Preparation and antirheumatic activity of optically active 2-acetylthiomethyl-4-(4-methylphenyl)-4-oxobutanoic acid (KE-298)

2-Acetylthiomethyl-4-(4-methylphenyl)-4-oxobutanonic acid (KE-298) is an antirheumatic agent. To elucidate the effects of optically active KE-298, we resolved the racemic acid and obtained the two optical isomers. (+)-KE-298 was converted to the 4-bromobenzyl ester derivative and the absolute structure was confirmed as (S) by X-ray crystallographic analysis. The pharmacological activities of the optical isomers and racemic KE-298 were compared by using the characteristic tests for KE-298. Though (+)-KE-298 showed a stronger suppressive effect on rat adjuvant arthritis than (-)-KE-298, no difference between the two isomers was detected in in vitro tests (enhancing effect on lymphocyte transformation, IL-1 antagonistic effect).

Monocyte function associated with intermittent lentinan therapy after resection of gastric cancer

The effect of lentinan administration on monocyte function in the peripheral blood were examined in 33 patients who underwent resection of gastric cancer. As parameters of monocyte function, IL-1 production, C3b receptor, Fc gamma receptor and monocyte ratio were determined every 4 weeks for a maximum of 24 weeks. Among patients who were taking combined therapy with lentinan, an increase in IL-1 beta production of more than 50% was found 8 weeks (2 months) after the initiation of therapy in 8 of 12 patients given 2 mg at 2-week intervals, and in 11 of 16 patients given the same dose at 4-week intervals. This increase was particularly clear in stage II or more advanced cases. There were no significant changes in the other parameters studied. It has been considered that lentinen is effective when administered once a week. The results of the present study, however, suggest that lentinan given every 4 weeks also stimulates monocyte function enough to maintain immunological activity.

Presence of the seven transmembrane thrombin receptor on human tumour cells: effect of activation on tumour adhesion to platelets and tumor tyrosine phosphorylation

Thrombin-treated tumour cells enhance their adhesion to platelets, fibronectin and von Willebrand factor in vitro, and enhanced their pulmonary metastasis in mice in vivo. A unique seven transmembrane spanning thrombin receptor has recently been cloned which is activated following thrombin proteolysis of the N-terminal end of the receptor with exposure of a tethered ligand. An N-terminal 14-mer (SFLLRNPNKYEPF) or 6-mer (SFLLRN) of the tethered ligand can serve as a thrombin receptor activation peptide (TRAP) by mimicking the action of thrombin on platelets, endothelial cells and smooth muscle cells. We have examined six human tumour cell lines for their response to TRAP, for the presence of this thrombin receptor mRNA by RT-PCR, protein by immunoblot and for their in vitro and in vivo response to TRAP. All six cell lines contain the receptor mRNA, and when treated with 100 microM 6-mer TRAP or 1 u/ml thrombin increase their adhesion to platelets 2-3-fold. Four of the six cell lines undergo tyrosine phosphorylation within 30 s to 1 min after exposure to 6-mer TRAP or thrombin. Thus tumour cells respond to thrombin via activation of their seven transmembrane spanning thrombin receptor.

Prevalence of neurological disorders in a Japanese town

The prevalence of all neurological disorders in a Japanese town was calculated, with a result of 91.1 per 1,000 population. The prevalence of cerebrovascular disease was 28.8; myelopathy and/or radiculopathy caused by deformity of the spine or disc herniation, 23.9; neuralgia, 11.5; dementia, 10.4; peripheral nerve disturbance, 5.5; epilepsy, 4.4; Parkinson's disease, 2.0; mental retardation, 2.9; brain/spinal tumor, 1.4; headache, 10.8, and vertigo/dizziness, 4.4. The prevalence of headache and vertigo/dizziness was also calculated from the results of the questionnaires sent to inhabitants: headache, 79.6, and vertigo/dizziness, 60.8. Neurological disorders are common in Japan and likely to continue to increase.

Plasticity of central motor and sensory pathways in a case of unilateral extensive cortical dysplasia: investigation of magnetic resonance imaging, transcranial magnetic stimulation, and short-latency somatosensory evoked potentials

We studied a 13-year-old girl with unilateral extensive cortical dysplasia who had mild hemiparesis with mirror movement and no sensory deficit. Transcranial focal magnetic stimulation (TMS) to the unaffected hemisphere elicited bilateral motor evoked potentials (MEPs) of the abductor pollicis brevis muscle (APB) with similar latency and amplitude. The scalp positions where the MEP amplitudes were highest were at the same site in the unaffected hemisphere for both APBs. TMS to the affected heimsphere showed no MEP for either APB. These data indicated that the APB response of the paretic side originated from the same motor cortex as for the contralateral APB, probably due to axonal sprouting. In the study of short-latency somatosensory evoked potentials, the cortical representation point of the paretic hand sensation was in the ipsilateral unaffected hemisphere; this point was located anterior to the cortical representation point of the contralateral hand sensation. We conclude that reorganization of primary motor and sensory cortex occurs when there is unilateral extensive brain damage in early gestation.

[Legionella pneumophila serogroup 3 isolated from a patient of pneumonia developed after drowning in bathtub of a hot spring spa]

A 71-year-old Japanese female, was found unconscious by drawing, in a hot spring spa, at around noon of 20 October 1994. She recovered by emergency cardiopulmonary resuscitation, and admitted to the Takinomiya General Hospital, with adult respiratory distress syndrome (ARDS). Although she recovered from ARDS within 4 days after her admission, she developed severe pneumonia accompanied with the second attack of ARDS. Ordinary bacteriological culture of her respiratory specimens failed to yield any significant pathogen for her pneumonia, and neither cefazolin nor imipenem/cilastatin was effective. Thus minocyclin was given on the 7th hospital-day and this was effective for blood gas and C-reactive protein (CRP) levels. Intratracheal exsudate inoculated on BCYE alpha agar plate yielded grayish white colonies. Cells of the colonies were clearly agglutinated by anti-Legionella pneumophila serogroup (SG) 3 serum. Antibody titers of patient's paired sera against the strain L. pneumophila SG3 Bloomington-2 and the patient's strain (Y-1) were determined by microplate agglutination test, and a significant rise from 1:20 to 1:320 was demonstrated. Patient recovered by erythromycin treatment and was discharged on the 59th hospital day. L. pneumophila SG3 organisms were again isolated from the spa water where the patient drawn. From these findings described above, we diagnosed the patient as pneumonia due to L. pneumophila SG3, and the spa water was the most probable source of infection.

In vivo ESR measurements of free radical reactions in living mice

In vivo ESR measurements were carried out to estimate free radical reactions in living mice using nitroxyl radicals as probes. The ESR signal of nitroxyl radical which was intravenously or intramuscularly injected to living female ddY mice decreased gradually by reducing to the corresponding hydroxylamine. The reduction rate was enhanced by oxidative stress, and pre-treatment of antioxidants suppressed the enhancement of signal decay. Oral administration of carbon tetrachloride enhanced signal decay in upper abdomen but not in thorax. These results indicated that free radicals, which can reduce nitroxyl radical, were produced in the upper abdomen by oral administration of carbon tetrachloride.

Species- and gender-related differences in amine, alcohol and phenol sulphoconjugations

1. Species-, gender- and strain-related differences in amine sulphoconjugations were studied in 105,000 g supernatants of liver samples isolated from mouse, rat, guinea pig, rabbit, dog, monkey and man and were compared with those of alcoholic and phenolic compounds. Substrates examined were desipramine (an alkylamine), piperazine and piperidine derivatives (alicyclic amines), aniline (an arylamine), tiaramide and dehydroepiandrosterone (alcoholic compounds) and 2-naphthol (a phenolic compound). 2. Sulphoconjugating activities of alicyclic and aryl-amines and tiaramide varied depending on the animal species, sex and strain used. In all animal species examined, the activity for desipramine was low or negligible but for 2-naphthol was consistently detected and high. Amine sulphoconjugations were higher in rabbit than in other animal species. Dog hepatic 105,000g supernatants exhibited low or neglible activities for amines and tiaramide. Females showed higher sulphoconjugating activities for all substrates in mouse and for amines and tiaramide in rat; males exhibited higher activities for 2-naphthol in rat and monkey and for amines in rabbit; there were no clear sex-related differences in other sulphoconjugations. 3. Among BALB/c, C57BL/6, DBA/2, and AKR mouse strains, the AKR strain showed higher activities towards amines and tiaramide than others. 4. In human liver 105,000g supernatants, sulphoconjugating activities for alicyclic amines, dehydroepiandrosterone, and 2-naphthol were detected. Among them, higher activities were observed in piperazine and phenol sulphoconjugations. There were no sex-related differences in the activities of all substrates examined. Good correlations were observed in activities between alicyclic amine and dehydroepiandrosterone sulphoconjugations. 5. These results indicate that activities of amine and alcohol sulphoconjugations vary considerably depending on the substrate, species, sex and strain but phenol sulphoconjugation is consistently detected in all species examined.

[Clinical studies of learning disability. Part II: A prospective study of children with risk factors for learning disability at three year-old screening]

We followed children with the risk factors for learning disability (LD) at the three year-old screening prospectively. The five risk factors were speech delay, hyperkinesia, delayed social skill, delayed comparative conception (big and small, long and short) and mutistic behaviour. We evaluated seventeen elementary school children using WISC-R and the Pupil Rating Scale Revised. Six of them were diagnosed as normal, six were learning-disabled, and five were mentally retarded children. We proposed that the screening of LD at three years by the risk factors were effective but only partially.

Effects of mazindol in two patients with Prader-Willi syndrome

Two patients with Prader-Willi syndrome, including gross obesity with food-related behavior and mild mental retardation, are presented. One patient was an 11-year-old girl with the diagnosis of development delay, hypoactivity, and waxy skin with normal female karyotype. The other patient was a 15-year-old girl with the diagnosis of abnormal chromosome 15. Obesity had been present since early childhood, and it was difficult for them to manage their weight control by means of diet and exercise therapy. With 24-week mazindol administration, they demonstrated marked improvement in weight control during the early period and improvement in pathologic behavior without side effects. Mazindol was given orally, 1.0-2.0 mg/day, in one or two daily doses. Mazindol may prove to be useful in the treatment of patients with Prader-Willi syndrome.

[Clinical studies of learning disability. Part I: Two-axial diagnosis of learning disability using the Pupil Rating Scale Revised (PRS) and WISC-R]

We investigated the correlation between intelligence quotient and school performance evaluated by PRS (the Pupil Rating Scale Revised) to assess an adequacy of two-axial diagnosis of learning disabilities (LD). The subjects were 37 children, including 31 cases with developmental or school problems and 6 normal children. The Japanese Wechsler Intelligence Scale for Children-Revised (WISC-R) was employed for an estimation of intelligence quotient (IQ) and, PRS was used to evaluate school performance. We defined 'LD risk child' as a child whose IQ was no less than 70 and PRS score was no more than 65. A statistical evaluation of IQ and PRS was done in this group separately. Ten children were diagnosed as 'LD risk' using this criterion. Fourteen children had normal IQ, and thirteen children were mentally retarded. There was a significant correlation (r = 0.68, P < 0.001) between IQ and the PRS score in these 37 children. On the other hand, no significant correlation was found between IQ and the PRS score of the 'LD risk child'. This result suggests that we can expect high PRS score in proportion to their IQ level. Because LD children generally tend to demonstrate deviated IQ-school performance correlation, we conclude that the WISC-R and PRS are appropriate for two-axial screening of LD.

[Retroperitoneal myxoid leiomyoma: report of a case]

We report a case of retroperitoneal myxoid leiomyoma in a 36-year-old woman complaining of urinary retention. An ultrasonogram revealed a mass in the pelvic space, while CT and MRI demonstrated a retroperitoneal tumor. Open resection of the tumor was performed. The resected tumor weighed 600 g and measured 16 x 11 x 9 cm. Histological examination disclosed a tumor mainly composed of smooth muscle with myxomatous change and only rare mitoses. The pathologic diagnosis was retroperitoneal myxoid leiomyoma. Twenty-seven cases of this type of lesion previously reported in the Japanese literature were reviewed.

Neuroleptic malignant syndrome in striatonigral degeneration

A 6-year-old boy with striatonigral degeneration had an episode of neuroleptic malignant syndrome after an upper respiratory infection. Dantrolene treatment was successful. Some reports have demonstrated that anesthetic and antipsychotic agents lead to neuroleptic malignant syndrome in disorders of the basal ganglia. However, neuroleptic malignant syndrome attributable to a respiratory infection has not previously been reported. Our patient illustrates the potential morbidity of neuroleptic malignant syndrome in patients with striatonigral degeneration.

[Short somatosensory evoked potentials in patients with Fukuyama type congenital muscular dystrophy--a comparison with CT and MRI findings]

Seven patients with Fukuyama type congenital muscular dystrophy were studied. Low density areas (LDs) in the cerebral white matter on cranial CT were present in all 4 patients younger than 13 years of age and in 1 of 3 adult patients. LDs corresponded to low signals on T1 weighted MRI image and high signals on T2 weighted MRI image. The follow-up MRI showed a decreased tendency of the abnormal signals in 2 patients. Short somatosensory evoked potentials (SSEPs) in two infants, aged 4 months and 8 months, showed absent or depressed N1 amplitudes and delayed interpeak latencies from P3 to N1. N1 amplitudes increased on follow-up studies. SSEPs of five patients, who were older than 2 years of age, showed normal N1-P3 latencies. Amplitude of N1 was low in 2 patients with LD. Since the absent or depressed amplitude and delayed latency of N1 improved with the decrease of abnormal signals on MRI, we considered that N1 abnormalities show delayed myelination.

Frequency of the Prader-Willi syndrome in the San-in district, Japan

Nineteen cases of the Prader-Willi syndrome were collected in the San-in district, in the western part of Japan, and an epidemiological study was carried out. The male to female ratio was 1:1.11. Deletion of chromosome 15q11-13 was found in seven of 16 patients examined by means of high-resolution chromosome banding. The incidence among live-births was estimated to be 6.64 x 10(-5) (1 in 15,060 live-births) in 1980-1989, and the mutation rate was 3.32 x 10(-5) per gene per generation, as determined by a direct method. The prevalence was estimated to be 5.72 x 10(-5) (1 in 17,483) in patients under 15 years old, which was higher than that in other autosomal dominant diseases (tuberous sclerosis and congenital myotonic dystrophy) also studied in the San-in district. A birth-order effect was revealed and a slightly significant difference was found as to the fathers' age between the patients and their normal siblings. The results of these two tests are in accord with the recent discovery that this syndrome is caused by paternal chromosomal aberrations.

Neuroradiological findings in the carbohydrate-deficient glycoprotein syndrome

The carbohydrate-deficient glycoprotein syndrome is a newly recognised genetic disorder characterised by mental retardation, liver disfunction during infancy, cerebellar ataxia and atrophy, polyneuropathy, growth retardation, stroke-like episodes, and the appearance of carbohydrate-deficient fractions of multiple glycoproteins in the serum. The neuroradiological findings have been known as features of olivopontocerebellar atrophy. However, whether the abnormalities in the cerebellum and brain stem progress after birth is not known. We have carried out serial CT and MRI on three Japanese patients with this syndrome at different ages. A small cerebellum, with peculiar enlargement of the cisterna magna, and a small brain stem are present in infancy and atrophy of the anterior vermis and from before backwards in the cerebellar hemispheres seem to progress throughout early childhood.

CT evaluation of hepatic tumors: comparison of CT with arterial portography, CT with infusion hepatic arteriography, and simultaneous use of both techniques

OBJECTIVE

We hypothesized that CT with arterial portography (CTAP) might depict tumors undetected by CT with infusion hepatic arteriography (CTIHA), and the converse. Accordingly, we compared the detection rate of malignant tumors using CTAP, CTIHA, and simultaneous use of both techniques to determine whether CTIHA can be used to distinguish malignant from benign hepatic nodules.

SUBJECTS AND METHODS

Fifty-four candidates for partial liver resection who underwent combined CTAP and CTIHA were studied. Histopathologic study confirmed 77 malignant and 15 benign nodules in these patients. CTAP, CTIHA, and combined CTAP and CTIHA were used by three observers before surgery, and the sensitivities of the three methods in detecting malignant tumors were compared. Contrast-enhancement patterns of the nodules on CTIHA scans were determined.

RESULTS

Sixty-eight malignant nodules (88%) were detected with CTAP, 64 (83%) with CTIHA, and 69 (90%) with simultaneous interpretation of both scans. These differences were not significant. CTIHA showed 16 malignant and 12 benign small nodules. Of these, 13 malignant and two benign nodules had rim enhancement. Use of rim enhancement as the criterion for malignancy of these small nodules gave an accuracy rate of 82%.

CONCLUSION

CTAP, CTIHA, and simultaneous use of both techniques are similar in their ability to detect malignant hepatic tumors. CTAP alone is recommended for the detection of malignant hepatic tumors. CTIHA is of value in differentiating malignant from benign small nodules.

Bilateral opercular syndrome: an unusual complication of perinatal difficulties

We describe an 8-year old boy with pseudobulbar palsy and speech disturbance associated with fetal distress, mild birth asphyxia and probably intracranial hemorrhage. There is a remarkable dissociation between orofacial voluntary movements and emotional expression. MRI revealed cortical atrophy and subcortical gliosis of both opercula. The clinical and neuroradiological features correspond to bilateral opercular syndrome. We assume that a reduction of cerebral blood flow involving both opercula induced pseudobulbar palsy with severe expressive speech disturbance.

Postsurgical intrahepatic portal thromboembolism: a possible cause of perfusion defects on CT during arterial portography

OBJECTIVE

Our goal was to investigate unexplained nontumorous perfusion defects on CT arterial portography (CTAP).

MATERIALS AND METHODS

The CTAP images of 35 patients who underwent partial hepatectomy or open biopsy were analyzed. Hepatic tumors consisted of hepatocellular carcinoma (n = 18) and colorectal carcinoma metastases (n = 17). Nontumorous perfusion defects were categorized into those previously explained and those unexplained. We investigated unexplained ones and their relationship with the underlying conditions.

RESULTS

Eight unexplained nontumorous perfusion defects were found in four patients with colorectal metastases. Statistical analysis showed that the defects occurred with significantly higher incidence in patients with colorectal metastases than in those with hepatocellular carcinoma (p = 0.046, Fisher test). All four patients with defects underwent CTAP within 1 month after colorectal surgery. A significant difference was seen in the distribution of surgery-CTAP time intervals between those patients with and those without defects (p < 0.05, Wilcoxon-Mann-Whitney test). Intrahepatic portal thrombi were pathologically proven in one of the four patients.

CONCLUSION

Unexplained nontumorous hepatic perfusion defects may represent postsurgical portal thromboemboli.

High cell-density culture system of hepatocytes entrapped in a three-dimensional hollow fiber module with collagen gel

A compact three-dimensional (3D) module is needed for hepatocyte culture in order to develop an effective hybrid artificial liver system that can retain hepatocellular structure and differentiated functions. We treated the 3D module with collagen gel to entrap rat hepatocytes. This method yielded a high hepatocellular density (2 x 10(7) cells/ml) over a period of 14 days and maintained the secretion of albumin and ureogenesis at the same level as the control monolayer method. The ammonia removal remained at 43% of the Day 0 value over 8 days of perfusion. Our data show that this approach may be useful for liver support therapy in an extracorporeal circuit.

[Endoscopic mucosal resection of esophageal cancer]

Limited surgery, esophagectomy without thoracotomy or endoscopic mucosal resection (EMR), is indicated for mucosal cancer of the esophagus without lymph node metastasis. Mucosal cancer less than 2 cm in size or less than a third of the circumference of the esophagus, is suitable for EMR. However, mucosal cancer invasive to the muscularis mucosa is excluded. As for postoperative complications, a small fissure, two cases of stenosis and 3 cases of oozing bleeding, were experienced. Conservative treatment was performed for all patients except one. The 5-year survival rate of EMR was 95%-100% in several institutions in Japan. Recurrence was observed in 3%-7%, however, it was cured by means of local treatment of esophageal cancer.

[Thoracoscopic enucleation of leiomyoma of the esophagus--report of two cases]

Thoracoscopic enucleation of leiomyoma of the esophagus was successfully performed in two cases. This paper mainly describes a 53-year-old man who experienced with a slight dysphagia and retrosternal discomfort when moving. Esophagoscopy showed a mass beneath normal mucosa located at 26 cm from the incisor of the left anterior esophagus. Endoscopic ultrasonography showed a sharply delineated low echoic mass with regular echo-pattern, measuring 4 cm along the axis. The lesion was diagnosed as leiomyoma. The operation was performed under general anesthesia, keeping the patient on the left postero-lateral position. A double-lumen endotracheal tube was utilized and the right lung was collapsed. Six trocars were inserted through right intercostal spaces for operation. The azygos vein first of all was dissected and divided by an EndoGIA. The esophagus was then mobilized lengthwise enough to rotate the left side to the right with two slings traction for better visualization of the lesion site. Intraluminal balloon-mounted esophagoscope was useful enough to expose the tumor inner side out of the esophageal wall and the tumor was easily enucleated. After resection, intact esophageal mucosa was confirmed by endoscopy and the proper muscle layer of the esophagus was closed with 2-0 Vicryl. In the 2nd case, leiomyoma located at 32 cm from the incisor of the right esophageal wall, 4 x 1.5 x 1 cm in size, was removed by the same technique using five trocars, where neither the azygos vein divided nor the esophagus mobilized. Both patients showed uneventful recovery and the symptoms disappeared after operation. Intraluminal balloon-mounted esophagoscope was useful to do this kind of thoracoscopic procedure.

Fatal reducing body myopathy. Ultrastructural and immunohistochemical observations

Two female infants who developed normally during infancy began to have progressive muscle hypotonia and weakness from 2 years 10 months and 2 years 3 months of ages, respectively. Both patients had rapidly progressive muscle weakness with death from respiratory failure at 4 years 11 months and 3 years 9 months, respectively. In addition to mild inflammation in their muscle biopsies, the most striking finding was the presence of numerous reducing bodies (RB) in almost all degenerating fibers. By electron microscopy, these bodies consisted of fine granular material, usually located around the degenerating nucleus. These bodies showed no immunohistochemical reaction to antibodies against structural, cytoskeletal and membrane proteins and a histone-specific antibody against nuclei and chromosomes. They were occasionally positively stained with a ubiquitin antibody. Although the origin of these bodies remains unknown, they appeared to be related to active myofibrillar degeneration, probably resulting from primary nuclear degeneration.

Carbohydrate-deficient glycoprotein syndrome: electrophoretic study of multiple serum glycoproteins

The serum glycoproteins in three patients with the carbohydrate-deficient glycoprotein (CDG) syndrome were examined using isoelectric focusing in polyacrylamide gels, SDS-PAGE, and a two-dimensional electrophoretic technique. Increases in isoforms with higher isoelectric points (pI's) were observed in all asparagine-N-linked glycoproteins tested. Abnormal components of transferrin, antithrombin III and orosomucoid had smaller molecular weights, about 3000 and 6000 Da, than normal ones. Antithrombin III gave an increased cathodal band. Its pI and molecular weight were the same as those of a physiological variant of antithrombin III (beta fraction), which is known to lack the asparagine-N-linked oligosaccharide chain at asparagine-135. The evidence suggests that a deficiency of asparagine-N-linked oligosaccharide transfer occurs in multiple serum glycoproteins in patients with CDG syndrome. Thus, examination of serum by isoelectric focusing in polyacrylamide gels and SDS-PAGE should be very useful for differentiating the CDG syndrome type I from clinical and biochemical variants.