Thrombus formation and growth after plaque disruption are affected by tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1) in acute coronary syndrome (ACS) . Recently, thrombus aspiration during emergency coronary angiography has allowed for histologic examination of thrombi and atheromas at the onset of ACS. To clarify the expression of TF and PAI-1 in the thrombus, we histopathologically examined samples aspirated during emergency coronary angiography from patients with ACS. One hundred seventy-eight patients with ACS were studied (147 men and 31 women: mean age, 65.6 years) . The area of whole thrombus, the area of white thrombus (platelets and fibrin), and the area of red thrombus (red blood cell and fibrin) were measured with an image analyzer after staining with hematoxylin and eosin, and phosphotungstic acid hematoxylin stain. Samples were then stained immunohistochemically with antibodies against TF and PAI-1. Immunostaining with antibodies against CD68, myeloperoxidase (MPO), and p-selectin was also performed. Mixed thrombi, composed of red and white thrombi, were observed in all 178 samples, and atheroma fragments were observed in 82 samples. In large thrombi (sample area<10 mm²), the red/white thrombus area ratio correlated significantly with the whole thrombus area (R=0.59, P<0.01) . In histopathological examination, TF was observed in macrophages, including foam cells, in atheroma fragments. In the thrombus, leukocyte infiltration was observed conspicuously in the boundary between white and red thrombi. TF and PAI-1 were observed on leukocytes with MPO and CD68 positive cells in the same area. Moreover, the percentage of TF and PAI-1 positive cells in the boundary between white and red thrombi significantly correlated to thrombus size. Growth of the thrombus is related to proliferation of red thrombus. TF and PAI-1 on leukocytes remote from atheroma fragments seem to participate in this process.

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We investigated the effects of different pacing rates (before pacing, 60, 80, 100 /min) on cerebral blood flow and hemodynamics in 5 patients (mean age 61.4 years) with a VVI pacemaker. We measured the cerebral blood flow at the middle cerebral artery using transcranial color Doppler imaging. We compared several pacing rates to hemodynamics such as stroke volume and cardiac output, as well as the cerebral blood flow velocity [maximum (Vmax), minimum (Vmin), and mean (Vmean) blood flow velocity] . Vmax was 0.9 ± 0.3 m/sec before pacing, and incrementally 1.2 ± 0.3 m/sec at 60 /min, 1.0 ± 0.3 at 80 /min, 0.9 ± 0.3 m/sec at 100 /min. Vmin was 0.3 ± 0.1 m/sec before pacing, 0.5 ± 0.2 m/sec at 60 /min, 0.4 ± 0.1 at 80 /min, 0.4 ± 0.1 m/sec at 100 / min. Vmean was 0.5 ± 0.1 m/sec before pacing, 0.7 ± 0.2 m/sec at 60/min, 0.6 ± 0.2 m/sec at 80 /min, 0.6 ± 0.1 m/sec at 100 /min. Stroke volume was 101.1 ± 27.3 ml before pacing, 119.1 ± 20.4 ml at 60 /min, 110.7 ± 18.0 ml at 80 /min, 104.3 ± 19.7 ml at 100 /min. Cardiac output was 4.0 ± 1.1 1/min at before pacing, 7.1 ± 1.21/min at 60 /min, 8.9 ± 1.9 1/min at 80 /min, 10.4 ± 2.01/min at 100 /min (p<0.05-P<0.01) . Blood flow velocity of the middle cerebral artery regarding stroke volume, Vmax, Vmin and Vmean was the highest at a pacing rate of 60 / min. From the results shown above, we conclude that the pacing rate of 60 /min gives the highest SV value, as well as the highest Vmax, Vmin, and Vmean values on blood flow velocity of the middle cerebral artery. Transcranial color Doppler imaging is non-invasive and a useful tool for observing changes of cerebral blood flow velocity at different pacing rates in patients with bradycardia necessary for cardiac pacing.

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While there have been numerous reports on surgical procedures (determination of the position of the bone tunnel, selection of a tendon graft, etc.) for the reconstruction of knee ligaments, particularly the anterior cruciate ligament (ACL), there have been few reports on the prevention of infections in these cases. We have published a number of reports on the therapeutic outcomes of reconstruction of the knee ligaments. In the present report, we describe“intraoperative innovation's, ”a preventive procedure against the development of infection after surgical reconstruction of knee ligaments. The subjects were 522 patients who underwent reconstructive surgery for knee ligaments under endoscopic observation from April 2001 to October 2005. From the insight we gained from our expresienece with infections since 2001, we continued to make innovations, including change of the suture thread material and the intraarticular indwelling drain. Recently, we developed the so-called“preservation of the ligament for reconstruction in Isodine”; i.e., the ligament is preserved in povidoneiodine until just before its insertion into the bone tunnel, and then washed with physiological saline before the actual insertion. There were 12 cases of infection between 2001 and 2004. However, there has not been a single case of infection since September 2004 when we began to practice“preservation of the ligament for reconstruction in Isodine.”Preventive procedures for infections, particularly the use of povidone-iodine, are essential for reducing the risk of suppurative arthritis, after endoscopic knee surgery, although the issue of cytotoxicity still remains to be evaluated.

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Wounded area infection in a percutaneous endoscopic gastrostomy (PEG) was examined for the infection in gastric fistula. 15 patients (males: 7, females: 8) . A mean age was 75.2 years (58-91 years old) . Five infectees and ten non-infectees. Distance from costa to gastric fistula was on the average 4.6 cm. Distance in the patients who had infection was on average 2.4 cm, distance in the patients who did not have infection was on average 5.7 cm. Distance from midline to gastric fistula was on the average 2.3 cm. Distance in the patients who had infection was on average 5.8 cm, distance in the patients who did not have infection was on average 0.6 cm. If there is not have infection, gastric fistula is used afterwards within two or three days. The patients who did not have infection did not have the trouble afterwards as far as we could chase it. If distance from costa is more than 5 cm, infection does not occur. In addition, the infection did not occur so that it was almost midline. When PEG is constructs, it is necessary more than 5cm at distance from costa to gastric fistula at least, and it is constructs at the place that is near to midline. It is supposed that can prevent an infection of postoperative by doing the above.

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The objective of this study was to examine the action of isoflavone on human endometrial cells. We determined the effect of a daidzein-rich isoflavone aglycone mixture (Dr. AglyMax^®) on the growth of hormone-dependent endometrial cancer cells (ISHIKAWA cell) in vitro. ISHIKAWA cells were plated into 96-well micoplates, treated with Dr. AglyMax^TM, and incubated for 24h. Cell proliferation was analyzed by ELISA using specific antibodies. We compared cell proliferation between Dr. AglyMax^®at a concentration of 100 μM and a control without Dr. AglyMax^®. Total RNA was isolated from cultured cells by the acid guanidine thiocyanatephenol/chloroform method. We also examined the changes in approximately 47, 000 gene expressions using a microarray method. Cell proliferation of the Dr. AglyMax^®-treated group was lower than that of the control group (67%) (p<0.01) . A total of 1165 genes were down-regulated and 1114 genes were up-regurated following treatment with 100 iM Dr. AglyMax^® . Our study suggests that daidzein-rich isoflavone aglycones inhibit endometrial cell growth and these genes, which are involved in steroid metabolism and cell cycles, are likely related to inhibition of cancer cell growth.

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A 31-year-old woman complained of tingly pain and itching in the mouth and throat immediately after she ate sushi with soy sauce. She also felt squeezing of the larynx. We suspected an allergy to raw fish or soy sauce, and performed detailed examinations to determine the allergen. CAP-FEIA and skin scratch (ST) tests were negative for soybeans, wheat and several types of fish, but positive for mackerel. Therefore, we assumed that the fish extract contained in soy sauce was responsible for the allergic oral and gullet symptoms. We then used a food elimination trial to confirm the allergy and performed scratch tests with all components of the soy sauce (pure soy sauce, sweet sake, extracts of bonito: skipjack tuna, extracts of tangle, and amino acids) . Extracts of bonito were strongly positive in this test, and therefore the oral allergy syndrome due to extracts of bonito was suspected. Soy sauce is a traditional Japanese seasoning made from soybeans and wheat, but fish extracts (so-called“dashi”) and various seasonings are often mixed with soy sauce for flavoring, but without indication on the product label. Japanese soy products such as tofu, soy sauce and natto have recently gained popularity in foreign countries, and it is important to be aware that additives in such products may cause allergic reactions. However, oral allergy syndrome due to food products derived from animals is relatively rare: therefore, we report this case as an example and provide a review of the literature.

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We describe a case of acute promyelocytic leukemia (APL) diagnosed in a woman at 11 weeks of gestation. The patient was successfully induced into hematologic remission by alltraps retinic acid (ATRA) . The role of ATRA and chemotherapy in APL during early gestation is discussed. A 38-year-old woman was admitted because of pancytopenea with disseminated intravascular coagulation diagnosed during pregnancy. Bone marrow aspirate demonstrated 92.9% abnormal cells which showed Auer bodies and faggot formation. Chromosomal analysis demonstrated an abnormality, t (15; 17) . The patient was diagnosed as having APL and started to receive ATRA treatment 70 mg/body/day. Hyperleukocytosis did not occur. Although fetal growth was not retarded, the patient, at her request, had intrauterine curettage on hospital day 47. The patient achieved complete hematologic remission on hospital day 65 with no major toxicities being recorded during induction. Management of pregnant patients with APL could be improved by using ATRA instead of conventional combinations of cytotoxic agents.

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