This concerns a patient with severe rheumatoid arthritis (RA) and lymphadenopathy (LA) who showed suboptimal clinical response to antitumor necrosis factor alpha (TNFalpha) antibody (Ab), cA2 therapy. The assessment of TNFalpha and IL-6 mRNA expression in the swollen lymph-node (LN) of the patient by reverse transcription, polymerase chain reaction (RT-PCR) before cA2 treatment, showed only enhanced IL-6 production, but not TNFalpha. Moreover, cA2 failed to inhibit in-vitro spontaneous IL-6 production in the LN block culture from the patient. Taken together, these results indicate that IL-6 production in the swollen LNs of the patient might not depend on TNFalpha. This might partly cause suboptimal clinical response to anti-TNFalpha Ab therapy in the patient.

Antibodies, Monoclonal↗

PubMed1998

A randomized study of short-versus long-term intravesical epirubicin instillation for superficial bladder cancer. Nagoya University Urological Oncology Group.

OBJECTIVE: A prospective randomized study was undertaken to determine whether prophylactic maintenance instillation of epirubicin following induction treatment is beneficial in patients with superficial bladder cancer. PATIENTS AND METHODS: One hundred and forty-eight patients with resectable superficial bladder cancer (Ta-1, single, multiple, primary or recurrent with, however, no recurrence during the last year) were enrolled in this study. In both arms, epirubicin (40 mg/ml in normal saline) was administered six times within 4 weeks after a transurethral resection of the bladder tumor(s). In arm A, the patients received 11 additional monthly instillations of epirubicin. RESULTS: Of the 148 patients, 138 (93.2%) were eligible and followed for an average of 29.6 months. 93 (67.4%) had a solitary tumor. No significant difference in the recurrence-free curve was observed between the two arms (p = 0.62). The recurrence rate per year was 0.16 in arm A and 0.17 in arm B. Toxicity included vesical irritability in 10 (7.2%) and hematuria in 1 patient. No significant difference in the frequency or degree of toxicity was observed between the two arms. CONCLUSION: These data suggest that maintenance instillation of epirubicin does not reduce superficial bladder cancer recurrence.

Administration, Intravesical↗

PubMed1998

Cardioprotective effect of intravenous nicorandil in patients with successful reperfusion for acute myocardial infarction.

This study was designed to assess the cardioprotective effect of intravenous nicorandil, a potassium channel opener, in preventing reperfusion injury in acute myocardial infarction. Seventy patients were treated with placebo or nicorandil concomitant with reperfusion therapy in a prospective, randomized, double-blind fashion within 6 h after the onset of acute myocardial infarction. Nicorandil was administered before reperfusion as a 2-mg bolus iv injection followed by continuous infusion of 2-6 mg/h for the next 3 h. Thirty-six patients (17 in the placebo group, 19 in the nicorandil group) who demonstrated both complete occlusion of an infarct-related vessel before treatment and successful reperfusion were included in the final analysis. No significant changes in left ventricular ejection fraction were observed between the immediate and chronic phases in each group. In the analysis of regional ventricular function, the placebo group did not show any significant change in regional chord shortening (26.8+/-8.2 vs 24.3+/-7.3%, NS) or hypocontractile perimeter (36.4+/-28.2% vs 28.3+/-24.8%, NS) between immediate and chronic phase left ventriculograms. In contrast, in the nicorandil group, a significant increase in regional chord shortening (21.5+/-11.0% vs 25.8+/-11.3%, p<0.05) and a significant decrease in hypocontractile perimeter (33.3+/-19.6% vs 25.6+/-24.3%, p<0.05) were observed in the chronic phase left ventriculogram. Thus, nicorandil may be a useful adjunctive therapy for preserving myocardial contractile function in patients with acute myocardial infarction undergoing reperfusion therapy.

Acute Disease↗

PubMed1998

Giant hepatic biloma following transcatheter oily chemoembolization in a patient with hepatic metastases from malignant pheochromocytoma.

A 48-year-old woman developed hepatic metastases from malignant pheochromocytoma resected 8 years previously. Angiography revealed multiple tumor stains in the liver. Transcatheter oily chemoembolization using styrenomaleic acid neocarzinostatin and iodized oil was performed. The patient complained of severe right upper quadrant pain immediately following the transcatheter oily chemoembolization. Necrotizing cholecystitis developed on the 4th day post-transcatheter oily chemoembolization, hepatic infarction on the 12th day, and a biloma on the 19th day. Despite the administration of antibiotics and percutaneous transhepatic drainage, neither the volume of drainage nor the size of the biloma decreased. Biliary reconstruction was performed using a metallic stent, which decreased the size of the biloma.

Adrenal Gland Neoplasms↗

PubMed1998

[Renal transplantation].

The clinical outcome of kidney transplantation worldwide is reviewed. Total number of kidney transplantations now number 411,071, and about 26,000 have been performed annually in recent years. In Japan, the total is 11,813, and about 600 to 700 have been performed annually in recent years. Graft survival is 80% at one year and 60% at five years in cadaveric renal transplantation worldwide, and 90% at one year and 70% at 5 years, respectively, in Japan. There is no difference in the graft survival rate between Japan and Western countries. However, there have been fewer kidney transplantations in Japan than in the west. Issues which should be resolved are (1) the number of kidney transplantations, especially cadaveric transplantations, should be increased enlarged; and (2) long-term graft survival rates should be improved. To improve the long-term graft survival rates, it is necessary to evaluate the mechanisms of chronic graft failure and develop new immunosuppressive therapies to eliminate rejection crises completely.

Graft Survival↗

PubMed1998

Learning curve and conversion to open surgery in cases of laparoscopic adrenalectomy and nephrectomy.

PURPOSE: We examine how the level of experience acquired by the laparoscopist affects the outcome of laparoscopic adrenalectomy and nephrectomy, and what is necessary to avoid complications in these surgeries. MATERIALS AND METHODS: We retrospectively evaluated the experience levels of 8 urological laparoscopists between 1991 and 1995. In addition, other cases that were converted to open surgery were collected from the institutes with which the 8 laparoscopists were affiliated. RESULTS: The rates of conversion to open surgery were 6.4% in 204 cases of adrenalectomy and 14.3% in 63 of nephrectomy. Conversion rates were related to blood loss volume but not operative time. The major causes of conversion were bleeding in 45% of cases and adhesion in 34%. There were no mortalities. Mean operative time decreased significantly, reaching that of open surgery as the number of procedures increased up to 20 adrenalectomies and 10 nephrectomies. The volume of blood lost remained low from the early experience. Blood transfusion rates were 4.4% for adrenalectomy and 11.1% for nephrectomy. CONCLUSIONS: Operative time of these procedures decreased significantly with surgeon experience and reached that of open surgery. Cases in which adhesion is anticipated should be restricted to avoid conversion. These laparoscopic procedures are acceptable as a standard operative techniques for adrenal and renal diseases.

Adrenal Gland Diseases↗

PubMed1998

[Clinical study on poor-risk patients with non-seminomatous germ cell tumor].

Between 1988 and 1996, we treated 11 poor-risk patients with non-seminomatous germ cell tumors (NSGCT) at Nagoya University Hospital. "Poor-risk" was defined as i) advanced disease equal to or greater than class 7 of the Indiana University Classification (7 patients), ii) primary mediastinal extragonadal NSGCT (2), iii) tumor markers not normalized by the induction chemotherapy (1) or iv) primary retroperitoneal NSGCT with multiple lung metastases (1). Two patients with mediastinal tumors died during the chemotherapy. The minimal volume of fluid must be administered to patients with giant mediastinal tumors. The tumor marker normalized during the induction chemotherapy in only three patients. Three patients, whose tumor markers elevated during or one month after the induction chemotherapy, eventually died of cancer. The tumor markers in five of the seven patients which had not normalized during the induction chemotherapy, had decreased to the normal range during the salvage chemotherapy and two of the five subsequently achieved the status of "no evidence of disease" (NED). Six patients with and two without normalized tumor markers underwent retroperitoneal lymph nodes dissection and/or resection of residual tumors. Pathological examination of the resected tumors showed necrosis/fibrosis in five patients and two had elevated tumor markers immediately after the surgery and eventually died of the disease. Overall, eight (73%) of 11 poor-risk patients achieved a complete response but only five (45%) eventually achieved a NED status that was maintained (6.6 +/- 3.0 years). Our results were not satisfactory, and we believe that new strategies, such as early high-dose chemotherapy, are required for poor-risk patients, who are not likely to respond well to the induction chemotherapy.

Adolescent↗

PubMed1998

[The treatment and prognosis of acute late rejection after kidney transplantation].

To examine the acute late rejection episodes (ALR) occurring 4 months after kidney transplantation, 330 cadaver kidney transplant recipients who were operated on between 1982 and 1996 and immunosuppressed by cyclosporine or tacrolimus were analyzed. In 213 recipients who were followed up for 5 years or longer, the frequency of ALR without an acute early rejection (AER) was 14% and ALR with AER was 16%, respectively. ALR was the strongest deteriorating factor for graft survival at the chronic stage. Judging from the renal function 1 month after an ALR episode, the complete and partial response rates were 22% and 62% with steroid treatment and 16% and 58% with DSG treatment, respectively. The 5-year graft survival after the treatment was 20% with steroid treatment and 45% with DSG treatment. Although the intensity of the rejection classified based on the Banff grading system was the strongest factor affecting the graft survival, the multivariate analysis by Cox proportional hazard model for non-pathological factors revealed that urine protein and hypertension 1 month before the episodes may also be important prognostic factors. The body weight of recipient (> 55 kg) and donor age (> 55 y.o) were slightly correlated to the graft prognosis. Due to incomplete immuno-suppressive methods for acute late rejection, the conservative nephron sparing policy after a rejection episode is inevitable to obtain better graft survival at the chronic stage.

Acute Disease↗

PubMed1998

The present status of endourologic surgery.

Explore the source record for details and available documents.

Adrenal Glands↗

PubMed1998

[Long-term results and quality of life of hemi-Kock orthotopic ileal neobladder after radical cystectomy].

We analyzed the long-term results and the quality of life in patients who received orthotopic lower urinary tract reconstruction using the Kock ileal neobladder. Between July 1990 and October 1993, 37 consecutive patients including 2 females received orthotopic hemi-Kock neobladder after radical cystectomy. In these patients, we analyzed the urinary continence, complications and urethral recurrence, and performed a questionnaire survey by mail. Good continence all day had been achieved in 71% of the patients 4 years after surgery. The rate of the pouch-related complications requiring reoperation was 27%. There was no urethral recurrence. Compared with preoperative conditions, 42% were not satisfied with urination. In these dissatisfied patients, the need to use pads in the daytime, sensation of residual urine and weak urine stream were significantly more frequent than in satisfied patients. In summary, the rate of complications was higher than that of other methods. However, the Kock orthotopic ileal neobladder is a stable procedure providing good function over the long-term.

Adult↗

PubMed1997

Structure and expression of the gsa-1 gene encoding a G protein alpha(s) subunit in C. elegans.

The heterotrimeric guanine nucleotide-binding proteins (G proteins) act as switches in the signal transduction from cell surface receptors to a variety of effectors. Among them, Gs proteins stimulate adenylate cyclase activities and regulate ion channels in mammals. We identified the gsa-1 gene encoding a G protein alpha subunit in the nematode Caenorhabditis elegans. The predicted product consists of 375 amino acid residues, 66% of which are identical with those of a mammalian Gs(alpha) subunit. The gsa-1 gene was physically mapped near the left end of chromosome I. A gsa-1/lacZ fusion gene was expressed in many cells in embryos, larvae and adults, including neurons, body wall muscle cells and muscle cells of the pharynx and the vulva. The results presents a basis for genetic studies of the gsa-1 gene.

Amino Acid Sequence↗

PubMed1997

The muscle of lawrence in Drosophila: a case of repeated evolutionary loss.

The muscle of Lawrence (MOL) is a bilaterally symmetrical muscle spanning the tergite of the fifth abdominal segment of adult male Drosophila melanogaster. It is not, however, a general feature of male-specific development within the subfamily Drosophilinae. Of 95 species surveyed within this subfamily, 67 exist with no MOL at all. By drawing comparisons with published cladograms of species relatedness, three conclusions regarding the evolutionary history of the MOL are made: (i) The MOL predates the major radiations of the genus Drosophila, given its presence in earlier-branching Chymomyza and Scaptodrosophila; the MOL has been subsequently excluded in at least one present species of each of these two primitive genera. (ii) Within the genus Drosophila the MOL is present sporadically in the radiation of the subgenus Sophophora, showing repetitive loss even in very close evolutionary lineages. (iii) The MOL may have been entirely excluded from the prolific radiation of the subgenus Drosophila. Thus the MOL shows a uniquely incongruous pattern of presence or absence relative to accepted drosophilid phylogeny.

Animals↗

PubMed1997

Cloning and molecular analysis of the Arabidopsis gene Terminal Flower 1.

The Arabidopsis gene Terminal Flower 1 (TFL1) controls inflorescence meristem identity. A terminal flower (tfl1) mutant, which develops a terminal flower at the apex of the inflorescence, was induced by transformation with T-DNA. Using a plant DNA fragment flanking the integrated T-DNA as a probe, a clone was selected from a wild-type genomic library. Comparative sequence analysis of this clone with an EST clone (129D7T7) suggested the existence of a gene encoding a protein similar to that encoded by the cen gene which controls inflorescence meristem identity in Antirrhinum. Nucleotide sequences of the region homologous to this putative TFL1 gene were compared between five chemically induced tfl1 mutants and their parental wild-type ecotypes. Every mutant was found to have a nucleotide substitution which could be responsible for the tfl1 phenotype. This result confirmed that the cloned gene is TFL1 itself. In our tfl1 mutant, no nucleotide substitution was found in the transcribed region of the gene, and the T-DNA-insertion site was located at 458 bp downstream of the putative polyadenylation signal, suggesting that an element important for expression of the TFL1 gene exists in this area.

Amino Acid Sequence↗