The levels of amyloid β protein (Aβ) and α1-antichymotrypsin (ACT) in cerebrospinal fluid (CSF) were evaluated as diagnostic markers of Alzheimer's disease (AD). The total of 95 subjects included 38 patients with AD, 14 with early-onset AD and 24 with late-onset AD, 25 normal control subjects, and 32 patients with other neurological diseases. The ACT levels were also examined in CSF from 66 patients with AD, 27 with early-onset AD and 39 with late-onset AD, and 54 normal control subjects. The level of Ag in the CSF of early-onset AD patients (n=14, 4.14 ± 1.37 pmol/ml) was significantly higher than in the age-matched controls (n=12, 2.27 ± 1.44 pmol/ml) (p<0.01). The level of CSF ACT in the late-onset AD group (n = 22, 5. 92±4.88μg/ml) was higher than in the normal control group (n=24, 2.27±1.40μg/ml) (p <0. 01). In the study of ACT in the larger group of subjects, the ACT level in the CSF of late-onset AD group (n=38, 7.02±5.18, μg/ml) was significantly higher than in the normal control group (n=53, 2.81±1.39μg/ml) (p<0.001). Thus, it is concluded that Aβ levels in the CSF are elevated in early-onset AD patients, and that the CSF ACT levels are elevated in late-onset AD patients. Clinical evaluation referring to both markers should be useful for the clinical diagnosis of AD.

View full abstract

We evaluated the method of multi-fractionated stereotactic radiotherapy using the linear accelerator with soft and painless fixation for selected patients with intracranial tumors. Stereotactic radiotherapy became available as a result of being able to evaluate the characteristics required for dose calculation, flatness of the dose distribution and dose measurement methods in small radiation fields. Dose distributions with and without various size cones for the narrow beam were calculated by film dosimetry. The absorbed doses at several reference points were calculated with an Si-semiconductor detector, shallow ionization chamber or a JARP (Japanese Association of Radiological Physicists) dosimeter. The results of the calculations suggested that the use of cones was useful to achieve a flat dose distribution and that the Si-semiconductor detector was better for narrow-beam dose calculations than other dosimeters. We simulated stereotactic radiotherapy for intracranial lesions fifteen times using a human head phantom and delivered 200cGy per fraction to a target point in the phantom. The mean absorbed doses for the calculated doses at the target point was 206cGy. We concluded that the Si-semiconductor detector with the smallest sensitive volume is the most suitable field dosimeter, and our methods of fractionated stereotactic radiotherapy were corroborated by an assessment of factors that might cause dose uncertainty.

View full abstract

24-hour ambulatory blood pressure (ABP) was measured in 184 patients with cerebral infarction (CI) and 14 normal controls. Hardly any of the patients with brainstem infarcts, multiple lacunar state or Binswanger's disease exhibited the normal nocturnal blood pressure (BP) decrease. Patients with CI in the lateral tegmentum of the pons displayed increases in nocturnal BP, suggesting that this region may be related to the normal circadian rhythm of BP.
The Binswanger's disease patients had significantly higher ABP and systolic-ABP standard deviation (SD) values than the normal controls. The ABP levels were correlated with Hasegawa Dementia Scale scores. It was postulated that both leukoaraiosis and dementia are closely associated with hypertension and high ABP variability, while the severity of dementia was accelerated by the low BP appearing in the last stages of Binswanger's disease.
Ninety-five patients with CI and hypertension were followed for 3 to 51 months (mean : 36. 5). The CI recurrence rate was 4.9% per patient-year and lowest in patients with a diastolic-ABP of 80 to 84 mmHg and systolic-ABP of 130 to 139 mmHg. Therefore, antihypertensive therapy should aim at these values to prevent recurrence of CI.

View full abstract

Chronic cerebral circulatory insufficiency (CCCI) is a recently proposed clinical entity characterized by symptoms such as dizziness, a feeling of heavy-headedness or vague numbness without any neurological signs or organic vascular lesions on CT. In order to elucidate its pathogenesis, ultrasonic quantitative blood flow measurement system, positron emission tomography (PET) and MRI were employed to study three groups of subjects : 60 subjects with CCCI (group A), 44 subjects with risk factors for cerebrovascular disease but without neurological abnormalities (group B), and 40 normal healthy volunteers (group C).
The results are summarized as follows :
1) Mean common carotid blood flow decreased with age in all groups. Common carotid blood flow was lowest in group A and second lowest in group B in every decade of patient age.
2) PET study revealed that CBF and CMRO₂ in all regions examined were significantly lower in group A than in group C.
3) The incidence of MR signal abnormalities in the white matter increased with age. Group A had the highest incidence, and group C had the lowest.
4) Reduction in mean common carotid blood flow and cerebral blood flow was associated with increasing incidence and severity of MR signal abnormalities.
These findings indicate that CCCI is a pathologic condition closely related to diffuse cerebral low perfusion resulting from cerebral arteriosclerosis. The symptoms seen in this condition, which are apt to be taken lightly, may warn of impending ischemic stroke.

View full abstract

Murine fibrosarcoma cell line Gc-4 PF grows exponentially in protein-free medium. The effect of conditioned medium of this tumor cell line on its growth was examined. The dye exclusion test and MTT assay showed that its growth was inhibited by addition of the crude fraction concentrated from the conditioned medium of this tumor cell line. The more cells plated initially, the earlier the inhibitory effect on growth was detected, suggesting that these cells produced a putative inhibitory factor (s) and that it acted on the cells in an autocrine fashion. Flow cytometric analysis using Hoechst 33342 dye revealed that the conditioned medium concentrate increased the number of small cells staining blue with strong fluorescence. However, neither cleavage of DNA into internucleosomal fragments nor its cleavage into high molecular weight fragments, which could be detected by pulse field gel electrophoresis, was augmented by addition of the conditioned medium concentrate. Flow cytometry showed no marked induction of cell cycle arrest in a specific phase of the cell cycle by the conditioned medium concentrate, although 10% decrease in cells in the S phase and 10% increase in the G2/ M phase were detected. These results suggest that Gc-4 PF cells that can grow in protein-free culture medium secrete a factor (s) which induces their own death and that the process of cell death might be apoptosis, which is independent of DNA fragmentation.

View full abstract

Treatment of metabolic acidosis with sodium bicarbonate is still controversial. A CO₂-absorbing alkalizing agent composed of an equimolar mixture of sodium bicarbonate and disodium carbonate was recently developed to compensate for the drawbacks of bicarbonate, however, the significance of premixing them was unclear. Changes in the pH of arterial blood have been the major concern when evaluating and correcting acid-base balance, however, in severely disturbed circulatory states the cellular environment is more clearly reflected by changes in venous blood than arterial blood. The aim of this study was to determine the comparative effects of sodium bicarbonate and carbonate on mixed, portal and hepatic venous blood under both steady-state and low-perfusion conditions in anesthetized dogs. Arteries and pulmonary, portal and hepatic veins of adult mongrel dogs were cannulated. Hemorrhagic shock at a mean arterial pressure of 40 mm Hg was introduced for 60 min. One mEq/kg of either sodium bicarbonate (Bicarb at 1M ; N = 8 dogs) or sodium carbonate (Carb at 0.5M ; N = 7 dogs) was infused before and after induction of shock. Hemodynamics, blood gas and lactate levels were measured before, 1 min, and 15 min after infusion of the buffers. Administration of the buffers did not result in any significant change in the Pco₂ of the venous blood even in the presence of low perfusion, but did increase the Pco₂ of arterial blood. The difference between the change in P_CO2 in arterial and venous blood seems to be attributable to the Haldane effect. The pH in venous blood had increased more with Carb than Bicarb at 1 min after buffer infusion (p <0.05), reflecting the difference in degree of change in CO₂ production induced by infusing the different buffers. Moreover, under low perfusion conditions, infusion of Bicarb produced a progressive increase in hepatic uptake of lactate. Infusion of Bicarb over 5 min had no deleterious effect on the pH or the Pco₂ of the mixed, portal, or hepatic venous blood in the steady and low perfusion states in comparison with infusion of equivalent doses of Carb. It is concluded from the result of the present study that sodium bicarbonate can be safely used in a disturbed circulatory states.

View full abstract

Primary chemotherapy and postchemotherapeutic salvage surgery for residual tumors were definite strategies for progressive testicular cancer. To resect multiple metastatic lesions, the one-stage operation consisted of retroperitoneal lymphnode dissection, thoracotomy, sternotomy or cervical dissection was performed by the staffs of urological and surgical units. Although the operation took a rather long time, no definite complications did not occur.The metastatic lesions were able to be resected completely in all cases.Recurrence occured in 2 patients with pure teratoma and another salvage surgery was performed to them. As a current status, three patients have no evidence of disease and one have no radiographical abnormality with a slight elevation of β-hCG level. We concluded that the one-stage operation for multiple lesions was well tolerable and was beneficial for the management of progressive testicular cancer.

View full abstract

We reviewed the clinical characteristics of non-germ cell testicular or paratesticular tumor. Of 95 patients with testicular or para-testicular tumor treated at Gunma University Hospital from January 1982 to December 1994, 5 (5.2%) had non-germ cell tumor. Malignant lymphoma, rhabdomyosarcoma and metastatic testicular tumor from renal cell carcinoma were seen in 2, 2 and 1 patients, respectively. Patients with malignant lymphoma and rhabdomyosarcoma were treated with combination chemotherapy and have no evidence of disease. Although, non-germ cell testicular or paratesticular tumor is rare, it contains important diseases with highly malignant potentials. We should take a great attention to such an entity in management of intrascrotal tumor, particularly testicular cancer.

View full abstract

Three approaches to central cranial base lesions are reported based on experience with orbital advancement in craniosynostosis. The basal approach for large lesions is indicated for total superior orbitotomy after bilateral frontal craniotomy. The basal interhemispheric approach by superomedial orbitotomy with bilateral frontal craniotomy was used for midline, suprasellar and third ventricle lesions. The orbitozygomatic approach by superolateral orbitotomy after front-temporal craniotomy was performed for the spheno-orbital lesion, cavernous sinus lesion and high-placed basilar top aneurysm. Our surgical techniques for each approach are described with case presentations, and the management of frontal sinus, dural and bone defects are stressed to prevent of liquorrhea.

View full abstract

Endoscopic hemostasis is the treatment of first choice for bleeding gastric ulcer. Endoscopic submucosal or perivascular ethanol injection and microwave coagulation are widely used. These methods of endoscopic hemostasis permit control in most bleeding cases. In some cases however, endoscopic hemostasis is impossible or re-bleeding occurs after endoscopic hemostasis. In these cases, distal gastrectomy is the most common treatment for both control of peptic ulcer and for control of bleeding. Recently, medical control of peptic ulcer has become routine and effective, so distal gastrectomy is considered to over invasive for the treatment of bleeding ulcer. In the standpoint of view, we have concluded that reliable hemostasis by direct suture is necessary to manage theses patients. For this procedure, mini-laparotomy (about 5cm length) and mini-gastrectomy is satisfactory, and it is very important for surgical invasion.
Since 1994, We have encountered 12 patients in whom endoscopic hemostasis had failed and mini-laparotomic operation was performed. The average operating time was 53 minutes and average length of hospital stay was 12 days. All of the patients have been discharged and no evidence of recurrence. We therefore conclude that mini-laparotomic direct suture hemostasis is the treatment of first choice in bleeding gastric ulcer in which endoscopic management has failed.

View full abstract

An epidemiological survey of young diabetic patients (15-45 years) was conducted in Gunma Prefecture in 1994. The prevalence of young diabetic patients in Gunma Prefecture was 10.4 percent of 9522 diabetic patients from 22 clinics in Gunma. There were 471 (58.9%) male patients and 329 (41.1%) female patients. Insulin-dependent diabetes mellitus (IDDM) was present in 64 cases (23.3%). The percentage of female patients with IDDM was 40%, and higher than percentage of male patients with IDDM (16%). There were 83 cases (34%) patients with triopathy. The prevalence of young diabetic patients was rather high and suggesting intensive care is necessary in Gunma Prefecture.

View full abstract

Seventeen patients with bilateral primary breast cancer (4.2% of all breast cancers) treated in our hospital from 1984 to June, 1995 were investigated in regard to clinical, histologic and prognostic characteristics. In five patients (1.2%) the lesions were synchronous and in 12 they were metachronous (3.0%). The ratio of synchronous to metachronous cases was 1 : 2.5. Mean age in the synchronous cases was 59.0 years. Mean age at the time of the first metachronous cancer was 48.0 years, and at the time of the second, 60.8 years. Two metachronous cases were diagnosed at an interval of over 30 years. The clinical stage in the synchronous cases was 1 Tis, 6 stage I, 2 stage II and 1 stage III b, In the first metachronous cancers there were 6 patients with stage I, and 4 with stage II lesions. The second cancers were stage I lesions in 4 patients, stage II in 5 patients, stage III a in 1 patient, and stage IV in 2. The stage of the second cancer was more advanced than that of the first. The pathological type of most of the lesions was solid-tubular carcinoma and papillo-tubular carcinoma. Axillary lymph node involvement was found in 2 (20%) of the synchronous cases and 10 (42%) of the metachronous cases. Only one patient was for lymph node positive bilaterally. Four synchronous and 7 metachronous cases have had a disease-free survival. In patients with unilateral breast cancer, examination of the contralateral breast, regular and long-term follow up, and breast self-examination are important in the early detection of a second breast cancer.

View full abstract

A clinicopathological study was conducted on 26 patients undergoing conservative breast surgery breast-conserving surgery [BCS] in 17, and 9 subcutaneous mastectomies with axillary dissection [SM] in 9, and 23 patients treated by BCS+ radiotherapy in our hospital between 1992 and July 1995. BCS was performed in 11% of all 160 breast cancers. The mean age of the patients was 50.8 years. There were 2 Tis lesions, 8 stage I, and 7 stage II. Mean tumor size was 1.9cm and tumor-nipple distance was 4.7cm. Surgical methods consisted of 2 quadrantectomies, 14 wide excisions and one lumpectomy. Fourteen patients were given subsequent radio therapy to the breast. Axillary node metastasis was positive in 4 of 16 cases. During a median follow-up period of 22 months, no patient developed recurrence. The SM patients had 2 Tis lesions, 1 stage I and 6 stage II with a mean tumor size of 2.7cm and a tumor-nipple distance of 3.1cm. They were all negative for node metastasis. Seven patients underwent breast reconstruction. The patients with BCS plus radiotherapy received a total dose of 50 Gy with 10 MV Linac X-rays. There were few side effects of radiation, and the cosmetic results were almost always good. The breast conserving-procedures have yielded a satisfactory cosmetic appearance and good outcome.

View full abstract

A 21-year old man with embryonal carcinoma arising from anterior mediastinum was treated with high dose chemotherapy with autologous bone marrow transplantation. His elevated α-fetoprotein level was decreased and the metastatic pulmonary lesion was disappeared. Surgical specimen of the residual tumor revealed complete necrosis. He has no signs of recurrence of tumor after 4 years of completion of the treatment. We thought that an early intensive chemotherapy for poor-risk tumor brought successful outcome.

View full abstract

A 43-year-old man with ulcerative colitis had severe irritative voiding symptoms manifested by frequency and pain on urination. The initial diagnosis was acute bacterial cystitis, and he received antimicrobial therapy. After initial treatment failure, a biopsy was performed and histological examination confirmed eosinophilic cystitis. The patient had been taking the herbal medicine “sairei-to” for 6 months. Dramatic resolution of his symptoms was obtained when discontinued taking the drug.

View full abstract

We encountered a patient with mucocele of the appendix causing strangulation ileus. A 71-year-old female was admitted because of abdominal pain, abdominal distension and vomiting. The patient underwent emergency surgery with a diagnosis of strangulation ileus. The mucocele of the appendix had adhered to the ileum, producing strangulation of the ileum of 1.5m proximal to the cecum. The appendix and the necrotic ileum were resected. Strangulation ileus is a rare complication of mucocele of the appendix. This is the 14th case report in Japan.

View full abstract