Partial hepatectomy of marmoset: clinical and pathological effects and utility in microsomal enzyme analysis

Liver biopsy based on a partial hepatectomy technique (shearing) was performed in 10 common marmosets (Callithrix jacchus). This is a preliminary study to evaluate the effects of drugs on hepatic microsomal enzymes: cytochrome P-450 and T4 uridine diphosphate glucuronyl transferase (T4-UDPGT), by comparing post-treatment values with pre-treatment values individually with a limited number of animals. The effects of the biopsy on clinical findings and liver pathology were evaluated during the first 5 post-surgical weeks. Although the plasma aspartate aminotransferase (AST) activities tended to decrease from 1 to 4 weeks post-surgery, no abnormality was noted in clinical sign, body weight, the hematocrit value or other blood chemical values. At necropsy, adhesion of the sheared site of the liver to the parietal peritoneum or the small intestine was evident in 2 of the 4 marmosets. Microscopic examination revealed focal fibrosis in the liver, but it was localized around the sheared site. Based on the above results, it was concluded that liver biopsy must be performed more than one month before administration of the drug to be tested. The biopsy samples and the whole liver samples obtained at autopsy were subjected to analysis of microsomal protein content, cytochrome P-450 content and T4-UDPGT activity. In comparison with the values from the whole liver samples, those from the biopsy samples showed no significant difference. Furthermore, there was a significant correlation rather than difference between matched values. This suggested that partial hepatectomy is a useful method for obtaining pretreatment values in liver biochemistry to evaluate the effects of drug-treatment in individual animals.

Malaria infection induces rapid elevation of the soluble Fas ligand level in serum and subsequent T lymphocytopenia: possible factors responsible for the differences in susceptibility of two species of Macaca monkeys to Plasmodium coatneyi infection

The intraerythrocytic stage of the simian malaria parasite Plasmodium coatneyi (CDC strain) was intravenously inoculated into two species of macaques with different susceptibilities to infection with this parasite, including four Japanese macaques (Macaca fuscata) and three cynomolgus macaques (M. fascicularis). The Japanese macaques infected with P. coatneyi developed severe clinical manifestations similar to those of severe human malaria and eventually became moribund, while the infected cynomolgus macaques, natural hosts of the parasite, exhibited no severe manifestation of disease except anemia and finally recovered from the infection. In the infected Japanese macaques, peripheral CD4(+) and CD8(+) T-cell populations were markedly decreased and fragmentation of chromosomal DNA in peripheral blood mononuclear cells was detected during the terminal period of infection, suggesting that apoptotic cell death was responsible at least in part for the T lymphocytopenia. Furthermore, soluble Fas ligand levels in sera of the infected Japanese macaques increased gradually to a markedly high level of 28. 83 +/- 10.56 pg/ml (n = 4) when the animals became moribund. On the other hand, none of the infected cynomolgus monkeys exhibited either T lymphocytopenia or elevated soluble Fas ligand level. These findings suggest that differences in immune response between the two species of macaque tested accounted for the contrasting outcomes after infection with the same isolate of malarial parasite, and in particular that a profound T lymphocytopenia due to Fas-derived apoptosis played a role in the fatal course of malaria in the infected Japanese macaques.

Results from surgical treatment for thymoma. 43 years of experience

OBJECTIVE

The biological behavior of thymoma and its prognosis after surgical intervention remain still controversial. The efficacy of surgical treatment for thymoma was investigated by examining long-term follow-up data.

SUBJECTS AND METHODS

Follow-up data for patients undergoing surgical resection of histopathologically-confirmed thymoma between 1954 and 1997 were obtained and were retrospectively analyzed. Clinical staging was based on Masaoka's staging system, and histological classification on Rosai's proposed criteria.

RESULTS

Data for 140 patients were collected. Sixty-four patients had stage I, 32 had stage II, 28 had stage III, and 16 had stage IV thymoma. There were significant differences in survival between patients with stage I and stage III, stage I and stage IV and stage II and stage III disease, but not between those with stage I thymoma and stage II thymoma. No significant difference in survival was observed between the 56 patients with myasthenia gravis (MG) and the 84 without MG. The 38 patients classified as having a predominantly-epithelial thymoma had a poorer prognosis than the 41 with a predominantly-lymphocytic thymoma. Until 1975, there were four patients with stage I thymomas who later showed recurrence, compared with 21 among those with stage II, III and IV diseases. Since 1976, extended thymectomy with thymomectomy under median sternotomy has been adopted as the standard operation for a thymoma, and there has been no recurrence in stage I patients.

CONCLUSIONS

Patients with stage III or IV invasive thymoma have a poorer prognosis and a higher recurrence rate than those with encapsulated thymoma, and patients with a predominantly-epithelial thymoma have a poorer prognosis than those with a predominantly-lymphocytic thymoma. Extended thymectomy with thymomectomy under median sternotomy can be considered as adequate treatment for a stage I thymoma. Myasthenia gravis does not appear to affect the prognosis of patients with a thymoma.

Femoral bone density and changes therein associated with differing histories of pregnancy and lactation in aged rats

OBJECTIVE

To examine the effect of prior pregnancy and lactation on bone density in aged rats.

MATERIALS AND METHODS

2 month-old female Fischer-344 rats were divided into 4 groups: 1)13 rats were allowed to get pregnant and to nurse their offspring for two or three cycles; 2)14 rats were allowed to get pregnant two or three times and were immediately separated from their young after each delivery prior to lactation; 3)10 rats were not allowed to become pregnant; and 4)7 rats were sacrificed at the beginning of the experiment. All rats were fed ad libitum. After the rats had completed two or three pregnancies with or without subsequent lactation, all were fed a restricted diet until they were 25 months old (aged rats). Then they were sacrificed and both femurs were removed from each rat. One bone was used for analysis of mineral content and the other bone was used for photodensitometry of the diaphysis.

RESULTS

31 rats (83.8% ) survived until they were sacrificed. The femurs of the aged rats showed increased ash weight compared to those of 2 month-old rats. Aged rats with prior pregnancies with or without subsequent lactation had higher femoral ash weight than those without prior pregnancies. There were no differences among aged rats in regard to marrow diameter, bone diameter, cortical width or bone density of the diaphysis in femur by photodensitometry.

CONCLUSION

In aged rats, past pregnancies but not lactation were related to increases in bone density of the femur.

[Management after hepatectomy of colorectal cancer metastases to the liver--intrahepatic arterial infusion chemotherapy and repeated hepatectomy]

Before Dec. 1993, we resected 17 patients with hepatic metastases from colorectal cancer. Hepatic recurrences developed in 82% patients who had been given mitomycin C or doxorubicin by hepatic-artery. The one-, 3- and 5-year survival rate after surgery was, 88%, 18% and 12%, respectively. Therefore, some new types of adjuvant therapy were needed to improve survival after surgery. This is a retrospective study to determine whether preventive intrahepatic artery infusion chemotherapy (HAI) and repeated hepatectomy are of benefit for patients with hepatic metastases from colorectal cancer who underwent hepatectomy. Thirty-five patients with hepatic metastases from colorectal cancer underwent hepatectomy and were administered 1,500 mg of 5-FU 10 times via the hepatic artery for 5 hrs every 1-2 weeks to prevent hepatic recurrence after Jan. 1994. Nine patients underwent repeated hepatectomy, then HAL following the operation. Non-resectable recurrence were treated by HAI. The amounts of the infused 5-FU dose were 8.5-46.5 g (mean 23 g) and 17-31 times HAI (mean 22 times). Survival rates were 81, 67, 67% and 24%, respectively, after 1, 2, 3 and 4 years. Hepatic disease-free interval rates were 49.3% and 32.5%, respectively, after 1 and 2 years. Preventive HAI could not control hepatic recurrence but prognosis after hepatectomy was improved by these modalities compared with treatment before Dec. 1993. Survival rates of 9 patients who underwent repeated hepatectomy were 89, 89% and 37%, respectively, after 1, 3 and 4 years. The prognosis of patients with hepatic metastases from colorectal cancer was improved by HAI and repeated hepatectomy, but further studies should be undertaken to improve preventive HAI.

[A case of microscopic polyangiitis with severe cardiac and respiratory muscle involvement]

A 66-year-old female was admitted to our hospital in January, 1998, complaining of low grade fever and muscle weakness of her legs. Physical examination revealed muscle weakness of her neck (4/5) and proximal skeletal muscles of her bilateral legs (3/5-4/5). She showed proteinuria and microhematuria. Her serum levels of ureanitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, creatinekinase, aldolase and myoglobin were all within the normal ranges. Antinuclear antibodies were negative, but her serum levels of pANCA (743 EU) and C reactive protein (18.0 mg/dl) were elevated. Neuroconduction velocity of her left common peroneal nerve was decreased to 40.8 m/sec and electric myograph showed neurogenic changes. Magnetic resonance images (MRI) of her bilateral thigh depicted high signal intensity in quadriceps by T 2 weighed images, but the signals were not enhanced by gadolinium injection. Muscle and renal biopsies revealed necrotizing vasculitis of the small arteries. Crescentic glomerulonephritis was also observed by renal biopsy. These findings supported the diagnosis of microscopic PN. On 16 th admission day, she developed acute cardiac and respiratory failures due to cardiac and respiratory muscle involvements with PN, and was assisted by mechanical ventilation. She was treated with methylprednisolone pulse therapy (500 mg/day, three consecutive days) on 18 th admission day, followed by 40 mg of oral prednisolone daily. However, her symptoms deteriorated, and herserum creatinine levels increased to 2.4 mg/dl. On 24 th admission day, intravenous cyclophosphamide pulse therapy (500 mg/day) was instituted. Her cardiac wall motion on echocardiography and serum creatinine levels gradually improved, but her skeletal and respiratory muscle weakness did not improve. On 38 th admission day, she was complicated with respiratory infection by methicillin resistant Staphylococcus aures. On 62 th admission day, she died of endotoxic shock. This is the first report describing respiratory muscle involvement with PN, and the second report describing MRI findings of muscle involvement by PN. Therefore, our case provides important clinical information for the diagnosis and treatment of the disease.

[A case of renal capsular leiomyoma]

A 50-year-old woman was admitted for the treatment of retroperitoneal tumor. Enhanced comtuted tomography showed a low density mass between the left kidney and psoas muscle. Magnetic resonance imaging revealed a high intensity and homogeneous mass on T1-weighted sequence, and a low intensity and heterogeneous mass on T2-weighted sequence. Surgical exploration revealed that the tumor was adherent to the left kidney and en bloc excision of the tumor and the left kidney was performed. Histopathological diagnosis was leiomyoma originating from the renal capsule.

Management of severe acute pancreatitis with a somatostatin analog in a patient undergoing surgery for dissecting thoracic aneurysm: report of a case

A patient who was admitted to our hospital to undergo surgery for a dissecting thoracic aneurysm suffered preoperatively from severe acute pancreatitis with pancreatic pseudocysts. Computerized tomography (CT) demonstrated the presence of new fluid collection around the cyst with the absence of pancreatic necrosis. He was given a somatostatin analog (sandostatin), which was effective in decreasing the abdominal symptoms, leukocyte counts, and the serum C-reactive/protein level. A CT scan revealed that the pancreatic pseudocyst and peripancreatic fluid collection had disappeared. Although somatostatin has been reported to be ineffective for acute pancreatitis with necrosis, pancreatitis without necrosis may regress after treatment with sandostatin. This is probably due to its suppressive effect on the exocrine function, thus resulting in a decrease of pancreatic juice infiltration.

Preparation of nanoparticles consisted of poly(L-lactide)-poly(ethylene glycol)-poly(L-lactide) and their evaluation in vitro

This study describes the preparation and the evaluation of biodegradable poly(L-lactide)-poly(ethylene glycol)-poly(L-lactide) copolymer (PLA-PEG-PLA) nanoparticles containing progesterone as a model drug. PLA and PLA-PEG-PLA copolymers, whose PEG content ranged from 5.2 to 25.8% (w/w), were polymerized in our laboratory. PEG with weight-average molecular weight (Mw) 6600 or 20 000 was introduced as a hydrophilic segment into a hydrophobic PLA homopolymer. A solvent evaporation method was used to prepare the nanoparticles. The drug trapping efficiencies were around 70% and the weight-averaged mean diameters of the nanoparticles were less than 335 nm. The amount of drug released increased as the PEG content and Mw of PLA-PEG-PLA copolymers increased and the total Mw of copolymers of nanoparticles decreased. The initial burst of drug release was reduced by removing the low Mw fraction from the polymer. During the release test, both the extent to which the copolymers were degraded and the size of the nanoparticles were increased slightly by increasing the content of PEG in the polymers. Drug release from the nanoparticles could potentially be controlled by changing the PEG content, PEG Mw and total Mw of the copolymer. The molecular weight distribution (Mw/Mn, Mn: number-average molecular weight) of copolymers was also an important factor for controlled release.

Transthoracoscopic needle biopsy for indeterminate lung nodules

BACKGROUND

The usefulness of transthoracoscopic needle biopsy for preoperatively indeterminate intrapulmonary nodules was evaluated.

METHODS

Thoracoscopy was performed on 38 patients with pulmonary solitary nodules suspected to be primary lung carcinomas. When the nodule was localized by simple observation or tactile sensor, a biopsy specimen of the tumor was obtained by a biopsy needle introduced through a trocar.

RESULTS

The nodules were 7 to 55 mm in diameter. All were located in the peripheral region of the lung. Biopsy specimens were obtained even from 17 nodules with no associated pleural changes. By cytology, all the malignant tumors were precisely diagnosed, 29 as primary lung cancers and 3 as metastatic lung neoplasms. Five of the remaining six benign nodules were not precisely diagnosed. However, they were cytologically classified as class I.

CONCLUSIONS

Transthoracoscopic needle biopsy is feasible for diagnosing small intrapulmonary nodules, particularly those of malignant neoplasms. As compared with thoracoscopic excisional biopsy, transthoracoscopic needle biopsy saves time and may reduce the possibility of tumor dissemination during the procedure.

Helicobacter heilmannii associated erosive gastritis

The spiral bacteria, Helicobacter heilmannii (H. heilmannii), distinct from Helicobacter pylori (H. pylori), was found in the gastric mucosa of a 71-year-old man without clinical symptoms. The endoscopic examination revealed erosive gastritis. Rapid urease test from the antral specimen was positive, but both culture and immunohistological staining for H. pylori were negative. Touch smear cytology showed tightly spiral bacteria, which were consistent with H. heilmannii. At the second endoscopy after medication regimen for eradication of H. pylori, inflammation was decreased and the rapid urease test was negative. The second cytology showed no evidence of H. heilmannii. Anti-H. pylori therapy may be a useful medication for H. heilmannii.

Expression of CD10 on lymphoid cells associated with thymoma

BACKGROUND

The thymoma is a mixture, in varying proportions, of epithelial and lymphoid cells. The aim of this study was to detect immature T-lineage components of lymphoid cells infiltrating thymoma tissue.

METHODS

Tissue-infiltrating lymphoid cells (N = 10) and normal thymocytes (TC, N = 3) were retrieved from surgical specimens. The surface antigens of these lymphocytes were examined with flow cytometry.

RESULTS

CD3 was detected on 48 +/- 19% of tissue-infiltrating lymphoid cells and 66 +/- 16% of TC, while CD19 was expressed on neither. CD4 and CD8 were co-expressed on 70 +/- 21% of Tissue-infiltrating lymphoid cells and 68 +/- 28% of TC. CD10 was expressed on 22 +/- 10% of tissue-infiltrating lymphoid cells, but was not expressed on TC (5 +/- 3%, p = 0.0003). Two-color analysis showed that the CD10+ fraction was weakly stained with CD3. It was also stained with anti-CD38 and anti-CD4, but not with anti-CD34.

CONCLUSIONS

Tissue-infiltrating lymphoid cells included CD10-positive T-lineage cells. This fraction corresponds to very immature thymocyte subsets. These observations suggest that the epithelial component of a thymoma either inhibits the normal differentiation of T-lineage cells, or attracts immature T-lineage cells of bone-marrow origin.

The ribs: anatomic and radiologic considerations

The ribs are essential structures of the osseous thorax and provide information that aids in the interpretation of radiologic images. Techniques for making precise identification of the ribs are useful in detection of rib lesions and localization of lung lesions. The big rib sign and the vertical displacement sign can be used to differentiate the right and left ribs on lateral chest radiographs. The clavicle, the xiphoid process, and the sternal angle may be used as anatomic landmarks for rib counting on computed tomographic scans. For rib counting on lateral chest radiographs, the sternal angle or the 12th rib may be used. Anatomic rib variants include developmental deformities, cervical rib, and short rib and may mimic true rib diseases. Detection of thoracic deformities such as funnel chest (pectus excavatum) and barrel-shaped thorax requires an awareness of the strong correlation between the transverse appearance of the thorax and costal shape. Shadows around the rib cage (eg, rib companion shadows, sharp lines along the lower margin of the ribs, rib overlying shadows) may mimic pleural and extrapleural disease on frontal chest radiographs. It is imperative that the radiologist be familiar with normal rib anatomy, normal rib variants, and the radiologic appearance of the ribs to prevent misdiagnosis.

Novel, highly potent aldose reductase inhibitors: (R)-(-)-2-(4-bromo-2-fluorobenzyl)-1,2,3,4- tetrahydropyrrolo[1,2-a]pyrazine -4-spiro-3'-pyrrolidine-1,2',3,5'-tetrone (AS-3201) and its congeners

A series of novel tetrahydropyrrolo[1,2-a]pyrazine derivatives were synthesized and evaluated as aldose reductase inhibitors (ARIs) on the basis of their abilities to inhibit porcine lens aldose reductase (AR) in vitro and to inhibit sorbitol accumulation in the sciatic nerve of streptozotocin-induced diabetic rats in vivo. Of these compounds, spirosuccinimide-fused tetrahydropyrrolo[1, 2-a]pyrazine-1,3-dione derivatives showed significantly potent AR inhibitory activity. In the in vivo activity of these derivatives, 2-(4-bromo-2-fluorobenzyl)-1,2,3,4-tetrahydropyrrolo[1, 2-a]pyrazine-4-spiro-3'-pyrrolidine-1,2',3,5'-tetrone (23t) (SX-3030) showed the best oral activity. The enantiomers of 23t were synthesized, and the biological activities were evaluated. It was found that AR inhibitory activity resides in the (-)-enantiomer 43 (AS-3201), which was 10 times more potent in inhibition of the AR (IC50 = 1.5 x 10(-8) M) and 500 times more potent in the in vivo activity (ED50 = 0.18 mg/kg/day for 5 days) than the corresponding (+)-enantiomer 44 (SX-3202). From these results, AS-3201 was selected as the candidate for clinical development. The absolute configuration of AS-3201 was also established to be (R)-form by single-crystal X-ray analysis. In this article we report the preparation and structure-activity relationship (SAR) of tetrahydropyrrolopyrazine derivatives including a novel ARI, AS-3201.

Development of melanocyte progenitors in murine Steel mutant neural crest explants cultured with stem cell factor, endothelin-3, or TPA

Stem cell factor (SCF) has been suggested to be indispensable for the development of neural crest cells into melanocytes because Steel mutant mice (i.e., Sl/Sl(d)) have no pigmented hairs. On the other hand, it has been demonstrated that the addition of endothelin 3 (ET-3) or TPA to neural crest cell cultures can induce melanocyte differentiation without addition of extrinsic SCF. In this study, we excluded the influence of intrinsic SCF by using Sl/Sl mouse embryos to study more precisely the effects of natural cytokines, such as extrinsic soluble SCF or ET-3, or chemical reagents, such as TPA or cholera toxin. We found that SCF is supplied within the wild-type neural crest explants and that ET-3 cannot induce melanocyte differentiation or proliferation without SCF. These results indicate that SCF plays a critical role in survival or G1/S entry of melanocyte progenitors and that SCF initially stimulates their proliferation and then ET-3 accelerates their proliferation and differentiation. TPA has the ability to elicit neural crest cell differentiation into melanocytes without exogenously added SCF but it is not as effective as SCF because many more melanocytes developed in the wild-type neural crest explants cultured with TPA.

[Thoracoscopic decortication for chronic empyema thoracis: report of a case]

Thoracoscopic surgery for empyema thoracis treatment is still uncommon in Japan. We report a case of chronic empyema thoracis which was successfully treated with decortication through thoracoscopy. A 63-year-old man presented with respiratory distress, appetite loss and hoarseness. He had been suffering from diabetes mellitus for 13 months. His chest X-ray film revealed that he had suffered from the left chronic empyema. As the decortication procedure was feasible at the preliminary exploration, it was then performed through the thoracoscopy. The lung re-expanded well after the pleural peel was removed. His chest drainage tube was drawn out on 19th postoperative day.

Unilateral absence of pulmonary artery and ventricular septal defect in an infant

A 2-month-old boy was diagnosed as having a rare combination of absence of left pulmonary artery and ventricular septal defect. He underwent intracardiac repair at the age of 8 months. Reconstruction of the left pulmonary artery was impossible because it could not be visualized through a median sternotomy. Although his early postoperative course was uneventful, he needed ipsilateral pneumonectomy 3 months later because of unremitting hemoptysis. Hilar left pulmonary artery, which used to exist, was not found even by histologic examination.

Time-course of antibody response in mice against oral infection with eggs of Echinococcus multilocularis

The kinetics of serum antibody response against infection with Echinococcus multilocularis eggs was evaluated in AKR mice. The animals were infected by oral inoculation with 300 parasite eggs, and necropsied at 1, 2, 4, 6, 9, 12 and 16 weeks post-infection (p.i.), respectively. The parasite formed the laminated layer at 4 weeks p.i., the brood capsule with a massive proliferation of germinal cells at 9 weeks p.i. and protoscoleces at 16 weeks p.i. Serum antibody responses of the mice to antigen preparations from metacestodes of different stages and protoscoleces were evaluated by ELISA, immunoblotting and immunohistochemistry. In ELISA, the antibody responses began to increase at 4 weeks and became more apparent at 9 weeks p.i. and thereafter. Immunoblots using sera collected at 16 weeks p.i. showed some common bands among the 3 different antigen preparations. In addition to this, the germinal cells and brood capsules of mature metacestodes were stained strongly in an immunohistochemical study. From above, it is suggested that some antigen molecules are expressed in the parasite through these stages and stimulated host antibody responses.