Post radiation inflammatory malignant fibrous histiocytoma arising from the chest wall.

A 59-year-old man who underwent radiation therapy (41 Gy) to the mediastinum through the anterior chest for Hodgkin's disease presented with a painful anterior chest wall tumor 18 years later. The tumor originated from the left parasternal region and was excised with the sternum. Chest wall reconstruction was performed. The tumor measured 45 x 45 mm and invaded the sternum. The pathologic diagnosis was malignant fibrous histiocytoma. Early and complete excision of the tumor is indicated.

[Autoimmune thrombocytopenia and erythroid hypoplasia associated with hepatitis A].

A 53-year-old woman developed fever and fatigue after eating raw oysters, and consulted a local clinic. She exhibited liver dysfunction and jaundice, and was therefore referred and admitted to our hospital. Hepatitis A was diagnosed based on virus markers, and palliative therapy was administered. After admission, the increased levels of transaminases and lactic acid dehydrogenase (LDH) normalized rapidly. However, marked thrombocytopenia was observed, and steroid pulse therapy was administered. Thereafter, idiopathic anemia developed, and a bone marrow puncture was performed. Bone marrow smears showed marked depletion of cells of the erythroblastic and megakaryocytic series. Parvovirus B19 infection was ruled out, and an additional steroid was administered. However, the patient's anemia and thrombocytopenia persisted. She suffered a prolonged period of cholestasis and died of acute renal failure. At autopsy, the bone marrow revealed severe erythroblastopenia. A diagnosis of thrombocytopenia due to an autoimmune mechanism was made on the basis of elevated levels of platelet-associated immunoglobulin G (PAIgG) and immune complex. Furthermore, the advanced anemia was complicated by concurrent hemolysis. This case may provide information useful for clarifying the pathogenesis of hematopoietic disorders complicated by hepatitis.

Langer-Giedion syndrome associated with submucous cleft palate.

We report a 4-year-old girl with characteristic features of the Langer-Giedion syndrome (trichorhinophalangeal syndrome type II) who also had submucous cleft palate. When she underwent a palatoplasty, a diagnosis of Langer-Giedion syndrome was made because of the characteristic facial features, multiple exostoses, and partial deletion of the long arm of chromosome 8. This is the first case of trichorhinophalangeal syndrome associated with cleft palate. We review the clinical alterations of trichorhinophalangeal syndromes and differential diagnosis of Langer-Giedion syndrome from trichorhinophalangeal syndrome type I and hereditary multiple exostoses. We also describe the importance of trichorhinophalangeal syndrome in plastic surgery.

Premorbid psychosocial behavior in demented patients.

We investigated the premorbid behavioral characters of demented patients in terms of life style, type A behavior, life events and coping behavior. We adopted the case control study. Significant differences were not found in the inventory scores of life style, passive coping behavior and type A behavior between dementia group and normal controls. However, the life events occurred significantly frequent in the vascular dementia group and the score of positive coping behavior was significantly low in dementia group. The results suggest that those life events and positive coping behavior might be related to the onset of dementia.

A new cleft palate repair.

Cleft palate can be repaired by a palatal mucoperiosteal flap, but we have devised a new technique for cleft palate repair using a wide mucoperiosteal flap with an alveolar ridge mucosa and a cleft margin flap. This technique leaves the mucosa of the nasal cavity and vomer intact. The results include (1) good velopharyngeal competence and normal articulation, (2) few cases of fistula formation, and (3) minimal maxillary retardation.

Consideration of operative procedures for zygomatic reduction in Orientals: based on a consecutive series of 28 clinical cases.

Operative procedures for reduction malar bone plasty were considered in our consecutive series of 28 Japanese cases. The patients consisted of 7 males and 21 females whose ages ranged from 21 to 57 years. The operative procedures used were either shaving the protruded zygomatic body and arch with chisels by means of an intraoral approach and/or an extraoral sideburn-lateral canthal approach or, alternatively, mobilizing the protruded zygoma en bloc medioposteriorly into reduction of the prominent zygoma by a coronal approach. In principle, the noncoronal approach was indicated for males and young females, and the coronal approach, conducted in association with forehead lifting with or without canthopexy, was indicated for females over age 40. These procedures have individual merits and demerits. In some cases, associated surgery was performed concomitantly according to the facial balance or facial rejuvenization. We believe that the optimal operative approach and operative procedure should be considered in accordance with the patient's sex, age, wishes, and/or cultural background.

[A feeding experiment on laboratory-bred male cynomolgus monkeys. I. Morphometrical study].

Effects of restricted feeding on the growth of laboratory-bred male cynomolgus monkeys (Macaca fascicularis) aged between one year and four years were studied morphometrically. A series of 11 variables representing physical elements were measured. Before 2.5 years of age, the amount of commercial diet (Type AS, 382kcal/100g and 28.1% of crude protein, Oriental Yeast Co. Ltd.) per day was restricted to 50g (group A), 30g (group B) or 20g (group C) and increased to 100g (group A), 50g (group B) or 40g (group C) respectively at 2.5 years old. Throughout the experimental period ca 100g of apples and oranges per day were provided. Significant differences in body weight between group A and C were detected excepting the early period of the experiment. Although the slight suppression in weight gain was observed in group B during the second trimester of the experiment, body weight increased gradually after increasing the amount of food and no significant difference from A was observed at four years of age. The minimum requirement of diets is judged to be 30g/day before two years old and 50g/day over two years old in the laboratory-bred male cynomolgus monkey. Moreover, the suppressive effects of restricted feeding were most significant on the growth of the limbs and, secondarily, on the growth of the trunk. Practically no effect on the growth of the head was observed.

[Feeding experiment on laboratory-bred male cynomolgus monkeys. II. Hematological and serum biochemical studies].

The effects of restricted feeding on hematological and serum biochemical values were studied in laboratory-bred male cynomolgus monkeys (Macaca fascicularis) aged between one year and four years. In animals younger than 2.5 years old, the amount of commercial diet (Type AS, Oriental Yeast Co. Ltd.) given per day was restricted to 50 g (group A), 30 g (group B) or 20 g (group C) and increased to 100 g (group A), 50 g (group B) or 40 g (group C) at 2.5 years old. Throughout the experimental period, about 100 g per day of apples and oranges were fed to the animals. Differences in red blood cell counts, hematocrit values and hemoglobin concentrations between groups A and C were detected in the middle period of the experiment. The function of hematogenesis may be suppressed by restricted feeding. A significant increase in serum triglyceride concentration in group C and slight increase in group B were observed during the second trimester of the experiment. A decrease in serum alkaline phosphatase activities in group C during the same period suggests that restricted feeding has a suppressive effect on bone growth. The results obtained by hematological and serum biochemical observations in this study are in good agreement with the previous somatometric study [10].

[Measuring bone mineral content and soft tissue mass in living the cynomolgus monkey].

Bone mineral content and soft tissue (lean and fat) mass in living female cynomolgus monkeys were successfully measured with a dual-energy X-ray absorptiometry (DEXA; DPX-alpha, LUNARE, USA). Measurements were performed using a restraining bed made of forming polystyrol with 5cm thickness to support the animal in a supine position. Accuracy of measurements was checked by using a dummy consisted by various combinations of lean, lard and ribs. The results confirmed that this system is able to measure each constituent exactly. The percentage of fat in the soft tissue is seemed to be better index of obesity in this primate species when compared with other obesity markers such as body weight and morphometry.

A variation of the vascular pedicle of the latissimus dorsi muscle.

A case of a rare variation of the vascular pedicle of the latissimus dorsi musculocutaneous flap is described. Its main vascular pedicle was the circumflex scapular vessel.

Changes in hematologic values in 11 months after birth in the cynomolgus monkeys.

Changes in hematological values were studied with 131 healthy cynomolgus monkeys aged less than 11 months. The parameters measured were erythrocyte count (RBC), hematocrit value (Ht), mean corpuscular volume (MCV), hemoglobin concentration (Hb), total leucocyte count (WBC), and differential leucocyte count. No remarkable change was found with RBC during the whole period of this study. Relatively high values were obtained with Ht, MCV, and Hb in the newborns aged 0 to 7 days. These values continued to decrease until 3 months of age, after which the values increased again attaining approximately adult levels at 11 months of age. WBC was very high at birth and then decreased to the minimum level at 3 days of age. It was followed by gradual increase until about 4 months of age at which a nearly adult level was attained. Lymphocyte counts were smaller than neutrophil counts on the day of birth. However, this numerical relation was inverted 2 days after birth and the lymphocyte counts became markedly larger than the neutrophil counts about 1 week after birth. Additionally, the values obtained from the cord blood of 6 Cesarean-delivered newborns were compared with those from the blood taken 5 hours after cesarean delivery.

[Incidence of trauma in a breeding and rearing colony of cynomolgus monkeys (Macaca fascicularis)].

A statistical survey was performed in 1982 to ascertain the incidence of various diseases, especially trauma, in the cynomolgus monkey colony at Tsukuba Primate Center for Medical Science. In total, 1,029 cases of disease, occurred of which 866, 89 and 74 were surgical, internals and reproductive disease cases, respectively (Table 1). Among the 866 surgical cases, trauma (746 cases) was most often observed (Table 2). It was shown that trauma occurred most frequently during the group feeding of juvenile monkeys (Table 3). Analysis of the factors influencing the incidence of trauma during group feeding was carried out. As a result, it was revealed that the number of days after beginning group feeding and the age at which group feeding was begun had marked influences on the incidence of trauma (Figs. 1 and 2). However, there was no significant relationship between the incidence of trauma and the number of animals per group or the sex-ratio in a group (Tables 4 and 5). From the present survey results, a prospective rearing system should be established to reduce the incidence of trauma in the cynomolgus breeding and rearing colony.