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AIM: The aim of this paper was to investigate the growth rate of abdominal aortic aneurysms (AAA) in Japanese patients. METHODS: We retrospectively studied patients conservatively followed with infrarenal AAA in terms of AAA diameter measured using computed tomography (CT) in our hospital between 1999 and 2009. The AAA surgery criterion in our institute was a diameter ≥ 5.0 cm or a growth rate ≥5 mm/year. We estimated operation-free ratios by initial AAA diameter and changes in AAA growth rates. Patients with an initial AAA diameter < 5.0 cm were divided into 2 groups. Patients with AAA that met the criteria for surgery were classified into the expansion group, and those remaining into the non-expansion group. Their AAA growth rates were compared. RESULTS: The group consisted of 124 patients (average age, 73.7±8.6 years (range 54-92)) who had at least 2 recorded AAA measurements. The average follow-up period was 3.0±2.2 years (range 0.3-10.2). There were no cases of rupture during follow-up. Twenty-six patients (21.0%) underwent surgery (open replacement [N.=20]; endovascular abdominal aneurysm repair [N.=6]). The growth rate determined from the initially measured diameter was significantly faster in AAAs measuring 5.0-5.4 cm than in AAAs measuring 4.5-4.9 cm (P=0.01). More than 90% of patients with an initial AAA diameter <5.0 cm were observed conservatively for 2 years or more. However, more than half of the patients with an initial AAA diameter ≥4.0 cm needed surgery within 5 years. The growth rates of AAAs for each size during growth were significantly faster when the AAA diameter was 4.5-4.9 cm than when it was 4.0-4.4 cm (P=0.006), and when the AAA diameter was 5.0-5.4 cm than when it was 4.5-4.9 cm (P = 0.009). The expansion and non-expansion groups consisted of 38 (34.2%) and 73 (75.8%) patients, respectively. The AAA growth rate in the expansion group was significantly faster than that in the non-expansion group (3.4±2.2 mm/year vs. 1.4±1.3 mm/year, P=0.0001). CONCLUSION: It may be considered that the appropriate indication for AAA repair is defined by a diameter of 5.0 cm for Japanese patients. Patients with AAA that is growing continuously by ≥3 mm/year and who have low operative risk may undergo surgery even if their AAA is <5.0 cm.

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Between October 1996 and June 2003, endovascular stent graft repair was performed in 87 patients with descending thoracic aortic aneurysms, graft replacement was performed in 24 patients with thoracoabdominal aortic aneurysms, and endovascular stent graft repair with concomitant surgical bypass of abdominal visceral arteries was performed in 3 patients with thoracoabdominal aortic aneurysms. The retrievable stent graft was inserted and evoked spinal cord potential were monitored in order to predict spinal cord ischemia for stent graft repair. There was no paraplegia or hospital death, although 3 patients had paraparesis in stent graft repair. Two of the 3 patients with paraparesis made a full neurologic recovery. There were no cases of paraplegia or paraparesis in surgical operations with thoracoabdominal aortic aneurysm. The concomitant surgical procedure was a good technique for patients in whom cardiopulmonary bypass could not be used. Our results of stent graft repair and surgical operation for descending thoracic or thoracoabdominal aortic aneurysms were acceptable. The retrievable stent graft was useful for prediction of spinal cord ischemia before endovascular stent graft repair of descending thoracic or thoracoabdominal aortic aneurysm.

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99mTc-tetrofosmin was developed as a myocardial perfusion imaging agent and can also be used to depict tumors. We have experienced five cases of malignant thymoma delineated on 99mTc-tetrofosmin SPECT. In one case significant activity was clearly detected in the primary tumor and metastatic lesions. In quantitative analysis, similar 99mTc-tetrofosmin and 201Tl-chloride uptake ratios were obtained (1.95+/-0.57 versus 2.27+/-0.85, respectively; n.s.). The ability of 99mTc-tetrofosmin to detect malignant thymoma was comparable to that of 201Tl-chloride. Therefore, 99mTc-tetrofosmin might be a useful tracer for the detection of malignant thymoma, although more studies will be required to evaluate its diagnostic accuracy.

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A coronary flow reserve (CFR) of 2.0 has been advocated as the endpoint for coronary intervention therapy. Experience shows, however, that CFR does indeed exceed 2.0 in many cases poststenting, while remaining below 2.0 in others. In this study, we assessed the clinical characteristics and IVUS findings of patients whose CFR remained below 2.0 after stent implantation, specifically 16 patients with CFR below 2.0 (22 lesions, 64 +/- 9 years, 4 female), and 102 patients with CFR above 2.0 (112 lesions, mean age 66 +/- 11 years, 22 female). Patient population comprised patients selected for retrospective study, but participants were selected on the basis of matching patient and lesion characteristics. The IVUS findings showed that incidence of calcified lesions and post-PTCA dissection of hard plaque were higher among patients with CFR < 2.0. Further, IVUS-obtained vascular measurements showed post-PTCA area stenosis to be 58.7 +/- 15.2% in the CFR < 2.0 group, and 45.3 +/- 12.5% among CFR > or = 2.0 patients (P < 0.05). These findings indicate that patients with diffuse calcified lesions or high post-PTCA % area stenosis, as determined by IVUS, are more likely to have lower CFR after stenting.

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A case of a retroperitoneal squamous cell carcinoma (SCC) in a 61-year-old woman is reported. Imaging studies demonstrated a well-defined solid and cystic mass with suggested inferior vena cava (IVC) invasion. She had had a history of uterine endometrioid adenocarcinoma (EAC) with squamous differentiation (Grade 1) five years previously. Based on the pathological findings, this retroperitoneal neoplasm was thought to be a metastasis from the uterine EAC.

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PURPOSE: To elucidate the MR appearance at different ages of osteoporotic vertebral compression fractures. METHODS: We retrospectively analyzed sequential MR studies of 107 vertebrae in 75 patients with osteoporotic compression fractures. RESULTS: Vertebral deformities comprised 35 anteriorly wedged vertebrae, 65 fish vertebrae, four flat vertebrae, and others. Signal alterations were depicted as geographic areas of low intensity on T1-weighted images (T1-WI) and high intensity on T2*-WI, or linear areas of low intensity on T1-WI and high or low intensity on T2*-WI. In the acute stage, geographic alteration predominated. During a three-month period following the injuries, the extent of the geographic areas increased in 40% of cases on T1-WI. Geographic alteration declined in the chronic stage, whereas the prevalence of linear signals increased. Restoration of fatty marrow was preceded by linear signals without geographic signals on T1-WI (36%). The anteriorly wedged vertebrae collapsed faster than the fish vertebrae. CONCLUSIONS: The acute or subacute stage of compression fractures is characterized by a larger alteration of the geographic signal, whereas the chronic stage was evidenced by a smaller area of alteration of the geographic and linear signals or by restoration of fatty marrow.

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In the Saitama prefecture in Japan, VMA (vanillyl mandelic acid) screening spot test for detection of neuroblastoma has been performed in 173,046 infants in the years 1981-1986 and 15 infants were found to have neuroblastoma. Two infants had mediastinal tumors and the remainder 13 had intraabdominal tumors. Only 7 infants had palpable masses. Although CT was documented to be the best imaging procedure to provide sufficient information for treatment, conventional radiographic examinations of the chest and abdomen, and abdominal ultrasonography were able, as initial imaging procedures, to detect reasonably small neuroblastomas in infants with a positive VMA screening test.

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After solubilization of rat adrenal microsomes with sodium cholate, 3 beta-hydroxysteroid dehydrogenase with steroid 5-ene-4-ene isomerase (abbreviated as steroid isomerase) activity was purified to a homogeneous state. The following characteristics of the enzyme were obtained: 3 beta-Hydroxysteroid dehydrogenase together with steroid isomerase was detected as a single protein band in SDS-polyacrylamide gel electrophoresis, where its mol. wt was estimated as 46,500. Either NAD+ or NADH was required for demonstration of steroid isomerase activity. Treatment of the enzyme with 5'-p-fluorosulfonylbenzoyladenosine, an affinity labeling reagent for NAD+-dependent enzyme, diminished both the enzyme activities.

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The estimation of placental leucine aminopeptidase (P-LAP) was carried out on pregnancy sera in order to assess its clinical usefulness. The P-LAP level rose progressively with advancing gestation, reaching the highest value (100 unit) at week 39. P-LAP levels in prolonged pregnancies, in which a healthy baby was born, were quite similar to normal pregnancy. On the other hand, the onset of labor in 4 prolonged pregnancies, in which severe neonatal distress occurred, began 14 days or more after the highest value for the daily mean P-LAP levels, and the levels at onset of labor were lower than normal pregnancy. The P-LAP levels in threatened premature delivery were in the order normal pregnancy, those treated only with bed rest and those treated with administration of isoxsuprine. There were no differences in P-LAP levels between normal and mild pre-eclampsia up to week 33, but thereafter the levels for the mild pre-eclampsia were higher than for the normal pregnancy. The P-LAP levels for the severe pre-eclampsia reached their maximum at week 31. Around this week, the levels for severe pre-eclampsia were higher than in the normal pregnancy. After week 35, the levels dropped precipitously to week 40. The levels for severe pre-eclampsia at week 39 and 40 were lower than in normal pregnancy.

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The prognosis of patients with ovarian carcinoma is believed as worst among malignant diseases in the field of gynecology. Multiple factors including clinical stage, histologic type and grade may play an important role in the prognosis of patients. Because of these factors and the few cases of ovarian carcinoma seen in any one center over a short period, the ability to make valid evaluation of these factors has been limited. We organized ovarian tumor studying group in Tokai district with eleven member hospital and analyzed 453 cases of solid ovarian tumor retrospectively. 1) Cumulative survival rate was calculated according to the clinical stages. Five year survival rate of stage 1 was about 80%, that of stage 2 was about 30% and that of stage 3 and stage 4 were around 10% respectively. 2) Cumulative survival rate was calculated according to histologic types. There was minor variation of survival by histologic types. When we compared with different histologic types by same clinical stages such as stage 1 and stage 3 there was no definite differences of survival rate except slightly poor prognosis in case of mucinous cystadnocarcinoma. 3) Cumulative survival rate was calculated according to histologic grading. Histologic grade affects the prognosis of patients with ovarian carcinoma.

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The excretion pattern of human chorionic gonadotropin (hCG) or luteinizing hormone (LH) was observed in the urine of 77 patients with trophoblastic neoplasia, 109 with complete remission from trophoblastic neoplasia, and 94 with no trophoblastic neoplasia, when the anti-beta-subunit hCG system radioimmunoassay (anti-beta-subunit RIA), which specifically measured hCG was used. The sensitivity of anti-beta-subunit RIA was limited to urinary hCG 16 mIL/ml from the specificity of the anti-beta-subunit serum. Luteinizing hormone in the urine of patients with complete remission and in normal menstrual, postmenopausal, and castrated women was less than 16 mIU/ml in most cases. The excretion pattern of urinary hCG in the patients undergoing treatment for trophoblastic neoplasia was more clearly comprehended with the anti-beta-subunit RIA as compared with the anti-hCH RIA. The criteria for judgment of complete remission were that the hCG value dropped to less than 16 mIU/ml and that cellular response was not observed at least in the last two courses.

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Histocompatibility antigen was analyzed in 1,104 patients with trophoblastic neoplasia and in their husbands. Furthermore, the patients were examined for cell-mediated immunity. (1) There was no significant difference in the frequency of the ABO blood groups between patients with hydatidiform or destructive mole or choriocarcinoma and healthy persons. (2) The incidence of appearance of anti-HL-A antibody was more frequent in the patients with destructive mole than in those with hydatidiform mole or choriocarcinoma. (3) Patients with choriocarcinoma were frequently incompatible at HL-A9, HL-A10, and HL-AW5. (4) The mixed lymphocyte culture (MLC) showed lower values in patients with choriocarcinoma than in those with destructive mole. Histocompatibility between the patients and their husbands was more remarkable in the patients with chriocarcinoma than in those with destructive mole. (5) In patients with choriocarcinoma, incompatibility was detected at HL-A10, HL-A11, HL-AW5, and HL-A13 in the group with good prognosis and at HL-A5, HL-AW15, and HL-A12 in the poor prognosis group. The MLC value was lower in the poor prognosis group.

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Phytohemagglutinin-induced lymphocyte transformation (PHA-T) was depressed in pregnant women, as compared with that in nonpregnant women. Pregnancy serum had a suppressive action on PHA-T which was enhanced with the advance in pregnancy. Hydrocortisone, progesterone, alpha-fetoprotein and trophoblast-specific antigen, were demonstrated as immune suppressive factors. From these results, it was concluded that cell-mediated immunity might be reduced in pregnant women and that this reduction might be one of the causes for the maintenance of pregnancy.

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