE: The lymphocyte immunosuppressant sensitivity test has been used to predict the pharmacodynamics of immunosuppressive drugs for the purpose of preventing acute rejection and infection after renal transplantation. On the other hand, measuring the ATP levels in peripheral CD4+ lymphocytes is also able to monitor the risks of rejection and infection in transplant recipients. In the present study, we examined the relationship between the mycophenolic acid pharmacodynamics and the ATP levels in peripheral lymphocytes before and after renal transplantation. METHODS: We examined both the pharmacological efficacy of mycophenolic acid and the lymphocyte ATP levels before and 2, 4 and 6 weeks after the operation in 20 renal transplant recipients. The drug's pharmacological efficacy was evaluated by the 50% inhibitory concentration of the drug against the in vitro proliferation of peripheral blood lymphocytes activated by T cell mitogen. The ATP levels in peripheral CD4+ lymphocytes were measured by the Immuknow assay kit. The relationships between the mycophenolic acid pharmacodynamics and ATP levels in peripheral lymphocytes were examined in these recipients. RESULTS: The immunosuppressive effects of mycophenolic acid against mitogen-activated lymphocyte proliferation were significantly and positively correlated with the lymphocyte ATP levels, but only at 6 weeks after transplantation. The relationship was not significant before or at 2 or 4 weeks after the operation. CONCLUSION: Our present data raised the possibility that evaluating the pharmacological efficacy of mycophenolic acid pre-transplantation and monitoring the ATP level 6 weeks after transplantation can predict the risk of rejection and/or infection in renal transplant recipients.

[An elderly case with impending myocardial infarction of endoventricular circular patch plasty with coronary artery bypass grafting].

An 81-year-old man with anterior impending re-myocardial infarction was urgently operated. Preoperative ECG and UCG examinations showed old myocardial infarction and LV aneurysm, respectively. We chose the Dor method (endoventricular circular patch plasty) and CABG aiming at early recovery from congestive heart failure. He fell into respiratory failure temporarily, but otherwise, the clinical course of this operation was good. He was discharged 47 days after the operation on foot. The Dor method combined with CABG is excellent way to relieve patients from congestive heart failure with LV aneurysm.

Surgical repair of a concealed aortocaval fistula associated with an abdominal aortic aneurysm: report of two cases.

Two cases of a concealed aortocaval fistula (ACF) associated with an abdominal aortic aneurysm (AAA) are presented herein. ACF is a rare complication of AAA and only a few cases have so far shown the triad of symptoms, including congestive heart failure, a continuous abdominal bruit, and a pulsating abdominal mass. Sometimes a definite diagnosis is not made preoperatively and as a result, massive bleeding is encountered. We believe that the presence of a large aneurysm, compression, and involvement of the inferior vena by an aneurysm, and pelvic venous dilatation on abdominal computed tomography and hematuria may additionally suggest the presence of a concealed ACF. A correct preoperative diagnosis will help greatly in selecting the optimal surgical modality and should also reduce the degree of bleeding.

The relationship between plasma concentration of mature adrenomedullin and jugular venous oxygen saturation during and after cardiopulmonary bypass.

UNLABELLED: Adrenomedullin (AM), a vasodilatory peptide, increases during cardiac surgery. However, the physiological role of AM during cardiac surgery remains unclear. AM dilates cerebral arterioles and increases cerebral blood flow in rats. Therefore, we investigated whether AM is related to cerebral oxygen balance during cardiac surgery. In nine patients undergoing coronary artery bypass grafts, plasma concentrations of mature AM from the radial artery (mAMa) and jugular bulb (mAMj) were measured, and jugular venous oxygen saturation was obtained before surgery (baseline), before aortic cross-clamp (preclamp), after aortic declamp (postclamp), and 20 min after weaning from the cardiopulmonary bypass (post-CPB). Plasma concentrations of mAMa and mAMj were significantly increased at postclamp (P < 0.01 for both) and post-CPB (P < 0.01 for both) compared with baseline values. SjO(2) correlated with plasma mAMj concentrations at preclamp (r = 0.79, P < 0.01), postclamp (r = 0.71, P < 0.05), and post-CPB (r = 0.72, P < 0.05), as well as with mAMa concentrations at preclamp (r = 0.79, P < 0.01) and postclamp (r = 0.72, P < 0.05). This suggests a relationship between AM and cerebral oxygen balance during cardiac surgery. IMPLICATIONS: Plasma concentrations of mature-form adrenomedullin, a vasodilatory peptide, was correlated with jugular venous oxygen saturation during cardiac surgery. This suggests a relationship between adrenomedullin and cerebral oxygen balance during cardiac surgery.

[An oral health scoring system for promoting 8020 achievement in residents].

The present study was undertaken to develop a self-scoring system which can be used by a resident to check lifestyle. The oral health scoring system which we used in Tobishima village, Aichi-ken, was named SAWAYAKA score. A total of 777 subjects were examined. The subjects responded to a questionnaire regarding their past individual lifestyles and dietary habits. Oral health conditions were also examined by dentists. The odds ratio and 95% confidence interval were calculated both from retained tooth numbers and the questionnaire. Questions with significant odds ratio were selected and the partial regression coefficients of quantification II method by Hayashi were calculated. The results are as follows; 1) Eleven questions showed a significant odds ratio between retained tooth numbers and past lifestyle and dietary habits. The questions involved the frequency of snack intake, tooth brushing frequency, having own tooth brush, smoking, drinking, having a hobby, having a family dentist, consulting a dentist before a problem got serious, gum bleeding, swollen gums and toothache caused by sensitivity to cold water. 2) The eleven items were analysed by using Hayashi's quantification II method. 3) The results showed that unswollen gums affected the retention of teeth by the range of 1.240. Toothache caused by sensitivity to cold water affected the retention of teeth by the range of 0.765. Having a hobby affected the retention of teeth by the range of 0.691. 4) The "SAWAYAKA" score was used to select important items, excluding drinking. 5) When results were analysed with the SAWAYAKA score, an average of 9.6 was obtained. It was concluded that the scoring list could be used for checking resident's lifestyles, and for promoting the preservation of more than 20 teeth at the age of 80.

Social images of medicine and dentistry in Japan. An exploratory study using correspondence analysis.

OBJECTIVE: To investigate social images associated with dentistry in comparison with nine other medical disciplines. DESIGN: A questionnaire survey among members of the general public. Subjects were asked to state, in not more than five words, the images which they associated with each of the ten disciplines. SETTING: Komaki City, Shikatsu Town and Nagoya City in Japan. PARTICIPANTS: 261 respondents from a convenience sample of 300 residents, not associated with any branch of medicine. OUTCOME MEASURES: Frequency distribution of word images used on at least five occasions and a correspondence analysis of the responses for the ten disciplines. RESULTS: Of the 163 coded image items, 60 were related to internal medicine, 56 to dentistry, 55 to dermatology, 51 to orthopaedic surgery, 51 to ophthalmology, 50 to surgery, 47 to obstetrics and gynaecology, 43 to otolaryngology, 40 to paediatrics and 33 to psychiatry. Correspondence analysis applied to the 163 items and 10 medical disciplines indicated that three similar paired image groups were found, namely between dermatology and ophthalmology, surgery and orthopaedic surgery, and between dentistry and internal medicine, which were the more commonly encountered disciplines across all age groups. However, compared with the other specialities, dentistry had a significantly greater association with pain, this response being four times more common than for surgery. CONCLUSIONS: This group of members of the public in Japan perceived dentistry-associated images in a similar way to internal medicine, but the negative associations with pain need to be addressed by the dental profession and health educators alike.

[Intermittent mini-dose vancomycin intravenous administration and closed continuous irrigation technique applied to mediastinitis caused by MRSA following mitral valve replacement].

Mediastinitis caused by MRSA (Methicillin-Resistant Staphylococcus aureus) remains an intractable infection producing high mortality even in these days of advanced chemotherapy. The authors report a case of mediastinitis due to MRSA complicated with acute renal failure following mitral valve replacement. The patient's mediastinum had been thoroughly cleaned with physiological saline solution with 0.2% povidone iodine, and underwent a chemotherapy regimen of mini-dose vancomycin. The patient made favorable progress and recovered completely. Our patient's progress confirmed that when chemotherapy using vancomycin is administered in a patient whose condition is complicated with acute renal failure, closely monitoring the vancomycin serum concentration is essential. Intermittent mini-dose intravenous administration is sufficient to maintain an effective vancomycin serum concentration. In our case, vancomycin serum concentration measured before and at completion of dialysis revealed no appreciable decline.

[Reoperations on valvular disease: an analysis of outcome].

To evaluate risks and complications of reoperation on valvular disease, we reviewed data on 186 patients who underwent reoperations because of prosthetic valve malfunctions, pregression of valvular disease after open mitral commissulotomy and previous valvular replacement. Overall hospital mortality was 4.8% (9/186 patients). The common causes of death was low cardiac output syndrome (3 pts.) and respiratory failure (3 pts.) and others (3 pts). Hospital mortality was different according to the risk factors. There was no significant difference between the operative procedures; AVR (6.2%), MVR (3.2%), DVR (8%), TVR (0%) and MVR + TVR (9%). Furthermore, advanced age, valve position, renal failure, preoperative %FS, LVDd and diagnosis of prosthetic valve malfunction did not appear to be significant risk factor. However, preoperative respiratory failure and emergency operation showed significant increase of hospital mortality in comparison with other factors. On the basis of this reports, hospital mortality and late survival indicated that reoperation should be performed early as the potentially safe condition.

[Efficacy of myocardial preservation using HTK solution in continuous 120 min cross-clamping method--a comparative study with GIK method].

The aim of this study is to investigate the efficacy of HTK solution in the 120 minutes cross-clamping method in comparison with conventional intermittent cardioplegia using GIK solution. Fifty-four open heart surgery were performed with cardioplegic solution using either HTK solution (HTK) or GIK solution (GIK). In the HTK, HTK (3L) was infused for the initial dose and 1L was added every 60 min after 120 min of cross-clamping. In GIK, 1L of GIK solution was intermittently infused initially and then every 30 min together with continuous cold blood perfusion. The effect of two cardioplegic solution was evaluated by postoperative cardiac function (CI, %SF), released enzymes (CPK), histology and dosage of catecholamine. Postoperative CI was 3.67 +/- 0.76 in HTK, and 4.34 +/- 1.04 in GIK (NS). % SF was 26.0 +/- 5.26 in HTK and 25.6 +/- 0.76 in HTK, and 4.34 +/- 1.04 in GIK (NS). %SF was 26.0 +/- 5.26 in HTK and 25.6 +/- 9.2 in GIK (NS). The CK-MB (IU/dl) level after reperfusion was significantly decreased in HTK at 60 and 180 min after reperfusion. Histology at 60 min of ischemia revealed a significant increase of edema of mitochondria in GIK. Postoperative catecholamine dose was 2.65 +/- 1.3 in HTK and 10.3 +/- 3.4 in GIK (p < -0.01). PH of myocardium was well maintained around 7.4 during cross-clamping in HTK, however, it was decreased in GIK. In conclusion, The HTK method offers a reliable cardiac protection due to effective buffering using Histidine in comparison with GIK.

Postcolumn fluorometric detection system for liquid chromatographic analysis of amino and imino acids using o-phthalaldehyde/N-acetyl-L-cysteine reagent.

A high-performance liquid chromatographic system for the determination of amino acid and imino acid was developed using a two-step reaction with sodium hypochlorite and o-phthalaldehyde/N-acetyl-L-cysteine (OPTA/AcCys) reagent. This reagent improved the sensitivity in the analysis of proline presumably because the fluorophore is more stable to hypochlorite which has been used for the oxidative cleavage of the imino linkage. The use of OPTA/AcCys facilitated the detection of imino acids at the same concentration level as that of amino acids. The detection limit for all the amino and imino acids was a few picomoles. This detection system, together with cation-exchange chromatographic separation, was applied to the determination of amino and imino acids in biological samples.