Summary A 74-year-old female developed pneumonia following herpes simplex encephalitis. Her white blood cell counts reached 28,400/μl, about 90% of which consisted of granulocytes. The polymorphonuclear (PMN) elastase/α1-arantitrypsin complex levels increased and reached the maximum of 5,019 ng/ml, indicating the release of a large amount of elastase derived from the granulocytes. The mechanism of PMN elastase release was most likely to be granulocyte destruction associated with phagocytosis. The cleavage of fibrinogen and fibrin by PMN elastase, independent of plasmin, was indicated by the presence of the fragments in immunoprecipitated plasma from the patient corresponding to elastase-induced FDP D and DD fragments and the absence of fragments corresponding to plasmin-induced FDP D and DD fragments on SDS-PAGE. These findings suggested that the large amount of PMN elastase released from the excessive numbers of granulocytes in this patient with herpes simplex encephalitis and pneumonia, induced the cleavage of fibrinogen and fibrin without the participation of plasmin.
We compared the level of fecal bile acids and neutral sterols in 15 Japanese with large bowel carcinoma and 10 healthy controls. There was no significant difference in the amount of total fecal bile acids and neutral sterols between the patients and the controls. However, the amount of primary bile acids, especially chenodeoxycholic acid, tended to be higher in the patients. Conversely, lithocholic, β-lithocholic and 3α-hydroxy-12-ketocholanoic acid levels were higher in the controls. Trace amounts of 3α-hydroxy-6-ketocholanoic acid were detected in some of the patients; none was found in the controls. Although a hasty conclusion should be avoided in the present study, it is of considerable interest that there was a difference in fecal bile acid composition between large bowel carcinoma patients and healthy controls.
Bathing in hot water induces vasodilatation of the peripheral vessels and alteration of blood distribution. Using a Doppler flowmeter, we evaluated the effect of bathing in hot water on portal hemodynamics. Eight controls and 8 patients with compensated liver cirrhosis remained immersed in hot water at 42 degrees C for 5 minutes. Portal flow significantly decreased from 811 +/- 141 (ml/min) at the baseline to 530 +/- 98 in the controls and from 855 +/- 308 to 642 +/- 208 in cirrhotics immediately after bathing. This decrease (25%) in cirrhotics was significantly less than that (35%) in controls because vessel diameter did not decrease as rapidly as it did in controls. Portal flow after 30 minutes returned to the baseline values in controls but remained low in cirrhotics. These findings suggest that cirrhotics have a lower hemodynamic response to bathing in hot water compared with that in controls.
α -Fetoprotein (AFP) messenger RNA (mRNA) in the peripheral blood of patients with hepatocellular carcinoma (HCC) may indicate hematogenous spread of HCC. This study examined the presence of AFP mRNA in the blood of 148 patients, in terms of clinical parameters, tumor metastasis and survival rate. For the prospective study, 109 patients with HCC were followed in the period between March 1996 and March 1999. AFP mRNA in the blood was examined by means of nested reverse transcription polymerase chain reaction. AFP mRNA was detected in the blood in 23 (15.5%) of 148 patients with HCC. AFP mRNA in the blood was significantly correlated with protein induced by vitamin K absence or antagonist II level, higher AFP level (200 IU/mL or more) and extrahepatic metastases, but not with tumor size, number of tumor nodules or tumor-nodule-metastasis stage. This prospective study confirmed that intra- and extra-hepatic metastases developed more frequently in the 22 AFP mRNA-positive patients than in the 87 AFP mRNA-negative patients (P < 0.01). The cumulative survival rate was significantly lower in the former than in the latter ( P < 0.01). In conclusion, AFP mRNA in the blood is closely related to hematogenous spread and might be a good predictor of metastasis and poorer survival rate in HCC patients.
Abstract: Superoxide dismutase (SOD) activities in Parkineon's disease (PD) were significantly lower than those in controls, especially in a treated PD group. However, SOD activities in an untreated PD group did not decrease. There was a signillcant correlation between SOD activities and the duration of illness in the treated PD group (p<0.05). There was a significant correlation between SOD activities and the present doses of L‐DOPA/carbidopa in the treated PD group.
This study was performed to examine the role of the endothelial constitutive NO synthase (ecNOS) gene in patients with abdominal aortic aneurysm (AAA).We determined the distributions of polymorphism in intron 4 of the ecNOS (ecNOS4) gene, amplified by polymerase chain reaction, and compared the allele frequencies between subjects with abdominal aortic aneurysms (AAAs) and healthy individuals.Fifty-eight patients with AAAs and 410 race-matched healthy controls were studied.Two alleles of the ecNOS4 gene, containing 4 (a-allele) and 5 (b-allele) repeats, were identified. We found that the a-allele frequency of this gene was significantly higher in the surgical than in the non-surgical group.The results of this study suggest that the a-allele of the ecNOS4 gene is indicative of the need for surgery for AAA. Analysis of the alleles of the ecNOS4 gene polymorphism could provide useful information concerning the clinical course of AAA progression.
Percutaneous ethanol injection therapy has been used widely for small hepatocellular carcinoma. This study was undertaken to determine factors predictive of local recurrence or new nodular recurrence in patients with small hepatocellular carcinoma treated with percutaneous ethanol injection.The authors studied 73 nodules treated with percutaneous ethanol injection in 49 patients with small hepatocellular carcinoma. The usefulness of predictive factors for recurrence was assessed with the Kaplan-Meier method. The clinicopathologic variables examined included age, gender, Child-Pugh classification, number of tumors (single vs. multiple), tumor size, degree of tumor differentiation, ultrasonographic findings such as peripheral hypoechoic band (so-called 'halo'), intratumoral echo pattern, tumor staining on enhanced computed tomography, combination therapy with transcatheter arterial embolization, and serum alpha-fetoprotein level.The local recurrence rates were 19%, 27%, 33%, 33%, and 33%, respectively, and the new nodular recurrence rates were 19%, 51%, 74%, 83%, and 83%, respectively, at 1, 2, 3, 4, and 5 years after percutaneous ethanol injection therapy. The frequency of local recurrence was associated with the histologic differentiation of more than moderately differentiated (P < 0.001), presence of a sonographic halo (P < 0. 005), an intratumoral heterogeneous echo pattern (P < 0.001), and positive tumor staining on enhanced computed tomography (P < 0.01). Multivariate analysis showed that the presence of a halo and an intratumoral heterogeneous echo pattern were the most important variables for predicting local recurrence. The frequency of new nodular recurrences was related to the presence of multiple tumors (P < 0.01) and a high serum alpha-fetoprotein level (P < 0.001). Multivariate analysis showed that a high serum alpha-fetoprotein level was a reliable predictor of new nodular recurrence.This study showed that the presence of a halo and an intratumoral echo pattern on ultrasonography were useful predictors for local recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma, and that a high serum alpha-fetoprotein level was associated with a higher frequency of new nodular recurrences.
A case of an uncommon granulomatous lesion of the parotid gland is presented. A tumorous lesion was pointed out in the upper left neck region of a 63 year old Japanese female and then extirpated. Histologically, the tumor arose in the parotid gland and showed a chronic granulomatous lesion with lymphocytes and histiocytic cells, including the multinucleated foreign body type. In addition, numerous so‐called crystalloids were deposited throughout the lesion. The crystalloids were partially positive on von Kossa's stain and non‐birefringent under polarized light. To the authors’knowledge, this is the second reported case of crystalloid granuloma of the parotid gland since the first one was described by Takeda in 1991.
