[Pyopericardium followed by acute progression of constrictive pericarditis].

A 65-year-old woman was referred to our hospital for treatment of pyopericardium and cardiac tamponade. Despite aggressive therapy that included pericardiaocentesis, drainage of pericardial effusion, and prolonged intravenous antibiotic therapy, constrictive pericarditis developed 2 weeks after an initial episode of pyopericardium. Pericardiectomy and omentopexy were performed, resulting in complete relief of the patient's symptoms and no recurrence of infection. The possibility of constrictive pericarditis should be kept in mind for the surveillance of the patients with pyopericardium and appropriate measures for pericardial drainage should be undertaken to prevent pericardial constriction.

Leukocyte accumulation in sparganosis: demonstration of eosinophil and neutrophil chemotactic factors from the plerocercoid of Spirometra erinacei in vivo and in vitro.

In order to determine whether the plerocercoid of Spirometra erinacei itself has eosinophil and neutrophil chemotactic factors, in vivo and in vitro examinations were carried out. We could observe large numbers of eosinophils and neutrophils which accumulated at the injection site of normal guinea pig skin following intradermal injection of soluble extract of plerocercoids of S. erinacei. At 1 hour after the injection, neutrophils appeared at the site, and the cell number reached its peak at 4 hours. Eosinophils appeared rather later than neutrophils (at 2-4 hours), and the number of cells reached its peak at 8 hours after the injection. Eosinophil and neutrophil chemotactic activities were also confirmed in an in vitro system by using a blind-well chemotaxis chamber with a Millipore filter in dose dependent fashion. An eosinophil chemotactic factor (ECF) with molecular weight of approximately 15,000, and two different neutrophil chemotactic factors, one of about same molecular weight as the ECF and the other of low molecular weight, were demonstrated by gel filtration on Sephadex G-200. Furthermore, it was confirmed that those factors were released from parasite by the detection of intensive eosinophil and neutrophil chemotactic activities in the culture supernatants containing plerocercoids.

Eosinophil and neutrophil chemotactic activities of adult worm extracts of Schistosoma japonicum in vivo and in vitro.

Large numbers of eosinophils and neutrophils attracted to the soluble extract of Schistosoma japonicum adult worms (SjAW-ext) were detected at the injection site of normal guinea pig skin. Eosinophil and neutrophil chemotactic activities were also confirmed in in vitro assay by using blind-well chambers with Millipore filters in dose-dependent fashion. Two components of SjAW-ext showed eosinophil chemotactic activity; one was in the high molecular weight fraction (JAE-H), estimated to be more than 440,000 daltons, the other in the low molecular weight fraction (JAE-L) obtained by Sephadex G-200 gel filtration. High neutrophil chemotactic activity was detected in the JAE-L. These eosinophil and neutrophil chemotactic activities were also detected in culture fluid of S. japonicum adult worms. Eosinophil chemotactic factor (ECF) of JAE-H was stable to heating (100 C, 30 min) and pronase digestion, but completely destroyed by periodate oxidation. It is suggested that the ECF of JAE-H is a glycoprotein. JAE-L was also stable to heating (56 and 100 C, 30 min) and pronase digestion for eosinophil chemotaxis. Possible roles of those activities in schistosome infections are discussed.

Malignant schwannoma metastasizing to the parenchyma of the brain--case report.

A 48-year-old male presented with a very rare case of malignant schwannoma metastasizing to the parenchyma of the brain. He had undergone previous radical surgical resection of an abdominal wall tumor that was histologically confirmed as a malignant schwannoma. Five years later, the patient presented with metastases to the parenchyma of the brain and lung. A large mass at the left frontoparietal region was totally resected immediately after intratumoral hemorrhage. He recovered well and the lung metastasis was also removed, but he later developed further multiple metastases in the lung and brain.

[Characteristics and progress of treatment for gastric cancers detected by mass screening].

We devised an X-ray examination to detect early gastric cancer, especially small gastric cancer, during the period between 1996 and 1997. As a result, the rate of gastric cancer detection by mass screening was 0.50%; and the rate of early gastric cancer detection was 79%. 1. Characteristics of gastric cancer detected by mass screening: Characteristics of gastric cancer were depressive-type undifferentiated cancer less than 4.0 cm diameter in work-place screening and depressive-type differentiated cancer less than 4.0 cm in area screening; 2. gastric cancer less than 2.0 cm in diameter was 75 (68%) of the 110 cases (total detected gastric cancer). 2) We have to consider that gastric cancer differs by sex and age. 3) EMR accounted for 39 (35%) of the 110 cases in treatment. This method resulted in a higher gastric cancer detection rate and served to maintain QOL.

Non-invasive characterization of brain tumor by in-vivo proton magnetic resonance spectroscopy.

We studied the feasibility of characterizing brain tumor tissue by localized proton magnetic resonance spectroscopy (1H-MRS). Twenty-six newly diagnosed tumors were examined by in-vivo 1H-MRS. The NAA (N-acetylaspartate)/Cho (choline) ratio of Grade 2 astrocytoma was higher than that of Grade 4. The Cho/Cr (creatine and phosphocreatine) ratio of meningioma was considerably higher than that of glioma of all grades. We have experienced only two cases of ependymoma and the Cho/Cr ratios of both were lower than that of glioma. It seems likely that 1H-MRS can be used to differentiate Grade 2 from Grade 4 in most cases of astrocytoma based on the NAA/Cho ratio, though a few cases will overlap. Meningioma can be distinguished easily from glioma, and the results of our study suggest that ependymoma shows a characteristic pattern on 1H-MRS, different from those of other brain tumors.

Long-term effects of the angiotensin-converting enzyme inhibitor enalapril on chronic heart failure. Examination by 123I-MIBG imaging.

To examine the long-term effects of the angiotensin-converting enzyme (ACE) inhibitor enalapril on chronic heart failure, 10 patients (7 men and 3 women, mean age: 62 +/- 11 years) with chronic stable heart failure, classified as New York Heart Association (NYHA) functional class 2-3 for more than 3 months, and a left ventricular ejection fraction less than 45% were treated with 2.5-5.0 mg of enalapril once a day for 3-15 months (mean 7 months). The causes of heart failure were old myocardial infarction (n = 7), hypertension (n = 2), and atrial fibrillation (n = 1). Radioiodinated metaiodobenzyl guanidine (123I-MIBG) imaging, radionuclide angiography, and treadmill exercise test were performed before and after the treatment. With enalapril treatment, (1) left ventricular ejection fraction (LVEF) increased significantly from 38.3 +/- 6.9% to 47.5 +/- 14.7%; (2) sub-maximal exercise time increased significantly from 205 +/- 112 to 272 +/- 120 seconds; (3) the heart to mediastinum (H/M) ratio of 123I-MIBG increased significantly (early image: 1.99 +/- 0.38 versus 2.20 +/- 0.50; delayed image: 1.86 +/- 0.44 versus 2.09 +/- 0.51); and (4) the washout rate of 123I-MIBG decreased slightly from 29.1 +/- 9.1% to 25.4 +/- 7.0%. The improvement rate of LVEF was significantly correlated with the improvement rates of the H/M ratio and washout rate after treatment with enalapril. Thus, the long-term effects of enalapril can be observed in the cardiac sympathetic nervous system, and 123I-MIBG imaging appears to be useful for evaluating the therapeutic effects of enalapril on the cardiac sympathetic nervous system in patients with chronic heart failure.