[Correlation between MR imaging and histopathological findings of cystic metastatic brain tumors]

To clarify the correlation between the histopathological findings and MR signal intensity of the cyst wall, fifteen cystic metastatic brain tumors of eleven patients were imaged using a 0.5T MR unit just before surgery, and the MRI findings were correlated with the histopathological findings of resected lesions. On T2-weighted images, all cyst walls showed hypointensity. On T1-weighted images, the intensity of the cyst wall could be classified into three groups, compared with the cerebral cortex. Walls with hyperintensity on T1WI(group H; n = 6) consisted of ample tumor cells, blood vessels and connective tissues, suggesting viable tumor cells. Iso-intense walls on T1W1(group I; n = 3)had abundant reactive glial tissues. Hypointense walls on T1W1 (group L; n = 5)revealed hemorrhage and/or hemosicerin in the wall, suggesting hemorrhagic necrosis. Thus a good correlation was demonstrated between the MR signal intensities and histopathological findings of cyst walls of cystic metastatic brain tumors. This may contribute not only to more precise diagnosis on MRI but also to more planning for treatment of cystic brain metastases.

Intermediate clinical results of combined gastroepiploic and internal thoracic artery bypass

BACKGROUND

To improve the postoperative results of coronary artery bypass grafting (CABG), the internal thoracic artery (ITA) has become the conduit of choice, with a low operative risk. The gastroepiploic artery as a third arterial conduit for grafting was first reported in 1987, and the early results were reported to be as good as those for the ITA graft. In this report, we present the intermediate-term results of combining ITA and gastroepiploic artery grafts up to 7 years after the operation.

METHODS

Between April 1988 and April 1992, 214 patients received CABG with at least one ITA graft and were followed up for more than 3 years. They were divided into two groups: Group I consisted of 155 patients who had CABG using one ITA with or without saphenous vein grafts, and group II consisted of 59 patients who had CABG using an ITA and a gastroepiploic artery with or without saphenous vein grafts. The duration of follow-up for hospital survivors ranged from 36 to 89 months.

RESULTS

There were six late cardiac deaths in group I and one in group II. Fifteen patients complained of recurrent symptoms of angina: 13 in group I and 2 in group II. The actuarial survival rate excluding noncardiac deaths was 95.9% in group I and 96.8% in group II at 7 years (p = not significant). The cardiac event-free rate was 75.4% in group I and 92.2% in group II, which was a significant difference (p < 0.05).

CONCLUSIONS

When using both the ITA and gastroepiploic artery, CABG can be performed with minimal operative risk and seems to offer an improved quality of life at least 7 years postoperatively.

Anti-idiotype cancer vaccines: past and future

Anti-idiotypic antibodies (Ab2) binding to the antigen-combining site of antitumor antibodies (Ab1) can induce anti-anti-idiotypic antibodies (Ab3) that specifically bind to the tumor antigen recognized by Ab1. Furthermore, Ab2, mimicking tumor antigens, have been shown to induce anti-anti-idiotypic proliferative T lymphocytes of the helper and suppressor type, as well as cytotoxic lymphocytes. The immunomodulatory activities of Ab2 have been demonstrated both in animals and in patients. The demonstration of tumor growth inhibition by anti-idiotypes in preclinical and phase I clinical studies emphasizes that randomized control trials should be performed to demonstrate clinical efficacy of Ab2 vaccines.

Establishment of anaplastic thyroid carcinoma cell lines useful for analysis of chemosensitivity and carcinogenesis

Anaplastic thyroid carcinoma (ATC) is usually associated with a poor prognosis, with most patients dying within a few months. The mechanism of its carcinogenesis is unclear, and its rapid growth and spread often prevent effective surgical therapy. Thus, chemotherapy is necessary. However, ATC is often resistant to anticancer drugs. Therefore, prediction of chemosensitivity is important in selecting appropriate treatment. In this study, after the establishment of three cell lines (K119, KOA2, and IAA) from patients with ATC, we analyzed them for abnormalities in certain oncogenes (myc, ras, ret, and c-erbB2) and the p53 tumor suppressor gene. Only one of three cell lines (KOA2) had a N-ras mutation [codon 61 CAA(Gln)-->CGA(Arg)] and a p53 gene mutation [exon 6 codon 192 Caa(Gln)-->TAG(stop)]. We also investigated their in vitro drug sensitivity and compared it with clinical chemosensitivity, retrospectively. In vitro drug sensitivity was determined using an adhesive tumor cell culture system. Only the K119 cells were sensitive to adriamycin and cisplatin in vitro. The other two were resistant to them in vitro. These results paralleled the clinical responses. We also evaluated the in vitro drug sensitivity of a poorly differentiated thyroid carcinoma cell line (SMP) and papillary thyroid carcinoma cell lines (NPA). None of the five cell lines expressed the multidrug resistance gene (mdr-1). In conclusion, we established ATC cell lines that are suitable models for characterizing the nature of multidrug resistance and carcinogenesis.

The first case of type B infant botulism in Japan

A six-month-old girl with a 5 consecutive day history of constipation and poor feeding developed generalized weakness, poor head control, difficulties in sucking and swallowing, and cranial nerve dysfunction within a few days. These characteristic manifestations and clinical course prompted examination of the possibility of infant botulism, although no history of eating honey was obtained. Mouse bioassay performed with enema effluent demonstrated type B botulinum toxin. Culture of the effluent was positive for Clostridium botulinum type B. This is the first case of type B infant botulism in Japan.

Eosinophil peroxidase deficiency in New Zealand white mice

Eosinophil peroxidase (EPO) is one of the granule enzymes in the eosinophil-specific granules and is distinct from myeloperoxidase. Here we report that peroxidase activity was absent in eosinophils of New Zealand White (NZW) mice. When NZW, New Zealand Black and their F1 mice were treated with cyclophosphamide followed by Toxocara canis infection, the kinetic changes in the number of eosinophils in peripheral blood, determined by counting in Hinkelman's diluting fluid, were almost comparable among the three strains. However, when their blood films were stained for peroxidase reaction, eosinophils of NZW mice, but not of the other strains, lacked EPO activity, though their specific granules were stained by eosin Y. Sudan black staining for phospholipid was also negative in eosinophils of NZW mice. EPO deficiency in NZW eosinophils was further confirmed by electron-microscopic observations and by measuring EPO activity in the extracts of eosinophil-rich cell suspensions. These results indicate that NZW eosinophils share most of the features with human EPO-deficient eosinophils, suggesting that the NZW mouse is a murine counterpart of human EPO deficiency.

[Intra-arterial infusion chemotherapy for liver metastases from breast cancer]

Twelve patients with liver metastases of breast cancer were treated with hepatic arterial infusion chemotherapy using 20-30 mg/body of epi-adriamycin (epi-ADM) every 2 weeks and continuous infusion of 250 mg/body/day of 5-fluorouracil (5-FU). All patients were followed by systemic chemo-endocrine therapy with oral administration of 600-1,200 mg/day of me droxyprogesterone acetate (MPA) alone or with 600-800 mg/day of 5'-deoxy-5-flurouridine (5'-DFUR). The response rate was 41.7% (5/12 cases). Duration of response was 2-28 months (mean 10 months). At one year, the survival rate was 46.8% (Kaplan-Meier method). As for side effects, gastrointestinal disturbance, bone marrow depression and alopecia were mild. These results suggest that hepatic arterial infusion therapy in combination with MPA is safe and effective for controlling liver metastases of breast cancer.

Expression of inter-alpha-trypsin inhibitor light chain (bikunin) in human pancreas

Expression of inter-alpha-trypsin inhibitor light chain (ITI-LC, also known as bikunin or urinary trypsin inhibitor) was examined in various human tissues. By reverse-transcription polymerase chain reaction, the mRNA was detected not only in the liver, a known site of ITI-LC production, but also in the kidney, heart, lung, and pancreas. By RNA blot analysis, the mRNA was also detected in the pancreas and liver, but not in the kidney, heart, or lung. The ITI-LC protein was immunohistochemically detected along the surface of pancreatic acinar cells. These results indicate the apparent expression of the gene for ITI-LC in the pancreas. ITI-LC protein on the surface of pancreatic acinar cells may play an important role in preventing autodigestion by exocrine enzymes such as trypsinogen and chymotrypsinogen.

Kinetic study of eosinophil chemotactic factor production with reference to eosinophilia and granuloma formation in mice infected with Schistosoma japonicum

Kinetic changes of eosinophil chemotactic factor (ECF) production from granulomas, splenic T-cells or mast cells were examined with reference to granuloma formation around newly deposited single eggs in Schistosoma japonicum-infected mice. The peri-ovular granulomas began to appear at around 5 weeks post-infection (p.i.). Their size reached a peak at 6 weeks and then decreased gradually. Up to 8 weeks p.i., eosinophils were the predominant cell type in the granulomas. ECF-release from isolated granulomas paralleled the size of granulomas. Circulating ECF-A, which was assumed to be derived from mast cells, was also detected 6 weeks afterwards in parallel with the level of specific IgE antibody level against egg antigens in the serum. The circulating ECF-A peaked at 8 weeks and decreased after 10 weeks. Spleen cells began to produce ECF specific to bone-marrow eosinophils began at 5 weeks p.i., reached a peak at 6 weeks and then decreased rapidly. On the other hand, the production of ECF specific to eosinophils obtained from the peritoneal cavity began at 6 weeks and decreased rapidly thereafter. These results suggest that various kinds of host-derived ECFs seem to contribute, in one way or an other, to the accumulation of eosinophils in and around granulomatous lesions. The possible role of these ECFs in eosinophil mobilization from the site of production to the inflamed site is discussed.

Myasthenia-like syndrome induced by overdosage of cibenzoline

A case of cibenzoline-induced myasthenia-like syndrome is reported. A 67-year-old woman with renal failure and no previous disorder of neuromuscular junction complained of fatigue during climbing up a flight of stairs and experiencing heavy eyelids after administration of 100 mg/day of cibenzoline. Repetitive nerve stimulation tests revealed decrement at 5-10 Hz. After reduction of the dosage, myasthenia-like signs and symptoms disappeared. The peak cibenzoline concentration was still high even after the dose reduction (666.4 ng/ml). In conclusion, cibenzoline, at a high plasma level, may induce myasthenia-like syndrome without any disorder of the neuromuscular junction.

Reevaluation of the exact CAG repeat length in hereditary cerebellar ataxias using highly denaturing conditions and long PCR

Hereditary cerebellar ataxias, including spinocerebellar ataxia type I (SCA1), dentato-rubro-pallidoluysian atrophy (DRPLA), and Machado-Joseph disease (MJD), have been associated with unstable CAG repeats. The length of the CAG repeat is a major factor in determining the age of onset of these diseases. In electrophoresis through acrylamide gels with formamide, the CAG repeat length following the polymerase chain reaction (PCR) coincides with the sequence-determined repeat length after subcloning. However, without formamide, PCR products with long CAG repeats appear 1-4 repeats shorter than when electrophoresed with formamide, and the repeat lengths are variable. In addition, the larger the CAG repeats are, the more difficult are the PCR reactions. A mixture containing thermostable Taq and Pwo DNA polymerases (so-called "long PCR") is much more sensitive than that with Taq polymerase alone in detecting- expanded CAG repeats. Therefore, highly denaturing conditions, especially formamide gel electrophoresis, and the "long PCR" protocol should be used to evaluate the exact CAG repeat length. We have used these principles to detect unstable CAG repeats. The normal ranges are 14-34 repeats for MJD, 6-31 repeats for DRPLA, and 21-32 repeats for SCA1.

McArdle's disease with non-insulin-dependent diabetes mellitus: the beneficial effects of hyperglycemia and hyperinsulinemia for exercise intolerance

A 64-year-old female with McArdle's disease and non-insulin-dependent diabetes mellitus (NIDDM) is reported. She had none of the characteristic symptoms of McArdle's disease such as muscle cramps but her serum creatine kinase level was elevated. Muscle biopsy with negative muscle phosphorylase staining showed McArdle's disease. Modified forearm ischemic exercise test was done at two conditions; fasting and two hours after a meal. When fasting, the level of lactic acid did not elevate after exercise. After a meal, however, the serum lactic acid level rose with the elevation of plasma glucose and IRI. Thus, we suggested that high plasma glucose and insulin due to NIDDM may induce blood-borne glucose uptake with exercise.

Cloning and expression of a rat brain basic helix-loop-helix factor

We cloned two rat cDNAs of brain basic helix-loop-helix factor 1 (BHF1). These have an identical coding region, contain 357 amino acids and exhibit 94.6% identity to MATH-2/NEX1 in the basic helix-loop-helix region. BHF1mRNAs are dominantly expressed in the brain particularly in the cerebellum, in the adult bovine, rat and mouse. Two shorter BHF1mRNAs (1.6 kb and 1.8 kb) were also detected in the mouse embryo, and these decreased in the developmental process. These results suggest that BHF1 may play important roles in cerebellum-specific functions and development of neurons.

A family with Machado-Joseph disease, previously diagnosed as dentatorubral-pallidoluysian atrophy

We report a family with Machado-Joseph disease (MJD) that was previously diagnosed with dentatorubral-pallidoluysian atrophy (DRPLA), on the basis of the neuropathologic findings. Because the clinical and pathologic reevaluation strongly suggested a diagnosis of MJD, we conducted a genetic study in the family. Two patients, aged 38 and 40, revealed CAG repeat lengths of the MJD1 gene of 80, 28 and 75, 14, confirming a final diagnosis of MJD.

Walking patterns and finger rhythm of older adults

Walking patterns and rhythmic movement of the fingers were examined in a total of 1,134 male and female community residents 65 years of age and over. Walking patterns were characterized according to the ratio of step length divided by step rate (cadence), called the Walk Ratio, during level walking at preferred and maximum speeds. The walking pattern tended to change according to age; older subjects walked with shorter steps (smaller Walk Ratio). Rhythmic movement was examined using the finger-tapping test in time to the sound of a 4-Hz metronome. Hastened tapping or finger festination, in which the subject tapped faster than requested (constant error of 3 msec. and over in the intertap interval), was characteristic of aging; 16.8% of the subjects exhibited finger festination and the occurrence increased with age, especially among those in their eighties (29.3%). Finger festination was accompanied by walking patterns with an increased step rate, or a smaller Walk Ratio. These characteristics of aging were discussed as similar to extrapyramidal symptoms of walking and rhythm production in patients with Parkinson's disease.

Molecular cloning and characterization of a cDNA encoding a novel basic helix-loop-helix protein structurally related to Neuro-D/BHF1

We cloned a novel basic helix-loop-helix protein, NDRF (NeuroD-related factor), cDNA. NDRF contains 383 amino acids and exhibits 53.4% and 52.2% sequence identity to NeuroD and MATH-2/NEX-1, respectively. NDRF mRNA appears in the brain of 12-day-old mouse embryos and is localized in certain regions of the adult brain, such as the hippocampus, dentate gyrus and cerebellum, Thus, the structure and expression patterns of NDRF are similar to but distinct from those of NeuroD and MATH-2/NEX-1, suggesting that NDRF may play distinct roles in neural development and plasticity as a novel member of the NeuroD family.

Cloning of the cDNAs for mast-cell chymases from the jejunum of Mongolian gerbils, Meriones unguiculatus, and their sequence similarities with chymases expressed in the connective-tissue mast cells of mice and rats

By using the combination of reverse-transcription CR and rapid amplification of cDNA ends methods, two distinct cDNAs encoding mast-cell proteases (chymases; MCPs), designated as gMCP-1 and -2, were successfully cloned and sequenced from the jejunum of Mongolian gerbil, Meriones unguiculatus, infected with Nippostrongylus brasiliensis. On the basis of a comparison of the deduced amino acid sequences with those of known rodent mast-cell chymases, gMCP-1 was found to be highly similar to mouse mast-cell protease (mMCP)-4 and rat mast-cell protease (rMCP)-1, while gMCP-2 was similar to mMCP-5 and rMCP-3. Alghough mMCP-4 and -5 and rMCP-1 and -3 were restrictedly or mainly expressed in connective-tissue mast cells and serosal mast cells, the gMCP-1 and -2 genes were mainly transcribed in the jejunal mucosa and to a lesser extent in the skin and tongue. Moreover, kinetic study after infection revealed that the amounts of the gMCP-1 and -2 mRNAs in jejunum paralleled well the degree of intestinal mastocytosis. The expression of gMCP-1 and -2 in mucosal mast cells of gerbil jejunum was also confirmed by in situ hybridization. Since a tryptase, another type of MCP, was also expressed in mucosal mast cells of gerbils but not in those of mice and rats, the expression of MPCs in mucosal mast cells of gerbils is different from those of mice and rats. The Mongolian gerbil would be a useful model with which to investigate the physiopathological role of MCPs.

[Molecular genetics of Machado-Joseph disease]

Machado-Joseph disease (MJD) is an autosomal dominant spinocerebellar degeneration. The CAG expansions of the MJD1 gene at chromosome 14q32.1 was identified as the cause of the disease. MJD has three factors that influence the age of the onset. The MJD1 repeat length inversely correlated with the age of onset (r = -0.87). Homozygosity of the gene exhibited an additive effect on age of onset. MJD has a gender-specific effect on the age of onset. A parent-child analysis showed the unidirectional expansion of CAG repeats. Among the three clinical subtypes, type I of MJD, with dystonia, showed a larger degree of expansion in CAG repeats of the gene and younger ages of onset than the other types.

Homozygosity for Machado-Joseph disease gene enhances phenotypic severity

Images

[The perinatal risk factors and periventricular leukomalacia (PVL) in premature infants--relationship between fetal heart rate decelerations and PVL]

Periventricular leukomalacia (PVL) has recently been recognized as an important risk factor of neurological impairment in premature infants. We studied 29 PVL cases on perinatal risk factors comparing with a non-PVL matched control group retrospectively. Variable decelerations were more frequently observed with statistical significance in the PVL group in the intrapartum period. Then another study was conducted to evaluate the relationship between fetal heart rate (FHR) decelerations and cystic PVL prospectively. Since January 1993 through December 1994 we studied 209 low birth weight infants (31.1 +/- 3.2 weeks, 1,424 +/- 419 g) who had been subjected to intrapartum FHR monitoring and postnatal sonographic intracranial examinations sequentially every 7 days until discharge. Cystic PVL was detected in 6 of 209 cases (2.9%) and occurred only in infants who had revealed severe variable deceleration or prolonged deceleration (6/37, 16%) in intrapartum FHR monitoring. We conclude that in low birth weight infants intrapartum severe variable deceleration or prolonged deceleration might play a causal role in cystic PVL.