[Changes of magnetization transfer ratio according to rat brain development]

We assessed the age-related changes in magnetization transfer ratio (MTR) value and the ratio of water content in rat brain (frontal lobe and pons) during normal development. All studies were done on 42 normal Wistar rats. MTR was calculated by using the equation (Moff-Mon)/Moff, where Moff and Mon were the measured signal intensities on the conventional and MT-prepared SPGR images, respectively. The ratios of water content were measured by comparing the wet weight with the dry weight of the frontal lobe and the pons, which were extracted from a rat brain soon after MTR measurements. The ratio of water content was calculated by using the equation 100 x (wet weight-dry weight)/wet weight (%). The ratio of water content decreased markedly during the first 30 days, but the decrease was very slight there after both in the frontal lobe and the pons. The change in MTR was similar to that of the ratio of water content, though the direction of change was opposite. Statistically significant inverse relationships existed between MTR and the ratio of water content both in the frontal lobe and the pons. MTR could be a new parameter with which to assess brain development.

[Incidence of cancer among Japanese patients with rheumatoid arthritis]

Most follow-up studies of patients with rheumatoid arthritis demonstrate no increase in the incidence of cancer apart from approximate doubling of the incidence of lymphoproliferative malignancies. A consecutive series of 1832 Japanese patients with rheumatoid arthritis seen at the center was studied to determine their cancer morbidity. Overall, 35 cancers were diagnosed in the series from 1982 through 1995 and were not significantly in excess of the expected number. No association was found between rheumatoid arthritis and subsequent development of cancer at any site, either.

Predicting long-term glycemic control of post-educational type II diabetic patients by evaluating serum 1,5-anhydroglucitol levels

1,5-Anhydroglucitol (1.5-AG) is known to closely reflect diabetic control within several days. The possibility of predicting long-term glycemic control after an educational hospitalization of type II diabetic patients was investigated by examining the relationship between changes in serum 1,5-AG levels after a short-term trial home stay following an educational program and long-term changes in glycosylated hemoglobin A1c (HbA1c) levels after discharge. After 22 patients with type II diabetes had successfully completed the educational hospitalization program, they returned as outpatients for 5 nights in a row. Changes in serum 1,5-AG levels were determined during this period. The HbA1c levels were then determined over a period of 3 months after discharge, and the relationship between changes in 1,5-AG and HbA1c levels was examined. Changes in serum 1,5-AG levels during the 5-day trial home stay and the changes in HbA1c levels during the 3 months after discharge from the hospital were found to be significantly correlated (r = 0.70, P < 0.01). A comparison of the decreased group, which exhibited a decrease in 1.5-AG levels of 5.0 mumol/l or more during the trial home stay, and the unchanged group, revealed that increases in body mass index 3 months after discharge were significantly higher in the decreased group (1.2 +/- 0.4%) than in the unchanged group (0.2 +/- 0.5%) (P < 0.05). Determination of serum 1,5-AG levels of patients with type II diabetes before and after a trial home stay following educational hospitalization was found to be useful in identifying patients at high risk of recurrence of poor glycemic control in the future.

Long-term effects of eicosapentaenoic acid on diabetic peripheral neuropathy and serum lipids in patients with type II diabetes mellitus

The present study was undertaken to investigate the efficacy of a new, highly purified (purity greater than 91%), ethyl esterification product from natural eicosapentaenoic acid (EPA-E, C20:5 omega 3) in patients with type II diabetes mellitus (NIDDM). Hemodynamic changes were assessed at the level of the dorsalis pedis artery using an ultrasonic color Doppler duplex system before and after oral administration of EPA-E at a dose of 1800 mg/day for 48 weeks. The cross-sectional area of the dorsalis pedis artery increased significantly from 2.5 +/- 0.2 to 3.9 +/- 0.4 mm2 (48 weeks, mean +/- SE, p < 0.05). Moreover, EPA-E improved the clinical symptom (coldness, numbness) as well as the vibration perception threshold sense of the lower extremities [from 32.1 +/- 8.5 to 16.1 +/- 4.8 (48 weeks) microns]. A significant decrease of serum triglycerides was also noted by EPA-E administration. Furthermore, significant decrease of the excretion of albumin in urine [from 24.4 +/- 3.3 to 13.9 +/- 1.8 (48 weeks) mg/g.Cr, p < 0.05]. The results of this study suggest that EPA-E has significant beneficial effects on diabetic neuropathy and serum lipids as well as other diabetic complications such as nephropathy and macroangiopathy.

Increased production of PDGF by angiotensin and high glucose in human vascular endothelium

The mechanisms responsible for the abnormalities in the vascular wall associated with long standing diabetes mellitus are incompletely understood. The aim of this investigation was to assess the effects of angiotensin II and high glucose on the production of platelet-derived growth factor (PDGF) in human endothelial cells. For this purpose, a primary culture was obtained from fresh human umbilical cords by collagenase digestion of the vein interior. A high glucose medium increased the production of PDGF and a similar effect was observed by the addition of mannitol. These data are consistent with a stimulatory effect of glucose on PDGF that is mediated by the osmotic effect of this substance. Angiotensin II significantly increased PDGF in human endothelial cells and the effect was accompanied by a transient increase in cytosolic calcium. The angiotensin II-induced intracellular Ca2+ increases, PDGF production were completely abolished by saralasin and neomycin, respectively. We postulate that the increased production of PDGF by the vascular endothelium in response to high glucose and angiotensin II may participate in the development of the diabetic angiopathy.

Nitric oxide induces apoptosis in mouse splenic T lymphocytes

The cytotoxic effect of nitric oxide (NO) on mouse T lymphocytes was investigated. Freshly isolated T lymphocytes from mouse spleen were incubated with NOR, a novel NO releasing agent, at different doses. After incubation for 4 h, apoptotic cell death was observed in both NOR-treated T lymphocytes and controls as judged by the appearance of DNA laddering in agarose gel electrophoresis, but a quantitative analysis by flow cytometry indicated that the high level of exogenous NO (500 micrograms ml of NOR) could promote apoptosis in T lymphocytes as compared with controls (30% vs. 8%). After 8 h, NO promoted apoptosis of T lymphocytes in a dose-dependent manner. This study indicated that NO might be one of the factors which regulate this life of T lymphocytes in vivo.

A case of connective tissue nevus associated with seborrheic keratosis-like eruption, atrophic scar, alopecia, and microtia

We report a 44-year-old Japanese man who had connective tissue nevus, seborrheic keratosis-like eruptions, atrophic scars on his hands and feet, alopecia, and microtia. These concurrent abnormalities are distinct from previously described multiple malformation syndromes.

Nasal mucosal thickening simulating a tumor: potential for misdiagnosis in brain perfusion imaging

A 33-year-old, female presenting with dementia was admitted to our institution. Except for slight muscle atrophy noted on both lower extremities there were no other significant physical signs or laboratory findings. Since initial Tc-99m HMPAO SPECT showed hypoperfusion on both temporal, parietal and occipital lobes, follow up study with the same radiotracer was done. Increase in uptake was noted in the left side of the face. There was no abnormality noted on ENT examination. CT scan and MRI showed slight nasal mucosal wall thickening. T1-201 SPECT showed increased uptake in the nasal area. The increase in uptake could be due to nasal mucosal thickening. This could simulate nasal tumor and interfere in determining ROI for brain perfusion studies.

IFN-gamma in combination with IL-3 accelerates platelet recovery in mice with 5-fluorouracil-induced marrow aplasia

The effects of interferon-gamma (IFN-gamma) on platelet recovery were examined in mice with marrow aplasia induced by i.p. injection of 250 mg/kg of 5-fluorouracil (5-FU). The cytokine was administrated by microosmotic pump, with an ability to deliver a consistent intact dose of cytokine for 7 consecutive days. Administration of 250 IU/kg/day of IFN-gamma in combination with 10(3) U/kg/day of IL-3, which alone had no effect on platelet counts, diminished the nadir for platelet count and shortened the duration of thrombocytopenia. The effect was comparable to that of higher doses of IL-3 (10(5) U/kg/day). The administration of 250 IU/kg/day of IFN-gamma in combination with 10(3) U/kg/day of IL-3 also induced megakaryocyte proliferation in bone marrow cell cultures. Single administration of either 250 IU/kg/day of IFN-gamma or 10(3) U/kg/day of IL-3 had no significant effects. The effect of this combination was also comparable to that of a higher dose of IL-3 (10(5) U/kg/day). We suggest that IFN-gamma accelerates megakaryocyte development, which leads to platelet production in chemotherapy-induced marrow aplasia. The administration of IFN-gamma in combination with IL-3 might be useful for the management of marrow aplasia.

Cloning and sequencing of a gene encoding a new member of the tetratricopeptide protein family from magnetosomes of Magnetospirillum magnetotacticum

A gene encoding the 22 kDa protein (MAM22) which was localized in the magnetosomes isolated from the magnetotactic bacterium, Magnetospirillum magnetotacticum, was cloned and sequenced. MAM22 was composed of 220 amino acids (aa) with a molecular weight of 24,186 Da. The deduced aa sequence exhibited significant homology with a number of proteins that belong to the tetratricopeptide repeat (TPR) protein family, including mitochondrial protein import receptors and peroxisomal protein import receptors. The presence of three repeats of a degenerate 34-aa consensus sequence, suggest that MAM22 localized in magnetosome membranes may interact with the cytoplasmic proteins containing similar TPR motifs.

Progesterone induces vascular endothelial growth factor on retinal pigment epithelial cells in culture

Diabetic retinopathy is known to frequently deteriorate during pregnancy but the cause remains obscure. Vascular endothelial growth factor (VEGF), also known as vascular permeability factor (VPF), is a potent vascular endothelial cell mitogen which is mainly up-regulated by hypoxia, and is closely associated with the development and progression of diabetic retinopathy. To examine the influence of the drastic hormonal alterations during pregnancy on the worsening of diabetic retinopathy, we examined the effects of estradiol (E2) and progesterone (P4) on the production of VEGF/VPF in bovine retinal pigment epithelial cells in culture. The VEGF/VPF production was significantly elevated (214.5 +/- 28.3 ng/g protein, P < 0.01) by 48 h of exposure to a high concentration of P4(10 microM), which is still within the physiological range during pregnancy, compared to that of the control group (147.7 +/- 17.9 ng/g protein). However, E2 significantly stimulated the production of VEGF/VPF only at concentrations (100 microM) much higher than normally encountered during pregnancy. These two hormones were not observed to have a synergistic effect, at least at physiological concentrations. As the increase in serum P4 levels during pregnancy is reported to be greater in pregnant diabetic patients with progressive retinopathy, our findings suggest that P4 may contribute to the worsening of diabetic retinopathy during pregnancy by up-regulating intraocular VEGF levels.

Vascular endothelial growth factor is induced by long-term high glucose concentration and up-regulated by acute glucose deprivation in cultured bovine retinal pigmented epithelial cells

Vascular endothelial growth factor (VEGF) is closely correlated to diabetic retinopathy. Its basal production in three types of cultured retinal cells (endothelial cells, pericytes and retinal pigment epithelial cells; RPE) was examined. RPE production of VEGF was markedly higher than the rest of the cells. VEGF production in RPE was significantly elevated by 10-day, but not by 1- or 3-day exposure to 16.5 mM glucose compared to a 5.5 mM glucose group. Transient deterioration of diabetic retinopathy is frequently observed during rapid correction of glycemic control. To determine whether VEGF is up-regulated following a sharp drop in the glucose concentration or not, we examined the changes in VEGF production in RPE before and after a sudden drop in the glucose concentration. VEGF production was significantly increased by a glucose concentration decrease from 5.5 to 0.5 mM, but not by a decrease from 33 or 16.5 to 5.5 mM. These findings suggest that up-regulation of VEGF may contribute to the development of diabetic retinopathy and its worsening by hypoglycemia.

Expression and regulation of neuropeptide Y messenger ribonucleic acid in cultured immature rat Leydig and Sertoli cells

Neuropeptide Y (NPY) potentiates the release of gonadotropins from the pituitary in response to GnRH in the hypothalamus and modulates reproductive function. In the present study, we showed that 1) specific organs in the male rat reproductive tract express NPY messenger RNA (mRNA); 2) the multifactorial regulation of NPY mRNA in rat Leydig and Sertoli cells is temporally and hormonally regulated in vitro; 3) both Sertoli cell factor(s) and germ cell factor(s) potentiated to stimulate NPY gene levels in Leydig cells; and 4) intense NPY immunoreactivity was detected in cultured Leydig cells. Using the RT-PCR method, we found that Leydig cells, Sertoli cells, epididymis, and vas deferens expressed NPY mRNA, whereas germ cells, seminal vesicle, and prostate did not. Northern blot analyses showed that NPY mRNA was not expressed in freshly isolated immature Leydig cells, but that NPY mRNA levels were increased by the addition of LH, cytokines such as interleukin-1 alpha and -1 beta, forskolin, or phorbol 13-myristate 12-acetate. Npy mRNA levels in immature Sertoli cells were also increased by FSH. In addition, a germ cell factor(s) secreted from pachytene spermatocytes or round spermatids purified by centrifugal elutriation as well as a Sertoli cell factor(s) stimulated by FSH increased NPY gene levels in Leydig cells. Immunocytochemical analyses showed that the immunostaining was more marked in Leydig cells than in Sertoli cells in vitro. These findings indicate that testicular NPY gene expression is induced in Leydig cells or Sertoli cells by gonadotropins or cytokines within the testes, and that factors secreted from Sertoli cells or germ cells affect NPY gene expression in Leydig cells in vitro. Our findings suggest that NPY expressed in the reproductive system may modulate reproductive function as well as that in the nervous system.

Effect of cilostazol on the production of platelet-derived growth factor in cultured human vascular endothelial cells

Increased levels of platelet-derived growth factor (PDGF) may play a central role in the development of arteriosclerosis, but the factors that inhibit PDGF production in vascular endothelial cells remain mostly unknown. We examined the effects of cilostazol, an antithrombotic agent, and high glucose on PDGF production in cultured human umbilical vein endothelial cells (HUVEC). HUVEC grown in high glucose exhibits increased PDGF production, which was markedly inhibited by cilostazol. Since cilostazol inhibits PDGF production in HUVEC, its use may exhibit anti-arteriosclerotic effects in diabetic patients.

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.

A case of renovascular hypertension with marked polyuria after percutaneous transluminal renal angioplasty

A 43-year-old female patient with hypertension was diagnosed as having one-kidney renovascular hypertension with dysfunction of the contralateral kidney, and percutaneous transluminal renal angioplasty was carried out. Marked polyuria was observed during the 2- to 72-hour postoperative period. During the 12- to 18-hour period of polyuria, the urine volume was 8.9 liters/6 h, which was 62% of the glomerular filtration, and was accompanied by high fractional excretion of sodium and of potassium and a high urine beta 2-microglobulin level. The mechanism of polyuria in this case is discussed.

Secondary amyloidosis in patients with rheumatoid arthritis: diagnostic and prognostic value of gastroduodenal biopsy

Upper gastrointestinal endoscopy was performed in patients with rheumatoid arthritis (RA) during the period 1989-1991, and biopsy specimens were obtained from the stomach and from the duodenum for examining amyloid deposits. Among 407 patients, gastrointestinal amyloidosis was confirmed in 54 (13.3%). Twenty-two patients were regarded as having slight amyloid deposits, while 32 patients were categorized as having marked amyloid deposits. The incidence of clinical manifestations suggestive of systemic amyloidosis was more frequent in the marked deposits group than in the slight deposits group (47% vs 14%, P<0.05). Among the patients who died of manifestations associated with amyloidosis, the survival period following endoscopy was shorter in the marked deposits group than in the slight deposits group. These findings suggest that gastroduodenal biopsies may be useful for diagnosing secondary amyloidosis and that the degree of amyloid deposits seems to be correlated with the clinical manifestations of RA.

[Imbalance of blood flow induced by sympathetic block was corrected by prostaglandin E1]

The purpose of this study was to investigate the effect of prostaglandin E2 (PGE1) on imbalance of blood flow induced by sympathetic block. Seven mongrel dogs were anesthetized with intravenous pentazocine 0.5 mg. kg-1, diazepam 0.1 mg. kg-1 and pancuronium 0.1 mg. kg-1. Bilateral brachial arterial blood flows were measured using an ultrasonic transit time flowmeter (Transonic T201, Advance). After a thoracotomy, left stellate ganglion block (SGB) with 0.5% mepivacaine was performed for sympathetic block. Left brachial arterial blood flow increased significantly by 80% 15 min after SGB, and statistically significant decrease (13%) in right brachial arterial blood flow occurred 15 min after left SGB. After intravenous infusion of PGE1 at a rate of 150 ng. kg-1. min-1 for 10 min, left brachial arterial blood flow increased (127%) still, and right brachial arterial blood flow returned to the pre-value. As to peripheral circulation, a combination of SGB and intravenous infusion of PGE1 was more effective than SGB alone. Moreover, the administration of PGE1 may improve imbalance of blood flow induced by sympathetic block.

Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis

Although a growing body of evidence supports that alkali therapy in diabetic ketoacidosis (DKA) might be counterproductive, our knowledge about the consequences of this treatment on ketone metabolism is limited. Consequently, we performed clinical and animal studies to further examine this topic. The clinical studies assessed seven patients with DKA treated with continuous insulin infusion at a low dosage. Three of them also received sodium bicarbonate (NaHCO3), whereas the remaining four acted as controls. The group receiving NaHCO3 showed a 6-h delay in the improvement of ketosis as compared with controls. In addition, there was an increase in acetoacetate (AcAc) levels during alkali administration, followed by an increase in 3-hydroxybutyrate (3-OHB) level after its completion. Significant differences were not found between groups in the response of plasma glucose to the overall therapy. The animal study examined the effects of a NaHCO3-rich perfusate on the hepatic production of ketones with the in situ rat-liver preparation. Alkali loading resulted in an immediate increase in the AcAc level followed by increases in both the 3-OHB level and the 3-OHB/AcAc ratio after its completion. Hepatic ketogenesis increased even further, to about twice the basal level, after termination of the NaHCO3 loading. This investigation confirms that alkali administration augments ketone production and unravels an effect of bicarbonate infusion that promotes a selective build up of AcAc in body fluids. The data support that alkali therapy in DKA has nonsaltuary effects in the metabolism and plasma levels of ketones.

[Surgical treatment of syringomyelia]

Eighty cases of surgically treated syringomyelia were retrospectively reviewed. The cases were classified into following 4 types, type 1: syringomyelia with Chiari malformation (54 cases), type 2: syringomyelia with basal arachnoiditis (15 cases), type 3: syringomyelia with an obstruction of the foramen Magendie (1 case), and type 4: syringomyelia with spinal arachnoiditis (14 cases). Foramen magnum decompression (FMD) was performed in patients with type 1, in type 2 fourth ventricle-subarachnoid shunt was additionally performed. Gardner's operation was performed in patients with type 3. Syrinx-peritoneal shunt was performed in patients with type 4. Surgical procedures for syringomyelia which we selected were thought to be appropriate, based on postoperative syrinx collapse rate in MRI. However, postoperative clinical course was much different in each type of syringomyelia after the collapse of syrinx had been equally achieved. Neurological disorders were stopped in deterioration after surgery in all cases of type 1. However, motor weakness was still deteriorated in half cases of type 2, and in 60% of type 4. When clinical severity of the patients with type 1 and 2, based on the distribution of dissociated sensory loss and motor weakness, were classified into 5 grades. The rate of improvement of patient's symptoms and signs was higher in the lower grades. We concluded that a surgical treatment for syringomyelia was essentially a preventive one, therefore it should be done in early stage of disorders.

A pilot/introducer needle for central vein cannulation

A kit for safe and easy insertion of a central vein cannula was devised. A small gauge (22 gauge) metal pilot needle was equipped with a Y-shaped hub which had a side-port to accept a small gauge (0.46 mm) Seldinger guide wire. Once the needle reached the vein, guidewire was threaded in through the side-port. There was no need to remove the pilot needle and no need to repeat vein puncture with a larger-bore needle. Three puncture methods were used with the kit: (1) the central approach via the internal jugular vein, (2) the supraclavicular approach via the junction of the internal jugular vein and subclavian vein, and (3) the infraclavicular approach via the subclavian vein. Each method was used on 20 patients, for total of 60 patients, with a high success rate. Less than 3 minutes were required from puncture to catheter insertion. No serious complications were encountered.

[Percutaneous placement of intraluminal stent-graft for aortic dissection: experimental study]

Highly porous fabric vascular grafts fabricated of ultrafine polyester fibers (UFPF-graft; porosity, 7,000 ml, 9,000 ml, 11,000 ml at 120 mmHg) were attached between two Gianturco stents connected with two stainless steel struts. UFPF-grafts with two Gianturco stents were placed into the aortas of six adult mongrel dogs without firm contact with the luminal surface. From two days to four months after placement, all the UFPF-grafts were completely sealed with fresh thrombus or neointima. Within two months, complete endothelialization was observed on both surfaces of the neointima. In three dogs, aortic dissections were created experimentally. Then an UFPF-graft (porosity, 9,000 ml) with two Gianturco stents was placed at the site of entry of the dissection, followed by additional Gianturco stents to expand the UFPF-graft. X-ray angiography showed that the entries were closed immediately after placement, and false lumens disappeared within one hour after placement. These results indicated that the method has the possibility of treating aortic dissection with complete sealing of the fabric by the neointima.