[A case of carcinomatous peritonitis for which combination therapy of 5-FU, leucovorin and cisplatin was effective]

This case report describes a case of carcinomatous peritonitis which showed a good response to the combination therapy of 5-FU, leucovorin and cisplatin. A 55-year-old man was admitted with complaints of meteorism due to ascites fluid. Ascitic examination showed a high concentration of CEA and CA19-9, and adenocarcinoma cells. Laboratory and radiological examination did not reveal the origin of the carcinoma, and laparotomy suggested an appendiceal origin. The combination chemotherapy with 5-FU, leucovorin and cisplatin was conducted for a total of 11 courses for 2 years with good QOL until his death. This therapy was suggested to be useful for inoperable carcinomatous peritonitis.

Setting reactions in dental amalgam. Part 2. The kinetics of amalgamation

The literature on the setting mechanisms of dental amalgams made from powders of silver-rich alloys of tin and/or copper has been critically reviewed. Part 2 is a review of the kinetics of the reactions that convert the mixture of alloy powder and liquid mercury to hardened amalgam containing the phases and microstructures described in Part 1. It is emphasized that amalgamation is a non-equilbrium process in which hardened microstructures are determined as much by kinetics as by chemistry. The setting reaction begins with dissolution of silver and tin into liquid mercury; most of the product phases precipitate in the liquid mercury. The processes that produce supersaturation in the liquid mercury and the subsequent nucleation and growth of solid phases are considered. Mass balance relationships that provide insight into the factors that control the volume fraction of the undesirable gamma 2 Sn-Hg phase are described. The nucleation and growth of eta' Cu-Sn crystals are also discussed; it is found that these crystals nucleate on copper-rich phases and grow into the liquid mercury. Finally, aspects of the setting reaction that are controlled by intergranular and interphase diffusion in the solid are discussed. These aspects include: the supersaturation of silver and tin within the liquid mercury, nucleation and growth of the beta 1 Ag-Hg phase in the surfaces of alloy particles, and the decomposition of initially formed gamma 2 Sn-Hg.

Mechanical properties of glass ionomers under static and dynamic loading

OBJECTIVES

This study evaluated the mechanical properties under static and cyclic loading conditions of various types of glass ionomers used for bases and core build-ups under restorations.

METHODS

Compressive strength and three-point flexural strength of two different glass ionomers and two metal-reinforced glass ionomers were determined 1 d after the start of mixing. The flexural fatigue resistance of these materials was measured in the load range of 650 g to 1050 g using a three-point bending machine, and fractured surfaces of the specimens were examined using SEM.

RESULTS

All the glass ionomers exhibited similar compressive and flexural strengths. The results analyzed by Cox' proportional hazard model demonstrated that the admixed-type metal-reinforced glass ionomer had the highest fatigue resistance, while the water-hardening glass ionomer had the lowest fatigue resistance among the materials examined (p<0.5).

SIGNIFICANCE

There was no significant improvement in the static mechanical properties from incorporating metal particles into the glass ionomers. However, the addition of metal particles as in the admixed-type metal-reinforced glass ionomer produced a material with increased fatigue resistance.

Mucopolysaccharidosis IVA: submicroscopic deletion of 16q24.3 and a novel R386C mutation of N-acetylgalactosamine-6-sulfate sulfatase gene in a classical Morquio disease

The N-acetylgalactosamine-6-sulfate sulfatase (GALNS) gene, which is responsible for autosomal recessive mucopolysaccharidosis IVA (MPSIVA), has been assigned to the long arm of chromosome 16, subregion 24.3, an area where the adenine phosophoribosyltransferase (APRT) gene and renal dipeptidase (DPEP I) gene are also localized. Molecular genetic studies on a severely affected patient with MPSIVA (Morquio disease), without karyotypic abnormality, revealed a partial submicroscopic deletion of 16q24.3 and a single point mutation on the other allele, with no functional GALNS activity. The patient, his mother, and siblings were hemizygous for GALNS and APRT loci, evidenced by informative RFLP and gene dosage analyses combined with a fluorescence in situ hybridization, utilizing a partial genomic clone of GALNS, but heterozygosity was retained at the DPEP I locus and proximal D16S7. Haplotyping of the family members revealed recombinational events between DPEP I locus and three other polymorphic loci on the paternal chromosome, localizing GALNS gene on the proximal side to DPEP I gene. As estimated from the genetic distance between two flanking markers of proximal D16S7 and distal DPEP I locus, size of the deletion was less than 3Mb. Mother of the boy and two older siblings were asymptomatic, despite this interstitial deletion of the Giemsa-light G band. The remaining paternal allele had no gene rearrangement but GALNS activity was not encoded as Arginine at 386 was replaced with Cysteine (R386C), suggesting this alteration accounts for the severe phenotype. Allelic loss of APRT is frequently observed in cancer tissues, thereby suggesting that the tumor suppressor gene locates near the APRT locus. No family member has evidence of any malignant disease. This study is apparently the first documentation of interstitial deletion of 16q24.3, involving GALNS and APRT genes.

Abnormalities of sex differentiation

Sex differentiation is determined by a cascade of events proceeding from chromosomal sex to the completion of sexual maturation at puberty. Many factors involved in this cascade have been identified. Here we focus on DAX-1, androgen receptor and cytochrome P450c17, and discuss their functions in sex differentiation. We analyzed the DAX-1 genes of two unrelated Japanese patients with congenital adrenal hypoplasia and hypogonadotropic hypogonadism using PCR amplification of genomic DNA and complete exonic sequencing, and established that congenital adrenal hypoplasia and hypogonadotropic hypogonadism result from not only inherited but also de novo mutation in the DAX-1 gene. Androgen insensitivity syndrome (AIS) is a good model to clarify the relationship between the structure and function of androgen receptor, the androgen receptor gene mutation and clinical phenotype. We analyzed 15 cases of AIS and demonstrate the structural and functional relationships of the androgen receptor. We have sequenced the CYP17 (P450c17) gene in DNA from several patients with 17 alpha-hydroxylase deficiency, reconstructed the mutations in a human P450c17 cDNA and expressed the mutant P450c17 in COSl cells to characterize the kinetic properties of 17 alpha-hydroxylase and 17,20-lyase activities. The molecular bases of cases clinically reported as 17 alpha-hydroxylase deficiency have turned out to be complete or partial combined deficiencies of 17 alpha-hydroxylase/17,20-lyase.

Setting reactions in dental amalgam. Part 1. Phases and microstructures between one hour and one week

The literature on the setting mechanisms of dental amalgams made from powders of silver-rich alloys of tin and/or copper has been critically reviewed. In Part 1 of the review, the microstructure and phase content of recently set amalgams are described. The composition, morphology, and location of product phases are emphasized, since these features are clues to the setting reaction. Thus, Part 1 provides the background needed to understand the kinetics of the setting reactions, which is the topic of Part 2 of the review.

Protective effect of the combined vaccine prepared from cell-free-antigen of Actinobacillus pleuropneumoniae serotypes 1, 2 and 5 in pigs

Cell-free-antigens prepared from a concentrated culture supernatant of Actinobacillus pleuropneumoniae (A. pleuropneumoniae) serotypes 1, 2 and 5 were mixed and emulsified with oil adjuvant. The combined vaccine of these 3 serotypes of A. pleuropneumoniae was tested for its ability to confer protection. Pigs immunized with the combined vaccine survived and showed no clinical signs against an intratracheal challenge with A. pleuropneumoniae. In contrast, control pigs inoculated with concentrated culture media emulsified with oil adjuvant developed typical symptoms of pleuropneumonia after challenge inoculation.

Shorter interval between cycles of cyclophosphamide, doxorubicin, cisplatin using recombinant human granulocyte colony-stimulating factor for urothelial cancer--phase I/II study

BACKGROUND

Despite improvement in the response rate and protraction of the progression-free period of urothelial cancer produced by chemotherapy, severe bone marrow suppression often results in delays in the initiation of treatment cycles and/or decreases in drug dosages. Reduction of leukopenia during chemotherapy has been demonstrated by the combined administration of granulocyte colony-stimulating factor (G-CSF) in various malignancies.

METHODS

A phase I/II study was conducted to assess whether the interval between cycles of CISCA (cyclophosphamide, doxorubicin, cisplatin) chemotherapy could be shortened under support of recombinant human granulocyte colony-stimulating factor (rhG-CSF) for urothelial cancer. Three or more patients with transitional cell carcinoma of the urinary tract were allocated to each of four different treatment intervals (step 1: 28 days, step 2: 21 days, step 3: 17 days, and step 4: 14 days) by reducing the interval in a step-wise manner. Two mg/kg/day of a rhG-CSF, lenograstim, was injected subcutaneously on days 3 to 16 (until day 14 for the 14-day interval group).

RESULTS

Sixteen patients were enrolled, four patients were treated with the step 1 protocol, five with step 2, four with step 3, and three with step 4. Leukopenia/neutropenia was the most severe toxic reaction, but none of the patients at any step manifested neutropenia of WHO grade 4 for more than four days. There were no significant differences in the hematological and nonhematological toxicities among the 4 steps. Seven of eight patients with measurable diseases were treated with CISCA on shortened schedules (steps 2-4), and one complete remission (CR) and four partial responses (PR) were demonstrated.

CONCLUSIONS

CISCA chemotherapy supported by rhG-CSF was safely shortened to a 14-day interval in the pilot study. The potential role of rhG-CSF in shortening the interval of CISCA, as well as the benefit of the intensified schedule, remains to be clarified.

Purification and characterization of angiotensin II degradation factor from porcine endothelial cells

We investigated the degradation of angiotensin II by vascular endothelial cells and smooth muscle cells in vitro. When angiotensin II was incubated with confluent culture of endothelial cells or with serum free conditioned medium of the endothelial cells, angiotensin II was destroyed rapidly. When angiotensin II was incubated with cultured vascular smooth muscle cells or their serum free conditioned medium, degradation was not observed. To identify the angiotensin II degradation factor (ADF), we have purified ADF from the conditioned medium of endothelial cells, by column chromatographies, i.e., hydroxyapatite, ion exchange and gel filtration chromatography. The partially purified ADF had apparent molecular masses of 154 kDa on gel filtration chromatography. Its pH optimum was about 7.0. ADF was inhibited by p-chloromercuribenzoic acid, iodoacetamide and high concentration of EDTA, but not by diisopropyl fluorophosphate, bestatin, amastatin or pepstatin A. Of the synthetic substrates examined, ADF degrades human angiotensin II, [Val5]-angiotensin II and [Asn1, Val5]-angiotensin II. It did not degrade angiotensin I.

Premature termination mutation (772Glu-->stop) in the hormone-binding domain of the androgen receptor in a patient with the receptor-negative form of complete androgen insensitivity syndrome

We have characterized the androgen receptor in a Japanese infant with complete androgen insensitivity syndrome (or androgen resistance), and have investigated the molecular basis. Androgen binding was undetectable in cultured genital skin fibroblasts from this patient by whole-cell androgen receptor binding assay. Sequence analysis of the entire coding region of the androgen receptor gene from this patient revealed a single nucleotide substitution (G-->T) at nucleotide position 2676 in exon E (or 5), resulting in conversion of glutamine codon (GAG) to amber stop codon (TAG) at amino acid position 772 within the hormone-binding domain of the androgen receptor. This premature termination mutation (or nonsense mutation), introducing a truncated androgen receptor that lacks most of its androgen binding capacity, is though to cause the receptor-negative form of complete androgen insensitivity syndrome in this patient.

Up-regulation of high-affinity dehydroepiandrosterone binding activity by dehydroepiandrosterone in activated human T lymphocytes

Although evidence indicates that dehydroepiandrosterone (DHEA) exerts direct physiological effects, its mechanism of action remains unknown. DHEA binding sites were examined using a whole-cell binding assay in a human T lymphoid cell line, PEER, revealing that a single class of high-affinity binding sites for DHEA (dissociation constant = 7.4 +/- 0.53 nmol/L, mean +/- SE, n = 4) was greatly increased when treated with DHEA, phorbol-12-myristate-13-acetate, and the Ca2+ ionophore A23187. Bound [3H]DHEA was displaced sensitively by DHEA and secondarily by dihydrotestosterone, but not effectively by other steroids, including DHEA sulfate. These results not only indicate the existence of a DHEA receptor, but also suggest that T cells become susceptible to regulation by DHEA during the process of signal-induced activation.

Casting of Ti-6Al-4V alloy compared with pure Ti in an Ar-arc casting machine

Dental prostheses of Ti are normally cast in pure Ti. Some appliances, however, require higher yield strength. Casting of Ti alloys is of interest in such cases. The objective of the present work was to study the quality of castings made of Ti-6Al-4V compared with those made of pure Ti. Casting was made into a mold kept at room temperature using a MgO-Al2O3 investment. A standardized five-unit bridge was cast, consisting of two cylindrical crowns with sharp margins and three pontics. The overall mold filling was satisfactory. The margins of the casting alloys were, however, more rugged and incomplete than those of pure Ti. The most likely reason for this difference is the increased formation of dendrites in the alloy and thus more resistance to fluid flow. Furthermore, the sprue of the alloy was also found to contain some spherical, internal pores. Such pores were rare in the pure Ti castings. The surface reactions were found to be minimal for both of the materials. Increased casting deficiencies observed in the cast bridges of the Ti-6Al-4V alloy, compared with pure Ti, were: 1) the margins of the crowns in the bridge were less complete and 2) there was a tendency to an increased internal porosity, particularly in the sprues.

[A case of toxic shock-like syndrome due to Streptococcus pyogenes]

A case of toxic-shock syndrome due to Streptococcus pyogenes is reported. A 76-year-old female was admitted with complaints of fevers and chills. She had been suffering from cellulitis on her right dorsum pedis for 7 months. Laboratory data on admission showed elevated values of WBC, CRP, and dysfunction of the liver and kidney. She was diagnosed as sepsis due to the cellulitis, and was treated with PIPC and FMOX. However, several hours after admission, her blood pressure decreased and oliguria appeared. Bacteriological examinations from the blood and the cellulitis revealed group A beta-hemolytic Streptococcus which gave streptococcal pyrogenic exotoxin (T-28, SPE.B + C). She died 23 hours after her admission in spite of changing antibiotics to a high-dose of PC-G therapy. This is one of the rare cases of toxic shock-like syndrome due to Streptococcus pyogenes from the cellulitis of the dorsum pedis.

Protective efficacy of cell-free-antigen of Actinobacillus pleuropneumoniae in mice

Cell-free-antigen (CFA) vaccines of strain Y-1 (serotype 1), G-4 (serotype 2) and E-3 (serotype 5) of Actinobacillus pleuropneumoniae (A. pleuropneumoniae) were prepared by emulsifying concentrated culture supernatant with oil-adjuvant. Mice immunized with the CFA vaccine had a high survival rate (90-100%) against challenge with the homologous strain. They also had cross-protective activity against challenge with the heterogeneous strains but their survival rate was low (20-50%). On the other hand, mice immunized with whole cell vaccine showed serotype specific protection and only a little cross protection. The protective antigens of the CFA were investigated. MAbs were produced by the standard method using spleen cells of mice immunized with CFA. MAbs to Apx I, II, III and capsular antigen of serotype 5 were obtained. Only MAbs to Apx I showed hemolysin neutralization activity among them. The protective effect of these MAbs against A. pleuropneumoniae infection were examined by passive immunization. Administration of Apx I MAb to mice extended survival time after challenge with serotype 5. The mice showed partial cross-protection against challenge with serotype 1. Survival rate was considerably low after the challenge infection. None of the mice given MAbs to Apx II or III were protected against challenge with serotype 5. The mice given MAb to capsular antigen of serotype 5 had a high survival rate (70%) against a challenge with a homologous serotype. Furthermore, mice given MAbs against Apx I and capsular antigen of serotype 5 were completely protected against a challenge with A. pleuropneumoniae serotype 5.(ABSTRACT TRUNCATED AT 250 WORDS)

[Squamous cell carcinoma of the lung with high CT number, but without calcification]

Squamous cell carcinoma of the lung was diagnosed in a 64-year-old man. Chest roentgenographic and tomographic examinations did not show areas of high-density in the tumor, but chest CT scan showed diffuse, scattered, high-density nodules in the tumor. Histologic examination did not show calcification, and calcium staining (Kossa method) was negative. Examination of the thin-slice CT, the soft X-ray film, and the resected slice of the lung indicated that the high-density nodules seen in the tumor on the chest CT scan corresponded to markedly fibrotic lesions with severe anthracosis. This case shows that high-density areas on a CT scan may reflect non-calcified lesions.

Effect of glass ionomer manipulation on early fluoride release

PURPOSE

To determine the amount of fluoride released from several glass ionomer products [Fuji Cap II, Fuji Ionomer Type II, Ketac-Silver, Chelon-Silver, and Miracle Mix (hand-mixed and encapsulated)], and to compare them between triturated (5, 10, 15 seconds) encapsulated and hand-mixed glass ionomers.

MATERIALS AND METHODS

The amount of fluoride released at 1, 2, 3, 7, 14, 21 and 28 days after the start of immersion in deionized-distilled water at 37 degrees C was determined with a fluoride ion selective electrode. Rates of fluoride release and cumulative amounts of fluoride release were calculated.

RESULTS

Each glass ionomer released the greatest amount of fluoride during the first 24-hour period. Although there was some variation between products, generally the hand-mixed specimens released significantly (P < 0.05) less fluoride than those prepared by mechanical trituration (10 and 15 seconds). The cumulative amounts of fluoride released from the mechanically triturated glass ionomers were significantly (P < 0.05) greater than the amounts released from the hand-mixed glass ionomers. No significant differences in the cumulative amounts of fluoride released from triturated materials were found among the different trituration times.

Follow-up study in a patient with Setleis syndrome

We report on an 8-year-old Japanese boy with Setleis syndrome. The patient had a very characteristic "coarse" facial appearance, bitemporal "forceps marks," skin aplasia, sparse hair, and skin hypo- and hyperpigmentation. He also had previously undescribed manifestations, including an aberrant hair pattern of the forehead, linear skin lesions on the forehead, short palpebral fissures, a small skin tag on the right cheek, cone-shaped teeth, and pectus carinatum. Dermatoglyphic studies documented aberrant distal palmar creases (simian crease variant), 8 arches, and reduced total finger ridge count. When serial photographs were reviewed, his facial characteristics became more obvious with increasing age.

Mercury vaporization from amalgams with varied alloy compositions

The fact that mercury is released from dental amalgam restorations after abrasion provides a source of continued controversy over the safe use of this material. Studies have shown that the amount and rate of mercury release vary for different amalgam products. The objective of this study was to determine how alloy composition affects mercury vaporization from experimental amalgams with similar alloy particle size and shape and percent residual mercury. An hypothesis to be tested was that mercury release is dependent upon the concentration of tin in the silver-mercury matrix phase of the amalgam. Seven spherical amalgam alloys (two low-copper and five high-copper) were made by a dental manufacturer (Tokuriki Honten, Japan). Trituration conditions were adjusted so that all set amalgams had the same residual Hg (47.3%). ADA-type amalgam cylinders were aged for 14 days at 37 degrees C, then lightly wet-abraded on #600 silicon carbide, dried, and placed into a tube through which air was blown at a rate of 750 mL/min. Mercury vaporization was monitored with a gold film analyzer (Jerome 411) for 30 min. Total Hg release was determined by integration. We analyzed polished specimens via electron microprobe to determine composition, volume fraction of silver-mercury matrix (gamma 1), and amount of tin in the gamma 1. The results showed a strong negative correlation (r2 = 0.941) between the log of total mercury released and the amount of tin in the gamma 1. The effect of alloy composition, specifically the presence or absence of zinc in the amalgam, could not be definitively determined.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of bilateral infection-induced urolithiasis in a bed-ridden elderly female]

A 79-year-old bedridden female in whom bilateral small renal calculi were pointed nine months previously, presented with a high fever and non-specific abdominal symptoms. A diagnosis of bilateral renal and ureteral stones causing hydronephroureters with severe infection was made. She was referred to the urology department and treated with extracorporeal shock wave lithotripsy (ESWL). Persistent urinary tract infection caused by urease-producing bacteria, often seen in the bedridden elderly contributes to form infection-induced renal calculi. Such calculi are sometimes found in bilateral kidneys, can grow rapidly, and can often form with few, if any, symptoms. ESWL has been established as noninvasive treatment of choice for the great majority of upper urinary tract stones. All types of stones, including renal staghorn calculi, can be treated by ESWL with endourological support. Recurrence of stones after treatment is expected in approximately 40% of cases. In order to prevent recurrence, the stone should be removed totally and the patients must be observed carefully to keep the urinary tract totally free of infection.

cDNA cloning of a NGFI-B/nur77-related transcription factor from an apoptotic human T cell line

A human T lymphoid cell line, PEER, dies by apoptosis in the presence of PMA and calcium ionophore. A new gene, TINUR, was cloned from apoptotic PEER cells. The expression of the TINUR gene is induced within 1 h after the cross-linking of the T cell Ag receptor complex. TINUR belongs to the NGFI-B/nur77 family of the steroid receptor superfamily and is an orphan receptor. TINUR binds to the same DNA sequence as NGFI-B/nur77. We also propose that the NGFI-B/nur77 family can be classified into two subtypes.

cDNA cloning of a NGFI-B/nur77-related transcription factor from an apoptotic human T cell line

A human T lymphoid cell line, PEER, dies by apoptosis in the presence of PMA and calcium ionophore. A new gene, TINUR, was cloned from apoptotic PEER cells. The expression of the TINUR gene is induced within 1 h after the cross-linking of the T cell Ag receptor complex. TINUR belongs to the NGFI-B/nur77 family of the steroid receptor superfamily and is an orphan receptor. TINUR binds to the same DNA sequence as NGFI-B/nur77. We also propose that the NGFI-B/nur77 family can be classified into two subtypes.

Trichostatin A inhibits both ras-induced neurite outgrowth of PC12 cells and morphological transformation of NIH3T3 cells

During screening for inhibitors of ras-mediated differentiation of PC12 cells, trichostatin A (TSA) was isolated from the metabolites of Streptomyces as a potent inhibitor. TSA blocked both oncogenic ras- and NGF-induced neurite outgrowth from PC12 cells. However, addition of TSA 1 h after NGF-stimulation did not inhibit neuronal differentiation, suggesting that TSA affects an early step in the NGF-signaling pathway mediated by ras. Northern blotting analysis showed that TSA prolonged the maximum expression period of c=fos mRNA triggered by NGF and delayed its return to the basal level. TSA reduced c-jun mRNA induction by NGF but greatly enhanced c-myc mRNA induced by NGF. Yoshida et al. (J. Biol. Chem, 265, 17174-17179, 1990) showed that TSA inhibits histone deacetylation, which might influence the gene expression involved in cellular differentiation. In this study, we also found that TSA prevents histone deacetylation in PC12 cells as well as other cell lines, suggesting that inhibition of histone deacetylation by TSA might affect the expression of early-response genes. We also demonstrated that TSA induced reversion of oncogenic ras-transformed NIH3T3 cells to a normal morphology, suggesting that inhibitors of ras-mediated differentiation of PC12 cells may be effective as anticancer agents.

[A case of metamorphopsia caused by a very localized spotty infarct]

A 51-year-old woman complained that her right side of the face looked blurring and the right margin of all the objects in her visual field looked blurred. Neurological examination on admission showed no abnormalities including higher cortical function and visual fields except the metamorphopsia. In this case, a very localized spotty infarct caused no neurological symptoms other than the metamorphopsia. CT scan and MRI revealed a spotty lesion of infarct between retrosplenium and cingulate gyrus on the left side. This can be a breakthrough case to locate the exact anatomic pathology that causes metamorphopsia.