The effect of takusha, a kampo medicine, on renal stone formation and osteopontin expression in a rat urolithiasis model

Kampo medicine is a traditional Japanese therapeutic system which originated in China and was used to treat various diseases for hundreds of years. Kampo medicine had been also used for the cure and the prevention of urinary calculi for many years, but the effect and the mechanism of this use of kampo medicine are unclear. We examined the inhibitory effect of the kampo medicine takusha on the formation of calcium oxalate renal stones induced by ethylene glycol (EG) and vitamin D3 in rats. We also investigated the effect of takusha on osteopontin (OPN) expression, which we previously identified as an important stone matrix protein. The control group rats were non-treated; the stone group rats were administered EG and vitamin D3, and the takusha group was administered takusha in addition to EG and vitamin D3. The rate of renal stone formation was lower in the takusha group than in the stone group; thus, the OPN expression in the takusha group was smaller than in the stone group. Takusha was effective in preventing oxalate calculi formation and OPN expression in rats. These findings suggest that takusha prevents stone formation including not only calcium oxalate aggregation but also proliferation.

Calcium phosphate stones produced by Madin-Darby canine kidney (MDCK) cells inoculated in nude mice

The canine renal distal tubular cell line Madin-Darby canine kidney (MDCK) forms calcium phosphate microliths during a long-term culture in vitro. We identified osteopontin (OPN) and calprotectin (CPT) from a urinary stone matrix. We recently also detected the expression of OPN and CPT in MDCK cells. The relationship between the mechanism of the stone formation and these stone matrix proteins is not yet known. Here, MDCK cells were cultured and inoculated in the subcutis of nude mice. After 4, 8 and 12 weeks, the inoculated tissues were resected, fixed and immunostained with polyclonal anti-human OPN and polyclonal anti-human CPT antibodies. Some serial specimens were stained with von Kossa's procedure. MDCK cells formed some follicular formations in the subcutis of nude mice at least at 12 weeks after transplantation. At 8 weeks after the inoculation, we detected small calcium phosphate stones with MDCK cells trapped in the follicles. The cells forming the stones also expressed both OPN and CPT. The CPT expression sites coincided with the stone formation sites. We confirmed that MDCK cells inoculated in nude mice had stone-forming potential, and we speculate that OPN and CPT play important roles in stone formation by MDCK cells.

Stereotactic radiosurgery for cavernous sinus cavernous hemangioma--case report

A 40-year-old female presented with cavernous sinus cavernous hemangioma manifesting as left abducens and trigeminal nerve pareses. Magnetic resonance imaging revealed a left cavernous sinus tumor. The tumor was partially removed. Histological examination of the specimen confirmed cavernous hemangioma. Radiosurgery was performed using the gamma knife. The tumor markedly decreased in size after radiosurgery and morbidity was avoided. Cavernous sinus cavernous hemangiomas may be difficult to treat surgically due to intraoperative bleeding and cranial nerve injury. Stereotactic radiosurgery can be used either as an adjunct treatment to craniotomy, or as the primary treatment for small cavernous sinus cavernous hemangioma.

Involvement of gonadal steroid hormone disturbance in altered prolactin receptor gene expression in the liver of diabetic mice

The levels of mRNA for long and three short forms of prolactin receptor (PRLR) were examined in the livers of normal (db+/db-) and insulin-resistant diabetic (db+/db+) mice to assess the role of gonadal steroid hormones in the regulation of PRLR gene expression in diabetes mellitus. In females, plasma levels of testosterone in diabetic mice were higher, and those of 17beta-estradiol were lower when compared with levels in normal mice. By contrast, diabetic male mice had lower plasma levels of testosterone than normal males and showed no significant difference in the low circulating level of 17beta-estradiol compared with normal males. The short 3 form of PRLR (PRLR3) mRNA was the most abundant in the liver of both normal and diabetic mice. In addition, the level of PRLR3 mRNA in normal females was 8-fold higher than in normal males. The level of PRLR3 mRNA in diabetic females was approximately a quarter lower than in normal females, whereas the level of PRLR3 mRNA in diabetic males was approximately 2-fold higher than in normal males. During postnatal development, the level of PRLR3 mRNA increased during puberty in normal females, while the level in diabetic females decreased to a nadir at 7 weeks of age followed by a progressive rise. On the other hand, the levels of PRLR3 mRNA in both normal and diabetic males decreased gradually during 5 to 14 weeks of age. Testosterone treatment of diabetic males and females resulted in a 49.1 and 49.8% decrease of PRLR3 mRNA respectively. 17beta-Estradiol treatment slightly (18%) increased levels of PRLR3 mRNA in diabetic males. These results suggest that the hepatic level of PRLR mRNA is regulated by the inhibitory effect of testosterone and the stimulatory effect of estrogen in both normal and diabetic mice.

Maturational disturbance of chondrocytes in Cbfa1-deficient mice

Cbfa1, a transcription factor that belongs to the runt-domain gene family, plays an essential role in osteogenesis. Cbfa1-deficient mice completely lacked both intramembranous and endochondral ossification, owing to the maturational arrest of osteoblasts, indicating that Cbfa1 has a fundamental role in osteoblast differentiation. However, Cbfa1 was also expressed in chondrocytes, and its expression was increased according to the maturation of chondrocytes. Terminal hypertrophic chondrocytes expressed Cbfa1 extensively. The significant expression of Cbfa1 in hypertrophic chondrocytes was first detected at embryonic day 13.5 (E13.5), and its expression in hypertrophic chondrocytes was most prominent at E14.5-16.5. In Cbfa1-deficient mice, whose entire skeleton was composed of cartilage, the chondrocyte differentiation was disturbed. Calcification of cartilage occurred in the restricted parts of skeletons, including tibia, fibula, radius, and ulna. Type X collagen, BMP6, and Indian hedgehog were expressed in their hypertrophic chondrocytes. However, osteopontin, bone sialoprotein, and collagenase 3 were not expressed at all, indicating that they are directly regulated by Cbfa1 in the terminal hypertrophic chondrocytes. Chondrocyte differentiation was severely disturbed in the rest of the skeleton. The expression of PTH/PTHrP receptor, Indian hedgehog, type X collagen, and BMP6 was not detected in humerus and femur, indicating that chondrocyte differentiation was blocked before prehypertrophic chondrocytes. These findings demonstrate that Cbfa1 is an important factor for chondrocyte differentiation.

Body composition analysis of cachectic rabbits by total body electrical conductivity

A simple formula (1.536 x TOBEC + 475.146 = LBM, where TOBEC is total body electrical conductivity and LBM is lean body mass) to estimate LBM in grams was developed on the basis of the total body fat data obtained by ether extraction and TOBEC in normal rabbits. The formula was also applicable to rabbits with cachexia induced by inoculation of VX2 carcinoma or by starvation. We were able to assess the losses of body fat in the rabbits with cachexia at 10-day intervals by using TOBEC.

Alteration in the low-frequency domain in power spectral analysis of fetal heart beat fluctuations

OBJECTIVE

Spectral analysis was conducted on fetal heart rate fluctuations for the purpose of investigating the change in gestational age and examining the usefulness as a method of estimating fetal blood gas.

STUDY DESIGN

Five hundred and twenty-nine pregnant women with a single normal fetus and 26 women with intrauterine growth restriction (IUGR) were studied during the 20th to 38th gestational weeks. In cases of IUGR, fetal blood gas levels were evaluated with percutaneous umbilical blood sampling. A time series of fetal heart rate fluctuation was obtained with a 1. 15-MHz ultrasonic transducer, and power spectral analysis of 200 consecutive stable beats was performed with an autoregression method. Integrated areas of 0.025-0.125 cycles/beat were defined as low-frequency areas (LFAs) and were examined in normal fetuses. In addition, the relation between LFA and fetal blood gas values was studied.

RESULTS

As pregnancy progressed, LFA increased with a cubic regression equation (Y = 6.484 - 0.764X + 0.029X2 - 0.00034X3). The correlation coefficient was 0.625 (p < 0.05). In the cases of IUGR, DeltaLFA was highly correlated with DeltapO2 and DeltapH (correlation coefficient, 0.650 and 0.618, respectively).

CONCLUSIONS

Measurement of LFA provides insight into the development of fetal autonomic function and also may serve as a quantitative index of fetal well-being in mid-pregnancy.

Alendronate inhibits osteopontin expression enhanced by parathyroid hormone-related peptide (PTHrP) in the rat kidney

It has been reported that osteopontin (OPN) plays an important role during urolithiasis as well as bone formation. Generation of stones in the urinary tract may be associated with osteoporosis and bisphosphonates are potent inhibitors of bone resorption, being used with effect in the management of bone disease. We therefore investigated the relationship between alendronate, a bisphosphonate derivative, and OPN expression in the kidney. Alendronate was administered to rats made hypercalcemic by treatment with parathyroid hormone-related peptide (PTHrP). The renal expression of OPN was then evaluated at both protein and mRNA levels. OPN expression was enhanced in the distal tubular cells of hypercalcemic rats and was decreased by alendronate. The observed inhibition of OPN expression suggests an ability of alendronate and other bisphosphonates to act as inhibitors of stone formation in the urinary tract.

[Application of ultrafast 3D-CT in cervical spine injury]

The authors investigated the usefulness of the ultrafast three-dimensional computed tomography (UF-3D-CT) in cervical spine injury. At Osaka City General Hospital, between April 1995 and March 1998, the authors examined 38 patients with cervical spine injury using UF-3D-CT. The ultrafast CT reduces scanning time. There were no complications associated with the examination. We examined 12 patients with vertebral body fracture, 11 patients with lamina fracture, 8 cases with subluxation including locking facet, 2 patients with atlanto-axial dislocation and 8 patients without bony abnormality. Results suggested that UF-3D-CT was very useful for helping us to understand the bony deformity and the relationship between the bone and the important vessels. UF-3D-CT is very useful for preoperative evaluation and pathophysiological evaluation in cervical spin injury.

Serial MR observation of cortical laminar necrosis caused by brain infarction

To examine the chronological changes characteristic of cortical laminar necrosis caused by brain infarction, 16 patients were repeatedly examined using T1-, T2-weighted spin-echo, T2*-weighted gradient echo, fluid attenuated inversion recovery (FLAIR) images, and contrast enhanced T1-weighted images at 1.0 or 1.5 T. High intensity cortical lesions were visible on the T1-weighted images from 2 weeks after ictus and became prominent at 1 to 3 months, then became less apparent, but occasionally remained at high intensity for 2 years. High intensity cortical lesions on FLAIR images became prominent from 1 month, and then became less prominent from 1 year, but occasionally remained at high intensity for 2 years. Subcortical lesions did not display high intensity on T1-weighted images at any stage. On FLAIR images, subcortical lesions initially showed slightly high intensity and then low intensity from 6 months due to encephalomalacia. Cortical lesions showed prominent contrast enhancement from 2 weeks to 3 months, but subcortical lesions were prominent from 2 weeks only up to 1 month. T2*-weighted images disclosed haemosiderin in 3 of 7 patients, but there was no correlation with cortical short T1 lesions. Cortical laminar necrosis showed characteristic chronological signal changes on T1-weighted images and FLAIR images. Cortical short T1 lesions were found not to be caused by haemorrhagic infarction.

Rupture mechanism of a thrombosed slow-growing giant aneurysm of the vertebral artery--case report

A 76-year-old male developed left hemiparesis in July 1991. The diagnosis was thrombosed giant vertebral artery aneurysm. He showed progressive symptoms and signs of brainstem compression, but refused surgery and was followed up without treatment. He died of rupture of the aneurysm and underwent autopsy in March 1995. Histological examination of the aneurysm revealed fresh clot in the aneurysmal lumen, old thrombus surrounding the aneurysmal lumen, and more recent hemorrhage between the old thrombus and the inner aneurysmal wall. The most important histological feature was the many clefts containing fresh blood clots in the old thrombus near the wall of the distal neck. These clefts were not lined with endothelial cells, and seemed to connect the lumen of the parent artery with the most peripheral fresh hemorrhage. However, the diameter of each of these clefts is apparently not large enough to transmit the blood pressure of the parent artery. Simple dissection of the aneurysmal wall by blood flow in the lumen through many clefts in the old thrombus of the distal neck may be involved in the growth and rupture of thrombosed giant aneurysms of the vertebral artery.

[A case of choroidal metastasis from bronchial atypical carcinoid tumor (well-differentiated neuroendocrine cell carcinoma)]

We describe a case of choroidal metastasis from bronchial atypical carcinoid tumor (well-differentiated neuroendocrine cell carcinoma). In this report, we compared the images of indocyanine green infrared fluorescence angiography (IA) to the histological appearance of the metastatic tumor. A 48-year-old male patient presented with metastatic choroidal tumors in both eyes. The IA findings revealed high intensity of fluorescence in the center of the tumor, but low intensity at the edge. Afterwards, the patient underwent enucleation of his left eye because of secondary glaucoma. Microscopic examination of the resected eyeball disclosed two histological patterns: one was that of typical carcinoid tumor; the other atypical carcinoid tumor. In addition, the tumor blood vessels had proliferated more densely in the center of the tumor than at the edge. Only two case reports in the English literature, as for as we know, have previously described the precise histological examination of both choroidal metastasis and primary bronchial carcinoid tumor. This case suggests that the extraordinary IA images are caused by the histologic character of the metastatic tumor: 1. rich vascularity, 2. variety of distribution of the tumor vessels.

Transcriptional regulation of osteopontin gene in vivo by PEBP2alphaA/CBFA1 and ETS1 in the skeletal tissues

Osteopontin (Opn) and polyoma enhancer-binding protein (PEBP) 2alphaA/core binding factor (CBFA) 1 have been suggested to play important roles in ossification. The overlapping localization of opn and PEBP2alphaA/CBFA1 mRNA, and the marked decrease of opn mRNA expression in PEBP2alphaA knockout mice, indicated that the transcription of opn gene was controlled by PEBP2alphaA. In the present study, we determined the direct regulation of PEBP2alphaA on the opn promoter activity. Opn promoter activity was markedly enhanced by PEBP2alphaA and ETS1 in a synergistic manner. The synergistic effect was diminished when either the PEBP2alphaA or ETS1 binding site was mutated, or the spatial arrangement of these sites was mutated by a 4-nt insertion. The distance between these sites was important for transactivation but not protein-DNA binding. The direct interaction between PEBP2alphaA and ETS1 was depended on protein-DNA binding. These results suggested that the specific spatial arrangement of both sites and direct interaction between PEBP2alphaA and ETS1, were essential for promoter function. Furthermore, endogenous opn mRNA was decreased with the introduction of dominant negative PEBP2alphaA to MC3T3/E1 cells expressing endogenous PEBP2alphaA, ETS1 and opn. These findings suggest that PEBP2alphaA and ETS1 cooperate in vivo to regulate expression of the opn gene in the skeletal tissue. Cell type-specific regulation of Opn gene expression will also be discussed.

Cerebellar mutism after basilar artery occlusion--case report

A 30-year-old female became comatose due to embolic occlusion of the basilar artery, caused by surgical injury to the origin of the vertebral artery during removal of a neurinoma in the upper thoracic paravertebral region. The basilar artery occlusion was treated by local fibrinolysis through a microcatheter. Two weeks later she recovered her consciousness but suffered mutism. Her speech disturbance was characterized by severe ataxic dysarthria known as "cerebellar mutism" but without cranial nerve paresis. The mutism gradually improved during the following 3 months. This is case of cerebellar mutism was apparently due to ischemic stroke. Disturbance by hypoperfusion of the cerebellum and brain stem may have been involved in the pathogenesis of cerebellar mutism.

Moyamoya disease and pregnancy: case report and review of the literature

OBJECTIVE AND IMPORTANCE

Many female patients with moyamoya disease are of childbearing years, including those who were diagnosed before entering their childbearing years. However, there have been no extensive reviews of the management of pregnancy and delivery in association with moyamoya disease. The purpose of this report is to describe the case of a patient with moyamoya disease complicated by pregnancy and to review the literature on other such cases.

CLINICAL PRESENTATION AND INTERVENTION

We report a 23-year-old primipara with moyamoya disease who delivered uneventfully by cesarean section under spinal anesthesia at 38 weeks of gestation. In the literature, 30 cases were reported of patients who had been diagnosed with moyamoya disease before pregnancy and delivery, and 23 patients who were symptomatic and were diagnosed for the first time with moyamoya disease in association with pregnancy.

CONCLUSION

There is no evidence that pregnancy increases the risk of cerebrovascular accident or that bypass surgery decreases its risk. Poor prognosis of the patient or the newborn is mostly caused by cerebral hemorrhage and not by cerebral ischemia. It is important to control blood pressure and especially to avoid toxemia during pregnancy. Either cesarean section or vaginal delivery can be accomplished safely. Any anesthetic method can be used, provided special attention is given to avoiding hypocapnia, hypotension, and hypertension. Oral contraceptives should be avoided.

[Management of elderly patients with incidentally discovered unruptured aneurysms]

Long-term natural history of unruptured cerebral aneurysms is not found frequently. Hence, the indications for surgery on unruptured asymptomatic cerebral aneurysms are still unclear. The benefit of treatment ultimately depends on the relative risk of subsequent aneurysm rupture in untreated patients versus the risk involved in surgery. Clinical features of fourteen elderly patients aged over 70 years with incidentally discovered unruptured aneurysms were analyzed. Two were male and 12 were female, with ages ranging from 70 to 82 years (mean: 74.5 years). Aneurysms were located in the anterior circulation in 13 patients and in the posterior circulation in 1 patient. One patient had multiple aneurysms, that is, bilateral middle cerebral aneurysms. The size of all these aneurysms was less than 10 mm. The indication for surgery was determined case by case. General information about the natural history of incidentally discovered aneurysms was given to the patients and their relatives. Informed consent was based on the fact that subarachnoid hemorrhage was associated with a poor prognosis, while excellent operative results were common in patients with unruptured aneurysms. Five patients agreed to surgical treatment. Four of them, their ages being 70, 70, 72 and 72 years old, with aneurysms located on the middle cerebral arteries, underwent neck clipping of their aneurysms with no operative morbidity or mortality. However, the remaining one patient was not recommended for surgery in spite of her consent to having it, because of her high age (82 years) and the location of her aneurysm (intracavernous internal carotid artery). Consequently, 10 patients who didn't receive surgery were followed-up at periods ranging from 3 months to 7 years. Two patients developed rupture of the aneurysms, either proven (one patient) or presumed (one patient). The former patient made an uneventful recovery after surgery, but the latter died. None of the remaining eight patients have experienced rupture of the aneurysms. It is our clinical impression, however, that they harbor an unruptured aneurysm with at least mild trepidation. With the rapid aging of the population, withholding aneurysm surgery merely because a patient is elderly may not necessarily be the most appropriate decision. Our conclusions are as follows: (1) Elderly patients in their early seventies are apt to agree to having surgical treatment for their unruptured aneurysms. (2) The cases reported herein show that asymptomatic middle cerebral artery aneurysms were able to be clipped very safely. (3) Most patients have experienced a decrease in quality of life from knowing they are living with an unruptured aneurysm.

Vectorcardiographic evaluation of myocardial infarct size: departure parameters are superior to conventional spatial parameters

To determine whether the departure parameters derived from a "departure loop" of a vectorcardiogram are more accurate than conventional spatial parameters in evaluating myocardial infarct size, 74 patients with first-onset myocardial infarction (MI) were studied. The correlation between the departure parameters (amplitudes in scalar leads of the departure loop) and the percent defect volume of thallium myocardial scintigrams (%DV) was compared with that of the spatial parameters (magnitude, azimuth, and elevation of the original QRS loop). In anteroseptal MI, the amplitude of a 20-msec vector in the z-axis and the azimuth of a 30-msec vector (H30) were significantly correlated with %DV (r=0.783, p<0.001 and r=0.572, p<0.05). In anteroseptal MI with involvement of the lateral wall, the amplitude of a 30-msec vector in the x-axis and H30 showed significant correlation with %DV (r=0.802, p<0.001 and r=0.772, p<0.01). In inferior and inferoposterior MI, the amplitude of a 30-msec vector in the y-axis and the elevation of a 30-msec vector were significantly correlated with %DV (r=0.920, 0.891, p<0.001 and r=0.871, 0.678, p<0.01, respectively). In conclusion, the departure parameters are more accurate than the spatial parameters for evaluation of myocardial infarct size.

[A case of ill-defined vitiliginous lesions in the posterior polar regions of both eyes]

In a 34-year-old man, who was examined for binocular visual disturbance as chief complaint at the department of ophthalmology, we found ill-defined vitiliginous lesions of a size about 1/5 approximately 1/7 the diameter of the papilla in the fundal posterior polar regions of both eyes. Fluorescein angiography (FA) revealed hyperfluorescence of the vitiligo. Blood tests showed increased herpes simplex and herpes zoster varicellosus antibody titers and positive antinuclear antibodies (spekled type). Following steroid treatment, the vitiligo remitted, but reappeared later. Indocyanine green infrared fluorescein angiography (IA) revealed hyperfluorescence of the vitiligo. Fundus findings suggested multiple evanescent white dot syndrome (MEWDS), but were judged to be negative because 1. the vitiliginous lesions were morphologically different; 2. the onset site of the vitiligo was more posterior and polar-sided, 3. onset of the vitiligo was binocular, 4. the vitiligo recurred and 5. late hypofluorescence was not observed in IA.

Embolic stroke in the territory of a cerebellar arteriovenous malformation--case report

A 63-year-old male presented with an embolic stroke in the right medial inferior cerebellum. Angiography at 2 and 8 months after the stroke revealed arteriovenous shunts from the vermian branch of the right posterior inferior cerebellar artery of the right inferior vermian vein. The shunts mimicked the arteriovenous shunts of post-recanalization in acute ischemic stroke, but were finally diagnosed as a pre-existing congenital arteriovenous malformation based on their persistence. Arteriovenous shunts that persists more than 2 weeks after ictus should be differentiated from the post-recanalization arteriovenous shunts of ischemic stroke, as the different etiology may affect the ultimate prognosis and course of treatment.

Relationship between 2,5-hexanedione concentrations in nerve, serum, and urine alone or under co-treatment with different doses of methyl ethyl ketone, acetone, and toluene

To ascertain the relationship among 2,5-hexanedione (2,5-HD) concentrations in nerve, serum and urine, rats were injected subcutaneously with 2.6 mmol/kg 2,5-HD alone, or together with 2.6 or 13.0 mmol/kg of methyl ethyl ketone, acetone and toluene. 2,5-HD concentrations in sciatic nerve (NC), serum (SC) and urine (UC) were determined, and the linear regression between each two of NC, SC, and UC were calculated. There was good correlation between NC and SC, SC and UC in the 2,5-HD alone group, and good correlation between NC and SC in the co-treated groups. Co-treatment solvent had little effect on the relationship between SC and NC. 13.0 mmol/kg co-treated solvent tended to decrease the regression coefficients compared with 2.6 mmol/kg co-treated solvent. These results show that SC can be used in estimating NC in the 2,5-HD alone or co-treated groups, and UC can be used in estimating SC in the 2,5-HD alone group.

Effects of methyl ethyl ketone, acetone, or toluene coadministration on 2,5-hexanedione concentration in the sciatic nerve, serum, and urine of rats

OBJECTIVE

To clarify changes in the serum, nerve, and urinary levels of 2,5-hexanedione (2,5-HD) in rats on coadministration with methyl ethyl ketone (MEK), acetone (AC), and toluene (TO).

METHOD

2,5-HD alone or combined with MEK, AC, and TO was injected subcutaneously into a total of 306 male Wistar rats. The rats were divided as follows into 7 groups: (1) 2.6 mmol/kg 2,5-HD alone (HD) and (2) 2.6 mmol/ kg 2,5-HD combined with 2.6 mmol/kg MEK (HD + MEK), (3) with 2.6 mmol/kg AC (HD + AC), (4) with 2.6 mmol/kg TO (HD + TO), (5) with 13.0 mmol/kg MEK (HD + 5MEK), (6) with 13.0 mmol/kg AC (HD + 5AC), and (7) with 13.0 mmol/kg TO (HD + 5TO). 2,5-HD concentrations in the serum, sciatic nerve, and urine of rats were determined within 16 h of the injections and pharmacokinetic parameters were estimated.

RESULTS

It was observed that (1) the 2,5-HD concentration and AUC value (area under concentration versus time curve) determined in the serum and nerve increased significantly in the cotreated groups as compared with the HD group; (2) the effect MEK had in elevating the 2,5-HD concentration and AUC in the serum and nerve was stronger than that of AC, and the effect AC had was stronger than that of TO; (3) a. dose increase from 2.6 to 13.0 mmol/kg for MEK and AC induced further increases in the 2,5-HD concentration and AUC determined in the serum and nerve; (4) elimination constants recorded for 2,5-HD (Ke) from the serum and nerve decreased in all the cotreated groups, and the degree of the decrease correlated inversely with the elevation in 2,5-HD concentration and AUC in the serum and nerve; and (5) urinary 2,5-HD concentrations measured in the 13.0-mmol/kg cotreated groups increased in parallel with the elevation in serum 2,5-HD concentrations.

CONCLUSION

Coadministration of 2,5-HD with MEK, AC, or TO can increase the concentration and AUC of 2,5-HD in serum and the sciatic nerve, and these increases can be further enhanced by an increase in the concomitant doses of MEK and AC.

Effects of plasmapheresis in a rabbit model of cancer cachexia

We developed a model of cancer cachexia by transplanting VX2 tumors into rabbits and investigated the effects of plasmapheresis in this model. AIS activity was identified in supernatants obtained from VX2 tumor by phenyl Sepharose chromatography. Fractions eluted with 0.5 M NaCl showed the ability to damage the red blood cell membrane and suppress immunity. Rabbits exhibited marked weight loss, anemia and immunodeficiency 40 days after transplantation of VX2 tumors. Plasmapheresis inhibited plasma-induced damage of the red blood cell membrane and suppression of immunity. Twice-weekly plasmapheresis resulted in gradual normalization of cellular immunity. Weight loss and survival were also improved. No side effects were observed.

Intracranial aneurysms in identical twins

BACKGROUND

Though familial intracranial aneurysms are well documented, only a few cases of intracranial aneurysms in identical twins have been reported.

CASE REPORT

Our patient, a 46-year-old woman, presented with a subarachnoid hemorrhage (SAH) due to a ruptured aneurysm. At the age of 36, her identical twin sister had also suffered SAH from a ruptured aneurysm. Both twins were treated successfully.

CONCLUSION

The likelihood of the occurrence of an aneurysm may be higher for a twin whose identical twin has developed an aneurysm than for the general population. Therefore, it is reasonable to perform certain screening procedures for aneurysms on an asymptomatic twin when the other presents with SAH due to a ruptured aneurysm.

[A case of polyneuropathy associated with osteosclerotic myeloma]

A 50-year-old woman presented with sensorimotor polyneuropathy in the lower limbs. Biopsy of the muscle revealed neurogenic changes, and electrophysiological study and pathology of the biopsied nerve indicated myelinoaxonal degeneration. Her symptoms responded to neither plasmapheresis nor prednisolone. Pelvic radiography disclosed an osteosclerotic lesion that was subsequently diagnosed as IgA-lambda plasmacytoma by biopsy. Radiation therapy for this solitary osteosclerotic myeloma improved the patient's polyneuropathy. In Japan, reports of cases of polyneuropathy associated with osteosclerotic myeloma without multiorgan disorders as in our case have not previously been described; thus, such cases may be misdiagnosed. Therefore, in patients with polyneuropathy of unknown etiology, a systemic bone survey and repeated searches for M-protein are important. Treatment of bone lesions in patients with solitary osteosclerotic myeloma may improve the associated polyneuropathy.

Magnetic resonance imaging features of unusually dilated Virchow-Robin spaces--two case reports

Two patients presented with unusually dilated Virchow-Robin spaces appearing as cystic lesions of varying size with signal intensity identical to the cerebrospinal fluid on all magnetic resonance pulse sequences. However, fluid-attenuated inversion-recovery (FLAIR) images disclosed small, high intensity foci adjacent to these cystic lesions in one patient. These high intensity foci on FLAIR images may represent chronic ischemic change, which produces the gradual dilation of the Virchow-Robin spaces.