New compressed tablet rapidly disintegrating in saliva in the mouth using crystalline cellulose and a disintegrant

We formulated a new compressed tablet which is rapidly disintegrated and dissolved in the mouth without the need to drink water. The crushing strength increased with increasing compression force and maximum values (8-18 kgf) for the formulations comprising crystalline cellulose and low-substituted hydroxypropylcellulose (L-HPC) were obtained at the compression force of 300 kgf. Rapid disintegration (within 30 s) was obtained in vitro using various compounding ratios of crystalline cellulose to L-HPC. Tablets prepared with crystalline cellulose and L-HPC rapidly disintegrated in saliva (small amount of water) in the mouth of humans.

Incidental detection of breast cancer during T1-201 myocardial SPECT study

A case of left breast cancer which was detected incidentally by T1-201 SPECT performed to evaluate the status of myocardial perfusion, is reported. Both stress and redistribution T1-201 SPECT clearly delineated the tumor. It was confirmed later as scirrhous carcinoma of the breast.

[Pulmonary infarct hardly differentiated from lung cancer--a case report]

A 64-year-old woman experienced high grade fever, chest pain, and hemosputum. She was admitted to a hospital for evaluation of the infiltrate on an chest X-ray. She was diagnosed as having lung cancer by sputum cytology and transferred to our hospital for operation. The tumor was obscure on palpation during thoractomy, but malignancy could not be ruled out based on analysis of frozen sections. Therefore, a right lower lobectomy and mediastinal lymph node dissection were performed. Pulmonary infarct was not suspected until thrombi were observed in the dissected pulmonary artery. Urokinase and heparin were intravenously administered soon after the operation, but the patient died of pulmonary thromboembolism of the sixth postoperative day. Examination of the operative specimen revealed pulmonary thromboembolism with infarction and no evidence of malignancy. Atypical cells observed in sputum cytology seemed to be derived from basal cell hyperplasia in the area of infarction. Type II alveolar epithelial cell hyperplasia was observed in the periphery of the infarction. These findings seemed to make accurate analysis of frozen sections difficult. An increasing number of cases of pulmonary thromboembolism is being reported in Japan. Therefore, pulmonary infarct with false positive cytology may be encountered more frequently in the future.

Diversity of quasispecies in various disease stages of chronic hepatitis C virus infection and its significance in interferon treatment

Hepatitis C virus (HCV) populations in vivo exist as a mixture of heterogeneous viruses called quasispecies, which have variations in the hypervariable region (HRV). However, the relationship between the diversity of HVR quasispecies, the disease stage, or the interferon (IFN) responsiveness remains to be elucidated. To study these, serum samples were obtained from 42 patients with chronic hepatitis C virus infection; 24 with chronic active hepatitis (CAH) treated with IFN, 9 with cirrhosis, 9 with hepatocellular carcinoma (HCC). HCV quasispecies populations were separated by the single-strand conformation polymorphism (SSCP) method targeted to the HVR. The patients were classified into two groups; a single-band group (n = 12) in which HVR quasispecies was homogeneous and a multiple-band group (n = 30) in which HVR quasispecies was heterogeneous. Patients with multiple bands had significantly more advanced liver disease than those with a single-band group (P = .0082). The percentage of patients with single band were 41% in CAH, 22% in cirrhosis, and 0% in HCC. Multivariate analyses showed that viral diversity was independently related to the progression of liver disease and was not correlated with the duration of infection. We also found that in CAH, the patients who had multiple bands (n = 14) were more resistant to IFN therapy than those who had a single band (n = 10) (P = .002). These results indicate that the diversity of HCV quasispecies becomes more complex as the disease stage progresses and that CAH with more complex diversity shows less IFN effectiveness.

Anterior mediastinal schwannoma: a case report

The most common neoplasms of the mediastinum are those of neurogenic origin, and the majority of these arise in the posterior compartment. We report a case of benign schwannoma originating in rare location, the anterior mediastinum, and its imaging findings.

Parameters of dynamic and static iodine-123-MIBG cardiac imaging

Dynamic and static 123I-MIBG studies were used to investigate various parameters with regard to their usefulness in evaluating cardiac disorders.

METHODS

Four patient groups and one control group were included in this study. Dynamic study was acquired immediately after injection at 1 frame/sec for 2 min and at 1 frame/6 sec for the next 30 min using a 64 x 64 matrix format. Static study consisted of planar images at the anterior and left anterior oblique 45 degrees views in a 512 x 512 matrix format for 1 min. The early and delayed planar images were acquired soon after dynamic acquisition and approximately 4 hr after injection, respectively. Net injection dose was calculated as the difference in syringe counts before and after injection. From the dynamic and static studies, the heart uptake ratios at 3 min and 30 min, early uptake ratio and delayed uptake ratio were calculated at various intervals. Early and delayed clearance rates, Ke and Kd, respectively were also determined. These parameters were compared and correlated with each other.

RESULTS

Three-minute heart uptake ratios were significantly higher than early or delayed uptake ratios or uptake ratios at 30 min in all groups. All uptake ratios in hemodialysis patients were significantly higher than those in other groups. The Kd values in dilated cardiomyopathy, doxorubicin therapy and vasospastic angina patients were significantly higher than those in hemodialysis patients and normal controls. At least bi-exponential clearance patterns of MIBG from the heart were observed in all groups.

CONCLUSION

Three-minute and delayed heart uptake ratios calculated from dynamic and static studies are helpful in elucidating the uptake at nonvesicular sites, which reflect the severity of sympathetic nervous system abnormalities in the heart.

Comparison of the hypervariable region of hepatitis C virus genomes in plasma and liver

Nucleotide sequences of the hypervariable region of hepatitis C virus genomes obtained from plasma change rapidly during the course of infection and are believed to play a part in immunological escape and consequently in the development of persistent infection. It is not known, however, whether these changes also occur in the liver. To clarify this aspect, RNA was extracted from the plasma and liver tissue of eight patients with chronic hepatitis C. After cDNA synthesis, DNA fragments that included the hypervariable region were amplified by the polymerase chain reaction. Consensus nucleotide sequences were determined directly from the polymerase chain reaction products by the dideoxy chain termination method. The diversity of the hypervariable region was analyzed further by the polymerase chain reaction-single strand conformation polymorphism analysis. Consensus nucleotide sequences of the hypervariable region were identical between the plasma and the liver in each patient. The polymerase chain reaction-single strand conformation polymorphism analysis showed multiple DNA bands that represented different hypervariable region sequences. Comparison of the single strand conformation polymorphism patterns revealed that the number, the mobility, and the density of bands were the same between the plasma and the liver. It is concluded that the population and the diversity of hepatitis C virus quasispecies as detected by the hypervariable region sequence are the same between the plasma and the liver despite rapid mutations, indicating that rapid changes in the population of hepatitis C virus quasispecies also occur in the liver.

Water deprivation induces regional expression of c-fos protein in the brain of inbred polydipsic mice

We studied the effects of water deprivation on the expression of c-fos protein (Fos) in the brain of inbred polydipsic mice, STR/N strain, that show extreme polydipsia without a lack of vasopressin in the body. Non-polydipsic mice, ICR strain, were used as controls. All male animals were deprived of water for 24 and 48 h. Fos-like immunoreactivity (Fos-LI) in the brain was studied by immunohistochemical techniques. In both groups of mice water deprivation induced a remarkable increase in Fos-LI in the hypothalamic paraventricular (PVN) and supraoptic (SON) nuclei, the median preoptic nucleus (MnPO), the organum vasculosum laminae terminalis (OVLT) and the subfornical organ (SFO). A far more increase, however, was seen in the MnPO, the SFO and the area postrema (AP) of the polydipsic mice compared to those of the non-polydipsic control mice. In the nucleus of the tractus solitarius (NTS) and in the anteroventral part of the PVN (avPVN), water deprivation caused a clear increase in Fos-LI in the polydipsic mice, while in the non-polydipsic mice the same treatment induced no Fos-LI in the NTS and no change in the avPVN. These results indicate that neurons in the circumventricular organs and the NTS are strongly activated by water deprivation in the polydipsic mice, suggesting that these brain structures play an important role in the polydipsia.

Detection of K-ras mutations in DNAs isolated from feces of patients with colorectal tumors by mutant-allele-specific amplification (MASA)

K-ras mutations are found in approximately half of all colorectal tumors examined. To explore the possibility of detecting mutated K-ras rapidly and efficiently in DNAs isolated from fecal material, we applied the mutant allele specific amplification (MASA)-PCR method to DNA from feces of patients with colorectal tumors. Among 55 colorectal adenocarcinomas or adenomas examined, 19 were found to carry K-ras mutations in codons 12 or 13. We were able to PCR-amplify DNAs isolated from feces of 15 of these 19 patients, but in only three of the fecal samples, we were able to detect the K-ras mutations corresponding to tumor DNA by MASA and ethidiumbromide staining of the gel. The carcinomas in these three cases were more than 40 mm x 40 mm in size and located in the sigmoid colon or rectum. However, we identified the K-ras mutations in fecal DNAs of additional seven patients by MASA when the gels were blotted and probed with a radio-labeled oligonucleotide; the tumors in those patients had arisen in the distal half of the colon and the smallest of these tumors was only 7 mm x 5 mm. No K-ras mutations were detectable in feces of the remaining five cases, whose tumors were relatively small and/or located in the proximal region. The results suggested that the MASA-PCR system has potential for development as a simple, rapid and noninvasive method for diagnosing the presence of colorectal tumors that carry mutant K-ras alleles, particularly tumors located in the distal colon.

Proliferation and differentiation of myelodysplastic CD34+ cells: phenotypic subpopulations of marrow CD34+ cells

In a search for a mechanism to explain the impaired growth of progenitor cells in patients with myelodysplastic syndromes (MDS), marrow CD34+ cells were purified up to 94.9% +/- 4.2% for normal individuals and 88.1% +/- 17.6% for MDS patients, using monoclonal antibodies and immunomagnetic microspheres (MDS CD34+ cells). Phenotypic subpopulations of these CD34+ cells were analyzed for CD38, HLA-DR, CD33, CD13, CD14, CD41 and CD3 plus CD19, in association with proliferative and differentiative capacities. The 15 studies performed included 12 MDS patients. Coexpression rate of CD13 significantly increased in the MDS CD34+ cell population with a value of 91.4% +/- 11.6% and ranging from 60.3% to 100%, and exceeded 99% in four studies, whereas that of normal CD34+ cells was 49.9% +/- 15.8%, ranging from 28.2% to 70.1% (P < .001). Coexpression rate of CD38, HLA-DR, CD33, CD14, and CD3 plus CD19 in MDS CD34+ cells did not significantly differ from that of normal CD34+ cells. The total number of colonies and clusters grown from 100 normal marrow CD34+ cells was 40.4 +/- 8.6, the range being from 27.2 to 50.3; this varied in MDS marrow CD34+ cells with a value of 34.0 +/- 28.7, the range being 0 to 95.9. The lineage of colonies and clusters promoted by MDS marrow CD34+ cells was predominantly committed to nonerythroid with impaired differentiation in 13 of 15 studies (87%). CD13 is first expressed during hematopoiesis by colony-forming unit granulocyte-macrophage and is absent in erythroid progenitors. Therefore, this study provides direct evidence for the lineage commitment of MDS CD34+ cells to nonerythroid with impaired differentiation and explains the mechanism of nil or low colony expression of MDS progenitor cells to erythroid lineage.

The usefulness and limitations of combined Tc-99m pertechnetate and Ga-67 citrate imaging of salivary gland disorders

The usefulness of combined Tc-99m and Ga-67 scans in diagnosing salivary gland disorders was evaluated in a total of 31 patients. Out of 6 patients with Warthin's tumor, 4 showed a typical pattern of high-activity in the gland with retention of Tc-99m, but without an affinity for Ga-67. Out of 9 patients with pleomorphic adenoma, 8 showed a "cold" area in the tumor by Tc-99m and 5 of the 9 patients had accumulated Ga-67. Five of 6 patients with malignant tumor showed an affinity for Ga-67. Nine of 10 patients with sialadenitis showed diffuse uptake of both Tc-99m and Ga-67 in the involved gland. Combined Tc-99m and Ga-67 imaging was useful in detecting the cases of Warthin's tumor and sialadenitis (90% sensitivity and 89% specificity for sialadenitis), but the study had limitations in differentiating malignant tumors from benign tumors (66% sensitivity and 84% specificity). However, Ga-67 imaging showed a 91% negative predictive value. A negative scan could almost rule out the possibility of malignant disease of the salivary gland.

[Adenosine triphosphate loading thallium-201 myocardial scintigraphy: optimal dose and diagnostic accuracy]

Adenosine triphosphate (ATP) is an alternative to dipyridamole or adenosine in thallium-201 myocardial scintigraphy. However, the optimal dose of ATP has not been determined. A Doppler guide wire study showed the coronary flow velocity at a dose of 0.15 mg/kg of ATP was equal or higher than that at 0.14 mg/kg of adenosine or 0.56 mg/kg of dipyridamole. ATP was given intravenously to 67 patients with coronary artery disease at 0.15 mg/kg/min for 6 min. Thallium-201 was injected at 3 min, followed by immediate and delayed (3 hrs) tomographic imaging. There was no serious side effect during examination, although chest pain (26%), dyspnea (17%), and flushing (33%) were common. The sensitivity and specificity to detect coronary artery disease were 98 and 100%, respectively. The sensitivity to detect left anterior descending artery, left circumflex artery, and right coronary artery lesions was 94, 59 and 77%, respectively. ATP loading thallium-201 scintigraphy provides an accurate diagnosis of coronary artery disease. The optimal dose of ATP is 0.15 mg/kg/min for 6 min.

[Evaluation of malignancy and viability of brain tumors by 201Tl SPECT: the correlation between 201Tl SPECT and pathology, clinical progress and the intensity of enhancement on CT images]

Thallium-201 (201Tl) SPECT was performed 48 times in 26 patients to clarify its usefulness in the evaluation of malignancy and viability of brain tumors. The early counts ratio (ER) and delayed counts ratio (DR) of a lesion compared with normal brain were obtained 10-15 minutes and 3 hours, respectively, after intravenous administration of 185 MBq of 201Tl chloride. Untreated high grade malignant tumors and recurrent tumors did not always show high ER and DR, and they were widely distributed. High grade malignant tumors that showed low ER and DR were not well enhanced on CT or MRI. In low grade malignant tumors, such as pituitary adenoma which was well enhanced on CT, ER and DR were as high as in high grade malignant tumor. Whether a tumor recurred within three months after radiotherapy or not was retrospectively predicted at accuracy rates of 93.8% and 87.5% with cut-off points of 4.0 for ER and 3.5 for DR. Cerebral radiation necrosis showed ring-like increased uptake of 201Tl in proportion to the progress of necrosis and intensity of enhancement on MRI. In conclusion 201Tl SPECT is considered to be less useful for lesions that are well enhanced on CT, because they show high uptake of 201Tl regardless of their malignancy and viability. On the other hand, in tumors that are not well enhanced on CT. 201Tl shows good accumulation in viable and high grade malignant lesions. 201Tl SPECT should be performed in such cases.

Scintigraphic changes in bone metastasis from prostate cancer after hormonal therapy--comparison with tumor markers and bone X-ray

Bone scintigraphy is often performed to assess the response to systemic therapy of bone metastasis from prostate cancer. We examined the changes in bone scintigraphic findings and the agreement with AIP, AcP, or other tumor markers measured in the follow-up of patients with known bone metastasis after hormonal therapy. Out of 32 patients, 22 (69%) showed improved scintigraphic findings on the first follow-up bone scintigraphy after hormonal therapy. However, 7 out of 22 patients who showed improvement on the first follow-up scintigraphy, deteriorated thereafter. Changes in the scintigraphic findings were closely correlated with those in the measured tumor markers except for patients with small bone metastasis. Though there were no significant differences in the agreement ratios of the 6 tumor markers evaluated, AIP might be a practical and acceptable indicator. Bone X-ray findings did not change at all in almost half of the cases though the scintigraphic findings showed improvement or deterioration.

Transitional changes in immunophenotypic subpopulations of human peripheral blood CD34+ cells expanded in vitro

We determined the appropriate incubation period to expand human peripheral blood (PB) CD34+ cells for clinical application and the role of recombinant human (rh) interleukin-3 (rhIL-3) in the expansion and differentiation of these cells. The cells were purified up to 40 +/- 16% and transitional changes in immunophenotypic subpopulations in suspension culture were examined following stimulation with three different combinations of rh colony-stimulating factors (rhCSFs): 1) rhIL-3 alone, 2) rhIL-6, rhSCF, rhG-CSF, plus rhGM-CSF, and 3) the four CSFs plus rhIL-3. With all three CSF combinations, the total cells increased continuously after day 5 until day 14, and a combination of the five CSFs always gave rise to the highest number of total cells. Immunophenotypic analysis of the expanded cells showed that with all three CSF combinations CD34+ cells reached a maximal rate on day 5 and then decreased in an inverse correlation between the logarithm of CD34 positive rate and the duration of suspension culture. The maximum expansion of CD34+ cells and PB progenitor cells (PBPC) with rhIL-3 alone, the four CSFs, or the five CSFs was observed on day 5, 10, or 7, respectively. The combination of the five CSFs was identified as the most potent stimulus for expansion of PBPC and CD34+ cells, as it increased non-erythroid PBPC 89 +/- 69-fold, with a range of 24 to 204-fold on day 7. However, differences in the expansion rate of these cells on days 5, 7, and 10 were not statistically significant. The majority of purified CD34+ cells coexpressed CD38 (91 +/- 3%) but were negative for CD33 (85 +/- 4%), and one-half coexpressed CD13. With all three combinations of CSFs, the mature CD34+ cells that coexpressed CD38, CD33, or CD13 expanded in parallel with the total CD34+ cells, while an increase in relatively immature CD34+ cells, which do not express CD38, CD33, or CD13, was only statistically significant with the five CSFs. Thus, rhIL-3 played a critical role when combined with the four CSFs by increasing both mature and immature CD34+ cells.

[Effects of byakushi and ogon on the hepatic drug metabolizing enzymes in rats]

The effect of single or daily oral administration of hot water extracts (HWE) from Byakushi or Ogon on rat hepatic drug-metabolizing enzymes were investigated in vivo. Enzymes were measured for 3 to 72 hr after single oral administration of HWE at the dose of 1.0 g/kg or 5.0 g/kg. Administration of 1.0 g/kg of Byakushi and 5.0 g/kg of Ogon inhibited aniline hydroxylase activity, while 5.0 g/kg of Byakushi inhibited it in the early phase, but increased it in the late phase. Byakushi inhibited aminopyrine N-demethylase activity, while 5.0 g/kg of Ogon increased it. Byakushi and Ogon decreased the amount of cytochrome P-450. Byakushi and Ogon increased the amount of cytochrome b5. Byakushi increased cytochrome c reductase activity 3 hr after administration and decreased it 6 and 12 hr after administration. In contrast, 1.0 g/kg of Ogon decreased cytochrome c reductase activity, and 5.0 g/kg increased it 6 hr after administration and decreased it 12 hr after administration. At 24 hr after the last administration to animals treated with a regimen of once a day administration of the HWE (0.1 or 1.0 g/kg) of Byakushi or Ogon for 14 days, the enzymes were measured. Byakushi decreased aminopyrine N-demethylase activity, the amount of cytochrome P-450, and cytochrome c reductase activity. Ogon decreased cytochrome c reductase activity. Byakushi altered the composition of cytochrome P-450 isozyme after daily administration.