Objective: To assess the value of procedures for pre-operative diagnosis of cervical involvement of uterine corpus carcinoma. Materials and Methods: Four diagnostic procedures, including cervical cytology, endocervical curettage (ECC), magnetic resonance imaging (MRI), and hysteroscopy, were performed for diagnosis of cervical involvement in 60 patients with uterine corpus carcinoma. The preoperative diagnosis based on results obtained using by each procedure was retrospectively compared with the diagnosis based on histological examination of surgical specimens. Data were analyzed according to the standard definition of sensitivity, specificity, positive predictive value and negative predictive value. Results: Cervical involvement was confirmed in 18 patients (30%). ECC showed high sensitivity (90.9%) and specificity (88.9%). Cervical cytology showed high specificity (88.6%). MRI showed very high specificity (99.2%) and high sensitivity (88.5%) in cases with cervical stromal invasion. Conclusion: Cervical cytology and MRI are useful for excluding cervical involvement. ECC is useful for positive diagnosis. MRI may be useful for cases with stromal invasion. The use of a combination of several procedures is essential for obtaining an accurate diagnosis of cervical involvement in cases of uterine corpus carcmoma.
Collectins, C-type (Ca2+-dependent) animallectins with both collagenous and carbohydrate recognition domains, function as opsonins against pathogens. We previously described an N-cetylglucosamine (GlcNAc)-binding lectin (ficolin/P35) with a collagen- and a fibrinogen-like sequence present in human serum. In this report we show that ficolin/P35 can serve as an opsonin and enhance the clearance of pathogens having surface GlcNAc. Ficolin/P35 bound to an Ra chemotype strain of Salmonella typhimurium (TV119) which has an exposed GlcNAc at the non-reducing termini of the polysaccharide. On the other hand, ficolin/P35 did not bind to LT2, a smooth type strain of S. typhimurium with additional O-polysaccharides covering GlcNAc. Ficolin/P35 enhanced the uptake of TV119 by monocytes or polymorphonuclear leukocytes but had no opsonic activity towards LT2. These results suggest that, like collectins, ficolin/P35 is a collagenous lectin which has a role in innate immunity against certain pathogenic organisms by acting as an opsonin. We prepared monoclonal antibodies against ficolin/P35 and developed an enzyme-linked immunosorbent assay (ELISA) for measuring ficolin/P35 concentrations in humans. The mean serum concentration of ficolin/P35 from 130 normal individuals was estimated to be 13.7 μg/ml.
While following the course of patients with Wegener's granulomatosis (WG) in which it had been possible to achieve a remission, we encountered a patient in whom we observed granuloma formation in the subglottis. A tracheotomy was performed because of the risk of respiratory distress, and after that there was a recrudescence of the patient's WG. During the course of the above, the patient remained cANCA (anti-neutrophil cytoplasmis antibody with cytoplasmic pattern)-negative. When these facts were considered, it appeared that when the lesions are localized and progressing gradually, cANCA positivity does not develop. While cANCA test has gradually become a powerful tool for the diagnosis of WG, a comprehensive physical examination to identify localized lesions, together with biopsy and histopathological examination, should allow the diagnosis of WG.
This study aimed to demonstrate the temporal bone histopathology of two cases of Wegener's granulomatosis in which the initial symptoms were profound hearing loss and facial nerve palsy respectively. The first case, a woman of 44, suffered profound hearing loss which was remarkably improved by steroid and cyclophosphamide treatment for a time, and which seemed to be caused by invasion from granulation tissue filled in the tympanic cavity. The second case was a 61-year-old woman presenting with the facial nerve palsy. The bony canal of the horizontal portion of the facial nerve was destroyed due to granulation tissue which filled in the tympanic cavity, and granulomatous involvement was observed in the facial nerve. Wegener's granulomatosis can involve the middle ear and/or inner ear, causing hearing loss of conductive, mixed or sensorineural type. Pathogenesis of facial nerve palsy seems to be related to Wegener's granulomatous involvement of facial nerve, because the facial nerve palsy also resolved by using steroid and cyclophosphamide.
A 70-year-old, menopausal Japanese woman with large uterine tumor underwent total hysterectomy. Microscopic examination revealed a myxoid leiomyosarcoma with 5 to 6 mitoses/10 high power field (HPF). Immunohistochemically, the tumor cells reacted with desmin, suggesting that they are derived from uterine smooth muscle cells. The patient was treated with the combination chemotherapy consisting of cisplatin, adriamycin and cyclophosphamide, and she has been free from disease for 70 months after the operation.
An-18-year-old woman was admitted to the medical center near her home with complaints of high fever and severe headache in June 1995. A diagnosis of adult-onset Still's disease was suspected and 50 mg/day of prednisolone was orally administered. In early April 1997, the patient suffered from sudden bilateral hearing loss and high fever. Pure tone audiogram taken at the same time showed an asymmetric bilateral neurosensorial hearing loss. A diagnosis of Cogan's syndrome was made. Administration of 60 mg prednisolone daily improved fever. Audiogram taken one month after administration of prednisolone showed improvement in the right ear. Monthly cyclophosphamide pulse therapy 700 mg combined with oral prednisolone was instituted. This combination therapy enabled the successful tapering of prednisolone without recurrence of hearing loss. Combined corticosteroid and pulse cyclophosphamide therapy would appear to be one effective regimen for Cogan's syndrome.
In this article, author summarizes the experience as a visiting scholar in Fukushima Medical University. The current status and technical innovations of living related liver transplantation in Japan are comprehensively evaluated. New approaches for islet transplantation in the laboratory of Prof. Gotoh and author's preliminary experience of the experimental islet xenotransplantation are also succinctly reported. In the meantime, the author emphasizes the importance of an “open” department and library in which there is a great difference by comparison with that in China. I had an opportunity to study as a visiting scholar in Fukushima Medical University from July 6th to Sept. 28th, 2000. Here, I summarize what I saw and learnt, which have left a deep impression on my memory in Fukushima.