Preoperative embolization of meningiomas fed by ophthalmic branch arteries

BACKGROUND

The efficacy of preoperative embolization for hypervascular meningiomas mainly fed by the branches of the ophthalmic arteries was examined.

CASES AND METHODS

Five hypervascular meningiomas mainly fed by the branches of the ophthalmic arteries, four posterior ethmoidal arteries, one anterior falx artery, and one recurrent middle meningeal artery were embolized with Gel-foam powder, polyvinyl alcohol (PVA) particles, and/or microcoils as a preoperative treatment using a microcatheter.

RESULTS

Catheterization of the ophthalmic and tumor feeding artery was possible and feeding arteries and lesion embolization were effective to reduce the bleeding during surgery in all cases. In three cases, visual acuity and visual field were preserved. However, in one case, visual acuity and visual field defect appeared due to the migration of Gelfoam powder (Upjohn, Kalamazoo, MI) into the retinal artery. In another case, the retinal artery was embolized with the feeding arteries since the patient was already blind.

CONCLUSION

Embolization of hypervascular meningioma feeding vessels arising from the ophthalmic artery is possible and effective with preservation of vision, if embolic agents are injected gently enough not to reflux into the central retinal artery.

Release profiles of recombinant human tumor necrosis factor from Ca(2+)-triggering liposome in vivo

After the administration of the recombinant human tumor necrosis factor (rHuTNF), plasma concentration could be controlled from egg yolk phosphatidylcholine (eggPC)-egg yolk phosphatidic acid (eggPA) liposome (EggPA liposome). The plasma concentration was highest after the rHuTNF solution administration. Although the concentration after the 30% EggPA liposome administration was much lower than that after the solution administration, the antitumor effect against Meth A sarcoma was equal to that of the rHuTNF solution. Non-linear elimination of rHuTNF in rat could explain these phenomena. First, to evaluate the intact absorption profile, we developed a non-linear absorption calculating program (NLAP). The calculation revealed little difference in the total absorption amounts between the solution and liposomes. The absorption rate from the liposomes was lower than that from the solution, and finally, the control of rHuTNF release from liposomes was also confirmed in vivo. These findings suggested that the sustained release of rHuTNF from liposomes maintained high drug concentration in the injected site and decreased the systemic drug concentration.

Deletion mapping on chromosome 1p in well-differentiated gastric cancer

To define the region on the short arm of chromosome 1 that is thought to include one or more tumour-suppressor genes for gastric cancers, we carried out loss of heterozygosity (LOH) studies in 26 gastric adenocarcinomas, using three restriction fragment length polymorphism (RFLP) markers and nine microsatellite markers. All tumours were informative with at least one locus; three revealed replication errors (RERs) at multiple microsatellite loci, and interstitial or telomeric allelic deletions were observed in 12 cases. Deletion mapping of these tumours defined a commonly deleted region between two loci, D1S201 and D1S197, that are 13 cM apart. As two loci within the commonly deleted region, D1S57 (pYNZ2) and D1S62 (pTHI54), were mapped respectively to 1p35 and 1p34.3 by fluorescence in situ hybridisation, we conclude that a locus likely to contain a tumour-suppressor gene for gastric cancer is located within a 13 cM region encompassing two chromosomal bands.

An improvement in the embryo quality and pregnancy rate by the pulsatile administration of human menopausal gonadotropin in patients with previous unsuccessful in vitro fertilization attempts

OBJECTIVE

To examine whether the pulsatile administration of hMG improves IVF outcomes in patients with previous unsuccessful attempts using IM injections of hMG.

DESIGN

A prospective randomized study.

SETTING

In vitro fertilization program at a university hospital.

PATIENTS

Eighty-eight endocrine-normal ovulatory women under 40 years of age, with normal male partners and a history of unsuccessful IVF treatment by the IM administration of hMG.

INTERVENTIONS

Patients were assigned randomly to receive either IM (bolus group) or pulsatile administration of hMG (pulsatile group) after pituitary desensitization by a GnRH agonist.

MAIN OUTCOME MEASURES

The proportion of retrieved oocytes with a polar body, the number of fertilized oocytes and embryos, the proportion of morphologically superior embryos, and the rate of pregnancy per initiated cycle were compared.

RESULTS

The proportion of retrieved oocytes with a polar body and the number of fertilized oocytes and embryos were similar in both groups. Significantly more embryos had superior morphology in the pulsatile group (77%) than the bolus group (52%). The rates of overall and clinical pregnancy per initiated cycle were significantly higher in the pulsatile group (39% and 30%, respectively, n = 44) than in the bolus group (18% and 11%, respectively, n = 44).

CONCLUSION

In women with failed IVF attempts using IM administration of hMG, the pulsatile administration of hMG produces superior embryos and, hence, a higher pregnancy rate.

Isolation and mapping of a novel human gene encoding a protein containing zinc-finger structures

We have isolated and characterized a cDNA clone, termed OTK18, representing a novel human gene. The 3754 nucleotides of this clone contain an open reading frame of 2133 nucleotides. As the predicted 711-amino-acid protein contains 13 contiguous zinc-finger stuctures of the C2H2 type, it would be expected to function as a DNA-binding multi-finger protein. The 4.3-kb transcript was expressed in all adult human tissues examined by Northern analysis. The gene was assigned to chromosomal band 19q13.4 by fluorescence in situ hybridization.

Effects of beraprost sodium, a prostacyclin analogue, on diabetic neuropathy in streptozotocin-induced diabetic rats

The effects of beraprost sodium (BPS), a stable prostacyclin analogue, on motor nerve conduction velocity and nerve blood flow of the sciatic nerve were investigated in streptozotocin-induced diabetic rats, and they were compared with the effects of epalrestat (aldose reductase inhibitor). Treatment with BPS for 4 weeks significantly inhibited the decrease in motor nerve conduction velocity and nerve blood flow dose-dependently, but epalrestat had no effect on nerve blood flow. Morphological changes of the myelinated fibers of the sciatic nerve were observed macroscopically. The mean axonal area and the mean circularity index of diabetic control rats were significantly less than that of normal rats, while after 6 weeks of BPS treatment, these decreases of the axonal area and the circularity index were inhibited. The enlargement of the mean lumen area of microvessels in the diabetic rats was significantly inhibited after 6 weeks of BPS treatment. Additionally, augmentation of the washed platelet aggregation in diabetic rats was significantly normalized by BPS. It was suggested that BPS is effective on diabetic neuropathy via amelioration of the decrease of blood supply to the structure. The effects of BPS on platelets might also contribute to the improvement of neuronal circulatory deficiency.

Protein phylogeny of translation elongation factor EF-1 alpha suggests microsporidians are extremely ancient eukaryotes

Partial regions of the mRNA encoding a major part of translation elongation factor 1 alpha (EF-1 alpha) from a mitochondrion-lacking protozoan, Glugea plecoglossi, that belongs to microsporidians, were amplified by polymerase chain reaction (PCR) and their primary structures were analyzed. The deduced amino acid sequence was highly divergent from typical EF-1 alpha's of eukaryotes, although it clearly showed a eukaryotic feature when aligned with homologs of the three primary kingdoms. Maximum likelihood (ML) analyses on the basis of six different stochastic models of amino acid substitutions and a maximum parsimony (MP) analysis consistently suggest that among eukaryotic species being analyzed, G. plecoglossi is likely to represent the earliest offshoot of eukaryotes. Microsporidians might be the extremely ancient eukaryotes which have diverged before an occurrence of mitochondrial symbiosis.

Impairment of suckling response, trigeminal neuronal pattern formation, and hippocampal LTD in NMDA receptor epsilon 2 subunit mutant mice

Multiple epsilon subunits are major determinants of the NMDA receptor channel diversity. Based on their functional properties in vitro and distributions, we have proposed that the epsilon 1 and epsilon 2 subunits play a role in synaptic plasticity. To investigate the physiological significance of the NMDA receptor channel diversity, we generated mutant mice defective in the epsilon 2 subunit. These mice showed no suckling response and died shortly after birth but could survive by hand feeding. The mutation hindered the formation of the whisker-related neuronal barrelette structure and the clustering of primary sensory afferent terminals in the brainstem trigeminal nucleus. In the hippocampus of the mutant mice, synaptic NMDA responses and longterm depression were abolished. These results suggest that the epsilon 2 subunit plays an essential role in both neuronal pattern formation and synaptic plasticity.

Urinary incontinence in elderly inpatients in Japan: a comparison between general and geriatric hospitals

This is the first multi-hospital epidemiological study to elucidate the prevalence and characteristics of urinary incontinence in elderly inpatients throughout Japan. Of the 2586 subjects to whom questionnaires were issued, 1563 (60.4%) (65 to 102 years old, 598 men, 965 women) were suitable for the study. A total of 817 patients were hospitalized in geriatric hospitals; that is, geriatric facilities under the regulation of the Department of Health and Welfare. All patients were evaluated by medical doctors for the following items: age, sex, duration of hospitalization, activities of daily living, medical diagnosis, presence or absence of urinary incontinence, type of urinary incontinence, and therapy for urinary incontinence. The prevalence of urinary incontinence in patients under 70, 70-79, 80-89, and over 90 years old was 59.3%, 67.7%, 79.8%, and 82.2%, respectively. Overall, 1142 patients (72.0%) suffered from urinary incontinence. Cerebrovascular disease was the major cause of admission to hospital in patients with urinary incontinence (37.0%). The most frequent type of urinary incontinence was functional urinary incontinence in patients who were mentally and/or physically unable to go to the bathroom without aid (21.5%). Specifically, 38.1% of patients in geriatric hospitals were diagnosed as having functional urinary incontinence, in contrast to only 3.9% of patients in non-geriatric units. In patients with dementia, 88.7% were incontinent, whereas in patients without dementia, the prevalence of urinary incontinence was much lower (51.5%, p < 0.001). Another predisposing factor for urinary incontinence was urinary tract infection. The prevalence of urinary incontinence in patients with and without urinary tract infection was 87.8% and 59.5%, respectively (p < 0.001). Almost all patients with poor activities of daily living (who were bedridden) suffered from urinary incontinence (98.5%). On the other hand, urinary incontinence was not so frequent in patients who could walk (26.9%). Pad (42.8%) and indwelling bladder catheter (18.3%) were the major means of management of incontinence, whereas behavioral therapy (4.9%) and surgery (0.5%) were not common. These results suggest that elderly patients with treatable urinary incontinence do not receive adequate therapy in Japan.

Urodynamic effects of intravesical oxybutynin chloride in conscious rats

PURPOSE

To examine the factors of intravesical oxybutynin influencing the cystometrogram in normal conscious rats at various pH levels and concentrations of oxybutynin.

MATERIALS AND METHODS

A cystostomy catheter was implanted into the bladders of male Sprague-Dawley rats. We compared the urodynamic effects of intravesical oxybutynin dissolved in pH 4.44, 6.44 and 8.44 buffer. Two concentrations of oxybutynin solution were adopted, 0.06 and 0.6 mg./ml., and were dissolved in each pH buffer.

RESULTS

Although a 26% increase in bladder capacity was recognized 1 hour after instillation of pH 8.44, 0.06 mg./ml. oxybutynin, no significant difference was found in comparison with control rats. At the concentration of 0.6 mg./ml., bladder capacity markedly decreased 30 minutes to 1 hour after instillation even at pH 6.44 and 8.44. Significant decreases in detrusor contraction pressure were recognized 30 minutes to 1 hour after instillation. However, there were no significant differences among the 3 pH oxybutynin solutions. Compared with preinstillation values, significant increases in residual urine rates were observed in all pH oxybutynin solutions. Furthermore, the residual urine rate after instillation of pH 8.44 oxybutynin solution differed significantly from that of pH 4.44 oxybutynin.

CONCLUSION

Our results demonstrate that pH and concentration of intravesical oxybutynin solution may play an important role in relaxation of the bladder. A high concentration of oxybutynin is considered irritating to the bladder mucosa.

Ectopic adrenocorticotropin syndrome associated with undifferentiated carcinoma of the colon showing multidirectional neuroendocrine, exocrine, and squamous differentiation

We report a rare case of ectopic ACTH syndrome associated with undifferentiated carcinoma of the ascending colon. A 62-year-old woman developed hypokalaemia and metabolic alkalosis associated with markedly elevated serum cortisol and plasma ACTH levels. High-dose dexamethasone (8 mg/day) did not suppress increased urinary 17-hydroxycorticosteroid and 17-keto-steroid excretion. Barium enema and abdominal computerised tomography showed a Borrmann II type tumour in the ascending colon, multiple metastatic nodules in the liver and bilateral enlargement of the adrenal glands. Histological examination of the resected primary colon cancer and metastatic liver tumour showed undifferentiated carcinoma with areas of distinct neuroendocrine, exocrine, and squamous differentiation. ACTH production by the tumour was confirmed by radioimmunoassay and immunohistochemistry. This is a unique case report of carcinoma of the colon with distinct multidirectional differentiation causing ectopic ACTH syndrome.

Effect of brief hypoxia on reperfusion arrhythmias and release of Ca2+ by rat heart homogenate blocked by ryanodine

OBJECTIVES

We previously reported that a brief period of hypoxic perfusion (BHP) prior to ischemia in rat hearts improved functional recovery upon reperfusion with reduced Ca2+ overload. The present study was designed to determine whether the effect of BHP would be associated with a reduction in reperfusion arrhythmias and a preservation of function of the sarcoplasmic reticulum (SR).

METHODS

Hearts were subjected to 40 min of global ischemia and 30 min of reperfusion after a 20 min period of oxygenated perfusion (oxygenated group: OG), or a 10 min period of oxygenation and 10 min of hypoxic perfusion (hypoxic group: HG). We evaluated the release of Ca2+ by SR blocked by ryanodine, the recovery of left ventricular function, and the reperfusion induced ventricular tachycardia/fibrillation (VT/VF).

RESULTS

Functional recovery improved and the incidence and duration of reperfusion VT/VF were reduced in HG. In HG the uptake of Ca2+ in SR decreased during ischemia, but this decrease was less than that in OG. However, recovery of Ca2+ uptake after reperfusion did not differ between groups. The release of Ca2+ by SR blocked by ryanodine was inhibited in HG throughout the ischemia-reperfusion sequence.

CONCLUSIONS

Observations suggest that the benefits of BHP on recovery of function and reperfusion arrhythmias were associated with a decrease in release of Ca2+ by SR blocked by ryanodine.

Demonstration of Borna disease virus RNA in peripheral blood mononuclear cells derived from Japanese patients with chronic fatigue syndrome

CFS, a recently named heterogeneous disorder, is an illness of unknown etiology. The association of CFS with viral infections has been suggested. A common association between CFS and several viruses examined has not been confirmed. Here, we centered on the possible link between CFS and BDV infection. By nested RT-PCR followed by hybridization, BDV RNA was demonstrated as a clear signal in PBMCs in 3 out of 25 CFS patients. The amplified cDNA fragments were cloned and sequenced. A total of 16 clones were studied. Intra-patients divergencies of the p24 were 2-9%, 3-20%, and 3-11% in the deduced amino acids. Inter-patient divergencies among the 16 clones were 3-24%. Antibodies to recombinant BDV p24 protein were detected in 6 CFS patients including one carrying BDV RNA. Overall, these gave the prevalence of 32% (8/25) in Japanese CFS patients, suggesting that Japanese CFS is highly associated with active infection of BDV, or a related agent.

Role of a truncated erythropoietin receptor for erythroid differentiation

Erythropoietin (EPO) is a cytokine that regulates erythropoiesis through the EPO receptor (EPOR). We reported previously that erythroid progenitor cells express both a full-length and a truncated form of EPOR (EPOR-F and EPOR-Tph). EPOR-Tph cannot transmit growth signals and acts as a dominant negative regulator against EPOR-F-mediated signals for cell survival and growth. Upon transfection of EPOR-F in a cell line, Ba/F3, beta-globin accumulation, which is considered to be a marker of erythroid-differentiation, is inducible in the transformants. We show here that the co-expression of EPOR-Tph in EPOR-F-transformants does not inhibit and rather upregulates the beta-globin induction while inhibiting survival and growth of the transformants. These data suggest that, in contrast to survival and growth signals, EPOR-Tph acts as a positive regulator for erythroid-differentiation signals in erythroid progenitor cells.

Radioiodinated metaiodobenzylguanidine scintigraphy for pheochromocytoma. A false-positive case of adrenocortical adenoma and literature review

Radioiodinated metaiodobenzylguanidine (MIBG) scintigraphy is known for its high specificity in detecting pheochromocytoma and other tumors of neural crest origin. We describe herein the first case of a definite adrenocortical adenoma that demonstrated false-positive uptake on MIBG scintigraphy. In addition, we reviewed all 13 reported cases showing false-positive uptake, and suggest that careful evaluation is needed before diagnosing a 'silent' or 'asymptomatic' pheochromocytoma.

Measurement of pupillary unrest in eyestrain

Using a computer-assisted infrared optometer with a pupillometer, we studied pupillary unrest in 20 eyes of 20 patients suffering from eyestrain, and 20 eyes of normal controls. The eyestrain patient group had smaller mean pupil area than the control group (29 mm2 vs 38 mm2; P < 0.01); showed prominent pupillary unrest, and had an increased mean coefficient of variation (CV) of the pupil area (9.2% vs 3.4%; P < 0.001). Long-duration waves of pupillary unrest (> 1 second) were frequently recorded in this group, but not in the control group. The patient group also had a significantly higher dark focus of accommodation than the control group (1.1 D vs 0.4 D; P < 0.01). These findings suggest that abnormal parasympathetic excitation of the iris and/or ciliary muscle may be a factor in the etiology of eyestrain.

Graft size-matching in living related partial liver transplantation in relation to tissue oxygenation and metabolic capacity

The influence of graft size-matching on tissue oxygenation and metabolic capability was studied in living related partial liver transplantations for 47 pediatric patients. Their age ranged from 4 months to 17 years 3 months, their body weight from 4.0 to 58.0 kg, graft weight from 191 to 440 g, and graft weight/recipient body weight ratio from 0.61% to 6.0%. Tissue oxygenation and its heterogeneity were investigated by measuring oxygen saturation of hemoglobin in the liver sinusoid (SO2), coefficient of variation of SO2, and arterial ketone body ratio. The metabolic capacity of the graft was investigated by measuring bilirubin clearance, recovery of cholesterol esterification, and ketone body production. In infants with a relatively large liver graft, both intra- and extracellular oxygenation remained low soon after reperfusion but recovered to the control value by the end of the operation. In adolescent recipients of a relatively small graft, by contrast, synthetic and detoxification capacities were relatively deficient; however, these improved with time. These results indicate that sufficient tissue oxygenation and liver regeneration are essential for successful liver transplantation with relatively large and small grafts, respectively.

Electron microscopic evidence of impaired intramembrane particles and instability of the cytoskeletal network in band 4.2 deficiency in human red cells

To obtain direct evidence of impaired intramembrane particles (IMPs) and a deranged cytoskeletal network in situ in human red cells of band 4.2 deficiency, electron microscopic studies were performed utilizing the freeze fracture method for IMPs and the quick-freeze deep-etching method for the cytoskeletal network. Three patients with three different previously identified mutations of the band 4.2 gene, i.e., band 4.2 Komatsu (homozygous; codon 175 GAT --> TAT), band 4.2 Nippon (homozygous; codon 142 GCT --> ACT), and band 4.2 Shiga (compound heterozygous; codon 317 CGC --> TGC and codon 142 GCT --> ACT), were selected for this study. The decrease in the number of IMPs with increase in their size was most marked in band 4.2 Komatsu, which was clinically most severe with no band 4.2 protein. In this regard, in band 4.2 Nippon, which showed moderate severity in clinical hematology with a nearly missing band 4.2 protein, increased sizing was less marked. The abnormalities in IMPs were the least in band 4.2 Shiga, which demonstrated compensated hemolysis with band 4.2 protein in a trace amount. The extent of the impairment of IMPs may be reflected by the total absence or the presence of band 4.2 protein even in a trace amount and/or by the specific site(s) of the mutation of the band 4.2 gene. Derangement of the cytoskeletal network was also observed in these three patients. It was most abnormal in band 4.2 Komatsu, and less so in band 4.2 Nippon and in band 4.2 Shiga. These results clearly indicate that 1) band 4.2 plays an important role not only in its binding to band 3 but also to the skeletal network (mostly to spectrins) vertically, and 2) its deficiency produces critical abnormality in maintenance of the structural and functional integrity of the integral proteins (such as band 3), as well as the cytoskeletal network.

Cloning, expression and chromosome mapping of adducin-like 70 (ADDL), a human cDNA highly homologous to human erythrocyte adducin

From a human fetal-brain cDNA library we isolated a novel human cDNA, termed human adducin-like 70 (gene symbol ADDL), whose predicted amino acid sequence showed a high degree of homology to adducins. This cDNA clone (ADDL), which contained an open reading frame of 2,022 nucleotides encoding 674 amino acids, revealed 54%, 53%, and 59% identity in predicted amino acid sequence with alpha and beta components of human adducin and rat adducin 63, respectively. Human adducin-like 70 is likely to play an important role in the skeletal organization of the cell membrane. Northern blot analysis indicated ubiquitous expression of this gene in adult human tissues. We localized the gene to chromosome bands 10q24.2-->q24.3 by fluorescence in situ hybridization (FISH).

Isolation, characterization and chromosomal assignment of the human WNT7A gene

The Wnt genes compose a large gene family encoding a group of secreted signaling molecules that have been implicated in oncogenesis and a number of developmental processes. We have isolated a full-length human cDNA clone that we consider to be a novel member of the Wnt gene family. The gene (WNT7A) encodes a deduced 349-amino-acid peptide with 98% identity in amino acid sequence to murine Wnt7a. Expression of this gene is restricted to certain tissues: placenta, kidney, testis, uterus, fetal lung, and fetal and adult brain. Furthermore, we have isolated a genomic clone of WNT7A and mapped it to chromosome 3p25 by fluorescent in situ hybridization.