Carbamazepine-induced thrombocytopenia and carbamazepine-10,11-epoxide: a case report

The case of a patient who developed thrombocytopenia during treatment with carbamazepine (CBZ) is described. The platelet count recovered soon after discontinuation of CBZ, Lymphocyte stimulation test with carbamazepine-10, 11-epoxide (CBZ-10, 11-EPOX), a major metabolite of CBZ, was positive, although with CBZ it was negative. These findings suggest that CBZ-10, 11-EPOX was possibly causative in the pathogenesis of CBZ-induced thrombocytopenia in this case.

Carbamazepine-exacerbated epilepsy with multifocal shifting independent epileptiform discharges on electroencephalogram: a case report

A 7 year old girl with epilepsy and spastic quadriplegia secondary to an episode of status epilepticus at 4 months of age is reported. At the age of 6 years, she began to experience increased generalized myoclonic and tonic seizures during treatment with carbamazepine (CBZ) 200 mg/day and clonazepam 1.5 mg/day. When the CBZ was increased to 400 mg/day, the seizures increased dramatically in frequency. Following discontinuation of CBZ, the seizure frequency decreased to a level less than that prior to starting CBZ. Serial electroencephalograms displayed multifocal independent epileptiform discharges (MIED) characterized by shifting localization, which could be one of the risk factors for exacerbation by CBZ. In this case MIED may indicate widespread rather than localized cerebral dysfunction.

The use of restriction landmark genomic scanning to scan the mouse genome for endogenous loci with imprinted patterns of methylation

Restriction landmark genomic scanning (RLGS) has been used to screen endogenous loci for imprinted patterns of methylation. The screening method is based upon the identification of genetic variation in RLGS profiles between different strains and determining whether specific variant landmarks are transmitted equally to the progeny of reciprocal F1 matings. The RLGS profiles of C57BL/6 (B6) and DBA/2 (D2) and their reciprocal hybrids were produced with two enzyme combinations that used NotI as the landmark enzyme and two combinations that used BssHII. An estimated 13% of the spots are either B5- or D2-specific in these tests, giving a total of nearly 1000 variant loci that were examined for imprinted methylation. Three candidate loci for imprinted regulation were identified in these analyses. We also used crosses of more genetically diverse parents to increase the number of variant loci screened. Interspecific crosses of B6 with the M. musculus strain PWK and intrasubspecific crosses between B6 and the M. molossinus strain MSM expanded the levels of variation between the parental strains in the cross to an estimated 31% and 26%, respectively. The RLGS patterns for one NotI combination and one BssHII profile were examined for each of these crosses, giving approximately 2000 additional loci that were screened for imprinted patterns of methylation. Eight loci with imprinted patterns of transmission were observed out of 3040 loci tested. The chromosomal locations for the three B6 and D2 specific loci, Irlgs 1-3, were identified using BXD recombinant inbred strain analysis. Irlgs 1 and 3 are B6- and D2-specific loci that had the same strain distribution pattern which mapped to the central region of chromosome 9.(ABSTRACT TRUNCATED AT 250 WORDS)

[Thoracoscopic enucleation of leiomyoma of the esophagus--report of two cases]

Thoracoscopic enucleation of leiomyoma of the esophagus was successfully performed in two cases. This paper mainly describes a 53-year-old man who experienced with a slight dysphagia and retrosternal discomfort when moving. Esophagoscopy showed a mass beneath normal mucosa located at 26 cm from the incisor of the left anterior esophagus. Endoscopic ultrasonography showed a sharply delineated low echoic mass with regular echo-pattern, measuring 4 cm along the axis. The lesion was diagnosed as leiomyoma. The operation was performed under general anesthesia, keeping the patient on the left postero-lateral position. A double-lumen endotracheal tube was utilized and the right lung was collapsed. Six trocars were inserted through right intercostal spaces for operation. The azygos vein first of all was dissected and divided by an EndoGIA. The esophagus was then mobilized lengthwise enough to rotate the left side to the right with two slings traction for better visualization of the lesion site. Intraluminal balloon-mounted esophagoscope was useful enough to expose the tumor inner side out of the esophageal wall and the tumor was easily enucleated. After resection, intact esophageal mucosa was confirmed by endoscopy and the proper muscle layer of the esophagus was closed with 2-0 Vicryl. In the 2nd case, leiomyoma located at 32 cm from the incisor of the right esophageal wall, 4 x 1.5 x 1 cm in size, was removed by the same technique using five trocars, where neither the azygos vein divided nor the esophagus mobilized. Both patients showed uneventful recovery and the symptoms disappeared after operation. Intraluminal balloon-mounted esophagoscope was useful to do this kind of thoracoscopic procedure.

Indications and results of gentamycin injection into the middle ear of patients with meniére's disease

Forty-six cases in whom endolymphatic drainage surgery was performed between 1986 and 1992 were followed up for more than 2 years. The results of numerical values (1985 AAOHNS) revealed complete control of definite spells in 26 cases; substantial control of definite spells in 18 cases; limited control of definite spells in 1 case; and insignificant control of definite spells in 1 case. Hence, endolymphatic drainage surgery for Meniére's disease was effective. There are, however, cases who cannot be operated on because of old age or underlying diseases. In these, we injected gentamycin sulfates mixed with prednisolone through a ventilated tube into the middle ear. The results for gentamycin injection based on numerical values showed complete control of definite spells in 12 cases; and substantial control of definite spells in 7 cases. Our treatment of choice for Meniére's disease is endolymphatic drainage surgery which resulted in 96% control of vertigo. In patients for whom operation has failed, in old patients and in those with hearing impairment more than 50 dB, gentamycin injection into the middle ear has proved to be an effective procedure to control vertigo attacks.

Purification and characterization of a novel superantigen produced by a clinical isolate of Yersinia pseudotuberculosis

A superantigen designated as Yersinia pseudotuberculosis-derived mitogen (YPM) was purified in an equal manner from both the culture supernatant and cell lysate of a clinical isolate (KUR-1) of Y. pseudotuberculosis serotype 4b. A significant proliferative response of human peripheral blood mononuclear cells to purified YPM was detectable even at a concentration of 1 pg/ml. The N-terminal sequence of YPM which included 23 amino acid residues was determined, by automated Edman degradation, as Thr-Asp-Tyr-Asp-Asn-Thr-Leu-Asn-Ser-Ile-Pro-Ser-Leu-Arg-Ile-Pro-Asn-Il e-Ala-Thr-Tyr-Thr-Gly-. This sequence differed from not only all the, hitherto, reported superantigens but also known proteins. While molecular weights of known bacterial superantigens are more than 22,000, electrospray ionization mass spectrometry showed that the molecular weight of YPM was 14524.4. These results indicate that YPM comprises a novel superantigen with substantial structural differences from other bacterial superantigens produced by Gram-positive cocci.

Combination chemotherapy with mitomycin C and cisplatin for advanced gastric cancer with multiple liver metastases

A patient with advanced gastric cancer with multiple liver metastases was treated by reduction surgery at the primary site as well as by the intraarterial administration of mitomycin C (MMC) and cisplatin (CDDP) through a reservoir catheter inserted into the proper hepatic artery. After a palliative subtotal gastrectomy, MMC 8 mg/m2 was administered intraarterially (i.a.) followed by the administration of CDDP 80 or 40 mg/m2 i.a. with an interval of less than 1 week. After the completion of five courses of this regimen, a complete reduction of the hepatic tumors was achieved, while the level of serum carcinoembryonic antigen decreased to the normal range. The patient is currently alive with signs of disease recurrence at 17 months after initial diagnosis, while additional therapy with MMC + CDDP was continuously undergone until 17 months' after initial diagnosis with various interval. Although thrombocytopenia occurred during the treatment, it resolved within a few weeks after completing the combination chemotherapy without any specific treatment. The present case showed a better prognosis than we had expected, which suggested that combination chemotherapy with MMC and CDDP might thus be clinically useful because of its excellent antitumor activity and low toxicity.

Gravitational and shear-associated pressure gradients in the abdomen

The abdomen has been variously characterized as a hydrostatic system, in which pressures exhibit a gravitational gradient and pressure fluctuations are spatially uniform, and as a compartment, in which pressure gradients are not simply gravitational and pressure fluctuations differ markedly from place to place. To characterize the pressures acting on the ventral abdominal wall, we used saline-filled catheters and air-filled balloons in anesthetized dogs in various body positions during spontaneous breathing and mechanical ventilation. Pressures were measured in the stomach and at multiple sites next to the abdominal wall. Under most circumstances, measurements next to the abdominal wall exhibited a hydrostatic gravitational gradient of approximately 0.89 cmH2O/cm height and pressure fluctuations were spatially homogeneous. Deviations from this hydrostatic behavior were seen when abdominal pressures were compared with gastric pressures, when measurements were made with a balloon catheter, and when the lower abdomen was constricted with a binder. Analysis of these and previously published data suggests that the abdomen does, at times, behave like a hydraulic system but can deviate from simple hydrostatic behavior to the extent that shape-stable abdominal viscera are deformed.

Ethylene production by strains of the plant-pathogenic bacterium Pseudomonas syringae depends upon the presence of indigenous plasmids carrying homologous genes for the ethylene-forming enzyme

The molecular characteristics of the ethylene-forming enzymes of strains of Pseudomonas syringae were tested. The ethylene-producing activities of the nine strains as measured in vivo and in vitro were similar, except for that of P. syringae pv. mori M5. A polyclonal antibody and a DNA probe for the ethylene-forming enzyme from P. syringae pv. phaseolicola PK2 were prepared to investigate homologies among the proteins and genes for the ethylene-forming enzymes. With the exception of P. syringae pv. mori M5, eight strains tested expressed the same antigen as the ethylene-forming enzyme from P. syringae pv. phaseolicola PK2 and were homologous to DNA sequences on indigenous plasmids. Molecular masses of antigenic proteins from all ethylene-producing strains were 40 kDa. The N-terminal amino acid sequence of the purified ethylene-forming enzyme from P. syringae pv. glycinea KN130 was identical to that of the enzyme from P. syringae pv. phaseolicola PK2. These results show that the ethylene-forming enzymes encoded by the indigenous plasmid(s) in the pathogenic bacteria examined were similar.

Gene expression of interstitial collagenase (matrix metalloproteinase 1) in gastrointestinal tract cancers

Collagenolytic proteinases play an important pathological role in the invasion and metastasis of cancer cells. However, little is known about the role of interstitial collagenase (matrix metalloproteinase-1; MMP-1) in this process. To investigate the expression of the MMP-1 gene in cancer tissues, an in situ hybridization study was carried out in gastrointestinal tract cancers (one esophageal cancer, five gastric cancers, and four colorectal cancers), using a 35S-labeled MMP-1 cDNA probe. The MMP-1 gene was expressed in the stromal cells of fibrous tissue around cancer nests, especially at the margin of invasion and/or within the cancer nest; however, no definite expression within cancer cells was observed. Expression of the MMP-1 gene in the stromal cells was more common in well differentiated gastric adenocarcinoma than in poorly differentiated adenocarcinomas. These findings indicate that expression of the MMP-1 gene is greater in stromal cells that are closely associated with cancer cells, suggesting a pathophysiological role of MMP-1 in the invasion and metastasis of cancer cells.

Transvaginal ultrasound imaging, histopathology and endocrinopathy in patients with polycystic ovarian syndrome

In order to investigate the pathological characteristics of polycystic ovaries diagnosed by transvaginal ultrasound (TVS) in patients with polycystic ovarian syndrome (PCOS) and to investigate the relationship between morphological and endocrine changes in the ovaries, 32 PCOS patients with bilateral polycystic ovaries (> 10 cysts) detected by TVS were studied; 20 ovulatory women served as controls. Ovarian tissues from wedge resection were examined histologically. A comparative histological and TVS study of ovarian morphology was made, and the relationship between the number of small cysts and the endocrine profile was examined. The position and size of small cysts on TVS agreed with those observed histologically. There was a significant correlation between the number of small cysts on TVS and the number of atretic follicles with hypertrophied and luteinized inner theca cells, and thickened ovarian capsules. Numerous atretic follicles and thickened ovarian capsules were observed in 97 and 64% of ovaries respectively, from PCOS patients. In patients with PCOS, a significant positive correlation was noted both between the number of small cysts and delta 4-androstenedione (ASD), and between ASD and the luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio. Furthermore, testosterone, ASD and the number of small cysts on TVS were significantly higher in PCOS patients with ovarian thickened tunica compared to PCOS patients without ovarian thickened tunica. TVS images of ovaries in patients with PCOS correlated with the histopathological and endocrine features. It is suggested that an increase in intra-ovarian small cysts leads to increased production of ovarian androgen, in turn influencing the secretion of gonadotrophin, and is correlated with ovarian capsular thickness.

Point mutations and allelic deletion of tumor suppressor gene DCC in human esophageal squamous cell carcinomas and their relation to metastasis

Since tumor suppressor gene DCC exhibits amino acid sequence homology to the neural cell adhesion molecule, there is a possibility that DCC might be related to tumor metastasis. In the present study, we examined 51 cases of primary esophageal carcinomas with regard to point mutations and loss of the DCC gene. We detected point mutations in two cases by screening using polymerase chain reaction-single strand conformation polymorphism analysis. When we determined the sequences, one case with lymph node metastasis showed an ATG (Met) to ACG (Thr) missense mutation in codon 168. Another case showed a CGA (Arg) to GGA (Gly) mutation in codon 201, which might be a polymorphic change, and two other mutations resulting in no amino acid change. We also examined loss of heterozygosity of the DCC gene. Forty-four of the 51 cases (86%) were informative, and among them 10 cases (23%) showed allelic deletion. The further away the lymph node metastasis was from the primary tumor, the higher the frequency of allelic deletions became. We also found allelic deletions in moderately and poorly differentiated squamous cell carcinomas but not in well differentiated ones. These results indicate that alterations of the DCC gene are related to the degree of lymph node metastasis and the degree of differentiation.

Boron neutron capture therapy of malignant melanoma using 10B-paraboronophenylalanine with special reference to evaluation of radiation dose and damage to the normal skin

A treatment regimen for boron neutron capture therapy of malignant melanomas is described using 10B-paraboronophenylalanine as the tumor-targeting compound. As a therapeutic dose, we adopted the maximum tolerable dose for the skin regardless of tumor 10B concentration. In practice, the maximum neutron fluence should be decided prior to starting irradiation. For this purpose, the kinetics of the concentration of 10B in the blood and skin and the skin-to-blood ratios were analyzed in the six patients who received 170 mg/kg of the compound intravenously, and skin concentrations during irradiation were predicted using a standard skin factor curve. This yields a skin concentration at time T based on the blood concentration at time 0. We calculated the maximum tolerable fluence yielding but not exceeding 18 RBE-Gy by assuming that the RBE of 14N(n,p)14C and 10B(n, alpha)7Li reaction for skin damage is 2.5. Actual skin reactions in three of five patients treated with the therapy were, as predicted, within tolerable limits, and we were able to obtain complete tumor regression in four cases. The results indicate that application of our logical approach will be useful for subsequent cases and further development of this therapy.

Three different types of dry eye syndrome

We analyzed patients with dry eye syndrome with regard to autoimmune conditions. A total of 116 patients with dry eye syndrome were divided into three groups: simple dry eye (SDE), i.e., dry eye with no circulating autoantibodies; autoimmune positive dry eye (ADE), dry eye with circulating autoantibodies; and Sjogren's syndrome (SS), dry eye associated with Sjogren's syndrome. Schirmer test showed values of 3.0 +/- 2.2 mm in SDE, 3.1 +/- 2.0 mm in ADE, and 2.4 +/- 2.3 mm in SS reflecting the inadequacy of this test in differentiating among the groups. However, Schirmer test with nasal stimulation showed values of 19.1 +/- 12.4 mm in SDE and 16.4 +/- 10.9 mm in ADE, which were significantly higher than the 7.0 +/- 6.6 mm found in SS (p < 0.01). Moreover, ocular surface alterations evaluated by vital staining and brush cytology were significantly milder in SDE and ADE than in SS. SDE and ADE have less ocular surface abnormalities with good reflex tearing, whereas SS has less reflex tearing and more squamous metaplasia.

[A comparative clinical study on the treatment of head and neck tumors by adjuvant chemotherapy with HCFU--Second Study by Kinki Head and Neck Tumor Study Group]

In the first study by the "Kinki Head and Neck Tumor Study Group," we performed a comparative study to investigate intergroup difference between a control group consisting of patients given radical treatment only, and a HCFU group consisting of patients receiving long-term administration of HCFU after radical treatment. We earlier reported that subsequent observations by stratification revealed a favorable tendency in the cumulative disease-free rate in Stage II and Stage III patients in the HCFU group. In the second study, the same methods of treatment as in the first study were compared in a prospective control study. No differences were found between the two groups in Stage II patients. In Stage III patients, however, the disease-free rate tended to increase significantly in the HCFU group as in the first study.

[Serum antibodies to type II collagen and immune complex in cases of Menière's disease]

In a previous study, endolymphatic hydrops was induced in 36% of guinea pigs immunized with type II collagen and a dominant negative SP was recorded from these hydropic animals. These results suggested that the immune response to type II collagen may have a role in the etiopathology of some cases of Menière's disease. In this study, we evaluated the levels of serum antibody to type II collagen and three other immune indexes in patients with Menière's disease, especially those who showed negative SP dominance on electrocochleography. Twenty-nine Menière's cases, 22 normal volunteers serving as controls, 28 RA cases, and 9 patients complaining of vertigo were examined to detect serum immune indexes. Menière's patients exhibited high values of serum anti-type II collagen antibody as compared to control subjects. Furthermore, total IgG, C3, anti-type II collagen antibody and circulating immune complex were increased with the highest levels being in the RA group, followed by Menière's disease and then the control group. These results probably reflect the extent of immune reaction development. The immune response may be generalized in RA cases and/or local in Menière's disease. Our study results suggest the development of certain immune status abnormalities in our cases, which lends support to the idea of an immunologic disorder playing a role in the etiology of some cases of Menière's disease.

[Early phase II study of FUT-187 (sepimostat mesilate) on reflux esophagitis--mainly on postgastrectomy reflux esophagitis]

An early phase II clinical study with the proteolysis inhibitor FUT-187 was carried out on patients with reflux esophagitis. FUT-187 was administered orally at the dose of 300 mg/day or 400 mg/day four times daily, after meals and at bedtime, for 4 consecutive weeks. The total number of patients admitted to this study was 40, of whom 9 were assigned to 300 mg/day group and 31 to 400 mg/day group. The rate of effectiveness on postgastrectomy reflux esophagitis was 88% (7/8) in 300 mg/day group and 85%(22/26) in 400 mg/day group when "improved" or better final general improvement ratings were taken into consideration, and 75% (6/8) in 300 mg/day group and 69% (9/13) in 400 mg/day group when "improved" or better endoscopic general improvement ratings were used. The overall safety rating "no problem as to the drug safety" was 89% (8/9) in 300 mg/day group and 71% (22/31) in 400 mg/day group. The main side effect was diarrhea, which was experienced in 6 patients in 400 mg/day group. However, it was resolved by discontinuation of the drug treatment. Other symptoms of gastrointestinal upsets, such as nausea and anorexia, were also induced. Based on these results, it may be concluded that FUT-187 can be a drug with clinical utility that benefits postgastrectomy reflux esophagitis at the dose level of 300 mg/day or less.

Suppressive effect of intravenous immunoglobulins on the activity of interleukin-1

In order to study the effect of human immunoglobulin preparations for intravenous use (IVIg) on the production and activity of interleukin-1 (IL-1) derived from monocytes, we treated cultured monocytes with IVIg and examined the lymphocyte-activating factor (LAF) activity of IL-1 in the culture supernatants. The results showed that IVIg suppressed the activity from most healthy adults and some febrile children with acute respiratory disease or Kawasaki disease. Further studies revealed that intact Ig (whole molecular Ig) did not suppress the mRNA expression of IL-1 alpha or IL-1 beta in mononuclear cells, that intact Ig and pepsin-digested Ig inhibited the LAF activity of recombinant IL-1 (rIL-1) and also that intact Ig contains immunoglobulin (probably anti-IL-1 antibody) which binds with rIL-1 by dot blotting using biotin-streptavidin. These results suggest that IVIg suppresses neither IL-1 synthesis nor the release of IL-1 from monocytes but does neutralize IL-1 alpha and IL-1 beta activity by binding IL-1 proteins as an anti-IL-1 antibody.

Effects of aldehyde dehydrogenase and glutathione on the degradation of (E)-4-hydroxy-2-nonenal and N-hexanal in rat liver

The relative contribution of the aldehyde dehydrogenase (EC 1.2.1.3, ALDH) and glutathione (GSH) conjugate system to the degradation of (E)-4-hydroxy-2-nonenal (4HN), a toxic breakdown product arising from lipid peroxidation, was investigated in rat liver. Significant increases in the contents of 4HN and hexanal (HA) and a decrease of ALDH but not alcohol dehydrogenase (EC 1.1.1.2, ADH) activity were recognized in rat liver following administration of carbon tetrachloride (3 ml/kg, p.o.). Hepatic ALDH activity was correlated with HA production (r = -0.82, P < 0.01) but not with 4HN. When lipid peroxidation was induced by t-butyl hydroperoxide, the ratio of HA to 4HN production in the liver of rats pretreated with the ALDH inhibitor, cyanamide (100 mg/kg, i.p.) was higher than that in controls, whereas the ratio was lower in the liver of rats pretreated with the glutathione-depleting agent, phorone (250 mg/kg, i.p.). These results suggest that 4HN in rat liver is metabolized by the GSH-conjugate system in preference to degradation by ALDH.

Hypomelanosis of Ito: MR findings

We present a patient with hypomelanosis of Ito who showed extensive white matter lesions on brain MRI. The finding of no apparent demarcation between gray and white matter may indicate a neuronal migration disorder.