bluuebunny/crossref_metadata_2025 huggingface dataset:
So‐called ‘hybrid’ lesion of desmoplastic and conventional ameloblastoma: Report of a case and review of the literature
Authors: Takata Takashi , Miyauchi Mutsumi , Ogawa Ikuko , Zhao Ming , Kudo Yasusei , Sato Sunao , Takekoshi Toshitsugu , Nikai Hiromasa , Tanimoto Keiji
Published: March 2003

So‐called ‘hybrid’ lesion of ameloblastoma, which is composed of desmoplastic ameloblastoma and conventional follicular/plexiform ameloblastoma, is an unusual variant of ameloblastoma and only eight cases of ‘hybrid’ lesion have been published in the English literature. To enhance knowledge of this interesting tumor, we add a case of ‘hybrid’ lesion that occurred in the right mandible of a 48‐year‐old Japanese male. Radiographic examination disclosed a honeycomb appearance at the anterior alveolar region, combined with a unicystic radiolucency in the molar region of the mandibular body. Histologically, the former showed microscopic features of desmoplastic ameloblastoma and the latter those of follicular ameloblastoma with focal granular cell transformation. The lesion was enucleated with curettage of surrounding bone and the lesional cavity was marsupialized. Although tumor tissues reappeared at 3, 5, 7 and 14 months after the surgery, the patient has remained disease free for 11 years after the last vaporization by CO2 laser of the recurred tumor. Many more cases of ‘hybrid’ lesion are needed to clarify the clinicopathological, histopathological and biological characteristics of this interesting variant of ameloblastoma.
Endotoxin priming and liver damage by experimental duodenal obstruction in the rat
Authors: Pirisi Mario , Scott Cathryn A. , Fabris Carlo , Cavarape Alessandro , Federico Edda , Falleti Edmondo , Beltrami Carlo A.
Published: March 2003

To verify whether endotoxin (LPS) might act as a priming cofactor of liver injury caused by obstructing the duodenum, four groups of male Wistar rats were studied. The first two groups comprised rats in which a closed duodenal loop (CDL) was created: CDL, n= 6 and CDL + LPS, n= 7; the next two groups comprised sham‐operated animals: Sham n= 6 and Sham + LPS, n= 6. LPS, 400 μg/kg bodyweight, was administered i.p. to the rats belonging to groups CDL + LPS and Sham + LPS, 24 h before laparotomy. Twenty‐four hours after laparotomy the animals were killed. Damage to bile ducts, extent and grading of coagulative and lytic spotty necrosis in liver tissue were evaluated morphologically. Coagulative necrosis was severe in four of seven rats of the group CDL + LPS, mild in six of six rats of group CDL, and absent in four of six and five of six rats of groups Sham and Sham + LPS (χ2 32.8, P= 0.0001). The animals of group CDL + LPS had more frequently diffuse lytic spotty necrosis than the animals in the three other groups (χ2 9.57 P< 0.01). The results of our study indicate that, in rodents subjected to a closed duodenal loop, priming with LPS exacerbates liver injury due to cholate stasis.
Alterations of myoepithelial cells in the rat mammary gland during pregnancy, lactation and involution, and after estradiol treatment
Authors: Jin Hua Shu , Umemura Shinobu , Iwasaka Toshiki , Osamura R. Yoshiyuki
Published: March 2003

Hormone‐induced alterations of myoepithelial cells in the mammary gland have not been fully investigated. The aim of the present study was to examine whether myoepithelial cells are altered in response to hormonal conditions. The immunohistochemical findings of smooth muscle actin for myoepithelial cells were studied during pregnancy, lactation and involution, and after estradiol dipropionate (ED) treatment (50, 500, 1000 μg/kg per week for 1–4 weeks) using a total of 71 Wistar female rats. Myoepithelial cells showed a stratified appearance around ducts during pregnancy, extended cytoplasmic processes with wider distance during lactation, and vacuolated cytoplasm after weaning. ED treatment (50–1000 μg/kg per week) for 1 week increased myoepithelial cells to a variable degree, achieving a level similar to that in pregnancy, but ED treatment for 4 weeks reduced them as the dose elevated. The present study showed that the myoepithelial cells became hyperplastic or hypertrophic by low‐dose ED treatment within the physiological range, while weaning pups, and excess high‐dose ED treatment beyond the physiological range or prolonged ED treatment induced reduction of the myoepithelial cells. Results indicate that myoepithelial cells themselves are also altered by hormonal conditions coordinating the mammary gland development.
Clear cell sarcoma arising in the transverse colon
Authors: Fukuda Takeaki , Kakihara Toshio , Baba Kyoko , Yamaki Toshifumi , Yamaguchi Tomiko , Suzuki Toshimitsu
Published: March 2003

A case of clear cell sarcoma (CCS) arising in the transverse colon is presented. The tumor consisted of sheets or small nests of epithelioid malignant cells possessing pleomorphic nuclei with one or more prominent nucleoli and ample clear or slightly eosinophilic cytoplasm. Some of the tumor cells contained various amounts of melanin pigments that were confirmed by histochemical and ultrastructural examinations. Immunohistochemical examination showed a positive immunoreactivity for HMB45 and S‐100 protein. A metastatic nodule, which was found 9 months after surgery, showed similar histological findings to those of the primary one but lacked melanin pigments. Reverse transcriptase– polymerase chain reaction using total ribonucleic acid obtained from metastatic nodule demonstrated the presence of EWS‐ATF‐1 fusion gene. Based on these findings, the present case tumor is a CCS of the colon.
Effects of various implant materials on regeneration of calvarial defects in rats
Authors: Lim Sung‐Chul , Lee Mi‐Ja , Yeo Hwan‐Ho
Published: March 2003

The purpose of the present study was to determine the best implant material, the best conditions to substitute absorbable membrane for non‐absorbable membrane, and the factors influencing guided regeneration of critical size defects using experimental rats. An 8‐mm circular transosseous calvarial bony defect was made and implant materials, such as demineralized freeze‐dried bone (DFDB), absorbable membrane (BioMesh; Samyang Co., Seoul Korea), non‐absorbable membrane (Millipore filter; Micro Filtration System, MA, USA) or a combination of these materials, was placed on the defect. As for the results of sequential time‐based guided bone regeneration, histological, histochemical, immunohistochemical and histomorphometric aspects were observed, and a statistical comparative analysis was performed, with control group of a soft tissue flap. Bone formation was significantly enhanced when DFDB was retained within the defect with a protective absorbable membrane. Inframembranous DFDB‐filling was required to prevent membrane collapse and to preserve spaces for bone regeneration. The absorbable membrane which was recommended to overcome the disadvantages of the non‐absorbable membrane should remain intact for more than 5 weeks in order for it to be effective. The macrophages recruited by grafts were involved partly in decreasing bone regeneration via the sequential events of releasing fibronectin, and in chemotactic effect of the fibronectin to fibroblasts and collagen lay‐down. Thus, the activity of new bone formation was dependent upon the physical barrier effect of the membrane, such as the preserving ability to secure spaces and the suppression ability of early infiltration of collagen and epithelium, inducible ability of inflammation by the implant material, and potential in guiding bone regeneration of the grafts.
Granzyme B‐positive primary gastric T‐cell lymphoma: Gastric T‐cell lymphoma with the possibility of extrathymic T cell origin
Authors: Murata Tetsuya , Nakamura Shigeo , Oka Koji , Kawakami Keiki , Kato Masami , Imai Takazumi , Nakayama Tsuyoshi , Kuroda Makoto , Nakano Hiroshi , Watanabe Masatoshi , Shiraishi Taizo
Published: March 2003

A case of primary gastric T‐cell lymphoma, which was positive for granzyme B, is reported. The patient was a 47‐year‐old Japanese female who complained of a dull upper abdominal pain. Radiographic and endoscopic examinations revealed an ulcerative infiltrative lesion in her stomach. Following the confirmation of a high‐grade malignant lymphoma, a distal gastrectomy with regional lymph nodal dissection was performed. The histology of the gastric lesion revealed a malignant lymphoma of the diffuse pleomorphic type without lymph nodal involvement. Immunohistochemistry revealed that the tumor cells were positive for LCA, CD3, TIA‐1 and granzyme B, but were negative for CD4, CD8, CD56, CD30, L‐26, EMA, TCR α/β and TCR γ/δ. Because the tumor cells showed T cell nature with cytotoxic activity proved by TIA‐1 and granzyme B, and without evidence of further maturation of T cell, a malignant lymphoma originating from extrathymic‐derived T cells was suggested.
Expression of the hepatocyte growth factor/c‐Met pathway is increased at the cancer front in breast carcinoma
Authors: Edakuni Genichiro , Sasatomi Eizaburo , Satoh Toshimi , Tokunaga Osamu , Miyazaki Kohji
Published: March 2003

Expression of hepatocyte growth factor (HGF) and c‐Met (HGF receptor) has been reported in many neoplasms. We investigated coexpression of HGF and c‐Met to determine the role of the HGF/c‐Met pathway in breast carcinoma, especially at the cancer front. Eighty‐eight cases of carcinoma of the breast were studied by immunohistochemistry and by in situ hybridization for HGF and c‐Met expression. The staining pattern was termed ‘front accentuation pattern’ when it was most conspicuous at the cancer front. HGF and c‐Met proteins were expressed in cancer and stromal cells, with autocrine and paracrine patterns. The front accentuation pattern of c‐Met was observed in cancer cells, but not in stromal cells. The front accentuation pattern was not observed in HGF. Coexpression of HGF and c‐Met at the cancer front was correlated with histologic grade, reduced patient survival and a high Ki‐67 labeling index. Our findings suggest that the HGF/c‐Met pathway acts primarily as a mitogen, especially at the cancer front, in a paracrine manner and affects some clinical factors, including patient survival.
Participation of endothelial cells and transformed mesangial cells in remodeling of glomerular capillary loops in Thy‐1 nephritis
Authors: Zhang Lianshan , Nakazawa Koh , Shigematsu Hidekazu
Published: March 2003

The relationship between mesangial cells (MC) and endothelial cells (EC) in the remodeling of glomerular capillary loops was investigated in a rat model of anti‐Thy‐1 antibody (Ab)‐induced glomerulonephritis. Immunohistochemical analysis showed that cells positive for α‐smooth muscle actin (α‐SMA) appeared in the mesangial stalks at day three, and had increased in number at day seven, after injection of Thy‐1 Ab. Double staining for α‐SMA and proliferating cell nuclear antigen (PCNA) showed that some MC expressing PCNA were negative for α‐SMA at day three, but by day seven almost all PCNA‐positive MC expressed α‐SMA. Western blotting for α‐SMA from isolated glomeruli was negative at day one after injection of Thy‐1 Ab, but positive at day seven. Type III collagen appeared at day seven, followed by an increase of EC in the capillary loops, as determined by double immunofluorescent staining for rat endothelial cell antigen‐1 (RECA‐1) and type III collagen. RECA‐1‐positive cells increased rapidly in number after day seven and eventually showed the same distribution pattern as that in control rats. Both type I and type III collagens were expressed in the mesangial and the ballooning area of the glomerulus at day seven. Electron microscopy revealed that immature MC and EC forming small capillary lumina appeared in the enlarged mesangial area at day seven. In accordance with the increase of capillaries and the enlargement of the lumina, the number of MC and the amount of mesangial matrix decreased gradually, and most of the glomeruli returned to a normal structure by week 4. These data show that type I and type III collagen produced by transformed MC may be of benefit to proliferation of EC and remodeling of the capillary in Thy‐1‐induced nephritis.
HHV‐8 infection status of AIDS‐unrelated and AIDS‐associated multicentric Castleman's disease
Authors: Suda Tetsuji , Katano Harutaka , Delsol Georges , Kakiuchi Chihiro , Nakamura Tomoko , Shiota Mami , Sata Tetsutaro , Higashihara Masaki , Mori Shigeo
Published: March 2003

Multicentric Castleman's disease (MCD) is a clinicopathologically defined entity characterized by systemic lymphadenopathy with unique pathomorphology such as angiosclerosis, blood vessel proliferation in and around follicles, and plasmacytosis. While its pathogenesis has remained unclarified for many years, identification of the human herpesvirus 8 (HHV‐8) in at least some MCD cases has opened new perspectives in this field. Because previous reports have described many inconsistencies regarding HHV‐8 positivity in MCD, we intended to clarify this issue by the introduction of more convincing methodologies. For this investigation, we introduced two antibodies produced in our laboratories that recognize a latent gene product ORF73 and a lytic gene product ORF59, together with two well‐recognized methods, in situ hybridization for the detection of lytic phase transcript T1.1/nut‐1, and genomic polymerase chain reaction (PCR). Eighty‐two cases of MCD were collected from Japan (n= 75) and France (n= 7). In three cases, the patients were suffering from acquired immunodeficiency syndrome (AIDS). Immunohistochemistry and in situ hybridization showed identical results: only three out of 82 cases were positively stained, and all the positive cases were found to be the patients with AIDS. Genomic PCR was done in 43 cases, and only one case produced positive results: the only AIDS case among the 43 cases studied by genomic PCR. Histopathologically, the HHV‐8‐positive cases showed the highest intensity of angiosclerosis and germinal center / perifollicular vascular proliferation, while plasmacytosis was not severe in the HHV‐8‐positive cases. Some of the HHV‐8‐negative MCD cases displayed similar histopathology, but at a far less intense level, except for the plasmacytosis. These results suggest that: (i) all three of the HHV‐8‐positive MCD patients in the present group are the patients with AIDS; and (ii) HHV‐8‐positive MCD patients develop typical but marked angiosclerosis and vascular proliferation that might be differentiated from HHV‐8‐negative MCD patients, who showed far less intense changes.
Overexpression of osteopontin in hepatocellular carcinoma
Authors: Gotoh Masahiro , Sakamoto Michiie , Kanetaka Kengo , Chuuma Makoto , Hirohashi Setsuo
Published: March 2003

Human hepatocellular carcinoma (HCC) is one of the most common and aggressive malignancies. In order to identify genes involved in HCC progression, we conducted a differential display analysis and found osteopontin (OPN) to be overexpressed in HCC. OPN is known to be a secreted adhesive glycoprotein, associated with tumorigenesis and metastasis in several cancers. Quantitative polymerase chain reaction analysis of 30 HCC cases revealed the average ratio of OPN to glyceraldehyde‐3‐phosphate dehydrogenase in tumors to be significantly higher than that in the surrounding non‐cancerous liver (4.7 ± 1.6 vs 0.18 ± 0.04, P = 0.0072). Immunohistochemistry confirmed the OPN protein was expressed mainly on cancer cells, and was positive in 12 of 30 HCC, most of which showed transcript overexpression. Both OPN transcript and OPN protein were significantly overexpressed in HCC with capsular infiltration, compared with HCC without capsular infiltration. Moreover, OPN‐positive cancer cells were often dispersed in the periphery of cancer nodules and were adjacent to stromal cells. Although OPN overexpression was not related to vascular invasion or intrahepatic metastasis, OPN was suggested to play a role in HCC, especially in cancer–stromal interactions.
Alterations of chaperone protein expression in presenilin mutant neurons in response to glutamate excitotoxicity
Authors: Maezawa Izumi , Wang Baiping , Hu Qubai , Martin George M. , Jin Lee‐Way , Oshima Junko
Published: March 2003

Mutations in the presenilin‐1 (PS1) gene underlie the most common form of familial dementia of the Alzheimer type (DAT). We demonstrated previously that the expression of PS1 with a M146V mutation in transgenic mice potentiates glutamate toxicity to neurons, due to an altered calcium homeostasis. Here, using a subtractive cDNA library approach, we report the identification of several genes, the altered expression of which may be associated with this unique PS1‐related vulnerability to glutamate. The identified genes, including chaperonin subunit 2 and nucleophosmin 1/B23, are involved in the intracellular trafficking of proteins and ions. Northern blot analysis revealed that the effect of glutamate on calcium‐binding proteins was augmented in neurons from PS1 mutation mice, compared with neurons from mice lacking other genes relevant to the pathogenesis of DAT (FE65 and APOE) or neurons from control wild‐type mice. Interestingly, mRNA for two chaperone proteins were expressed at lower levels specifically in neurons from PS1 mutant mice. These findings suggest that PS1 mutations may, in part, contribute to the development of DAT via altered expression of chaperone proteins.
Molecular relationships within Bostrychia tenuissima (Rhodomelaceae, Rhodophyta)
Authors: Zuccarello Giuseppe C. , West John A. , Karsten Ulf , King Robert J.
Published: March 2003

Bostrychia tenuissima King and Puttock is restricted to southern Australia and New Zealand. Previous studies in Australia have revealed two distinct patterns in the presence of osmotically active polyols. Southern populations only have D‐sorbitol whereas northern populations have both D‐sorbitol and D‐dulcitol. These polyol patterns lead to speculation on the ecotypic differentiation of these two population types. Using single‐stranded confirmation polymorphism to rapidly score plastid haplotypes, plus DNA sequencing, a 100% congruence was found between polyol patterns and plastid haplotype. Analysis of 33 B. tenuissima isolates shows that the plastid relationships closely follow biogeo‐graphic regions, with south‐eastern Australia (southern NSW and Victoria) and South Australia and Tasmania having one haplotype and central and northern NSW having two alternate haplotypes. There is an overlap at the haplotype boundary just south of Sydney, New South Wales.
New and interesting desmids (Zygnematales, Chlorophyceae) collected from Asia
Authors: Kanetsuna Yoshiyasu
Published: March 2003

Many desmid taxa were found in collections from Asia (Japan, Cambodia, Malaysia and Thailand). The following 21 new taxa and two new combinations belonging to five genera (Closterium, Euastrum, Cosmarium, Xanthidium and Staurastrum) and a rare species of Xanthidium, are reported. These include Closterium nasutum Nordstedt var. kazukoae Kanetsuna var. nov., Closterium nematodes Joshua var. nematodes f. kriegeri Kanetsuna f. nov., Euastrum binale (Turpin) Ehrenberg ex Ralfs var. protuberans Kanetsuna var. nov., Euastrum borgeanum Scott et Prescott var. cambodiense Kanetsuna var. nov., Euastrum dubium Nägeli var. protuberans Kanetsuna var. nov., Euastrum fissum W. et G. S. West var. yasukoae Kanetsuna var. nov., Euastrum gemmatum Brébisson var. tenuius Krieger f. porosum (Förster) Kanetsuna comb. nov., Euastrum pseudojenneri Scott et Prescott var. glabrum Kanetsuna var. nov., Cosmarium denticulatum Borge var. multispinum (Hirano) Kanetsuna comb. nov., Cosmarium furcatospermum W. et G. S. West var. fallax Kanetsuna var. nov., Cosmarium pileatum Borge var. cambodiense Kanetsuna var. nov., Cosmarium retusiforme (Wille) Gutwinski var. incrassatum Gutwinski f. retusum Kanetsuna f. nov., Cosmarium trapezoideum Kanetsuna sp. nov., Cosmarium zonatum Lundell var. zonatum f. majus Kanetsuna f. nov., Xanthidium cristatum Brébisson var. delpontei Roy et Bisset f. mizoroensis Kanetsuna f. nov., Xanthidium fasciculatum Ehrenberg ex Ralfs var. siamense Kanetsuna var. nov., Xanthidium pseudofreemanii Kanetsuna sp. nov., Xanthidium subtrilobum W. et G. S. West var. inornatum Skuja f. depressum Kanetsuna f. nov., Xanthidium subtrilobum W. et G. S. West var. inornatum Skuja f. singulare Kanetsuna f. nov., Staurastrum boergesenii Raciborski var. verrucosum Kanetsuna var. nov., Staurastrum dickiei Ralfs var. polypyrenoideum Kanetsuna var. nov., Staurastrum neglectum G. S. West var. fuseense Kanetsuna var. nov., Staurastrum trissacanthum Scott et Prescott var. dissacanthum Scott et Prescott f. longispinum Kanetsuna f. nov., and a rare interesting form, Xanthidium superbum Elfving var. centricornis Prowse.
Thoracoscopic procedures for intrathoracic diseases: The present status
Authors: Asamura Hisao
Published: March 2003

Thoracoscopic operations, alternatively termed as video‐assisted thoracic surgery (VATS), are replacing the variety of surgical procedures which have been otherwise performed by open thoracotomy. The minimally invasive nature of the procedure, reduced postoperative pain, shortened hospital stay, and reduced cost, are the potential advantages of VATS. While these merits are being proven, the limits to this technique are also getting clearer. In fact, VATS has already become a standard treatment of choice in several diseases, such as bullectomy for spontaneous pneumothorax and biopsy for indeterminate nodule and diffuse interstitial lung disease, while others, such as major video‐assisted lung resection for lung carcinoma and resection of metastatic lung tumour, await further evaluation of their roles in terms of oncological and technical aspects. Three issues that currently need to be addressed as the present role of thoracoscopy evolves are instrumentation, economics, indication, and end results in certain procedures.
Progressive bronchial obstruction associated with toxic epidermal necrolysis
Authors: Minamihaba Osamu , Nakamura Hidenori , Sata Makoto , Inage Minoru , Shirakabe Masanori , Tanida Hideki , Osada Yukie , Kondo Shigeo , Tomoike Hitonobu
Published: March 2003

Toxic epidermal necrolysis (TEN) is an acute life‐threatening condition, characterized by erosion of the mucous membranes, extensive detachment of the epidermis, and severe constitutional symptoms. Pulmonary complications of TEN are reported as rare, but are one of the most common causes of death. Our report focuses on an unusual case of toxic epidermal necrolysis which showed multiple bronchial obliteration during the chronic phase of the disease. Biopsied tissue of the obliterated bronchi demonstrated non‐specific granulation. To improve the obliterated ventilatory function, we tried to reopen the bronchial obliteration using a balloon catheter under the guidance of fibreoptic bronchoscopy, however rapid restenosis of the bronchi ensued.
Regulation of ventilation before and after sleep in patients with obstructive sleep apnoea
Authors: Fuse Katsuya , Satoh Makoto , Yokota Tatsuya , Ohdaira Tetsuro , Muramatsu Yoshiyuki , Suzuki Eiichi , Arakawa Masaaki
Published: March 2003

The objective was to examine whether abnormal breathing during sleep may affect regulation of ventilation after awakening in patients with obstructive sleep apnoea (OSAS). In 19 patients with OSA and 12 normal subjects we examined ventilatory responses to hypoxia (HVR) and to hypercapnia (HCVR) before and after sleep (BS and AS), and compared the changes in ventilatory responses with respiratory events during sleep. In the OSA group, the values of resting ventilation were significantly smaller in AS than those in BS and end‐tidal partial pressure of CO2 in arterial blood (PCO2) (PETCO2) rose significantly from BS to AS. The slopes of the HVR or HCVR did not differ between BS and AS. However, both the response lines shifted downward and minute ventilation (VE)80 (VE at arterial oxygen saturation (SaO2) of 80%) in HVR and VE60 (VE at PETCO2 of 60 mmHg) in HCVR decreased significantly from BS to AS. The percentage changes of VE80 and VE60 were significantly correlated with mean SaO2, total sleep time below SaO2 of 90% and lowest SaO2 during sleep. However, in normal subjects we observed no circadian variation in their ventilatory responses. These data support the hypothesis that repeated episodes of nocturnal hypoxia and hypercapnia may modify the regulation of ventilation after awakening in patients with OSA.
Effect of early application of biphasic positive airway pressure on the outcome of extubation in ventilator weaning
Authors: Jiang Jiunn‐Song , Kao Shang‐Jyh , Wang Shin‐Ning
Published: March 2003

Extubation failure is significantly associated with increased morbidity and mortality in mechanically ventilated patients. In respiratory distress after extubation, non‐invasive positive pressure ventilation (NIPPV) has been suggested to avoid the complications of invasive mechanical ventilation. The purpose of this study was to evaluate the effect of early application of NIPPV on extubation outcome. We conducted a prospective study in 93 extubated patients with a mean age of 72.7 ± 14.7 years (range, 24–93). Elective extubation was performed in 56 patients and unplanned extubation occurred in 37 patients. After extubation, patients randomly received either biphasic positive airway pressure (BIPAP) therapy (n = 47) or unassisted oxygen therapy (n = 46). Non‐invasive positive pressure ventilation was delivered via face mask in BIPAP group. Of the 93 extubated patients, 73 (78.5%) were successfully extubated, and 20 (21.5%) had to be re‐intubated. There were no significant differences in age, sex, pre‐extubation blood gas data between re‐intubated patients and those who were not re‐intubated. While seven of the 46 patients in the unassisted oxygen therapy group required re‐intubation, 13 of the 47 BIPAP‐treated patients also required re‐intubation. This difference was not statistically significant. The postextubation respiratory management, BIPAP or unassisted oxygen therapy, did not correlate with the extubation outcome, but the elective extubation had significantly better outcome than unplanned extubation. Patients with excessive bronchial secretions and intolerance to the equipment are poor candidates for NIPPV. We conclude that early application of BIPAP support did not predict a favourable extubation outcome. Our experience did not support the indiscriminate use of NIPPV to facilitate ventilator weaning.
Diagnostic issues in tuberculosis of the ribs with a review of 12 surgically proven cases
Authors: Chang Jung H , Kim Sung K , Lee Won Y
Published: March 2003

The ribs and surrounding chest wall are uncommon sites of tuberculosis (TB). Tuberculosis of the rib bone is often delayed in diagnosis or is recurrent with medical treatment. Rib TB is often negative or shows nodular shadows which is mimicking a metastatic tumour. We reviewed 12 cases of rib TB, which were confirmed by surgical rib resection. The most common reason given for attending the hospital was palpation of the chest wall mass, the onset of chest pain or draining sinus on the chest wall. The correct diagnosis was often delayed due to misdiagnosis of the other conditions. The misdiagnosis was produced from vague symptoms and various radiological features of rib TB. Occasionally, previous TB history could provide an indication of rib TB. Occasionally, their pre‐operative diagnostic processes were inadequate and were not consistent depending on the physician. From these reviews, we attempted to reconstruct the best diagnostic and therapeutic modalities. Our recommendation for detecting rib TB is an accurate medical history and physical examination, and early differential diagnosis with bone scintigram, computed tomogram, and percutaneous needle biopsy. Surgery can be a final diagnostic option for differential diagnosis or in a therapeutic role for recalcitrant or complicated cases.
Hospitalized low‐risk community‐acquired pneumonia: Outcome and potential for cost‐savings
Authors: Hoe Lee Kang , Keang Lim Tow
Published: March 2003

Objective: In the USA, a group of low‐risk patients with community‐acquired pneumonia (CAP) with a low risk of mortality were identified and it was suggested that they may be treated as out‐patients to save costs. We evaluated the outcome of these low‐risk CAP patients that were hospitalized in our local setting, and gauged the number of such patients in order to estimate the potential cost‐savings by treating them as out‐patients, as well as the safety of such an approach.

Methodology: All patients with CAP admitted to the National University Hospital, Singapore, from 1 April to 1 November 1997 were enrolled into a prospective cohort study. Low‐risk patients were identified, and their hospital outcomes were compared with the other patients. Hospitalization charges were obtained from the Finance Department.

Results: There were 155 CAP patients (69 females and 86 males). The age was 56.6 ± 22.2 years, ranging from 12 to 93 years old. The average hospital stay was 8.4 ± 11 days. Mortality was 12.9%. There were 37 (24%) low‐risk CAP patients, and there was no mortality in this group. No low‐risk patient required mechanical ventilation. They had a significantly shorter hospital stay compared with high‐risk patients. An identifiable organism was found in 27% of the low‐risk CAP with only one patient having a positive blood culture. The average hospitalization charge for low‐risk CAP patients was, as expected, significantly lower than for the high‐risk patients, and was 11.9% of the total cost for hospitalized CAP patients.

Conclusion: Nearly one‐quarter of our CAP admissions consisted of low‐risk patients that had no mortality, and required a significantly shorter hospitalization period. The management of such patients who are young (≤ 50 years), and had no serious coexisting conditions in an out‐patient setting, may lead to significant cost‐savings as the average hospitalization charge was US$1295 and 11.9% of total hospitalization charges for CAP.
Bronchodilator response to inhaled beta‐2 agonist and anticholinergic drugs in patients with bronchiectasis
Authors: Hassan J Abu , Saadiah S , Roslan H , Zainudin Bmz
Published: March 2003

Objective:

An increase in incidence of reversible airflow obstruction and bronchial hyperresponsiveness occurs in patients with bronchiectasis. We conducted a study to assess the efficacy of bronchodilators in the treatment of bronchiectasis.

Methodology: Twenty‐four patients with confirmed bronchiectasis were studied. Each patient inhaled fenoterol 400 μg administered by metered dose inhaler via a spacer after a baseline lung function and a lung function test was repeated 30 min later. This was followed by a second dose of fenoterol 5 mg via nebulizer and another lung function test 30 min later. A repeat study was done at least 24 h later with ipratropium bromide 40 μg by metered dose inhaler and 500 μg by a nebulizer.

Results: The results showed a significant improvement from baselines (mean percentage change ± SD) of peak expiratory flow rate (PEF) by 8.5 ± 8.72% and 15.3 ± 11.63%, forced expiratory volume in 1 s (FEV1) by 8.77 ± 9.69% and 10.2 ± 12.2% and forced vital capacity (FVC) by 10.25 ± 11.61% and 10.09 ± 10.88% after low‐ and high‐dose fenoterol, respectively. The improvements after low‐ and high‐dose ipratropium bromide for PEF, FEV1 and FVC were 9.89 ± 9.35% and 14.39 ± 12.82%, 9.38 ± 10.41% and 13.52 ± 17.09%, and 8.03 ± 10.85% and 9.63 ± 13.85%, respectively. Eleven patients (45.8%) responded to one or both bronchodilators significantly (> 15% improvement in FEV1). Five patients (20%) responded to both, three (12%) to fenoterol alone and another three (12%) to ipratropium bromide alone.

Conclusion: There is significant bronchodilator response in a subset of patients with bronchiectasis and patients with bronchiectasis should therefore undergo bronchodilator testing. Skin prick testing against a panel of nine allergens done on each individual yielded a positive result in 13 patients (54.2%).
The effect of glucocorticoid on T cell activation, interleukin‐4 and interleukin‐5 mRNA expression in patients with steroid‐resistant asthma
Authors: Sun Yongchang , Luo Weici
Published: March 2003

To investigate the mechanisms of steroid‐resistant (SR) asthma, we studied: (i) serum levels of sIL‐2R before and after oral prednisone therapy; (ii) the inhibitory effects of dexamethasone and oxymatrine on PHA‐induced lymphocyte proliferation; and (iii) the effect of dexamethasone (10–7 mol/L) on interleukin (IL)‐4 production and IL‐4 and ‐5 mRNA expression in PBMC cultures. Fifteen patients with SR asthma were selected, and 15 patients with steroid‐sensitive (SS) asthma served as controls. Levels of sIL‐2R and IL‐4 were measured using an ELISA kit. Interleukin‐4 and ‐5 mRNA were measured with semi‐quantitative reverse transcriptase–polymerase chain reaction. The results showed that there was no difference in the baseline serum levels of sIL‐2R between SR and SS asthmatics, but after prednisone (20 mg/d, 7 days) therapy, levels of sIL‐2R were significantly decreased in SS asthmatics (P < 0.001), but not in SR asthmatics. The inhibitory effects of dexamethasone on proliferation of lymphocytes from SR asthmatics were significantly less than those from SS asthmatics (P < 0.002), but oxymatrine inhibited cell proliferation to a similar degree between these two groups. Dexamethasone inhibited in vitro production of IL‐4 by lymphocytes from both SR and SS asthmatics, but the degree of inhibition was higher in SS asthmatics (P < 0.001). There was no difference in expressions of IL‐4 and ‐5 mRNA between SR and SS asthmatics, but after dexamethasone treatment, mRNA expressions were significantly decreased in SS asthmatics but not in SR asthmatics. The results indicate that persistent T cell activation due to reduced responsiveness of the cells to glucocorticoids may be the immunological feature of asthma. T cells from SR asthmatics remained responsive to other agents with immunosuppressive effect, which suggests that these agents may be of therapeutic benefit in the management of SR asthma.
A comparative clinical study of pneumonia by penicillin‐resistant and ‐sensitive Streptococcus pneumoniae in a community hospital
Authors: Watanabe Hiroshi , Sato Satoshi , Kawakami Kenji , Watanabe Kiwao , Oishi Kazunori , Rikitomi Naoto , Ii Tsuyoshi , Ikeda Hideki , Sato Akiyoshi , Nagatake Tsuyoshi
Published: March 2003

Objective:

This study aimed to determine the clinical difference of pneumonia between penicillin‐resistant and penicillin‐sensitive Streptococcus pneumoniae.

Methodology: Forty‐nine cases in 46 patients of pneumococcal pneumonia were studied from December 1992 to May 1997. There were 24 cases (in 22 patients) of penicillin‐resistant pneu‐mococci (PRSP) pneumonia which were compared with 25 cases (in 24 patients) with penicillin‐sensitive pneumococci (PSSP).

Results: Both the mean age and the underlying disease states did not differ between the two groups. However, hospital‐acquired pneumonia and previous use of antibiotics were observed in eight (33.3%) and 12 (50.0%) patients in PRSP compared with three (12.0%) and two (8.0%) in PSSP, respectively. The clinical efficacy rate and bacteriological eradication rates were 87.5 and 87.5% in PRSP compared with 87.5 and 87.0% in PSSP, respectively. Minimum inhibitory concentration (MIC) of antibiotics against 30 pneumococcal isolates was examined, and 10 strains ranged from 0.10– 0.78 μg/mL and five strains were more than 1.56 μg/mL against penicillin G, while the MIC showed higher resistance to other antibiotics except for the carbapenems. Serotyping of the isolates by antiserum revealed differences in the predominant types PRSP (19B, 23B) and PSSP (6B, 9C).

Conclusions: We must care for not only community‐acquired infection but also nosocomial transmission of PRSP pneumonia. Most patients with infections due to PRSP tended to have a milder illness with a good outcome (no patient died). As such it appears that empiric therapy for pneumococcal pneumonia does not require modification from what is recommended at present. However, in patients with infection due to highly resistant strains, and who are not responding to conventional therapy should have their treatment modified according to subsequent susceptibility testing.
Intravascular ultrasound imaging of the pulmonary arteries in primary pulmonary hypertension
Authors: Nakamoto Takaaki , Yoshitake Junro , Hase Tatsuya , Harasawa Hiroshi , Okamoto Shingo , Fuse Daisuke , Kawasaki Ryuichi , Kuga Hideyo , Kishiro Izumi , Machida Suguru , Oshiro Hiroaki , Totsuka Masayuki , Kaneko Noboru
Published: March 2003

Objective:

Intravascular ultrasound has the unique ability to provide cross‐sectional images of the arterial wall. This study examined intravascular ultrasound (IVUS) images of the proximal pulmonary arteries in primary pulmonary hypertension (PPH).

Methodology: Study 1: Specimens from four patients who had died of PPH (in vitro PPH group) were compared with those of three patients who had died of subarachnoid haemorrhage but had no evidence of cardiopulmonary disease (in vitro control group). Three‐centimetre segments of the following levels were examined by IVUS: pulmonary trunk, eight secondary branch arteries of the upper, middle, and lower lobes of both lungs, and the thoracic descending aorta. Study 2: Four patients with PPH (in vivo PPH group) and five patients without pulmonary hypertension and no evidence of cardiopulmonary disease (in vivo control group) were examined. The IVUS images of the apical segmental artery of the right upper lobe and the descending branch of the right pulmonary artery were studied.

Results: Echographic examination of formalin‐fixed preparations of secondary branch sections of the pulmonary artery failed to show a clear three‐layer structure in the in vitro control group (24 preparations), but a distinct three‐layer structure and increased vessel wall thickness were observed in the in vitro PPH group (32 preparations). Similar findings were obtained in the in vivo study. The mean echo density of the proximal pulmonary arterial wall correlated well with the mean pulmonary arterial pressure (mPA) in the in vitro PPH, and also correlated with the mPA in the in vivo study (r = 0.960, P < 0.0001). The echo intensity of secondary branch sections of the pulmonary artery was higher in the in vitro PPH group than in the in vitro control group (180.5 ± 27.0 vs 132.5 ± 26.7 counts, P < 0.001); similar results were obtained in the in vivo study (144.7 ± 23.4 vs 85.0 ± 14.3 counts, P < 0.01).

Conclusions: These results suggest that the histological changes detected in the pulmonary artery walls in the PPH group were responsible for the increased echo intensity.
A double‐blind, placebo‐controlled dose–response study with budesonide Turbuhaler in Japanese asthma patients
Authors: Miyamoto Terumasa , Takahashi Terumi , Nakajima Shigenori , Makino Sohei , Yamakido Michio , Mano Kenji , Nakashima Mitsuyoshi , Selroos Olof
Published: March 2003

Objective:

The aim of this study was to investigate the dose–response for inhaled budesonide via Turbuhaler® in Japanese patients with mild to moderate asthma.

Methodology:

Inhaled budesonide 100 μg, 200 μg, 400 μg or placebo was administered twice daily via Turbuhaler for 6 weeks, to 267 adult Japanese patients (mean age 51 years) with mild‐to‐moderate, non‐steroid‐dependent bronchial asthma, in a double‐blind, placebo‐controlled, randomized, parallel group study. The patients had to be symptomatic for more than 3 days/week and have an average morning peak expiratory flow (PEF) 50–80% of predicted normal value.

Results:

The response to budesonide was rapid, all treatments showing a significant improvement in morning PEF after 1 week (P < 0.05). During week 6, mean improvements of 15, 45, 53 and 71 L/min were observed for the placebo, 200 μg, 400 μg and 800 μg budesonide groups, respectively. Compared with placebo all improvements in the budesonide groups were statistically significant and a significant dose–response was demonstrated (P < 0.001). The difference between the 200 μg and 800 μg doses was significant. Also, for several secondary efficacy variables (e.g. evening PEF, symptom score, treatment score, daily activity score and sleep score) significant dose–responses were shown. Other variables included the investigators’ assessments of improvement and usefulness. They also showed statistically significant dose–response relationships and confirmed the rapid onset of action. Budesonide was well tolerated at all tested doses, with a low incidence of adverse events, all of which were minor in severity.

Conclusions:

Budesonide Turbuhaler in the doses 100 μg to 400 μg twice daily was effective, well tolerated and showed a rapid onset of action in patients with mild‐to‐moderate asthma. Dose–response was demonstrated for several variables of clinical efficacy.
Clinical significance of vascular endothelial growth factor in patients with primary lung cancer
Authors: KISHIRO IZUMI , KATO SHIRO , FUSE DAISUKE , YOSHIDA TAKESHI , MACHIDA SUGURU , KANEKO NOBORU
Published: March 2003

Objective: Vascular endothelial growth factor (VEGF) is an angiogenesis factor closely associated with the growth and metastasis of malignant tumours.

Methodology: In the present study, we measured plasma VEGF levels in 20 normal subjects (N), 35 patients with benign lung diseases (B), 28 patients with untreated advanced lung cancer (NT) and 10 patients with treated lung cancer (T). In addition, we measured the VEGF levels in pleural effusions from five patients with primary lung cancer and two patients with active infectious diseases. Vascular endothelial growth factor was measured by ELISA.

Results: The mean (±SD) plasma VEGF level in NT patients (160.8 ± 177.4 pg/mL)

was fivefold higher than that in other patient groups (T, 17.7 ± 4.9 pg/mL;

B, 28.3 ± 17.6 pg/mL) and the N group (14.9 ± 7.0 pg/mL; P < 0.01). Vascular endothelial growth factor from lung cancer pleural effusions (17 526.0 ± 22 498.2 pg/mL) was 25‐fold higher than that from patients with active infectious diseases (665.5 ± 259.0 pg/mL).

Conclusions: Plasma VEGF may be a good clinical indicator for the assessment of primary lung cancer and pleural effusion VEGF in primary lung cancer is higher than pleural effusion VEGF in patients with inflammatory diseases.
Genetic variation in clonal traits of Trifolium repens and species interactions
Authors: Sawada Hitoshi
Published: March 2003

Plants exhibit a great variety of types of clonal growth. Moderate variation in clonal traits often exists even within species. The consequences of these variations for species interaction are of great interests to ecologists. In this paper, I address the small‐leaved (phalanx) to large‐leaved (guerrilla) variation in white clover (Trifolium repens), and discuss its consequences for species and genotype coexistence. I also address the clonal and sexual resource allocation variants within the large‐leaved type. Small‐leaved and large‐leaved genotypes differ in various aspects of clonal growth. The large‐leaved genotype displays greater phenotypic plasticity but is less physiologically integrated than the small‐leaved genotype. We examined the consequences in a grazed sward, where white clover and zoysia grass coexist. In this sward, white clover is patchily distributed. We first tested the hypothesis that the large‐leaved genotype is more advantageous in growth than the small‐leaved genotype. Results from both common garden and competition experiments supported the hypothesis. Second, we tested the hypothesis that within large‐leaved plants, the clonal subtype (which invests more resources to stolons but less in flower heads than the sexual one) is more advantageous than the sexual one because it is more competitive. This hypothesis was rejected. Both subtypes coexisted in the sward. This is probably because the sexual subtype is superior for interpatch migration than the clonal one. Both subtypes differ in advantages they offer for between‐patch and within‐patch processes, which promotes their coexistence. Finally, field monitoring of the behavior of a large‐leaved clone is described. This monitoring was conducted in a moderately grazed sward, where microenvironmental heterogeneity is extremely high in time and space.
Cryptic andromonoecy in Tilia japonica implicated by flower abortion
Authors: Ito Eriko , Kikuzawa Kihachiro
Published: March 2003

Tilia japonica Simonkai has morphologically perfect flowers with stamens and a pistil. However, some flowers fall without developing into immature fruits. We clarified that: (i) the flower abscission is a facultative abortion, (an abscission layer was observed at the base of the stalk of aborted flowers); (ii) fallen flowers have functional stamens (the flowers are protandrous and they had shed germinable pollen grains before the flower abscission); and (iii) fallen flowers have a non‐functional pistil (they were abscised before stigma opening). The aborted flowers were functional male flowers, although they were morphologically perfect. Hence, the functional sex expression of T. japonica is andromonoecous having both perfect and male flowers within an individual tree.
Safe site for seedlings of Rhododendron metternichii var. hondoense
Authors: Kameyama Yoshiaki , Nehira Nobukazu Nakagoshi and Kunito , Nehira Kunito
Published: March 2003

Safe sites for seedlings of Rhododendron metternichii Sieb. et Zucc. var. hondoense Nakai (Ericaceae) were determined in the field in Japan. Microhabitats were classified by overlaying a distribution map of ground conditions (moss and rock patches) with crown projection diagrams. Seedlings of R. metternichii var. hondoense were highly dependent on ground conditions; seedling density was extremely low on soil but high on moss mats. Considering the canopy condition, seedling density on soil and rock was significantly lower at open sites than under tree crowns. In contrast, seedling density on moss mats was high at open sites, especially under deciduous trees. Moss–deciduous trees or moss–open sites were the best microhabitats as they usually provided both water and sunlight for seedlings. Of seedlings 0–2 cm in height, 87.7% were on moss mats while only 2.7% were on soil. This proportion of seedlings on moss and soil gradually changed with seedling development. Only 6.1% of the seedlings over 10 cm in height were on moss mats, while 81.8% were found on soil: this apparently was due to changes in ground conditions. The change from moss to soil occurred more frequently than a change from soil to moss during a 2‐year observation period. Although early seedling establishment of R. metternichii var. hondoense is highly dependent on moss mats, seedlings seem to gain tolerance for drought and instability of the substrate as they grow and they continue to survive after the disappearance of moss mats.