Localization of insulinomas. Comparison of conventional arterial stimulation with venous sampling (ASVS) and superselective ASVS

PURPOSE

To examine the value of superselective arterial stimulation venous sampling (ASVS) to localize insulinomas.

MATERIAL AND METHODS

Superselective ASVS (SS-ASVS) was performed in 9 patients with insulinoma. Injection of secretagogue (calcium gluconate: 0.01 mEq Ca++/kg) was performed into the gastroduodenal, splenic (proximal and distal), and superior mesenteric arteries in 9 patients and additionally into the dorsal pancreatic artery in 6 patients. Sampling from the hepatic vein was performed to measure serum insulin concentrations at 30, 60 and 120 s after each injection of secretagogue into these arteries. SS-ASVS results were correlated with surgical findings, compared to those of conventional ASVS.

RESULTS

Insulinomas were correctly localized to the head, body or tail of the pancreas by SS-ASVS in 8 patients (89%). Conventional ASVS detected insulinomas in 7 patients (78%), although it could not distinguish whether the insulinoma was located in the pancreatic body or tail in 4 of the 7 patients. There were eight-fold or more increases in serum insulin levels in hepatic venous samples related to the artery supplying the tumor in 8 patients. Localization of the insulinomas was verified at surgery in all patients.

CONCLUSION

SS-ASVS is a useful method for detailed evaluation of overproduction of insulin from pancreatic insulinomas and their localization. When the pancreatic insulinoma is situated in the pancreatic body or tail, the localization is more accurately made by SS-ASVS than by conventional ASVS.

Fast separation of oligonucleotide and triplet repeat DNA on a microfabricated capillary electrophoresis device and capillary electrophoresis

A laser-induced fluorescence detection system coupled with a highly sensitive silicon-intensified target (SIT) camera is successfully applied to the imaging of a band for DNA fragment labeling by fluorescence dye in a microchannel, and to the visualizing of the separation process on a microfabricated chip. We demonstrated that an only 6 mm separation channel is sufficient for the separation of triplet repeat DNA fragment and DNA molecular marker within only 12 s. The separation using the microfabricated capillary electrophoresis device is confirmed to be at least 18 times faster than the same separation carried out by conventional capillary electrophoresis with 24.5 cm effective length. The use of a short capillary with 8.5 cm effective length is also efficient for fast separation of DNA; however, the microchip technology is even faster than capillary electrophoresis using a short capillary.

Early glottic squamous cell carcinoma. Predictive value of MR imaging for the rate of 5-year local control with radiation therapy

PURPOSE

To evaluate MR findings in early (T1 and T2 stages) glottic carcinomas and the predictive value of MR imaging for the rate of 5-year local control with radiation therapy.

MATERIAL AND METHODS

Eighty-three patients with early glottic carcinomas were prospectively examined with MR at 1.5 T. MR investigation included unenhanced T1-weighted, T2-weighted, dynamic and contrast-enhanced T1-weighted images. Three patients with presumed advanced diseases on MR were initially treated with total laryngectomy and were excluded from the study. The remaining 80 patients were treated with radiation therapy with curative intent. Tumor detectability, size and relationship to the thyroid cartilage were determined on MR images. The MR findings were then correlated with the rate of local control.

RESULTS

Forty-eight of 80 lesions (60%) were detected on MR imaging. All detected lesions but 1 demonstrated increased signal on T2-weighted images. The lesions were best delineated on dynamic images (statistically significant). The 5-year local control rate with radiation therapy was 72%. Univariate analysis revealed clinical T stage, MR detectability, tumor size and relationship to the thyroid cartilage as significant predictors. Multivariate analysis revealed that the relationship to the thyroid cartilage was an independent factor.

CONCLUSION

MR provides prognostic information about the results of definitive radiation therapy. To evaluate the tumor extension in lesions detected on precontrast MR images, contrast-enhanced dynamic images should be obtained.

[Percutaneous mechanical thrombectomy for thrombosed vessels with a hydrolyser (hydrodynamic thrombectomy catheter): clinical experience]

A hydrodynamic thrombectomy catheter was prospectively evaluated for the treatment of thrombosed vessels. Seven patients (7 males: age range from 56 to 82 years; mean age: 79 years) presenting with acute or chronic occlusion of peripheral native arteries (n = 6) and dialysis shunt (n = 1) were treated with the hydrolyser (Cordis, Johnson and Johnson, Japan). Mean occlusion time was 135 days (range: 2-300 days), and mean thrombus length 16 cm (range: 5-20 cm). Removal of the thrombus was successful in five patients (71%), regardless of the length of the thrombus. Mean procedure time was 20 minutes (range: 15-30 minutes). No major complications occurred. Adjunctive thrombolysis was required for persistence of the residual thrombosed distal vessel in one patient. Adjunctive balloon angioplasty was performed in two patients (one native vessel and one dialysis shunt), and stent placement was performed in one patient (dialysis shunt). In two unsuccessful cases, the hydrolyser could not be advanced to the distal side because of the solid thrombus. Therefore, thrombolytic therapy was chosen. However, this therapy failed because the guidewire did not pass within the thrombus. Surgery was performed in these two patients. We conclude from this clinical experience that percutaneous thrombectomy with a hydrolyser is a promising technique for the treatment of thrombosed vessels. Especially in the acute stage of thrombosed occlusion, percutaneous thrombectomy with a hydrolyser is superior to thrombectomy with a Fogarty balloon catheter because of its shorter procedure time and fewer complications.

Factors that predict intrahepatic recurrence of hepatocellular carcinoma in 81 patients initially treated by percutaneous ethanol injection

BACKGROUND

In Japan, where liver transplantation has not been used to treat patients with hepatocellular carcinoma (HCC), percutaneous ethanol injection (PEI) has been employed for those with small HCCs that are not amenable to surgical resection. In the current study, the authors evaluated PEI as a treatment for HCC patients by studying recurrence rates and survival after treatment. They then examined the clinicopathologic factors that predicted patterns of local and distant intrahepatic recurrence.

METHODS

For 81 patients who underwent PEI as initial therapy between 1990 and 1997, the cumulative recurrence and survival rates and their correlations with 16 clinicopathologic factors were studied using the Kaplan-Meier method.

RESULTS

The 3-year overall cumulative rates of intrahepatic recurrence and survival were 81% and 84%, respectively. At the end of the observation period, intrahepatic recurrence was detected in 56 patients (69%). In 21 (38%) of 56 patients, local recurrences were significantly associated with earlier stages of underlying cirrhosis, decreased indocyanine green retention at 15 minutes (ICG R15), larger tumor size, and histologically advanced tumor grade. Distant intrahepatic recurrence was also significantly associated with liver function and ICG R15.

CONCLUSIONS

PEI is most effective as the initial treatment for patients with well-differentiated HCC when the tumor is less than 15 mm in greatest dimension. However, local recurrence depends predominantly on the biologic characteristics of the tumor, regardless of the efficacy of PEI. Surgical resection of HCC should be considered, especially for patients with mild liver dysfunction.

Capillary affinity gel electrophoresis: new technique for specific recognition of DNA sequence and the mutation detection on DNA

The present state of studies on capillary affinity gel electrophoresis, which is a new technique for the specific recognition of a target DNA sequence, is reviewed. This article includes the principle, theory, methods, and applications of this technology. The great potential of capillary affinity gel electrophoresis for the sequence-specific recognition of DNA and the detection of mutations in specific genes is illustrated.

DNA sequencing by capillary array electrophoresis with an electric field strength gradient

We examined the effect of an electric field strength gradient on DNA sequencing efficiency using capillary array electrophoresis. Several types of gradients were applied to DNA sequencing and tested in terms of read length and accuracy. Our original method improved the accuracy of DNA sequencing for longer fragments at high temperature.

Unusual capillary electrophoretic behavior of triplet repeat DNA

We investigated the electrophoretic behavior of triplet repeat DNA fragments by capillary electrophoresis and found triplet repeat DNA fragments showed unusual mobilities compared with those of commercially available DNA molecular marker. The electrophoretic data are analyzed by means of Ogston model and the mechanism of a change in mobility of triplet repeat DNA is discussed. The unusual mobilities are caused by the characteristic higher-order structure formed by GC-rich triplet repeat DNA.

Dendritic Ca2+ transient increase evoked by wind stimulus in the cricket giant interneuron

In vivo Ca2+ imaging was applied to the cricket median giant interneuron (MGI), to visualize the dendritic processing of mechanosensory signals. Wind stimulation (air-puff) to the cerci induced a transient increase in the cytosolic Ca2+ concentration ([Ca2+]i) in the MGI with a latency of a few seconds, suggesting the release of Ca2+ from the intracellular store site in the MGI. The amplitude of the transient increase in [Ca2+]i in the dendrites depended on the direction of the air-puff, and the increase in [Ca2+]i evoked by the air-puff was suppressed by the hyperpolarizing current injection which blocked the generation of action potentials. These results indicate that the action potential is necessary to the direction-sensitive increase in [Ca2+]i induced by wind stimulation.

Factors that predict intrahepatic recurrence of hepatocellular carcinoma in 81 patients initially treated by percutaneous ethanol injection

BACKGROUND

In Japan, where liver transplantation has not been used to treat patients with hepatocellular carcinoma (HCC), percutaneous ethanol injection (PEI) has been employed for those with small HCCs that are not amenable to surgical resection. In the current study, the authors evaluated PEI as a treatment for HCC patients by studying recurrence rates and survival after treatment. They then examined the clinicopathologic factors that predicted patterns of local and distant intrahepatic recurrence.

METHODS

For 81 patients who underwent PEI as initial therapy between 1990 and 1997, the cumulative recurrence and survival rates and their correlations with 16 clinicopathologic factors were studied using the Kaplan-Meier method.

RESULTS

The 3-year overall cumulative rates of intrahepatic recurrence and survival were 81% and 84%, respectively. At the end of the observation period, intrahepatic recurrence was detected in 56 patients (69%). In 21 (38%) of 56 patients, local recurrences were significantly associated with earlier stages of underlying cirrhosis, decreased indocyanine green retention at 15 minutes (ICG R15), larger tumor size, and histologically advanced tumor grade. Distant intrahepatic recurrence was also significantly associated with liver function and ICG R15.

CONCLUSIONS

PEI is most effective as the initial treatment for patients with well-differentiated HCC when the tumor is less than 15 mm in greatest dimension. However, local recurrence depends predominantly on the biologic characteristics of the tumor, regardless of the efficacy of PEI. Surgical resection of HCC should be considered, especially for patients with mild liver dysfunction.

Ipecac alkaloids from Cephaelis acuminata

From the dried roots of Cephaelis acuminata, five ipecac alkaloids, neocephaeline, 7'-O-demethylcephaeline, 10-O-demethylcephaeline, 2'-N-(1"-deoxy-1"-beta-D-fructopyranosyl)cephaeline and 2'-N-(1"-deoxy-1"-beta-D-fructopyranosyl)neocephaeline, were isolated, along with emetine, cephaeline, psychotrine, protoemetine, 9-demethylprotoemetinol and isocephaeline. Structures were determined by spectroscopic and chemical means.

[The incidences of virulence genes in Escherichia coli strains from sporadic diarrheal children]

To investigate the incidence of diarrheagenic Escherichia coli among E. coli strains screened by commercially available O-antigen antisera, we used PCR to isolate 8 virulence genes (eae, bfpA, IpaH, LT, ST, VT1, VT2, and aggR) in 184 E. coli strains sampled from sporadic diarrheal children in our district. eae and bfpA are the localized adherence factor genes of enteropathogenic E. coli (EPEC). IpaH is the invasion antigen gene of enteroinvasive E. coli (EIEC), LT and ST are the toxin genes of enterotoxigenic E. coli (ETEC), VT1 and VT2 are the toxin genes of enterohemorrhagic E. coli (EHEC), and aggR is the adherence factor gene of enteroaggregative E. coli (EAggEC). The results were as follows: eae, 7 (3.8%); bfpA, 0 (0%); IpaH, 0 (0%); LT, 0 (0%); ST, 2 (1.1%); VT, 5 (2.7%); aggR, 8 (4.3%). Seven isolates with eae did not have bfpA, and did not show a localized adherence to HeLa cells. Seven of the 8 isolates with aggR showed aggregative adherence to HeLa cells, while their O-serotypes of them were O111:H21 or O111:HUT. Because of the low incidence of the virulence gene, the commercially available O-antigen antisera was not expected to be useful for the screening of diarrheagenic E. coli, except for EHEC and EAggEC. EAggEC may be important as a pathogen of sporadic diarrhea of children as well as EHEC.

[Interrelationship among nerve conduction velocity, amplitudes of compound muscle and compound nerve action potentials in diabetic neuropathy]

In order to clarify the relationship among amplitudes of compound nerve action potential (CNAP), compound muscle action potential (CMAP) and nerve conduction velocity parameters, data of nerve conduction studies were analyzed in 102 patients with diabetes mellitus. In motor conduction studies CMAP amplitudes after stimulations at the distal nerve trunk, and the polyneuropathy index (PNI), a mean percentage of normal for 12 indices from 4 nerves concerning to the velocity or long distance latency, were evaluated. CNAP was recorded in the median and ulnar nerves from an intrafascicularly inserted microelectrode at the elbow after wrist stimulation. CMAP amplitudes were high in the median and ulnar nerves, and were reduced in the tibial and peroneal nerves. A close relationship was found between PNI and CNAP amplitudes. Among CMAP amplitude parameters tibial nerve, not median or ulnar nerves, had a good correlation with PNI and CNAP amplitude. Along with the progression of diabetic neuropathy, neuropathic signs or symptoms become conspicuous, and nerve conduction velocity drops as is expressed by the PNI level, which reflects the change in nerve conduction velocity in the upper and lower limbs. At the same time CNAP amplitude or CMAP amplitude in the tibial nerve decreases, but in nerves of the upper limb CMAP amplitude doesn't always decrease. So, tibial nerve is best among CMAP amplitude parameters in evaluating the degree of diabetic neuropathy. It is necessary to judge the degree of diabetic neuropathy after due consideration of these facts.

Identification of the SH2 domain binding protein of Bruton's tyrosine kinase as BLNK--functional significance of Btk-SH2 domain in B-cell antigen receptor-coupled calcium signaling

Bruton's tyrosine kinase (Btk) is a critical component in the B-cell antigen receptor (BCR)-coupled signaling pathway. Its deficiency in B cells leads to loss or marked reduction in the BCR-induced calcium signaling. It is known that this BCR-induced calcium signaling depends on the activation of phospholipase Cgamma (PLCgamma), which is mediated by Btk and another tyrosine kinase Syk and that the SH2 and pleckstrin homology (PH) domains of Btk play important roles in this activation process. Although the importance of the PH domain of Btk has been explained by its role in the membrane targeting of Btk, the functional significance of the SH2 domain in the calcium signaling has remained merely a matter of speculation. In this report, we identify that one of the major Btk-SH2 domain-binding proteins in B cells is BLNK (B-cell linker protein) and present evidences that the interaction of BLNK and the SH2 domain of Btk contributes to the complete tyrosine phosphorylation of PLCgamma.

Evidence for apoptosis induction in myofibroblasts during palatal mucoperiosteal repair

Apoptosis is thought to be a requisite event for maintaining kinetic homeostasis within continually renewing tissues such as the oral mucosa and skin. However, no systematic study of the apoptotic process in fibroblasts in the oral mucosa following injury has been performed. In this study, we have assessed the expression of transforming growth factor-beta1 (TGF-beta1) and basic fibroblast growth factor (bFGF), which are among the most important modulators of wound repair, during wound healing following mucoperiosteal injury in the rat palate. In addition, we have investigated fibroblast differentiation and apoptosis by immunohistochemical analysis for alpha-smooth-muscle (alpha-SM) actin or DNA strand breaks, respectively, to clarify the mechanisms of the wound healing process. TGF-beta1-positive cells were noted in the subepithelium from Day 2 to Day 14 after injury, by which time the wounds were completely reepithelialized. Strong expression of bFGF was observed, mainly in macrophages and monocytes at the injured site, from Day 10 to Day 14 after injury. TGF-beta1 and bFGF-immunostaining was significantly lower during the later phase of wound healing. In addition, the number of myofibroblasts expressing alpha-SM actin increased (peak at Day 14), and thereafter gradually decreased. In parallel, the apoptosis in myofibroblasts was prominent on Day 14. These results suggest that TGF-beta1 and bFGF may be potential stimulators of apoptosis in myofibroblasts after re-epithelialization in the palatal wound healing process. The regulation of apoptotic phenomena during wound healing may be important in scar establishment and development of pathological scarring.

[A case of an intracranial tuberculoma, mimicking meningioma, that developed during treatment with anti-tuberculous agents]

A 54-year old female patient presented with intracranial tuberculoma attached to the dura mater during treatment with anti-tuberculous agents. Compared tomography (CT) and magnetic resonance imaging (MRI) revealed a lesion resembling a cystic meningioma. A granulomatous tumor that adhered to the cerebral cortex and dura was totally removed. Histological diagnosis was epithelioid granuloma. After removal of the tuberculoma and treatment with anti-tuberculous medications, the patient seemed to be cured, and regrowth of the tumor has not been observed to date. Tuberculoma mimicking meningioma is a very rare phenomenon. In the present study, we review intracranial tuberculomas and discuss their radiological features.

[Perioperative considerations for a holoprosencephaly patient]

We had twelve anesthetic experiences of seven holoprosencephaly patients for the past thirteen years. We classified these seven patients and compared the difficulty in perioperative control in the patients. Seven patients were divided according to two different holoprosencephaly classifications, one is that by DeMyer and the other by Osaka. We studied them retrospectively about airway management, the control of convulsion or instability of body temperature, and so on. Case of abortive type had nothing particular to be considered about, but cases of semilober type which had more severe brain anomaly, required careful respiratory management, due to their immature nasopharyngeal function. Concerning the convulsion or body temperature, cases of semilober type were difficult to control. When we anesthetize these holoprosencephaly patients, we must consider the classification of the anomaly and clinical conditions in each case. Especially, in cases of semilober types, prudent treatment is needed thoughout the perioperative period.

Small hepatocellular carcinoma supplied by the right renal capsular artery. A case report

We present a case of hepatocellular carcinoma (HCC), which was fed only by the right renal capsular artery. Ten years earlier, this patient underwent surgery for a solitary HCC in segment IV. However, the hepatic artery was patent and did not participate in feeding the HCC. We consider the renal capsular artery as an essential extrahepatic parasitic feeding artery to HCC.

A comparison of hepatocellular carcinoma associated with HBV or HCV infection

BACKGROUND/AIMS

Close relationships between hepatocellular carcinoma (HCC) and hepatitis virus infection have been elucidated. However, clinical differences between HBV- and HCV-associated HCC remain unclear.

METHODOLOGY

Four hundred and sixteen patients with HCC were examined for both HBsAg and HCV-Ab. Sixty-nine of the 416 patients (16.6%) were positive for HBsAg and negative for HCV-Ab (B-HCC), while 290 patients (69.7%) were negative for HBsAg and positive for HCV-Ab (C-HCC). Various comparisons were made between the 2 groups.

RESULTS

B-HCC patients were younger in age (p < 0.0001), and had significantly better liver function than C-HCC patients. The motivation of HCC detection was different between the 2 groups (p < 0.0001), and the tumor size of B-HCC was significantly larger when comparing groups with regard to symptoms (p < 0.05). Although B-HCC demonstrated better survival in Stage I/II treated by surgery (p < 0.05), it was associated with poorer survival in Stage III/IV receiving hepatic arterial infusion chemotherapy when compared to C-HCC (p < 0.01).

CONCLUSIONS

These results suggest that clinical differences between B-HCC and C-HCC may depend upon the difference of the natural course between HBV and HCV infection, and B-HCC may be more resistant to treatment than C-HCC in the advanced stage. This also illustrates the need for early tumor detection in B-HCC.

Bruton's tyrosine kinase activity is negatively regulated by Sab, the Btk-SH3 domain-binding protein

Bruton's tyrosine kinase (Btk) is a cytoplasmic tyrosine kinase that is crucial for human and murine B cell development, and its deficiency causes human X-linked agammaglobulinemia and murine X-linked immunodeficiency. In this report, we describe the function of the Btk-binding protein Sab (SH3-domain binding protein that preferentially associates with Btk), which we reported previously as a newly identified Src homology 3 domain-binding protein. Sab was shown to inhibit the auto- and transphosphorylation activity of Btk, which prompted us to propose that Sab functions as a transregulator of Btk. Forced overexpression of Sab in B cells led to the reduction of B cell antigen receptor-induced tyrosine phosphorylation of Btk and significantly reduced both early and late B cell antigen receptor-mediated events, including calcium mobilization, inositol 1, 4,5-trisphosphate production, and apoptotic cell death, where the involvement of Btk activity has been demonstrated previously. Together, these results indicate the negative regulatory role of Sab in the B cell cytoplasmic tyrosine kinase pathway.