Gene expressions of oxytocin and oxytocin receptor in cumulus cells of human ovary

Oxytocin (OT) has been detected in mammalian granulosa-luteal cells during the early stages. The purpose of this study was to explore gene expressions of OT and OT receptor (OTR) in human cumulus cells. Cumulus cells enclosing a mature oocyte were obtained from 6 women undergoing clinical in vitro fertilization and embryo transfer programs. OT and OTR gene expressions were investigated by employing reverse transcription polymerase chain reaction and reverse transcription polymerase chain reaction/single-strand conformation polymorphism methods. OT gene expression in the cumulus cells was positive in 5 women and weakly positive in the remaining patient. The structure of OT mRNA in the cumulus cells was equivalent to that in human hypothalamus. OTR gene expression was also observed in the cumulus cells. This study is the first to describe the simultaneous expression of both OT and OTR genes in human cumulus cells. It is suggested that local OT plays some important roles in fertility through modification of the micro-environment around the oocyte.

Effect of arm cranking exercise on skin blood flow of lower limb in people with injuries to the spinal cord

The purpose of this study was to examine whether arm cranking exercise induces changes in skin blood flow in the paralyzed lower limbs of people with injuries to the spinal cord (PISC). Ten PISC with lesions located between Th5 and L5 and six control subjects performed arm cranking exercise for 6 min at three intensities, 10, 30 and 50 W, at a room temperature of 25 degrees C. Oxygen uptake (Vo2) and heart rate (HR) were measured for the last 2 min of each exercise period. The skin blood flow at the anterior thigh (BFsk,t) was continuously monitored using laser Doppler flowmetry for the whole 6-min period and for the first 10 min of recovery following exercise. During exercise, the PISC showed lower Vo2 and greater HR than the control subjects. No increase in BFsk,t was found in six of the PISC with lesions at or above Th12, irrespective of the exercise intensity. On the other hand, in PISC with lesions at L1 or below, BFsk,t increased significantly (P < 0.05) with an increase in Vo2 and HR, although the BFsk,t at a given Vo2 and HR was lower than that in the control subjects. These results would suggest that arm exercise can promote the blood circulation in the skin of the lower limbs if the injury level is below L1.

Effects of a dopamine antagonist (metoclopramide) on the release of beta-endorphin, ACTH and cortisol in hyperprolactinemic-amenorrheic women

Responses of LH, TSH, PRL, beta-endorphin-like immunoreactivity, ACTH and cortisol to metoclopramide were evaluated in hyperprolactinemic-amenorrheic women and normal women. Augmented TSH responses and blunted PRL responses to metoclopramide were found in hyperprolactinemic women compared to normal women. A significant increase in serum LH levels was found only in hyperprolactinemic women after metoclopramide. Thus, the hyperprolactinemic women showed hormonal changes compatible with increased central dopaminergic tone. A significant increase in circulating levels of beta-endorphin-like immunoreactivity, ACTH and cortisol was found in hyperprolactinemic women but not in normal women after metoclopramide administration. Thus, beta-endorphin and ACTH secretion appear to be tonically inhibited by increased central dopaminergic tone in hyperprolactinemic-amenorrheic women.

Leser-Trélat sign associated with Sézary syndrome

A 74-year-old Japanese male had developed generalized erythroderma and rapid growth of multiple verrucous lesions over the entire surface of his face, trunk, and extremities three months before he was seen. Histologically seborrheic keratoses were revealed. Laboratory examinations showed peripheral leukocytosis with atypical lymphocytes and high levels of IgE and IgG. On the basis of these clinical and histopathologic findings, we diagnosed the patient as having Leser-Trélat sign associated with Sézary syndrome. The erythroderma subsided after administration of oral predonisone, and no new formations of seborrheic keratosis were observed. However, because of subsequent aggravation of the generalized erythroderma, we administered chemotherapy. Six months after the initial examination, lung cancer was found, and the patient subsequently died of respiratory and renal failure.

Characteristics of the health conditions of old patients with spinal cord injury

The state of health of old patients with spinal cord injury (SCI) was investigated to clarify the disorders that they are presently suffering from. A questionnaire was sent by mail to 668 patients with SCI living in western Japan. Valid answers were returned from 448 (67%), and they were divided into a young group (160 patients aged 18-39 years), middle-aged group (193 patients aged 40-59 years), and elderly group (95 patients aged 60-73). About 30% in the young group answered that they were ill or worrying about their health. This percentage was about 60% in the middle-aged and elderly groups. According to disease types, none of the young group had urological diseases except urological impairment or cardiovascular diseases, but many of the elderly group had urological tract infection, kidney diseases, cardiovascular diseases, and digestive diseases. Decubitus ulcer was reported in all groups. Urological diseases and decubitus ulcer were considered to be characteristic ailments of individuals with SCI. The elderly group was also characterized by a high incidence of adult diseases such as hypertension and diabetes mellitus. Therefore, the types of diseases and their frequency are considered to be different in older patients with SCI compared with the aged population in general because of the characteristic conditions of SCI in addition to adult diseases.

[Recurrent dislocation of the elbow]

A case of a recurrent dislocation of the elbow joint in a 13-year-old female is described. The patient sustained a medial epicondylar fracture of the humerus and consulted us four months later. There was no deformity but marked lateral instability of the elbow was recognized. It could be fully flexed and hyperextended ca 20 degrees. The elbow joint could be easily dislocated by pronation of the hyperextended elbow. Roentgenogram demonstrated an apparent non-union of the medial epicondylar fracture. The fragment was repositioned so that the medial collateral ligament became taut. There was no recurrence of the dislocation ten months postoperatively.

[Aortic dissection with giant pseudoaneurysm as a rare late complication of aortic valve replacement--a case report]

A 60-year-old man who had received aortic valve replacement for aortic regurgitation at 47 years of age developed sudden syncope and shock on Mar. 28, 1991. Close examination including CT scan and aortography revealed DeBakey type I aortic dissection with giant pseudoaneurysm which compressed superior vena cava and right pulmonary artery and caused superior vena cava syndrome. He underwent elective ascending aortic replacement under profound hypothermic cardiopulmonary bypass and circulatory arrest on Jun. 17, 1991. The giant pseudoaneurysm was present posterolaterally to the ascending aorta. It communicated with the false lumen and contained massive thrombi. The intimal tear of the ascending aorta existed along the suture line of previous aortotomy.

Relationship between heart rate and oxygen uptake during submaximal arm cranking in paraplegics and quadriplegics

The purpose of this study was to clarify the effect of the level of spinal cord injury (SCI) and of daily exercise on the relationship between heart rate (HR) and oxygen uptake (VO2) in persons with SCI (PSCI) during an arm cranking exercise. Eighteen PSCI were divided into three groups according to the level of SCI; 4 quadriplegics (C6-C8), 7 high- level paraplegics (T3-T8), and 7 low-level paraplegics (T10-L2). In the relationship between HR and VO2, the higher the level of SCI, the smaller the slope of regression line, that means the HR at a given VO2 become larger as level of SCI was higher. Significant differences were found among these regression lines (P < 0.01). In addition, the regression lines between HR and VO2 in active persons tended to shift toward upper in comparison with those in inactive persons. The present investigation clearly shows that the HR-VO2 relationship in PSCI is remarkably influenced by the level SCI and physical training.

[Locating the central sulcus using three dimensional image fusion system of helmet shaped whole head MEG and MRI]

We compared MR anatomy and magnetoencephalographic (MEG) functional methods in locating the central sulcus. In 20 normal volunteers and 58 patients with intracranial structural lesions, the short latency somatosensory evoked magnetic fields for median nerve and posterior tibial nerve stimuli were measured over the entire head, using a helmet shaped MEG system. The dipole positions estimated by a single current dipole model were projected onto the three dimensional MRI. In 94% of a total of 156 hemispheres, N20m dipole positions for median nerve stimuli coincided with the central sulcus defined by MR anatomical image only. For posterior tibial nerve stimuli, the P38m dipole positions were estimated as being near the medial end of the anatomical central sulcus. MRI and MEG are complementary in locating the central sulcus, even in cases of intracranial structural lesions.

[Whole head measurement of auditory evoked magnetic field using a MR-linked helmet shaped MEG system]

Authors compared MR anatomy and magneto-encephalographic (MEG) functional methods in locating auditory cortex in 20 normal volunteers and 56 patients with intracranial structural lesions. Auditory evoked response was measured over the entire head, using a helmet shaped 64 channel MEG system. In each subject, three dimensional MR image was obtained with identical coordinate system of MEG. Best fit sphere to each subject's head was calculated from MRI data. Signal source of auditory evoked MEG was estimated using a two dipole model in the best fit sphere. Position and orientation of dipoles were superimposed on each subject's MRI. Both left and right dipolar patterns appeared about 100 ms after unilateral auditory stimuli (N100m) in 19 normal subjects and 47 patients. These dipolar patterns overlap each other across the midline. A two dipole model successfully localized bilateral N100m dipoles in the upper surface of superior temporal planes. N100m response was missing unilaterally in 1 normal subjects and 9 patients inspite of normal audiometry findings, suggesting sub-clinical auditory dysfunction. The MR-linked whole head MEG is a non-invasive tool to localize source of auditory evoked N100m response even in the case with intracranial structural lesions.

[Adjunctive methods for surgery of descending thoracic aortic aneurysm]

During the last 6 years, we employed partial extracorporeal circulation (PEC) in 7 cases and left heart bypass (LHB) in 9 cases as adjunctive methods for surgery of descending thoracic aortic aneurysm. During the aortic clamping, systemic heparinization was performed to keep an ACT more than 400 seconds in a PEC group, while it was kept from 200 to 250 seconds in LHB group. The bypass flow was controlled to maintain the distal arterial pressure over 50 mmHg in both groups. Hemodynamics during the aortic clamping were stable in both groups and significant differences were not found between them. However, ventricular fibrillation occurred in one case of LHB group, who suffered from coronary artery disease, and required subsequent PEC to maintain systemic circulation. Both PEC and LHB provided adequate intraoperative hemodynamics and postoperative serum biochemistries. But we preferred to adopt PEC to maintain the diatal perfusion in cases with heart disease, who are likely to develop circulatory deterioration under the aortic clamping.

Influence of left ventricular regional nonuniformity on afterload-dependent relaxation in intact dogs

The time course of systolic loading conditions is considered an important factor in affecting left ventricular (LV) relaxation. However, the exact underlying mechanisms remain controversial. The goal of this study was to evaluate the role of the change in loading sequence on LV regional wall motion and LV relaxation. Early and late systolic loading were produced by constricting the ascending aorta and the descending aorta, respectively, in seven anesthetized dogs. In two pairs of cardiac beats with a comparable peak LV pressure during the mild and moderate constrictions of the ascending or descending aorta, we measured LV time constant (T) of LV pressure decay and determined regional nonuniformity in basal and apical segmental motion during the isovolumic relaxation period (by Lew's method). Constriction of the descending aorta led to a significant delay of the timing of peak LV pressure, associated with an increase in T, end-systolic pressure, and the regional nonuniformity between the two segments. T was correlated well with the amount of the nonuniformity, suggesting that LV regional nonuniformity between basal and apical regions might be involved in the complex mechanism of afterload-dependent relaxation.

Pathology of olfactory mucosa in patients with Alzheimer's disease

Characteristic changes that appear in the biopsied olfactory mucosa of patients with Alzheimer's disease (AD) were examined with immunohistochemical staining. Specimens were obtained from patients with clinical diagnoses of AD. Patients with vascular dementia and age-matched patients without dementia were used for controls. In most AD cases, neurofibrillary tangle-like abnormal tau protein (Tau) immunoreactivity was seen in the dendrites and perikarya of the olfactory receptor cells and in the nerve bundles. A senile plaque-like extracellular mass was found in the olfactory epithelium, and it reacted strongly to an anti-Tau antiserum and weakly to an anti-amyloid-beta protein antiserum. Ubiquitin (Ubq) immunoreactivity was also observed in the dendrites. Tau immunoreactivity of the perikarya and extracellular mass, and Ubq immunoreactivity were especially characteristic of the olfactory mucosa of AD patients. From these results, it is clear that the same pathologic changes in the brain are also present in the olfactory mucosa of patients with AD. Not only disruption of the central olfactory pathway, but also an olfactory disturbance of AD patients is caused by peripheral changes. Furthermore, an olfactory mucosal biopsy could be a useful method for a definitive diagnosis of AD.

Biochemical and genetic heterogeneity of staphylococcal protein A

We investigated the biochemical and genetic heterogeneity of protein A from Staphylococcus aureus. SpA genes (spas) of various strains were heterogeneous when detected as DraI and EcoRV fragments of chromosomal DNA. Polymerase chain reaction using primers to detect DNA encoding the IgG-binding domains in spa revealed that they numbered between 2 and 5. Protein A from several S. aureus strains showed two types of reactivities to immunoglobulins in normal canine serum according to the number of active domains.

[Mitral valve aneurysm in a patient with mitral regurgitation: a case report]

A 66-year-old man admitted to our hospital complaining of severe dyspnea. Echocardiography demonstrated severe mitral regurgitation and an abnormal echo at the anterior leaflet of the mitral valve. It was a persistent bulge that protruded toward the left atrium throughout systole and diastole. Left ventriculography also demonstrated the same abnormal shadow of the mitral valve. At the operation, it was seen that two of the chordae tendineae of the anterior leaflet had ruptured and a small aneurysm, approximately 10 mm in length, originated from the lateral part of the leaflet. The aneurysm protruded into the left atrium and had neither rupture nor perforation. Because the aneurysm of the mitral valve was too large to resect and repair the valve, it was replaced with St. Jude Medical Valve (29 M). IABP was needed at the weaning from cardiopulmonary bypass, but he recovered gradually well afterwards. The excised anterior leaflet showed myxomatous degeneration, but had no vegetation and rheumatic change. Microscopic examination of the valve aslo revealed myxomatous degeneration and no signs of the inflammation.

Long-term results of primary closure for ventricular septal defects in the first year of life

The long-term results of primary closure for large ventricular septal defects (VSDs) in infants under 1 year of age with severe symptoms were studied over a period of more than 10 years. Between January, 1971 and March, 1982, 49 infants underwent primary closure of a VSD through a right ventriculotomy using complete cardiopulmonary bypass with mild hypothermia. There were four hospital deaths but no late deaths. Two of four infants with residual shunts had a left ventricular-right atrial shunt which necessitated reoperation. Surgical heart block occurred in two infants who recovered sinus rhythm in the late period. The cardiothoracic ratio decreased from 60.5% preoperatively to 50.6% in the late postoperative period. Examination by cardiac catheterization revealed that the pulmonary-to-systemic pressure ratio (Pp/Ps) of 23 patients with a Pp/Ps of over 0.75 fell from 0.89 +/- 0.09 preoperatively to 0.42 +/- 0.12 by 1 month postoperatively, then to 0.27 +/- 0.05 in the late postoperative period. The latest values for the cardiac index and left ventricular ejection fraction were 3.4 l/min per m2 and 64.4%, respectively. More than 10 years after their operation, all the survivors were growing normally and maintaining a good quality of life, which supports our recommendation that primary repair should be performed in the first year of life for infants with large VSDs.

[Postlaminectomy kyphosis of the cervical spine complicating spinal cord tumor in the foramen magnum]

Postlaminectomy kyphosis is rarely encountered as a sequela of decompression of the upper cervical spine, especially in adults. We present a case of disabling cervical kyphosis which developed after laminectomy for excision of a foramen magnum tumor and was treated successfully by occipito-vertebral fusion. A sixty-one-year old female was treated by laminectomy of the first through to the third cervical spine for a foramen magnum meningioma. One year later, the laminectomy was extended downward to include the fourth through to the seventh cervical spine because of neurological deterioration. Seven years after the first laminectomy, she was referred to our spinal service because of severe neck pain, numbness and muscle weakness of both upper extremities. Lateral X-ray of her cervical spine presented a severe kyphosis. Roentgenogram two months after the first laminectomy already showed slight deformity and, timewise, it corresponded with the time when the patient experienced neurological deterioration. Subsequent X-rays showed progression of kyphosis. After we confirmed a lessening of the pain and improvement of the neurological symptoms during an axial traction using a halo-vest, posterior occipito-cervico-thoracic fusion was performed using Luque segmental spinal instrumentation and autogenous bone graft. After surgery the pain decreased and neurological symptoms improved. It is important to be aware of the complication of kyphotic deformity after laminectomy and once it has developed, it is recommended to stabilize the progression by early spinal fusion.

[Conduction disturbances after coronary artery bypass grafting with retrograde cardioplegia]

We studied forty-six cases, who had undergone coronary artery bypass grafting with retrograde cold blood cardioplegia for myocardial protection, to manifest the frequency and causative factors of postoperative conduction disturbances. We obtained the following conclusions. 1) Postoperative conduction disturbances developed in nineteen cases (41.3%), all of which were right bundle branch blocks, but these were usually transient and were not associated with further complications in the follow-up period. 2) There were no significant differences in many factors, including number of grafts, aortic cross-clamp times, or peak CK-MB between cases with and without postoperative conduction disturbances.

Role of vagal afferents in hypotension induced by venous air embolism

To evaluate the role of the autonomic nervous system in the development of hypotension during air embolism, we studied the effects of an intravenous bolus injection of air (0.5 ml/kg) on mean blood pressure (MBP), central venous pressure (CVP), and renal nerve activity (RNA) in urethan-anesthetized rabbits of three groups: animals with an intact neuraxis (intact group; n = 5), cervical-vagotomized animals (vagotomy group; n = 5), and sinoaortic-denervated animals (SAD group; n = 5). In the intact group, despite a significant decrease in MBP at 10 s after air injection, RNA did not increase from the preinjection level. This response of RNA was associated with a significant increase in CVP and lasted for 20 s after the injection. Vagotomized animals, however, exhibited a significant augmentation in RNA in response to a drop in MBP at 10 s after the injection. In the SAD group, profound declines in both MBP and RNA were observed at 10 s after the injection of air. Animals in these two groups showed remarkable increases in CVP. At 5 min after the air administration, MBP in the vagotomy group was significantly higher than that in the intact group. All animals in the SAD group died within 5 min of the injection. These results indicate that during hypotension induced by air injection, sympathetic activation through arterial baroreceptors may be depressed by vagal afferents emanating from cardiopulmonary receptors; the results also suggest that the arterial baroreceptor nerves may be required to overcome the lethal events that should occur during venous air embolism.

[Total aortic replacement in a patient with extensive thoracoabdominal aortic aneurysm--a case report]

A 35-year-old woman with a form fruste of Marfan's syndrome, presented the extensive thoracoabdominal aortic aneurysm. CT scan, MRI and aortogram revealed that she had a true aneurysm of ascending aorta and aortic arch and chronic DeBakey IIIb dissecting aneurysm extending throughout the descending thoracic and abdominal aorta. The surgical treatment was consisting of two staged operations. At the first operation, ascending aorta and aortic arch were reconstructed under cardiopulmonary bypass and selective cerebral perfusion. Elephant trunk method was employed for the second operation. The second operation was performed by graft replacement of the entire descending thoracic and abdominal aorta with reattachment of intercostal and visceral arteries. She discharged the hospital without any complication including paraplegia.

Parathyroid hormone-related protein during pregnancy and the perinatal period

To evaluate whether parathyroid hormone-related protein (PTHrP) plays any role in calcium metabolism during pregnancy and the perinatal period, we measured parathyroid hormone (PTH), immunoreactive PTHrP and calcium in maternal serum of women during pregnancy and puerperium, and in maternal and cord serum at delivery. Serum PTH levels in pregnant women were lower than those in nonpregnant women (p < 0.01). However, serum PTHrP levels were similar in the two groups of women. Cord serum total and ionic calcium levels were higher, and cord serum PTH levels were lower compared to maternal values (p < 0.01). Cord serum PTHrP levels were higher than maternal values, and umbilical arterial levels were higher than umbilical venous levels (p < 0.01). Higher levels of PTHrP in umbilical arterial blood than in umbilical venous blood suggest that the main source of cord blood PTHrP may be the fetus. PTHrP is reported to stimulate placental calcium transfer from mother to fetus in animals. The elevated cord blood PTHrP level in association with the decreased PTH level suggests that stimulation of placental calcium transfer by PTHrP may also be operative in humans.

A novel biological aspect of ovarian oxytocin: oxytocin gene expression in cumulus/luteal cells and the effect of oxytocin on embryogenesis in fertilized oocytes

Recently, several reports have demonstrated the presence of oxytocin (OT) in the corpus luteum of mammalian species. However, the biological role of ovarian OT remains obscure. This study was performed to examine OT gene expression in cumulus cells of mice and humans, and in human corpus luteum, and the role of OT in early embryogenesis. OT gene and OT mRNA were analyzed by reverse transcription-polymerase chain reaction, with single-strand-conformation polymorphism and heteroduplex procedures. OT-treated in-vitro-fertilized mouse oocytes were cultured and the rate of blastocyst development estimated. An immunohistochemical study was also carried out to detect OT on the surface of the mouse oocytes.