Diagnostic criteria of Buerger's disease.

After many changes, Buerger's disease stands as an independent clinicopathologic entity, but a better understanding of Buerger's disease has been impeded by the lack of unanimous diagnostic criteria of the disease. Since specificity of Buerger's disease is characterized by peripheral ischemia of an inflammatory nature and with a self-limiting course, diagnostic criteria of Buerger's disease should be discussed from clinical point of view. Our clinical criteria for the diagnosis of Buerger's disease are: (1) smoking history; (2) onset before the age of 50 years; (3) infrapopliteal arterial occlusions; (4) either upper limb involvement or phlebitis migrans; and (5) absence of atherosclerotic risk factors other than smoking.

Development of pyothorax-associated pleural lymphoma in relation to focal cytokinemic condition and Epstein-Barr virus infection.

We report an initial case of pyothorax-associated pleural lymphoma (PAPL) in which the level of interleukin 6 (IL-6) was remarkably high in the pleural fluid contaminated with tumor cells; at the same time Epstein-Barr virus (EBV)-encoded small RNAs (EBERs) were detected in the lymphoma cells by in situ hybridization. These findings suggest the possibility that EBV-transformed B cells proliferated in the focal cytokinemic condition caused by long-standing chronic inflammation of the pleura and give us a clue to the lymphoma genesis of PAPL.

Hematologic response in patients with aplastic anemia after long-term administration of recombinant human granulocyte colony-stimulating factor and erythropoietin.

Twenty patients with aplastic anemia underwent long-term administration (10 weeks) of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in doses from 50 to 800 micrograms/m2 per day by intravenous infusion or 50 to 100 micrograms/m2 per day by subcutaneous injection and re-combinant human erythropoietin (rhEPO) in doses ranging from 2000 to 8000 IU/m2 per day by intravenous injection three times a week for at least 4 weeks. The goal was to evaluate whether therapy ameliorated pancytopenia in these patients as well as to determine its safety. All assessable patients showed a substantial increase in absolute neutrophil count, with a recovery of myeloid components (granulocyte series) in the bone marrow, after 2 to 10 weeks of treatment.

Recovery of portal blood flow after percutaneous transhepatic biliary drainage in patients with obstructive jaundice.

Using an ultrasonic Doppler system, we prospectively studied the changes in portal venous flow (PVF) following percutaneous transhepatic biliary drainage (PTBD) and evaluated the correlation between PVF and liver function in 10 patients with obstructive jaundice. The patients were divided into two groups according to their rate of decrease in serum bilirubin ("b"). Group A comprised 5 patients with a "b" of less than -0.

A novel quantitative 'stretch PCR assay', that detects a dramatic increase in telomerase activity during the progression of myeloid leukemias.

Telomerase activation is important for carcinogenesis. However, the timing and magnitude of the activation during cancer development are unknown. In this study, a new PCR-based method for measuring telomerase activity was developed and shown to be very useful for quantitative analysis of human telomerase.

Hepatic blood flow after acute biliary obstruction and drainage in conscious dogs.

Background Aims: Obstructive jaundice is a factor which effects hepatic blood flow and the relative contribution of the hepatic arterial flow and portal venous flow. In this study, and were measured in conscious dogs and the influence of biliary obstruction and drainage was investigated.

Material And Methods: Hepatic arterial flow (HAF) and portal venous flow (PVF) after biliary obstruction and subsequent drainage were continuously measured in conscious dogs using implantable transit time ultrasonic flow-meters.

Effect of lipid emulsions for total parenteral nutrition on regeneration of the liver after partial hepatectomy in rats.

We studied the effects of lipid emulsions for total parenteral nutrition (TPN) on hepatic regeneration after partial hepatectomy in rats. Daily energy intake was maintained at 1172 kJ.kg-1.

Fibromuscular dysplasia as a cause of abdominal aortic aneurysm.

A 53-year-old woman presented with abdominal discomfort and was diagnosed using ultrasonography to have an abdominal aortic aneurysm. Aortography revealed a saccular aneurysm 4 cm in diameter of the infrarenal aorta with a 'string of beads' appearance. The renal and other visceral arteries appeared to be normal.

Genomic instability of microsatellite repeats and its association with the evolution of chronic myelogenous leukemia.

Tumorigenesis has been shown to proceed through a series of genetic alterations involving protooncogenes and tumor-suppressor genes. Investigation of genomic instability of microsatellites has indicated a new mechanism for human carcinogenesis in hereditary nonpolyposis colorectal cancer and sporadic cancer and this instability has been shown to be related to inherited predisposition to cancer. This study was conducted to determine whether such microsatellite instability is associated with the evolution of chronic myelogenous leukemia (CML) to the blast crisis.

Muscle sympathetic outflow in Buerger's disease.

One of the pathophysiological features in Buerger's disease, i.e. thromboangiitis obliterans (TAO), contains a sympathetic contribution which relates to vasospastic phenomenon.

Buerger's disease: diagnosis and management.

Buerger's disease is characterized by peripheral arterial occlusion of the extremities in young male smokers. In true Buerger's disease lesions rarely occur in the proximal arteries. The incidence of the disease is low in Europe and the USA, but its management remains a major problem for vascular surgeons in Asia where its incidence is higher.

Interportal communicating branch at the hepatic bifurcation--report of two cases.

An interportal communicating branch was found at the hepatic bifurcation in two (2.4%) out of 83 hepatectomized cases of carcinoma of the biliary tract. The first case was a 54-year-old male with intrahepatic bile duct cancer, and the second was a 64-year-old female with gallbladder cancer.

[A case of T-cell lymphoma showing multiple nodular shadows and an elevated titer of human T-lymphotropic virus type I (HTLV-I) antibody].

A 42-year-old man, born in Chiba prefecture, was admitted to our hospital because of multiple nodular shadows on chest X-ray film and an elevated titer of human T-lymphotropic virus type I (HTLV-I) antibody. The pulmonary lesion was diagnosed as T-cell lymphoma by open lung biopsy. There has been only one previous report of T-cell lymphoma showing multiple nodular shadows on chest X-ray.

[A case of pulmonary aspergillosis by immunodiagnosis during remission induction therapy of acute myelocytic leukemia].

The frequency of a visceral mycosis grows definitely higher with an immunocompromised host. Invasive fungal infection can be controlled by means of development of early diagnosis and antifungal therapy. In these types of cases, it is difficult to establish an antemortem diagnosis of invasive pulmonary aspergillosis and most of them were diagnosed postmortem.

Cholangiocellular carcinoma in the caudate lobe with intraluminal growth in the extrahepatic bile duct.

A case of cholangiocellular carcinoma in the caudate lobe with intraluminal growth in the extrahepatic bile duct is reported. The main tumor in the caudate lobe was detected by computed tomography and angiography, and two intraluminal tumors at the hepatic hilus and at the root of the right posterior segmental duct were well demonstrated by cholangiography and percutaneous transhepatic cholangioscopy. Independent total caudate lobectomy with bile duct resection was performed.

Paradoxical response to cerulein on sphincter of Oddi in the patient with gastrectomy.

Sphincter of Oddi motility was measured in 55 gallstone patients either through the sinus tract of percutaneous transhepatic biliary drainage or through the T tube. The influence of cholecystectomy and gastrectomy on the sphincter of Oddi was analyzed by comparing responses in patients with or without surgery to the administration of cerulein and the ingestion of dry egg yolk. When comparing cholecystectomized patients to nonsurgical subjects, cholecystectomy revealed no influence on the response to cerulein and feeding.

[A case of intrahepatic cholesterol stone complicated with atrophy of the anterior superior ventral and anterior superior lateral subsegments (S8ab) of the liver].

A 61-year-old male patient with intrahepatic cholesterol stone is reported. Stones were detected in the anterior superior lateral subsegment (S8ab) of the right lobe with bile duct stenosis, the lateral anterior segment (S3) of the left lobe, and the left caudate lobe (S11). Partial hepatectomy including S8ab, S3 and S11 was performed to remove all stones.

Interventional embolization with fibrin glue for a large inferior mesenteric-caval shunt.

We report an unusual case of a large inferior mesenteric-caval shunt in a 25-year-old man without cirrhosis with hypoproteinemia and hypochromic anemia. In this large shunt the direct communication was between the inferior mesenteric vein and the internal iliac vein. Hemodynamic change as a result of the shunt was thought to cause his present clinical problems and future portosystemic encephalopathy.

Clinicopathologic studies on perineural invasion of bile duct carcinoma.

To elucidate the clinical significance of perineural invasion on bile duct cancer, a clinicopathologic study was performed on 70 resected patients with bile duct carcinoma. The overall incidence of perineural invasion in the resected specimen was 81.4%.

Microcirculatory characteristics in patients with Buerger's disease.

The most characteristic pathophysiologic change in Buerger's disease or thromboangiitis obliterans (TAO) is considered the breakdown of microcirculation in the extremity, but this has not yet been proven. The purpose of this study is to examine the damage of microcirculation in TAO objectively, by means of intra-arterial injection of two kinds of radioisotope. In 7 TAO and 4 infrainguinal arteriosclerosis obliterans (ASO) patients, thallium 201 chloride (201Tl) and 99mTc macroaggregated human serum albumin (99mTc-MAA) were administered through bilateral common femoral artery injections.

An unusual growth pattern of a mucin-producing intrahepatic cholangiocellular carcinoma involving the hepatic hilus.

The case of a mucin-producing intrahepatic cholangiocellular carcinoma in a 73 year-old-man is presented. A tumor originating in the right posterior inferior segment of the liver was found to be invading the right posterior and anterior bile ducts, and the hepatic hilus. Extensive superficial spread was observed in the entire posterior segmental bile duct extending to the hepatic hilus.

Abdominal aortic aneurysm due to congenital hypoplasia of the aortic media: a case report.

A 44 year-old woman with a family history of abdominal aortic aneurysm (AAA) underwent resection of an AAA. Histological examination revealed a lack of elastic fibers of the media and a diminished content of smooth muscle cells. A congenital hypoplasia of the aortic media was postulated as the etiology of this AAA.

Decrease in regeneration capacity of rat liver after external biliary drainage.

In order to discover the effect of external biliary drainage on liver regeneration, we have produced a model system carrying cannula in the common bile duct of rat liver and examined the regeneration capacity of liver after partial hepatectomy under various conditions. Previously we have shown that hepatic cells proliferate by obstructive jaundice alone without partial hepatectomy [Terasaki et al; Jpn J Cancer Res 1991;82:170-175]. In the present study, we showed that DNA polymerase-alpha was induced by partial hepatectomy of rats suffering from obstructive jaundice and the induced level was similar to that of the normal regenerating liver.

Aneurysm of the extracranial internal carotid artery caused by fibromuscular dysplasia.

A case of aneurysm of the extracranial internal carotid artery (ICA) caused by fibromuscular dysplasia (FMD) is reported. The patient also had an aneurysm of the contralateral intracranial ICA, but the renal arteries were normal. A review of the literature shows extracranial ICA aneurysms to be uncommon, with only 3% caused by FMD.

A case of early asymptomatic carcinoma of the hepatic hilus.

We describe a 54-year-old asymptomatic male with carcinoma of the hepatic hilus. Elevated serum transaminases were detected during the annual medical examination. The diagnosis was confirmed by ultrasonography (US), computed tomography (CT), percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP).