Percutaneous diskectomy for lumbar disk herniation. A preliminary report

Percutaneous diskectomy is a new method for reducing lumbar disk herniation. This procedure is simple, safe, and only semiinvasive since it causes no direct damage to the dura or nerve roots. This technique employs a nucleotome (blunt-tipped, suction-cutting probe) with a rotating electric shaver (3 mm in diameter) that was specially developed for this procedure. It was applied to 117 patients with lumbar disk herniation whose sciatica had not been relieved by conservative treatments. The results of the technique were considered effective in 94 patients (80.3%). The improvements were even more marked in patients with protrusion or prolapse type herniation. Reviewed with postoperative examinations using magnetic resonance imaging (MRI), excision of the herniated disk, resulting in decompression of the nerve root, may be correlated with the relief of symptoms.

Treatment of bilateral urolithiasis

Patients with bilateral urolithiasis diagnosed at their first visit were followed for at least one year after the start of treatment. In this retrospective study of 123 patients, the basic metabolic workup revealed no specific underlying cause of simultaneously occurring bilateral nephrolithiasis, and none of the currently used therapeutic regimes proved to be efficient in attaining clinically acceptable stone-free rates at the 3, 6 and 12-month follow-ups. Of 38 patients treated with extracorporeal shockwave lithotripsy (SWL), 21 underwent treatment of both kidneys and 10 (48%) were free of stones bilaterally after 12 months. All of the 17 patients treated with unilateral SWL failed to achieve a stone-free state on the contralateral side. In another group, treated with medication alone to minimize risks of stone recurrence, only 3 of 26 (11.5%) patients were stone-free on both sides 12 months after the start of medication. Since we achieved a stone-free state of both kidneys in no more than 12% of the non-medicated cases, it seems warranted to treat bilateral urolithiasis with SWL more frequently, particularly when patients cannot return regularly to the stone clinic for a longterm follow-up.

[A rare case of choroid plexus papilloma in the third ventricle]

A rare case of choroid plexus papilloma in the third ventricle is presented. A 19 year old male patient was admitted to our hospital for further examination of a head injury. On admission, he was asymptomatic. CT and MRI showed a homogeneous mass extending from the third ventricle to the right lateral ventricle. The right lateral ventricle was slightly enlarged. Craniograms showed calcification above the sella turcica. Cerebral angiograms disclosed a tumor stain fed by the right medial posterior choroidal artery in the third ventricle. Anterior transcallosal approach was chosen for the extirpation of the tumor. Histological study revealed choroid plexus papilloma. The postoperative course was uneventful.

Plasma calcitonin gene-related peptide levels in patients with various hypertensive diseases

OBJECTIVE

To clarify the pathophysiological role of calcitonin gene-related peptide (CGRP) in hypertensive diseases.

METHOD

Using a sensitive radioimmunoassay established in our laboratory, plasma CGRP levels were evaluated in control subjects and in patients with essential hypertension, phaeochromocytoma or primary aldosteronism.

RESULTS

The CGRP levels in the three hypertensive groups were significantly higher than in normal controls, but no statistically significant difference was observed among CGRP levels in the three hypertensive groups. In the three cases of secondary hypertensives (one patient with phaeochromocytoma and two with primary aldosteronism), a significant decrease in plasma CGRP levels and a marked reduction in blood pressure were observed after adrenalectomy.

CONCLUSION

These results suggest that increased plasma CGRP levels in hypertensive patients could be a compensatory reaction to elevated blood pressure.

Abscess within a glioblastoma multiforme--case report

A rare case of abscess within a glioblastoma with an unusual presentation occurred in a 46-year-old female who developed right hemiparesis and seizure. Computed tomography and magnetic resonance imaging demonstrated hemorrhage which mimicked hemorrhagic infarction. However, the lesions developed ring enhancement. Aspiration showed one to be an abscess, which collapsed by drainage but later re-expanded. The mass was removed, and histological examination revealed glioblastoma.

Follicular dendritic cells in the alternative antigen transport pathway: microenvironment, cellular events, age and retrovirus related alterations

Follicular dendritic cells (FDC) are located in lymphoid follicles of secondary lymphoid tissues and play a pivotal role in the initiation and maintenance of the secondary antibody response. FDC are an integral part of the microenvironment of the follicle and function as members of the 'alternative antigen transport pathway.' This pathway consisting of the antigen transport cell-FDC-ICCOSOME-B cell axis, leads to the formation of germinal centers where antibody-forming cell and memory B cell development are initiated through interaction of FDC-retained antigen, B cells and T helper cells. Evidence suggests that these interactions are down-regulated through antibody feedback, or as needed, reactivated with the utilization of FDC-retained antigen for the maintenance of antibody levels. Age- and retrovirus-related FDC defects seriously compromise the capacity of this pathway to maintain immunity.

Enhancement of murine alveolar macrophage functions by orally administered beta-glucan

The effect of orally administered SSG, a beta-1,3-glucan obtained from the culture filtrate of the fungus Sclerotinia sclerotiorum IFO 9395, on alveolar macrophage (AM) functions of CDF1 mice was examined. SSG administered orally (20, 40, 80 or 160 mg/kg) for 10 consecutive days enhanced the lysosomal enzyme activity of AM. The greatest enhancing effect was observed at 80 mg/kg of SSG. Multiple oral administrations of SSG (10 consecutive days) were needed to induce significant enhancing effects. Phagocytic activity and interleukin-1 (IL-1) production of AM were also augmented by oral administration of SSG, and the kinetics of the activated state differed depending on the kind of activity. However, H2O2 production of AM was not affected by SSG. Orally administered SSG also (40 or 80 mg/kg, 10 consecutive days) increased the number of AM and the greatest increment was observed 14 days after the first administration. On the other hand, the supernatant of Peyer's patch (PP) cells from mice administered SSG (80 mg/kg) orally stimulated the lysosomal enzyme activity of AM in vitro, and enhanced colony stimulating activity (CSA) was detected from this supernatant. These results demonstrate that SSG given by the oral route can activate murine AM both qualitatively and quantitatively, and it would mediated, at least in part, by the activation of PP cells in the intestine.

[A rare case of delayed traumatic Millard-Gubler syndrome]

We reported a rare case of traumatic Millard-Gubler syndrome exhibiting right peripheral facial palsy and right abducens palsy plus left hemiparesis. A 60-year-old male patient was admitted to our department due to tetraparesis. He fell down and struck his neck and shoulder. Several hours later he was aware of muscle weakness in all extremities. On admission neurological examination revealed right peripheral facial palsy, right abducens palsy and left hemiparesis suggesting Millard-Gubler syndrome. CT demonstrated a high density mass in the prepontine cistern. MRI showed an iso intensity mass compressing the right ventral surface of the pons at T1 weighted and low intensity at T2 weighted image. The presence of a subarachnoid hematoma in acute stage was suggested. This is the third case report of traumatic Millard-Gubler syndrome in literature. Its etiology and the mechanism are discussed here. We tend to conclude that, in addition to direct damage, its mechanism can be attributed to vasostenosis of the perforators from the basilar artery compressed by the prepontine subarachnoid hematoma.

Signal transduction cascade shared by epidermal growth factor and platelet-derived growth factor is a major pathway for oncogenic transformation in NRK cells

We have isolated two recessive, mutually complementary NRK cell mutants that are refractory to transformation by epidermal growth factor (EGF) and transforming growth factor-beta. Both mutants are defective in a signal transduction cascade shared by EGF and platelet-derived growth factor (PDGF). Analysis of the mutants suggests that transformation of NRK cells by the v-fms, v-erbB, activated erbB-2, v-ras, v-fos, v-mos, v-fes, v-src, SV40 large T, polyomavirus middle T, and human papillomavirus type 16 E6,E7 oncogenes is mediated by the EGF/PDGF signal cascade. The data also suggest that the EGF/PDGF cascade branches into mitogenic and oncogenic signals, the latter of which is required for soft agar growth and focus formation.

Development of thermotolerance in hsp70 induction-defective mutant of NRK cells

We investigated the relation between the synthesis of inducible form of heat-shock protein 70 (hsp70) and the development of thermotolerance using NRK (normal rat kidney) cells and their mutant cell line (39-1 cells). In NRK cells, hsp70 was clearly induced by conditioning treatments (42 degrees C for 2 h, 45 degrees C for 15 min or 100 microM sodium arsenite for 1 h). On the other hand, the induction of hsp70 in 39-1 cells was very low or not detectable by these treatments. Other high molecular weight hsps, hsc70 (constitutive form), hsp90 and hsp110 were induced in both cell lines. However, thermotolerance as defined by clonogenic survival was induced in both cell lines to a similar extent by the conditioning treatments. When cells were made thermotolerant by conditioning heating at 45 degrees C for 15 min, the inhibition of protein synthesis after challenge (second) heating was less in NRK cells than in 39-1 cells. This indicated that the extent of 'translational thermotolerance' was much higher in NRK cells than in 39-1 cells. From these results, it is suggested that the synthesis of inducible hsp70 is involved in the translational thermotolerance rather than the development of thermotolerance as defined by clonogenic survival.

Murine follicular dendritic cells and low affinity Fc receptors for IgE (Fc epsilon RII)

The present study was undertaken to determine whether mouse follicular dendritic cells (FDC) bear Fc epsilon RII (CD23) and whether IgE-immune complexes are retained by FDC. Mouse Fc epsilon RII was localized by both L and electron microscopy using the mAb B3B4. In lymph nodes of normal mice, Fc epsilon RII was low but detectable on FDC. By 14 days after Nippostrongylus brasiliensis infection, the level of Fc epsilon RII increased on B lymphocytes located in the cortex of draining mesenteric lymph nodes. However, the Fc epsilon RII level on FDC remained low. Although numerous IgE-producing plasma cells were seen at day 14, very little IgE was associated with FDC. By 26 days after infection, Fc epsilon RII was observed on FDC in increased levels and IgE binding was clearly associated with FDC. Unexpectedly, FDC of control mice immunized with albumin in CFA to elicit an IgG response showed intense labeling for Fc epsilon RII. In contrast, the B cells exhibited very little Fc epsilon RII. IgE immune complexes were observed in association with FDC in the CFA-immunized mice. When mice were given a hapten-specific monoclonal of the IgE isotype, hapten carrier complexes were trapped and retained on Fc epsilon RII-bearing FDC. In conclusion, FDC were clearly one of the major murine cell types bearing Fc epsilon RII. IgE immune complexes were found in association with FDC and Fc epsilon RII appeared to play a major role in trapping and retaining IgE immune complexes. FDC Fc epsilon RII was subject to regulatory control, but the Fc epsilon RII level on FDC was regulated very differently from the Fc epsilon RII level on B cells.

Murine follicular dendritic cells and low affinity Fc receptors for IgE (Fc epsilon RII)

The present study was undertaken to determine whether mouse follicular dendritic cells (FDC) bear Fc epsilon RII (CD23) and whether IgE-immune complexes are retained by FDC. Mouse Fc epsilon RII was localized by both L and electron microscopy using the mAb B3B4. In lymph nodes of normal mice, Fc epsilon RII was low but detectable on FDC. By 14 days after Nippostrongylus brasiliensis infection, the level of Fc epsilon RII increased on B lymphocytes located in the cortex of draining mesenteric lymph nodes. However, the Fc epsilon RII level on FDC remained low. Although numerous IgE-producing plasma cells were seen at day 14, very little IgE was associated with FDC. By 26 days after infection, Fc epsilon RII was observed on FDC in increased levels and IgE binding was clearly associated with FDC. Unexpectedly, FDC of control mice immunized with albumin in CFA to elicit an IgG response showed intense labeling for Fc epsilon RII. In contrast, the B cells exhibited very little Fc epsilon RII. IgE immune complexes were observed in association with FDC in the CFA-immunized mice. When mice were given a hapten-specific monoclonal of the IgE isotype, hapten carrier complexes were trapped and retained on Fc epsilon RII-bearing FDC. In conclusion, FDC were clearly one of the major murine cell types bearing Fc epsilon RII. IgE immune complexes were found in association with FDC and Fc epsilon RII appeared to play a major role in trapping and retaining IgE immune complexes. FDC Fc epsilon RII was subject to regulatory control, but the Fc epsilon RII level on FDC was regulated very differently from the Fc epsilon RII level on B cells.

[Dyspnea sensation and chemical control of breathing]

In order to estimate the role of peripheral chemosensitivity in dyspnea sensation, we performed BH experiment under the acute or chronic hypoxic condition. The former was simulated by a given rate (0-3.2 mg/kg/hr) of doxapram infusion. The latter experiment was carried out during sojourn in Lhasa (3700 m), China. Subjects conducted BH by inhaling 7% CO2 in O2 and assessed dyspnea sensation by visual analog scale (VAS) while repeatedly measuring PCO2 at breaking point (BP). Lowering of resting PETCO2 by augmented ventilation was derived by doxapram infusion and during acclimatization at high altitude. The effect of PCO2 on VAS was enhanced by doxapram. However, altitude acclimatization resulted in attenuated effect of PCO2 on VAS despite of further development of hypocapnia. The rate of PCO2 elevation during doxapram infusion was reduced and it might be attributed to decreased body storage of CO2. On the other hand, its rate was tended to recover to sea level value after acclimatization at high altitude and it may have cancelled the mitigated dyspnea sensation. Thus, BHT almost comparable period in both acute hypoxia and during altitude acclimatization. These results suggest that CO2 storage in the body contributes to modify dyspnea sensation as well as augmented peripheral chemosensitivity.

Reversibility of catechol-induced rat glandular stomach lesions

The potential reversibility of glandular stomach lesions induced by the clastogen, catechol, was examined in groups of male F344 rats treated continuously with 0.8% catechol in the diet for 12, 24, 48, 72, or 96 weeks. After a return to basal diet for 84, 72, 48, 24, and 0 weeks, respectively, the animals were killed for histopathological examination. Incidences of submucosal hyperplasia, adenomas and adenocarcinomas, average number of tumors per rat, and the size of tumors in rats treated with catechol for 12, 24, 48, 72, and 96 weeks increased time dependently. After cessation of catechol treatment, although average number of tumors per rat slightly decreased, the size of tumors tended to increase. Labeling indices in both tumorous and nontumorous areas decreased after cessation of catechol treatment. The results thus indicate that whereas some submucosal hyperplasias or adenomas may regress, others have the potential to develop into adenomas or adenocarcinomas. However, tumor growth does depend to a certain extent on continued catechol treatment.

Abnormal increase in multinuclear macrophages in primary cultures of BUF/Mna rat thymomas

The in vitro characteristics of spontaneous thymomas from BUF/Mna rats, a strain with a high incidence of these tumors, were studied. In primary cultures, the adherent cells consisted of mononuclear macrophages, mono- and multi-nuclear epithelial cells and some fibroblastic cells on day 3. The macrophages rapidly increased in number with the formation of large multinuclear cells by day 9. A modest increase in the number and nuclearity of macrophages was also noted in adherent cultures of normal thymuses from 5-week-old BUF/Mna rats. On the other hand, in cultures of thymic cells from 1-year-old or 5-week-old ACI/NMs rats, a normal control rat strain, macrophages did not increase in number and only rarely formed multinuclear cells in adherent cell cultures. These results suggest that abnormal proliferation signal(s) to thymic macrophages and/or their progenitor cells accompanies and may be involved in the development of thymomas in BUF/Mna rats.

Dependence of biphasic heart rate response to sustained hypoxia on magnitude of ventilation in man

We studied the dynamic profile of respiratory and circulatory activities during sustained isocapnic hypoxia in healthy males. In response to end-tidal PO2 depression to about 55 Torr, minute ventilation first increased briskly and then depressed. Such biphasic response to hypoxia was also observed in the heart rate. A significantly positive correlation was found between the magnitudes of ventilatory and heart rate responses. No significant increases were found in arterial noradrenaline and potassium, but adrenaline significantly increased gradually with time. Furthermore, when VT and f were intentionally maintained constant so as to prevent the biphasic ventilatory change, the biphasic heart rate response previously seen in spontaneous hypoxic breathing disappeared. We suggest that the heart rate is mainly determined by the pulmonary vagal inflation reflex. Putative neurochemicals to elicit hypoxic ventilatory depression, and arterial catecholamine and potassium concentrations may not be directly related to the specific profile of the biphasic heart rate response during moderate hypoxia.

[Clinical statistics on operations for inpatients at Department of Urology, Tokai University Hospital 1975-1989]

Operations on inpatients during the 15-year period from 1975 to 1989 were analyzed statistically. A total of 3,791 operations were performed at our Department of Urology, including 717 operations on the kidney, 316 operations on the ureter, 583 operations on the bladder, 811 operations on the prostate, 136 operations on the urethra, 1,097 operations on the scrotum, 43 operations on the adrenal gland, 19 operations on the retroperitoneal space and 69 operations on other organs.

Effect of verapamil on ventilatory and circulatory responses to hypoxia and hypercapnia in normal subjects

Recent investigations have shown that the calcium channel blocker verapamil attenuated the hypoxic ventilatory chemosensitivity of carotid body in animals. To determine whether this is also the case in humans, transient physiological chemodenervation by O2 breaths (withdrawal test) during sustained hypoxia (N = 7), and ventilatory and circulatory responses to progressive hypoxia and hypercapnia (N = 8) were examined after oral administration of verapamil. During sustained hypoxia after verpamil, there was a significant reduction of withdrawal response from 5th to 25th min value (p < 0.01), but not after placebo. On the other hand, no significant difference in ventilatory responses to progressive hypoxia and hypercapnia was observed after verapamil. Verapamil run reveals similar features with placebo run in circulatory parameters except blood pressure response, which tended to be suppressed by verapamil. We conclude that verapamil attenuates peripheral chemoreceptor activity with time during sustained mild hypoxia in normal adult humans and this may be explained by delayed depletion in intracellular Ca2+ for chemotransduction of the peripheral chemoreceptors.

High accuracy measurement of isotope ratios of molybdenum in some terrestrial molybdenites

The isotope ratios of molybdenum in molybdenites were studied. A special triple filament technique was used to obtain stable and lasting signals for MO(+) . There are no differences bigger than ±0.4 parts per IO4 among four samples and the standard.

[Giant müllerian duct cyst: a case report]

A case of giant müllerian duct cyst is reported. The patient was a 27-year-old male, complaining of microscopic hematuria. A giant cystic abdominal mass was palpable. After screening examination including ultrasound tomography, intravenous pyelography, computed tomography and magnetic resonance-imaging, müllerian duct cyst was suspected. Operation for this cyst was performed with median incision. The cyst measured 25 x 21 x 14 cm. The surface as smooth and consistency was soft. Included fluid was slightly turbid and yellowish measuring 2,200 ml. This was considered to be the largest müllerian duct cyst case reported in the Japanese literature.

Anaesthesia for Treacher Collins syndrome using a laryngeal mask airway

Patients with Treacher Collins syndrome pose a serious problem to anaesthetists in maintaining their airway because of retrognathia. Two patients with Treacher Collins syndrome undergoing tympanoplasty are reported in whom a laryngeal mask was used in place of an endotracheal tube for airway maintenance.

[Clinical evaluation of hypopharyngeal cancer]

Clinical results of cases of hypopharyngeal carcinoma treated from 1966 to 1990 at Kyushu University Hospital were investigated. In 1966-1972, all cases were treated with only radical operation. We used FAR therapy since 1972, and preoperative chemotherapy (CDDP and Peplomycin) in addition to FAR therapy since 1984. The crude five-year survival rate of the operative therapy-group (25 cases in 1966-1972) was 24%, and that of the FAR therapy-group with or without operation (47 cases in 1972-1980) was 38%. Although it was cumulative survival rate by Kaplan-Meier's method, the five-year survival rate of the group (16 cases in 1984-1990) treated with a combination of FAR therapy, preoperative-chemotherapy, and operation was 76%. The improvement in the survival rate and the role of preoperative treatment (FAR therapy and chemotherapy) are discussed.

Testosterone increases thromboxane A2 receptors in cultured rat aortic smooth muscle cells

Previous studies have demonstrated increased contractile responses to thromboxane A2 (TXA2) mimetics in aortas obtained from male rats compared with those obtained from females. This study was designed to determine the effects of testosterone and 17 beta-estradiol treatment on TXA2 receptors in cultured rat aortic smooth muscle cells (RASMCs). TXA2 receptor affinity and density were determined through equilibrium binding experiments using the TXA2/prostaglandin H2 mimetic [1S-(1 alpha,2 beta(5Z),3 alpha(1E,3R*),4 alpha)]-7-[3-(3- hydroxy-4-(4'-125iodophenoxy)-1-butenyl)-7-oxabicyclo[2.2.1]hep tan-2-yl]- 5-heptenoic acid (125I-BOP). Incubation with testosterone (100 nM) for 24 or 48 hours resulted in a significant (p less than 0.05) 31% and 48% increase in TXA2 receptor density without any change in affinity. 17 beta-Estradiol (100 nM) had no significant effect on either the density or affinity of TXA2 receptors. Coincubation with the testosterone receptor antagonist hydroxyflutamide (1 microM) blocked the testosterone-induced increase in TXA2 receptor density. The maximum increase in intracellular free calcium induced by I-BOP was significantly (p less than 0.05) greater in testosterone-treated RASMCs than controls. Similarly, increases in inositol trisphosphate induced by the TXA2/prostaglandin H2 mimetic U46619 were significantly (p less than 0.05) greater in testosterone-treated RASMCs compared with controls. The results demonstrate that testosterone increases vascular TXA2 receptor density and support the notion that sex steroid hormones modulate the expression of this receptor.