Induction of macrophage migration inhibitory factor precedes the onset of acute tonsillitis.

We investigated the serum macrophage migration inhibitory factor (MIF) levels of palmoplantar pustulosis patients, before and after the tonsillar provocation test. Higher serum MIF levels of palmoplantar pustulosis patients were decreased after the tonsillar provocation test (n=29). To confirm these phenomena, two patients with acute tonsillitis had their changes in body temperature, C-reactive protein (CRP) and serum MIF levels examined during the course of their illness. Surprisingly, increased MIF preceded fever and CRP elevation, and MIF subsequently decreased at the onset of fever and CRP elevation. Since MIF is an initiator of other proinflammatory cytokines, we suggest that the induction of MIF may precede other inflammatory conditions

Immunotherapy of transitional cell carcinoma of urinary bladder

Karcinom prijelaznog epitela mokraćnog mjehura najčešći je karcinom mokraćnog sustava. Klinički razlikujemo dva oblika ove bolesti: mišićno-neinvazivni i mišićno-invazivni oblik. Temeljna klinička odrednica mišićno-neinvazivnih tumora su recidivne novotvorinske promjene; 60 – 90 % mišićno-neinvazivnih tumora recidivirat će ako se liječe samo transuretralnom resekcijom (TUR). Upravo stoga se nakon TUR-a u pacijenata u kojih postoji visoki rizik od ponovne pojave ili progresije bolesti provodi intravezikalna imunoterapija BCGom (bacillus Calmette-Guerin). BCG predstavlja živi atenuirani soj Mycobacterium bovis. U primjeni BCG-a intravezikalne terapije razlikujemo indukcijsku terapiju i terapiju održavanja. Intravezikalna aplikacija BCG-a uzrokuje masivan ulazak upalnih stanica u stijenku mokraćnog mjehura te produkciju citokina detektibilnih u sluznici mjehura i u urinu, što dovodi do imunog odgovora protiv tumora. Činjenica je kako BCG uzrokuje dugotrajan i dugodjelujući imuni odgovor. Do eradikacije tumorskih stanica dolazi zbog celularnih fokusa u stijenci mjehura, a kao direktan antitumorski efektorski mehanizam navodi se direktna antitumorska aktivnost IFN (interferon) i citotoksičnost NK (engl. natural killer) stanica.Bladder cancer is the most common cancer in urinary system. There are two clinical aspects of this disease: muscle non-invasive and muscle invasive disease. Basic characteristic of non-muscle invasive disease is tumor recurrence; 60-90 % of tumors will recurr if treated by transurethral resection (TUR) only. That is the reason why patients in whom exists the risk of recurrence or progression undergo intravesical bacillus Calmette-Guerin (BCG) immunotherapy. BCG represents live attenuated Mycobacterium bovis. There are two phases in BCG therapy: induction and maintenance therapy. Intravesical BCG application causes massive agregation of immune cells in bladder wall and producton of cytokins which causes cytotoxic tumor response. Direct effector mechanism is achieved by IFN (interferon) and NK (natural killer) cell cytotoxicity

健常大学生における僧帽弁逸脱症の検討

学会報告要

Management of Blunt Hepatic Trauma

One hundred and twelve consecutive cases with blunt hepatic trauma between January 1, 1965 and December 31, 1988 at the First Dpartment of Surgery, Nagasaki University were reviewed. Fifty-seven patients had minor injuries, 33 moderate injuries and 22 severe injuries. Sixty-five patients (58%) sustained also one of more associated injuries. Out of 43 patients over the last ten years 30 were diagnosed by US or CT. Eighty-eight patients (78.3%) underwent laparotomy ; laparotomy and drainage alone in 13, suture and packs in 57, debridement and minor liver resection in 11 and right lobectomy in 9. The results of treated patients were assessed according to the grading of liver injury and assocated injury. The overall mortality was 13.4% (15 of 112). True liver-related mortality due to hemorrhage was 26.7% (4 of 5), and the other 11 patients who died were due to refractory shock and the development of multiple organ failure (MOF). Twenty-one patients were conservatively managed with only one death, and the other 20 survivors had no complications and healed completely from 6 to 12 months after trauma. Although lobectomy or resectional debridement are advocated as an operative procedure for massive injury, a conservative management for mild or moderate ruptures is still recommended as far as possible