The correlation between Salter's criteria for avascular necrosis of the femoral head and Kalamchi's prognostic classification following the treatment of developmental dysplasia of the hip.

AIMS: The aim of this study was to evaluate the correlation between Salter's criteria and Kalamchi's classification of avascular necrosis in patients treated for developmental dysphasia of the hip (DDH). PATIENTS AND METHODS: The study involved a retrospective analysis of 123 patients (123 hips) with DDH treated by operative and non-operative reduction before the age of two years, with a minimum follow-up of ten years. Salter's criteria (S1 to S4) were determined from radiographs obtained at one to two years post-reduction, whilst the Kalamchi grade was determined from radiographs obtained at ten or more years of age. Early post-reduction radiographs were also used to evaluate the centre-head distance discrepancy (CHDD) and the occurrence of a dome-shaped deformity of the proximal femoral metaphysis (D-shaped metaphysis). The prognosis was described as good (Kalamchi grade K0 or KI), fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for analysis and correlation with the early Salter criteria, CHDD and D-shaped metaphysis. RESULTS: S1 and S2 criteria were predictive of a poor prognosis. The outcome following S3, S4 and S3 + S4 varied; 18 (40%) had a good prognosis, 17 (38%) a fair prognosis and ten (22%) a poor prognosis. A CHDD ≥ 10% and a D-shaped metaphysis were also predictive of a poor prognosis. CONCLUSION: The Salter criteria were predictive of the Kalamchi grade of avascular necrosis in patients with DDH aged ten or more years after reduction of the hip. Cite this article: Bone Joint J 2017;99-B:1115-20.

New superselective intra-arterial infusion via superficial temporal artery for cancer of the tongue and tumour tissue platinum concentration after carboplatin (CBDCA) infusion.

We developed a new technique of superselective intra-arterial chemotherapy for tongue cancer using a modified (1.35 mm) angiographic catheter. The catheter was confirmed to be inserted into the lingual artery by the new technique. We measured the platinum concentrations in resected tumour tissues after infusion of carboplatin (CBDCA) at 20 mg/m2 over 30 min from 30 min before tumour resection in 12 patients with cancer of the tongue (6 patients: superselective intra-arterial infusion; 6 patients: conventional intra-arterial infusion). The mean platinum concentration in tumour tissue was 10.5 +/- 1.2 micrograms/g wet, which was more than twice higher than, and significantly different from, 4.3 +/- 3.8 micrograms/g wet by the conventional intra-arterial infusion method. This new superselective intra-arterial infusion method allows direct infusion of the anticancer agent into the artery supplying the tumour and is expected to become a new therapeutic modality for cancer of the tongue.

Noninvasive measurement of renal function with 99mTc-MAG3 gamma-camera renography based on the one-compartment model.

OBJECTIVE: The aim of this study was to develop a method for measuring renal function with 99mTc-MAG3 gamma-camera renography without blood or urine sampling and evaluate its feasibility. PATIENTS, MATERIAL AND METHODS: Twelve patients with nephrological disorders underwent 99mTc-MAG3 renography and para-aminohippurate clearance measurement. Plasma clearance of 99mTc-MAG3 (ClMAG) was calculated through early renal uptake of 99mTc-MAG3 after appropriate correction of parameters (background, measured attenuation coefficient of 99mTc, and the actual depth of kidneys measured with computed tomography), and on one-compartment assumption of the kinetics of 99mTc-MAG3. We compared the resultant ClMAG with standard effective renal plasma flow (ERPF), using the para-aminohippurate clearance method and with simulated ClMAG derived from the two-compartment model. RESULTS: ClMAG calculated by the one-compartment model (283+/-131 ml/min, mean +/- SD) correlated with ERPF (r = 0.94, p <0.001), and was similar to the simulated ClMAG estimated from the two-compartment model in all patients (283+/-139 ml/min). CONCLUSION: This alternative method, which employs theoretical modeling of the pharmacokinetics of 99mTc-MAG3, may provide easy, noninvasive measurement of individual renal function without blood sampling or in vitro equipment. Further studies should be warranted.

Accuracy of standardized uptake value measured by simultaneous emission and transmission scanning in PET oncology.

We assessed the accuracy of the standardized uptake value (SUV) measured by simultaneous emission and transmission scanning in cancer patients using FDG positron emission tomography (PET). Conventional, independent emission (E)/transmission (T) scans and simultaneous E/T scans were conducted consecutively in 30 patients who underwent FDG PET examinations. The SUVs of 35 mass lesions and 34 selected normal tissues were derived from the independent E/T scan and simultaneous E/T scan. Experimental studies using a cylindrical phantom were also conducted to evaluate the accuracy and reproducibility of the SUV derived from a simultaneous E/T scan. The SUVs of 18F solution in the phantom were estimated to be approximately 1, with high reproducibility in the range of total counts observed in the clinical examinations. There were no significant differences in the SUVs in 35 tumours derived from simultaneous E/T scans and those derived from independent scans, and there was a strong positive correlation between the two (r = 0.99, P < 0.01). There were also no significant differences in the SUVs in 34 normal tissue regions derived from simultaneous E/T scans and those derived from independent scans. In conclusion, simultaneous E/T scanning with FDG in patients with malignant tumours is a valid method, since the SUV derived from the simultaneous scan is accurate and reproducible.

Mass mortality of the Japanese pearl oyster Pinctada fucata martensii in relation to water temperature, chlorophyll a and phytoplankton composition.

Mass mortalities of the Japanese pearl oyster Pinctada fucata martensii have widely occurred in western Japan since 1994. The causes of these mass mortalities are at present not thoroughly understood. In this study, we investigated oyster survival in relation to some environmental factors such as water temperature, concentration of chlorophyll a and density or composition of phytoplankton. The examined mass mortality occurred from September to December 1998, and the color on the adductor muscle of the oysters was red-brown, suggesting an infectious disease. Oysters that became moribund during the experiment lost weight, while the weight of unaffected oysters increased. The cell density of Nitzschia spp., an inedible algae for the oyster, in Uchiumi Bay increased before and during the mass mortality event. From the results of our study, we hypothesize that P. fucata martensii was weakened by starvation because of the dominance of inedible food and then contracted an infectious disease that resulted in mortality.

Alternating myocardial sympathetic neural function of athlete's heart in professional cycle racers examined with iodine-123-MIBG myocardial scintigraphy.

Myocardial sympathetic neural function in professional athletes who had the long-term tremendous cardiac load has not been fully investigated by myocardial iodine-123-metaiodobenzylguanidine (MIBG) uptake in comparison with power spectral analysis (PSA) in electrocardiography. Eleven male professional cycle racers and age-matched 11 male healthy volunteers were enrolled in this study. The low frequency components in the power spectral density (LF), the high frequency components in the power spectral density (HF), the LF/HF ratio and mean R-R interval were derived from PSA and time-domain analysis of heart rate variability in electrocardiography. The mean heart-to-mediastinum uptake ratio (H/M ratio) of the MIBG uptake, in professional cycle racers was significantly lower than that in healthy volunteers (p < 0.01) and HF power in professional cycle racers was significantly higher than that in healthy volunteers (p < 0.05). In the group of professional cycle racers, the H/M ratio showed a significant correlation with the R-R interval, as indices of parasympathetic nerve activity (r = 0.80, p < 0.01), but not with the LF/HF ratio as an index of sympathetic nerve activity. These results may indicate that parasympathetic nerve activity has an effect on MIBG uptake in a cyclist's heart.

Introducing a downsized, open computer system with asynchronous transfer mode in PACS and its effect on image data transfer.

To assess the effectiveness of the introduction of a downsized, open computer system and asynchronous transfer mode (ATM) as a network in a medium-sized picture archiving and communication system (PACS), we conducted experiments on image data transmission. The speed of image transfer, including registration in the computers in the new PACS, was four to eleven times faster than that in our first PACS. However, the introduction of ATM did not contribute significantly to the improvement of speed of image transfer because of the use of Ethernet branches between the gateway and display workstation computers. A star architecture without Ethernet branches may be suitable for PACS using an ATM network.

[Use of urinary hydroxyproline excretion as a marker of bone metastases in prostatic cancer (1)].

Twenty-four hour urinary hydroxyproline and urinary hydroxyproline creatinine ratio was measured without prior dietary restriction in 24 patients with prostatic cancer and 16 patients with benign prostatic hypertrophy. Both were elevated in patients with prostatic cancer with active bone metastases compared to the values of prostatic cancer without bone metastasis and benign prostatic hypertrophy. In these cases, the values of urinary hydroxyproline creatinine ratio were more reliable. The results show that urinary hydroxyproline creatinine ratio is a very sensitive indicator of active bone metastases of prostatic cancer without dietary restriction.

[Prostatic specific antigen (PA) in mass screening for prostate cancer].

The usefulness of prostatic specific antigen (PA) was compared with that of prostatic acid phosphatase (PAP). PA was determined in the serum of 2,183 patient examined by the mass screening for prostate cancer from 1987 to 1990. The serum samples of these patients were obtained from our serum bank. PA was measured by the E test "TOSOH" II (PA). The relationship of PA and PAP to prostate size estimated by digital rectal examination (DRE) and ultrasound tomography (US), and age was investigated. PA and PAP correlated with aging and prostate size estimated by DRE. However PA was more apparently related with these things. The correlation between PA and prostatic size estimated by US was relatively high (r = 0.53), but the correlation between PAP and prostate size estimated by US was low (r = 0.20). When the upper limit of normal range was set at 6.0 ng/ml, the sensitivity, specificity and efficiency was 64%, 97% and 62%, respectively. PA was more sensitive than PAP and could be more useful since none of the patients with prostate cancer was PAP positive and PA negative. We conclude that PA should be a reliable tumor marker in our mass screening system.

[Clinical evaluation of Augpenin (clavulanic acid-ticarcillin) in urinary tract infections: especially against beta-lactamase producing strains].

Augpenin contains ticarcillin (TIPC) and clavulanic acid (CVA), at a ratio of 15:1. The beta-lactamase inhibitor, CVA, has been added to protect the TIPC from inactivation by beta-lactamase. To investigate the drug efficacy and safety against urinary tract infections (UTI), Augpenin was administered to 33 patients with chronic complicated UTI and 7 patients with acute pyelonephritis. Thirty two cases were evaluable by the UTI criteria. Excellent results were obtained in 6 of the cases of acute pyelonephritis, and moderate results in 1 case, with an overall effectiveness rate of 100%. Excellent results were obtained in 14 of the cases of chronic complicated UTI, moderate results in 9 cases, and poor results in 2 cases, with an overall effectiveness rate of 92%. No adverse reactions were noted, but a transient elevation of glutamic oxaloacetic transaminase and glutamic pyruvic transaminase levels was observed in 2 cases.

[Significance of prostatic specific antigen in the mass screening for prostate cancer].

The significance of prostatic specific antigen (PSA) was investigated in the subjects examined by the mass screening for prostate cancer from 1985 to 1990. All subjects was examined by digital rectal examination (DRE) and with prostatic acid phosphatase (PAP) and the subjects in whom prostate cancer (Pca) was suspected from abnormal DRE and/or elevated PAP were recommended to receive the secondary screening to confirm the presence of Pca. PSA was measured by radioimmunoassay using Ball-Elsa-PSA-kit. 1,600 serum samples were obtained from our serum bank. The relationship among PSA, prostate size estimated by DRE and age was investigated. PSA was increased with age and the prostate size, PSA being more closely related with the latter. Therefore, we estimated that PSA has an ability to detect benign prostatic hypertrophy (BPH) in the mass screening. This estimation should be confirmed by using an ultrasound tomography because the prostate size obtained by DRE is inaccurate as compared with that obtained by ultrasound tomography. The cut off level of PSA was determined by control which was composed from the subjects with normal size prostate and one with BPH. When the cut off level was 8.6 ng/ml, the sensitivity, specificity and efficiency as Pca marker was 73.9%, 97.4% and 97.1%, respectively. PSA was more than 8.6 ng/ml in all of Pca with elevated PAP. PSA was expected to improve the Pca detection rate in our mass screening system.

[Voiding disturbance in elderly males examined by prostate mass screening. Gunma Urological Oncology Study Group].

Information about voiding disturbance was obtained from 34,140 elderly males in Gunma Aged Club Association (Q group) through a questionnaire and from 8,129 males by prostate mass screening for prostate disease (MS group) as to: (1) the characteristics of the subjects examined by the mass screening, (2) the relationship between the voiding disturbance and aging and (3) the frequency of voiding disturbance in the normal elderly males. In MS group, the percentage of young subjects, especially less than 60 years old, who complained voiding disturbance was higher than the expected percentage on the assumption that it increases with aging. The percentage of voiding disturbance in these young subjects was also higher than that of males in the same decade in Q group. In their past and present history, the percentage of benign prostatic hypertrophy (BPH) in these young subjects was higher than the expected percentage on the assumption that the incidence of BPH increases with aging. Judging from these results, it was estimated that they were not satisfied with the medical care by which they were treated or were being treated, and they received this mass screening to obtain consultation for their complains. Loss of the force was related with the prostate size estimated by digital rectal examination but not with aging. However, nocturia was well related with aging but not with the prostate size. Hesitancy, strain and dribbling were not apparently related with either the prostate size or aging. It was demonstrated that frequency of nocturia was 0 to 1 in less than 60 years old normal males, 0 to 2 in 60 to 79 years old ones and 0 to 3 in over 80 years old ones. The other symptoms studied in each decade were also analyzed and discussed.

[The significance of six sextant biopsy for prostate cancer].

The significance of six sextant ultrasound guided biopsies of the prostate (SS-biopsy) was evaluated in a total of 114 patients. The presence of prostate cancer was suspected (Pca) in 59 subjects through mass screening (MS) for Pca and in 47 patients in out-patient clinics (OPC). The recurrence (REC) was suspected in 3 patients diagnosed previously as Pca. All of them had elevated PSA, abnormal digital rectal examination (DRE) and/or abnormal transrectal ultrasonography (TRUS). All of these tests in 5 patients with benign prostate hypertrophy (BPH) were normal. Moreover, in 34 patients among them, oriented biopsies were performed to the area where Pca was suspected by DRE and or TRUS. Twelve Pca patients were detected in MS group (20.3%), 17 Pcas in OPC group (36.2%) and 3 Pcas in REC group (100%). No Pca patients were detected in BPH group. In 12 Pca patients with T1 or T2, only one Pca patient (8.3%) had over 3 Pca samples among the samples obtained by SS-biopsy. In 20 patients with T3 or T4, 13 patients (65%) had over 3 Pca samples. There was significant relationship between T category and Pca sample numbers among 6 samples obtained by SS-biopsy (p < 0.01). Ten of 12 Pca patients in MS group (83.3%) and 8 of 17 patients in OPC group (47.1%) had less 3 Pca samples. Pca was detected in 9 of 34 patients examined by the oriented biopsy. However al of these Pca were detected by SS-biopsy. It may be not necessary to examine Pca suspected patients by the oriented biopsy if they were examined by this SS-biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prognostic factor for prostate cancer. Gunma Urological Oncology Study Group].

The study of prognostic factors in patients with prostate cancer (Pca) may be of value in understanding the natural history of the disease and may also assist in planning and analyzing the results of clinical trials. Moreover some information through this study would be beneficial to assessing the prognosis and decision of better therapy form of individual patients. The significance of items studied was evaluated from the two view points, survival rate and Pca death rate. Stage, pathological differentiation and acid phosphatase were significantly related to them, in the category grade depending manner. Past history and complication, and age were also significantly related to them but higher category grade as a survival factor showed lower Pca death rates. ESR, gait disturbance and hematuria were related to only survival rate. Any significant relationship was not observed in serum testosterone, voiding disturbance and cancer-pain. Prognostic factors should be clinically used through the well understanding of each characteristics. This paper also showed that statistical significance not always provide a wide difference between categories compared.

[The analysis of prognostic factors for prostate cancer by multivariate analysis].

Multivariable analysis (quantification method I and II) was used to investigate the relationship between survival rates and prognostic factors. The items studied were age, stage, pathological differentiation, gait disturbance, acid phosphatase and erythrocyte sedimentation rate (ESR). The data were available for 353 patients for all items. The significance of each item was evaluated in all patients-group, subgroup stratified by their cause of death, and subgroup stratified by their stage. The significance of age and gait disturbance which represent the general condition was proven in all patients, non-cancer death group and stage ABC group. In the cancer death group, stage D group was the most significant as prognostic factor. ESR was the most significant in the stage D group and the significance was gradually increased with the observation time.

Radioimmunoassays for melatonin using an antiserum raised against a novel antigen.

The highly specific antiserum to melatonin (MT) was produced, and the sensitivity and specificity of the radioimmunoassays (RIAs) using this antiserum was investigated. An immunogen was synthesized by binding 6-hydroxy-melatonin (6-OH-MT) to bovine serum albumin with a spacer of 6-bromohexanoic acid ethyl ester. Rabbits were immunized subcutaneously once a month with 1.0 mg of the immunogen for 7 months. The antiserum was characterized by a crossreactivity test by RIA using 125I-labelled MT. The antiserum specifically recognized MT but hardly did other analogues except for 6-OH-MT with a crossreactivity of only 0.4%. Two RIAs were established using [o-methyl-3H]MT and 2-[125I]iodo MT. In both RIAs, inhibition curves for MT were obtained in the range of 10 pg to 10 ng and 1-2 ng of MT inhibited the value of the assay at "0" by half. The similarity of the RIAs in sensitivity and inhibition by unlabelled MT is discussed on the basis of the structures of radioactive MTs and that of the immunogen.

[Age estimation from tooth attritions of lower incisors--discussion on the "Amano's method"].

As a method of age estimation from teeth we focused our attention on attritions of lower incisors. Using the Amano's method, we took records of tooth attritions in the planted state of 83 subjects whose ages ranged from 14 to 76 years. A positive correlationship was found to exist between the tooth attrition index and the actual age, allowing to establish the following formula which graphically shows a straight line: Y = 8.505X + 26.073 (r = 0.607), where X is the mean of attrition indexes of lower incisors and Y, the estimated age. In our method of age estimation through attrition indexes, we took advantage of probability and confidence interval. In addition, our method was contrasted with Amano's method, a widely used one in Japan.

[Schizophrenia and ocular misalignment: phenotypic and genetic association analysis].

The increased incidence of minor physical anomalies (MPAs) in schizophrenia is the fundamental basis for the neurodevelopmental hypothesis of schizophrenia etiology. Ocular misalignment falls into the category of MPAs, but this phenotype has not been assessed in schizophrenia. This study reveals that constant exotropia displays marked association with schizophrenia. To assess the genetic mechanisms, we examined the transcription factor genes ARIX and its paralogue, PMX2B. We identified frequent deletion/insertion polymorphisms in the 20-alanine homopolymer stretch of PMX2B, with a modest association between these functional polymorphisms and constant exotropia in schizophrenia. The polymorphisms were also associated with overall schizophrenia and more specifically with schizophrenia manifesting strabismus. These results suggest a possible interaction between PMX2B and other schizophrenia-precipitating factors, increasing the risk of the combined phenotypes. This study also highlights the unique nature of the polyalanine length variations found in PMX2B.

[Age-associated increase in amount of DNA adducts in rat and human organs and its application to age estimation].

An age-associated increase of I-compounds, kinds of DNA adducts, was investigated in DNA extracts from various organs of rat and human for the possible application of it to the age estimation in legal medicine. Detection and relative quantitation of the I-compounds were made by 32P-postlabeling assay which is commonly used for analyzing DNA-adducts. In rats which were from 4 to 69 weeks old, the positive correlation was observed between age and relative I-compound level. A coefficient of correlation ranged from 0.906 to 0.435; the highest was that of the kidney and the lowest was that of the liver. Similar correlation was observed in the human aged from 18 to 79 years old (n = 22-24). A coefficient of correlation ranged from 0.700 to 0.415; the highest, the kidney and the lowest the liver, although coefficients of correlation in human were approximately 10-20% lower than those in rats. In spite of the fact that there were many considerable factors that affect to the amount of the I-compound, for example, various circumstances until death, diets, diseases and causes of death, those results in human encouraged us to estimate age from soft tissues. The regression lines of every organs obtained in this study (heart: Y = 44.018X + 28.527, standard error of estimate (S.E.) = 13.40, liver: Y = 88.099X + 23.833, S.E. = 13.76, kidney: Y = 218.029X + 3.263, S.E. = 12.14, brain: Y = 105.626X + 21.697, S.E. = 11.82, lung: Y = 36.838X + 26.891, S.E. = 12.94) enabled us to estimate age. The author found that this method was sufficiently useful even in comparison with previous methods for the age estimation from soft tissues.

Development of prostate cancer in a patient with primary hypogonadism: intratumoural steroidogenesis in prostate cancer tissues.

Intratumoural steroidogenesis may play a significant role in the progression of prostate cancer (PC) in the context of long-term ablation of circulating testosterone (T). To clarify the mechanism accounting for the progression of PC in a 74-year-old man who had undergone bilateral orchiectomy when he was 5 years old, we performed immunohistochemical studies of androgen receptor (AR) and steroidogenic enzymes in the prostate. We also measured steroid hormone levels in the serum and prostate, as well as mRNA levels of genes mediating androgen metabolism in the prostate. Positive nuclear staining of AR was detected in malignant epithelial cells. The levels of androstenedione (Adione), T, and 5-alpha dihydrotestosterone (DHT) in the serum of the patient were similar to those in PC patients receiving neoadjuvant androgen deprivation therapy (ADT), but were higher in the patient's prostate than in PC patients not receiving ADT. The gene expression of CYP17A1 and HSD3B1 was not detected, whereas that of STS, HSD3B2, AKR1C3, SRD5A1, and SRD5A2 was detected. Moreover, cytoplasmic staining of HSD3B2, AKR1C3, SRD5A1, and SRD5A2 was detected in malignant epithelial cells. Hence, in the present case (a man with primary hypogonadism), steroidogenesis in PC tissues from adrenal androgens, especially dehydroepiandrosterone sulphate, was the mechanism accounting for progression of PC. This mechanism might help elucidate the development of castration-resistant PC.