Intracellular hyperthermia for cancer using magnetite cationic liposomes: ex vivo study

Heating properties of magnetite cationic liposomes (MCL) were investigated in ex vivo experiments using implanted cell pellets. The cell pellets, which consisted of rat glioma T9 cells into which MCL had been incorporated in a petri dish, were implanted subcutaneously in the left femoral region of female F344 rats. The rats were placed in a magnetic field generating coil and irradiated with an alternating magnetic field (384 Oe, 118 kHz) for 60 min. The cell pellets were heated to over 43 degrees C by MCL in the magnetic field, but other body parts of the rats were not heated. After 3 cycles of magnetic heating, all glioma cells were killed and no tumor take was observed.

Differential flotation centrifugation study of hepatitis C virus and response to interferon therapy

Hepatitis C virus (HCV) appears to circulate in various forms such as native virion, immune complexes, and nucleocapsids during chronic infections. To determine the association of the physicochemical properties of HCV and its response to interferon therapy in patients with chronic hepatitis C, we examined pretreatment serum samples from 43 patients with HCV RNA who had received interferon therapy, using differential flotation centrifugation in a NaCl solution with a density of 1.063 g/ml. After centrifugation, the ratio of HCV RNA in the top and bottom fractions was determined by the polymerase chain reaction and expressed as T/B. Patients with a sustained response to IFN therapy were found to have higher T/B ratios than transient responders who relapsed after treatment (P < 0.01) and nonresponders (P < 0.01). With regards to HCV genotypes, patients with genotype 1b had higher T/B ratios in the sustained response group than in the nonsustained response groups (P = 0.001), but patients with genotype 2 had a similar distribution of T/B among the 3 response groups (not significant). These findings indicate that the physicochemical properties of HCV affect the effectiveness of interferon therapy, particularly in patients with genotype 1b.

Warthin's tumor of the parotid gland with extension into the parapharyngeal space

A case of Warthin's tumor of the parotid gland which extensively extended into the parapharyngeal space is presented. The tumor border against the parotid gland was ill-defined but the border towards the parapharyngeal structures was clear. Solid portions of the tumor appeared hypointense relative to the gland on both unenhanced T1- and T2-weighted MR images without fat suppression, whereas cystic portions appeared hypointense on T2-weighted images and hyperintense on unenhanced T1-weighted images. Pathologic study showed that the ill-defined margin was caused by inflammation and cystic material consisted of highly proteinaceous material. We concluded that the atypical extension into the parapharyngeal space of the tumor was caused by its location in the deep lobe of the parotid gland and its bulky size.

Assessment of parotid masses: which MR pulse sequences are optimal?

The objective of this paper is to determine which MR pulse sequences are optimal for delineation of lesion and predicting pathologic nature of lesion with signal intensity. A prospective study was performed in 53 parotid masses (39 benign and 14 malignant lesions) in 53 patients. Signal intensity of lesion was visually assessed and lesion/parotid contrast-to-noise ratios were measured. On visual assessment, detection sensitivity was 100% for nonenhanced nonfat-suppressed T1-weighted images, 91% for nonfat-suppressed fast spin-echo (FSE) T2-weighted images, 83% for gadolinium-enhanced fat-suppressed T1-weighted images, and 75% for fat-suppressed FSE T2-weighted images. The highest contrast-to-noise ratios were obtained with nonenhanced T1-weighted images. Hypointensity of lesion relative to the parotid gland on nonfat-suppressed FSE T2-weighted images was seen in 11 of 14 malignancies, 12 of 15 Warthin tumors, and two of 18 pleomorphic adenomas. Cystic portion of hyperintensity on nonenhanced T1-weighted images was solely seen in benign tumors (n = 11). Thus, the highest accuracy (81%) (79% sensitivity and 82% specificity) for predicting malignancy was obtained with a criterion of hypointensity on nonfat-suppressed FSE T2-weighted images plus absence of cystic portion of hyperintensity on nonenhanced T1-weighted images. Nonenhanced T1-weighted images combined with nonfat-suppressed FSE T2-weighted images is optimal for delineation of lesion and prediction of pathologic nature of parotid masses.

Enzyme immunoassay of glioma cell tenascin secretion and augmentation by tumor necrosis factor-alpha

Expression of tenascin, an extracellular matrix glycoprotein, was measured in glioma cell lines using a newly established enzyme immunoassay. Secreted tenascin was found at concentrations greater than 800 ng/ml in eight of 14 glioma, three small cell lung carcinoma, two melanoma, and one sarcoma cell lines. The remaining six glioma and other carcinoma cell lines, and cell lines originating from normal tissues demonstrated low levels or no secretion into the supernatant. The glioma cell line, U-251-MG nu/nu, which has almost 100% transplantability in nude mice, had the highest expression level of tenascin among the glioma cell lines examined. Even low secretor glioma cell lines released high concentrations of tenascin, detectable by assaying the NP-40 solubilized cell lysates. Flow cytometric analysis revealed that tenascin was located on both the cell surface and primarily in the cytoplasm of glioma cells. When the glioma cell lines were exposed to tumor necrosis factor-alpha (TNF-alpha), levels of secreted tenascin increased between 36% and 380%, whereas transforming growth factor-beta induced only minimal changes. These results suggest that glioma cell lines may be classified according to the degree of tenascin secretion/expression: high secretor type, low secretor type, and non-expressing type. The increase in tenascin secretion by TNF-alpha suggests that the expression of tenascin in glioma growth and development may be mediated through a cytokine network.

The prognosis of resected lung carcinoma associated with atypical adenomatous hyperplasia: a comparison of the prognosis of well-differentiated adenocarcinoma associated with atypical adenomatous hyperplasia and intrapulmonary metastasis

BACKGROUND

Radiologically undetected intrapulmonary solitary nodules are sometimes found in the resected lung. When the main tumor is a well-differentiated (w/d) adenocarcinoma, especially a bronchioloalveolar carcinoma (BAC), it can be difficult to determine morphologically whether the intrapulmonary nodules are atypical adenomatous hyperplasia (AAH) or intrapulmonary metastasis (PM). The authors evaluated the accuracy of the differential diagnosis of these two lesions from the prognostic point of view.

METHODS

A retrospective study was conducted of 1360 lung carcinoma patients who had undergone surgical resection. Differential diagnosis was made between AAH and PM based on the conventional histologic specimens. Their clinicopathologic features were also studied. Survival rates were compared between these two groups.

RESULTS

AAH was found in 137 patients (10%) with resected lung carcinoma. The 5-year survival rates were 72.9% in Stage I, 60.6% in Stage II, 27.1% in Stage IIIA, 0% in Stage IIIB, and 0% in Stage IV. They were not significantly different from the figures for all patients in the corresponding pathologic stages. Seventy-six cases were diagnosed as w/d adenocarcinoma associated with AAH, whereas PM was found in 46 cases of w/d adenocarcinoma. The 5-year survival rates of AAH and PM differed significantly: 64.6% and 35.5%, respectively (P 0.0004). When a comparison was made between cases of pT1-2, N0 w/d adenocarcinoma, most of which were BAC, with PM (n = 22) and those with AAH (n = 52), the latter had significantly better survival (P = 0.0086).

CONCLUSIONS

The prognosis of resected lung carcinoma was not affected by association with AAH. The significant difference in prognosis between AAH and PM in w/d adenocarcinoma, especially in BAC, indicates that their morphologic distinction was correctly made by conventional pathologic examination in most cases.

Comparison of vasodilatory effect of carbon dioxide inhalation and intravenous acetazolamide on brain vasculature using positron emission tomography

Carbon dioxide (CO2) and acetazolamide are increasingly being used as vasodilators to detect cerebrovascular reserve capacity in patients of chronic cerebrovascular disease. The functional cerebrovascular reserve or ability of cerebral vessels to lower their resistance in response to decrease in cerebral perfusion pressure is expressed as change in cerebral blood flow from baseline under a vasodilatory stimuli. Theoretically a vasodilator causing maximum vasodilation, and thereby expressing complete reserve capacity would be more suitable for such a purpose. We quantitatively compared the vasodilating effect of 5% CO2 inhalation and 1 g of intravenous acetazolamide by positron emission tomography. Cerebrovascular reserve was quantified in six patients with chronic cerebrovascular disease in the same sitting, using oxygen-15 labeled water (H2(15)O) positron emission tomography at rest, during 5% CO2 inhalation and after 1 g intravenous acetazolamide. A significant linear correlation in both nonlesion hemisphere (r = 0.701, p < 0.001) and in lesion hemisphere (r = 0.626, p < 0.005) was found between CO2 and acetazolamide for cerebrovascular reserve capacity. This correlation improved by considering cerebrovascular reserve per unit change in arterial carbon dioxide (r = 0.744, p < 0.001 in nonlesion hemisphere and r = 0.721, p < 0.001 in lesion hemisphere). The quantitative value of global reserve capacity was different by CO2 stimuli (5.2%) and acetazolamide (49.7%). Though a similar vasodilatory response is elicited by both vasodilators, acetazolamide seems to be more potent and therefore should be preferred to detect patients with exhausted cerebrovascular reserve capacity.

Xanthogranulomatous cholecystitis versus gallbladder cancer: clinical differentiating factors

Xanthogranulomatous cholecystitis (XC) is occasionally difficult to differentiate from gallbladder cancer and mandates efforts to avoid extensive operations. We studied the clinical factors to differentiate XC from cancer. Subjects were a consecutive series of 10 patients with XC and 10 with carcinoma, all of whom radiologically showed thickened gallbladder walls. As opposed to cancer, XC was typified by invisible gallbladders on cholangiography (1), the presence of cholelithiasis (P = 0.01) (2), and, intraoperatively, an aspirate of pus or nothing (P < 0.01) (3). To diagnose XC against gallbladder cancer, (1) and (2) in combination and (3) demonstrated an accuracy of 82.4% and 85.0 per cent, respectively. Clinically, XC can be distinguished from gallbladder cancer by cholangiography, calculous findings, and a gallbladder aspirate of pus or nothing.

Vasodilator effects of C-type natriuretic peptide on cerebral arterioles in rats

The vasodilator effects of C-type natriuretic peptide (CNP) were investigated in isolated rat cerebral arterioles. CNP caused dose-dependent vasodilation, maximally by 10.0 +/- 2.2% at 10(-6) M. The median effective concentration (EC50) was 5.2 x 10(-10) M. In contrast, atrial natriuretic peptide and B-type natriuretic peptide, other members of the natriuretic peptide family, produced little or no vasodilation. Pretreatment with methylene blue (10(-4) M) abolished CNP-induced vasodilation, whereas pretreatment with NG-monomethyl-L-arginine or indomethacin did not inhibit vasodilation. Thus, CNP is suggested to cause significant vasodilation in cerebral arterioles via a cyclic guanosine monophosphate-dependent mechanism.

Abducens nerve neurinoma--case report

A 61-year-old female presented with an abducens nerve neurinoma manifesting as diplopia and facial numbness. The tumor was totally removed, and the exact origin was confirmed intraoperatively. Neuroradiological imaging and clinical history are frequently insufficient to obtain an accurate preoperative diagnosis of intracranial neurinoma.

Surgical treatment for pediatric moyamoya disease: use of the superficial temporal artery for both areas supplied by the anterior and middle cerebral arteries

OBJECTIVE

To revascularize ischemic territories of both the anterior cerebral artery (ACA) and the middle cerebral artery (MCA), a simple and effective combined bypass operation was performed in 36 pediatric patients with moyamoya disease during the past 8 years.

METHODS

The branches of the superficial temporal artery (STA) were used to revascularize the ACA and MCA territories. In children older than 5 years, the parietal branch of the STA was usually used for an end to side anastomosis with a cortical branch of the MCA. In children who were younger than 5 years, the parietal branch of the STA was used for an encephaloduroarteriosynangiosis instead of a direct anastomosis. Encephaloduroarteriosynangiosis, using the proximal part of the intact frontal branch of the STA, and encephalomyosynangiosis, using the temporal muscle, were also performed in all patients to stimulate spontaneous anastomosis. In addition, bilateral frontal burr holes were made in all patients to induce vascularization of the ACA territories from the distal part of the intact frontal branch of the STA. The first operation was performed on the dominant side, then a similar procedure was performed on the opposite side after an interval of at least 3 months.

RESULTS

Postoperative clinical symptoms and the findings from magnetic resonance imaging, magnetic resonance angiography, angiography, and electroencephalography demonstrated improvement in all patients.

CONCLUSION

These results suggest that the placement of bilateral burr holes (while leaving the frontal branch of the STA intact), in addition to the STA-MCA anastomosis, encephaloduroarteriosynangiosis, and encephalomyosynangiosis, is very effective in vascularizing the ischemic ACA and MCA territories in pediatric patients with moyamoya disease.

Magnetic resonance imaging quantitation of superior sagittal sinus flow: correlation to cerebral blood flow measured by xenon-enhanced computed tomography

We compared measurements of venous blood flow velocity in the superior sagittal sinus (SSS) obtained by magnetic resonance imaging (MRI) and quantitative measurements of cerebral blood flow (CBF) obtained by xenon-enhanced CT, in neurosurgical patients and normal volunteers, to assess the clinical usefulness of MRI for determination of CBF. Flow measurements were obtained in 15 neurosurgical patients and 3 normal volunteers. SSS velocimetry was performed using the direct bolus imaging technique with a 1.5-tesla MRI system near the point of lambda on a sagittal MR image. Quantitative CBF was measured by xenon-enhanced CT and correlated with SSS flow velocity. We also examined the effect of surgical evacuation of a hematoma or cranioplasty in 3 patients, mannitol in 5 patients and acetazolamide in 4 patients by performing SSS velocimetry. The peak SSS flow velocity during the entire cardiac cycle was 27.2 +/- 6.3 cm sec-1 (mean +/- SD) in normal volunteers and 23.5 +/- 8.9 cm sec-1 in patients. The SSS flow velocity increased after surgery. Mean SSS peak flow velocity increased by 24% and 48% at 10 min after administration of mannitol and acetazolamide, respectively. SSS peak flow velocity showed significant linear correlations with both cerebral cortical (r = 0.74) and hemispheric flows (r = 0.73). Our results suggest that SSS flow velocity reflects CBF and that MRI assessment of SSS flow provides a simple method for assessing and monitoring global changes in cerebral hemodynamics.

Intravenous infusion of adrenomedullin and increase in regional cerebral blood flow and prevention of ischemic brain injury after middle cerebral artery occlusion in rats

The intravenous infusion of rat adrenomedullin, at concentrations ranging from 0.1 to 1.0 microgram/kg/min, for 60 min increased the regional cerebral blood flow (rCBF) in a dose-dependent manner in rats. rCBF was measured using a laser Doppler flowmetry device placed on the surface of the parietal cortex. The increase in rCBF induced by 1.0 microgram/kg/min of adrenomedullin was up to 145 +/- 10.8% of controls at 60 min (n = 5, p < 0.001). These concentrations of adrenomedullin did not affect systemic blood pressure or other physiologic parameters, including pH, PaCO2, PaO2, hemoglobin, and blood glucose. Repeated infusion of 1.0 microgram/kg/min of adrenomedullin at 2-h intervals caused tachyphylaxis (n = 5, p < 0.01). Rat adrenomedullin (1.0 microgram/kg/min) demonstrated a more potent effect than the same dose of human adrenomedullin. The C-terminal fragment of human adrenomedullin (0.5 and 5.0 micrograms/kg/min), adrenomedullin22-52, which did not affect rCBF alone, inhibited the effect of rat adrenomedullin (0.5 microgram/kg/min) as a receptor antagonist in a dose-dependent manner. In a model of middle cerebral artery (MCA) occlusion in spontaneously hypertensive rats, pre- and postinfusion of 1.0 microgram/kg/min of adrenomedullin suppressed the reduction in rCBF following MCA occlusion (control, 29 +/- 15.1%; adrenomedullin group, 45 +/- 14.4%; not significant) and decreased the volume of ischemic brain injury (control, 288 +/- 35 mm3; adrenomedullin group, 232 +/- 35 mm3; p < 0.05). These results suggest that adrenomedullin increases rCBF and prevents ischemic brain injury, partly by increasing the collateral circulation.

Accessory parotid gland tumor: a case report

We report a case of pleomorphic adenoma which was assessed pre-operatively as arising from the accessory parotid gland. Computed tomography (CT)-sialography provided information about the relationship between the tumor and the remaining normal accessory parotid tissue, and fine-needle aspiration of the tumor provided additional information as to the histologic features of the tumor, i.e. it was identified as of salivary origin. Zygomatic and buccal branches of the facial nerve extended over the accessory parotid gland tumor and the parotid duct was located just beneath the tumor. Therefore, pre-operative assessment of the tumor's nature was important for prevention of facial nerve damage and salivary fistula. The normal accessory parotid gland tissue associated with the accessory parotid tumor was histologically different from that of normal parotid gland tissue dissected in other patients with pleomorphic adenoma of the parotid gland. It is suggested that the difference in cell composition between these glands affects the development of the associated tumors.

A new table-fixed soft tissue retractor for the anterior cervical spinal surgery

Since surgeons sometimes encounter difficulty in keeping self- retaining soft tissue retractors in the proper position for anterior cervical spinal surgery, we have developed a new, simple soft tissue retractor system, which is fixed to the side rails of the operating table via retractor stands. All three joints of the retractor can be tightened simultaneously with a single handle. Each of two retractor blades can keep its position independent of the other thereby maintaining a well-exposed operative field for a long period of time. Fine adjustments of the blade position, after fixation of the retractors, is possible by sliding the head of the blade assembly along the axis of a ratchet mechanism. We have used these retractors in 43 surgical exposures, including 35 for anterior cervical fusion, 2 for posterior thoraco-lumbar decompression, and 6 for carotid endarterectomy. There have been no complications related to tissue damage.

Outbreak of multi-drug resistant Staphylococcus aureus: a cluster analysis

BACKGROUND

Outbreaks of multi-drug resistant Staphylococcus aureus over eight years were investigated to prevent future endemic.

METHODS

Isolates of multiresistant S. aureus underwent a cluster analysis combined with canonical discriminant analysis using bacteriologic biotyping and sensitivity to 21 drugs.

RESULTS

Of a total of 786 strains recovered from 155 in-patients, the specialty surgical ward (SW) exhibited 470 isolates (59.8%) and the general SW 214 (27.2%). Among six clusters formed, four clusters were predominant in the general SW. An ordination diagram from the canonical discriminant analysis revealed a distribution in which clusters were localized temporally (year) and spatially (ward). A yearly shift of clusters indicated emergence of a new phenotype of multiresistant S. aureus.

CONCLUSIONS

The cluster analysis of isolates of multiresistant S. aureus using biotyping and sensitivity may supplement the classical method of tracing the spreading patterns of this microbe.

Molecular neurosurgery using gene therapy to treat malignant glioma

In the last decade, the prognosis of brain tumor patients has dramatically improved due to recent advances in microsurgical techniques and the development of functioning neuroimaging, computer-assisted neuronavigation, endoscopic surgery, intravascular surgery and radiosurgery. According to a report by the Committee of Brain Tumor Registry of Japan, the ten year survival rate of patients with benign brain tumors (meningioma, neurinoma and pituitary adenoma) is more than 95%. In contrast, patients with glioma (which constitute 33% of primary brain tumor cases) still have a poor prognosis, especially in the case of malignant (anaplastic astrocytoma and glioblastoma). This poor prognosis is related to the fact that malignant glioma cells aggressively infiltrate into normal brain tissues, making total removal of the tumor impossible. The median survival time of glioblastoma patients is less than 2 years, despite multimodality treatment with extensive surgical resection and adjuvant therapies using radiation and immunochemotherapy. In order to overcome this formidable neoplasm, the effectiveness of molecular neurosurgery using gene therapy has been investigated since 1992. In this paper, molecular genetic studies and the current state of gene therapy for malignant brain tumors are described, and the future direction of this fascinating approach is discussed.

Development of a target-directed magnetic resonance contrast agent using monoclonal antibody-conjugated magnetic particles

We developed a novel magnetic resonance (MR) imaging contrast agent, MAb-magnetite, that was prepared by covalently linking polyethylene glycol-coated magnetite to a monoclonal antibody specific for a human glioma cell-surface antigen. When MAb-magnetite was injected intravenously into tumor-bearing nude mice at a dose of 100 mumol Fe/kg body weight, a 50% decrease in the T2 signal intensity of the tumor was observed, immediately following administration and continued for 48 h. Microscopic observation of the tumor tissue demonstrated localization of MAb-magnetite in cancer cells. These results suggest that MAb-magnetite is a promising agent for MR imaging of neoplasms.

Intracellular hyperthermia for cancer using magnetite cationic liposomes: in vitro study

'Magnetite cationic liposomes (MCL)' were developed as a means to generate intracellular hyperthermia. Affinity of the MCL to glioma cells was ten times higher than that of magnetite 'neutral' liposomes due to the electrostatic interaction based on the positive charge of the MCL. Heat generation of the MCL was studied using agar phantoms and small pellets of rat glioma cells. When a high-frequency magnetic field, 118 kHz, 384 Oe was applied to glioma cells in the presence of MCL, the glioma cell pellet of 80 microl (5.4 mm in diameter) was heated to over 43 degrees C and all the cells died after 40 min irradiation owing to the hyperthermic effect. The terminal temperature of the cell pellet was proportional to the pellet volume when other parameters were constant. It thus appears that the MCL can heat a tumor of more than 80 microl in volume to above 42 degrees C.

Major salivary gland lesions: correlation of MR findings with flow cytometric DNA analysis and prognosis

OBJECTIVE

We correlated MR imaging findings with those from flow cytometry and determined prognostic factors of patients with major salivary gland lesions.

SUBJECTS AND METHODS

DNA ploidy (11 aneuploid, 35 diploid lesions) and S-phase fraction (SPF) (12 high-SPF, 28 low-SPF lesions) percentages as determined by flow cytometric technique in 46 major salivary gland lesions were correlated with MR findings and signal-intensity ratios of lesion to muscle on fast spin-echo T2-weighted images, unenhanced spin-echo T1-weighted images, and gadolinium-enhanced fat-suppressed spin-echo T1-weighted images. SPF percentages were correlated with the three signal-intensity ratios by stepwise regression analysis. Prognostic indicators of disease-free survival were assessed with Cox multivariate analysis (range of follow-up, 2-50 months; mean, 16.6 months).

RESULTS

Signal-intensity ratios for all pulse sequences were significantly smaller in aneuploid lesions than in diploid lesions. Incidence of ill-defined margins (p < .001), invasion (p = .014), and hypointensity to the gland on T2-weighted images (p = .047) was significantly higher in aneuploid lesions than in diploid lesions. Of these, signal-intensity ratios on enhanced T1-weighted images were most accurate for predicting aneuploidy. A threshold of 1.55 for signal-intensity ratios on enhanced T1-weighted images yielded the highest accuracy (86%) for aneuploidy. Signal-intensity ratios on T2-weighted images (p = .025) and enhanced T1-weighted images (p < .001) were significantly smaller in high-SPF lesions than in low-SPF lesions. A threshold of 1.73 for signal-intensity ratios on enhanced T1-weighted images yielded 73% accuracy for high-SPF lesions, which was inferior to the prediction possible from ill-defined margins (80% accuracy). Aneuploidy (p = .008), ill-defined margins (p = .036), and signal-intensity ratios on unenhanced T1-weighted images (p = .008), related significantly and negatively to disease-free survival. A signal-intensity ratio of 1.22 or less for unenhanced T1-weighted images indicated a high risk of developing recurrence (100% sensitivity).

CONCLUSION

MR findings and signal-intensity ratios can reflect DNA ploidy and SPF status and can predict prognoses for patients with major salivary gland lesions.