[Long-term results of TIPS]

The long-term results of transjugular intrahepatic portosystemic shunt(TIPS) were analyzed in 48 patients between February 1992 and December 1998, for treatment of esophageal varices and ascites caused by portal hypertension. The procedure was successful in 42 patients. Portal vein pressure was reduced from 29 mmHg +/- 7.9 to 19 mmHg +/- 7.3 immediately after TIPS and to 17 mmHg +/- 6.5 one year later. Varices were controlled in 82% (23/28) of patients after one year and in 78% (7/9) of patients after five years. Ascites disappeared or decreased in 79% (11/14) after one year. Primary shunt patency was 12%, with a secondary patency rate of 79% after five years. The overall incidence of new or worsened encephalopathy was 31% (13/42). Long-term follow-up showed one-, three-, and five-year survival rates of 82%, 68%, and 59%, respectively. TIPS is an effective means of lowering portal hypertension, and it controls varices and ascites with little risk of hepatic encephalopathy.

Selective inhibition of cyclooxygenase-2 with antisense oligodeoxynucleotide restricts induction of rat adjuvant-induced arthritis

The effects of cyclooxygenase (COX)-2 antisense oligodeoxynucleotide (ODN) in induction of adjuvant-induced arthritis were investigated. Female Lewis rats were injected with Mycobacterium butyricum intradermally at the base of tails to induce arthritis. Synthetic 18 mer phosphorothioate ODNs corresponding to the translation initiation site of rat COX-2 mRNA were prepared. The antisense (AS), sense (S), and "scrambled" (Sc) ODNs were intraperitoneally administered. Arthropathy was evaluated with arthritis score, paw edema, and histological examination. Expression of COX-1 and -2 protein and mRNA were examined with immunostaining and reverse-transcription polymerase chain reaction, respectively. COX-2 AS ODN significantly suppressed induction of arthritis in a dose-dependent manner without severe adverse effects, whereas S and Sc ODNs did not show significant inhibitory effects. COX-2 mRNA and protein expression were also suppressed only by COX-2 AS ODN without any alteration of COX-1 expression. These data suggest that selective inhibition of COX-2 with AS ODN may have a therapeutic potency in the treatment of rheumatoid arthritis.

Identification of 187 single nucleotide polymorphisms (SNPs) among 41 candidate genes for ischemic heart disease in the Japanese population

To investigate whether common variants in the human genetic background are associated with pathogenesis of ischemic heart diseases, we systematically surveyed 41 possible candidate genes for single-nucleotide polymorphisms (SNPs) by directly sequencing 96 independent alleles at each locus, derived from 48 unrelated Japanese patients with myocardial infarction, including 25.8 kb 5' flanking regions, 56.8 kb exonic and 35.4 kb intronic sequences, and 1.8 kb 3' flanking regions. In this genomic DNA of nearly 120 kb, we identified 187 SNPs: 55 in 5' flanking regions, seven in 5' untranslated regions (UTRs), 52 in coding elements, 64 in introns, eight in 3' UTRs, and one in a 3' flanking region. Among the 52 coding SNPs, 26 were non-synonymous changes. Allelic frequencies of some of the polymorphisms were significantly different from those reported in European populations. For example, the Q506R substitution in the coagulation factor V gene, the so-called "Leiden mutation", has a reported frequency of 2.3% in Europeans, but we detected the Leiden mutation in none of the Japanese genomes that we investigated. The allelic frequencies of the -33A>G SNP in the thrombomodulin gene were also very different; this allele occurred at a 12% frequency in the Japanese patients that we examined, although it had been detected in none of 82 Caucasians reported previously. These data support the hypothesis that some SNPs are specific to particular ethnic groups.

Identification of 142 single nucleotide polymorphisms in 41 candidate genes for rheumatoid arthritis in the Japanese population

Single-nucleotide polymorphisms (SNPs) can make an important contribution to our understanding of genetic backgrounds that may influence medical conditions and ethnic diversity. We undertook a systematic survey of genomic DNA for SNPs located not only in coding sequences but also in non-coding regions (e.g., introns and 5' flanking regions) of selected genes. Using DNA samples from 48 Japanese patients with rheumatoid arthritis (RA) as templates, we surveyed 41 genes that represent candidates for RA, screening a total of 104 kb of DNA (30 kb of coding sequences and 74 kb of non-coding DNA). Within this 104 kb of genomic sequences we identified 163 polymorphisms (1 per 638 bases on average), of which 142 were single-nucleotide substitutions and the remainder, insertions or deletions. Of the coding SNPs, 52% were non-synonymous substitutions, and non-conservative amino acid changes were observed in a quarter of those. Sixty-nine polymorphisms showed high frequencies for minor alleles (more than 15%) and 20 revealed low frequencies (<5%). Our results indicated a greater average distance between SNPs than others have reported, but this disparity may reflect the type of genes surveyed and/or the relative ethnic homogeneity of our test population.

Hepatocellular carcinoma extending into the portal vein: restoration of extended-term patency by placement of uncovered Wallstents

A 74-year-old man presented with hepatocellular carcinoma extending into the main portal vein. Two bare Wallstents were placed to maintain portal vein patency. The main portal vein remained patent for 6 months after treatment. No serious complications were observed during or after treatment.

Isolation of acein-2, a novel angiotensin-I-converting enzyme inhibitory peptide derived from a tryptic hydrolysate of human plasma

We previously described a novel angiotensin-I-converting enzyme (ACE) inhibitory peptide, designated Acein-1, that was isolated from a tryptic hydrolysate of human plasma. We now report a second such inhibitory peptide, Acein-2 obtained from the same hydrolysate. The peptide was purified by gel filtration and cation exchange chromatography followed by reversed-phase gradient and isocratic high performance liquid chromatography. Acein-2 was found to be a tripeptide, Leu-Ile-Tyr, which is thought to correspond to f(518-520) of human alpha2-macroglobulin. The synthetic tripeptide showed a potent dose-dependent inhibition of ACE, with an IC(50) value of 0.82 micromol/l. Lineweaver-Burk plots suggested that Acein-2 as well as the previously described Acein-1 are non-competitive inhibitors.

Cytotoxicity of docosahexaenoic acid and eicosapentaenoic acid in tumor cells and the dependence on binding to serum proteins and incorporation into intracellular lipids

Docosahexaenoic acid (DHA) inhibited the DNA synthesis in Ehrlich ascites tumor cells more markedly than eicosapentaenoic acid (EPA), which was more inhibitory than oleic-, linoleic-, linolenic-, and arachidonic acids. Their activities augmented according to the increase of number of double bonds in the molecule. To correlate the cytotoxicity with lipid syntheses in the cells, distribution of EPA and DHA incorporated into cellular lipids was assessed. EPA was incorporated into triglycerides (TG) and DHA into phosphatidylcholine (PC). These synthesis into TG and PC etc., which shattered from cytotoxicity, may be involved in tumor-cellular protecting actions against EPA or DHA. EPA and DHA involved in cytotoxicity exhibition are their free acid forms. Thus, as an anticancer reaction, intracellular accumulation in the free acid form of DHA was more marked than that of EPA.

Balloon-occluded arterial infusion chemotherapy, simple total hysterectomy, and radiotherapy as a useful combination-therapy for advanced cancer of the uterine cervix

We first performed 3 or 4 courses of balloon-occluded arterial infusion (BOAI) chemotherapy in 19 patients with advanced cancer of uterine cervix classified as stage III-IV according to the International Federation of Gynecology and Obstetrics. In the patients in whom the first BOAI resulted in insufficient drug accumulation in tumor tissue, the ovarian arteries and veins were ligated to improve the therapeutic effect. Ultimately simple total hysterectomy and radiotherapy were performed in 9 patients in whom the uterus was resectable (the combination group), and radiotherapy alone was conducted in the other 10 patients in whom hysterectomy was not practicable (the incomplete group). The survival rates were significantly higher in the combination group (2-year survival 88. 9%; 5-year survival 66.7%) than in the incomplete group (p=0.0013).

Auranofin inhibits interleukin-1beta-induced transcript of cyclooxygenase-2 on cultured human synoviocytes

The aim of this study was to characterize the effects of auranofin (2,3,4,6-tetra-O-acetyl-l-thio-beta-D-gluco-pyranosato-S) on cyclooxygenase expression and prostaglandin E(2) synthesis on cultured human synovial fibroblast-like cells (synoviocytes). Synoviocytes were treated with auranofin in the presence or absence of interleukin-1beta. Cultured supernatants were harvested for prostaglandin E(2) synthesis. Cyclooxygenase-1 and -2 expression was analyzed with Western and Northern blotting. Translocation of nuclear factor-kappa B p65 was determined by immunostaining. Cytotoxicity was measured with 51Cr release assay. Auranofin attenuated interleukin-1beta-induced prostaglandin E(2) production of the cells in a dose-dependent fashion. Auranofin selectively suppressed interleukin-1beta-induced cyclooxygenase-2 mRNA and protein expression of the cells without alteration of cyclooxygenase-1 expression. Also, auranofin interfered with interleukin-1beta-induced translocation of nuclear factor-kappa B. These inhibitory effects did not originate in the cytotoxicity of the agent. Our data indicate that auranofin inhibits interleukin-1beta-induced prostaglandin E(2) synthesis and cyclooxygenase-2 expression via suppression of nuclear factor-kappa B activation on synoviocytes.

Occurrence of D-amino acids in a few archaea and dehydrogenase activities in hyperthermophile Pyrobaculum islandicum

The contents of D-enantiomers of serine, alanine, proline, glutamate (glutamine) and aspartate (asparagine) were examined in the membrane fractions, soluble proteins and free amino acids from some species of archaea, Pyrobaculum islandicum, Methanosarcina barkeri and Halobacterium salinarium. Around 2% (D/D+L) of D-aspartate was found in the membrane fractions. In the soluble proteins, the D-amino acid content was higher in P. islandicum than that in the other archaeal cells: the concentrations in P. islandicum were 3 and 4% for D-serine and D-aspartate, respectively. High concentrations of free D-amino acids were found in P. islandicum and H. salinarium; the concentrations of D-serine (12-13%), D-aspartate (4-7%) and D-proline (3-4%) were higher than those of D-alanine and D-glutamate. This result showed a resemblance between these archaea and not bacterial, but eukaryotic cells. The presence of D-amino acids was confirmed by their digestion with D-amino acid oxidase and D-aspartate oxidase. The occurrence of D-amino acids was also confirmed by the presence of activities catalyzing catabolism of D-amino acids in the P. islandicum homogenate, as measured by 2-oxo acid formation. The catalytic activities oxidizing D-alanine, D-aspartate and D-serine at 90 degrees C were considerably high. Under anaerobic conditions, dehydrogenase activities of the homogenate were 69, 84 and 30% of the above oxidase activities toward D-alanine, D-aspartate and D-serine, respectively. Comparable or higher dehydrogenase activities were also detected with these D-amino acids as substrate by the reduction of 2, 6-dichlorophenolindophenol. No D-amino acid oxidase activity was detected in the homogenates of M. barkeri and H. salinarium.

A multimedia intervention on cardiopulmonary resuscitation and advance directives

OBJECTIVE

To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans.

DESIGN

Prospective randomized controlled, single blind study of educational interventions.

SETTING

General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC).

PARTICIPANTS

One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions.

INTERVENTION

The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs.

MEASUREMENTS AND MAIN RESULTS

Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p <.001) and this effect, although diminished, persisted in the follow-up questionnaire (OR = 3.92, p =. 003). Prior to any intervention, 15% of subjects correctly estimated the likelihood of survival after CPR. This improved after the intervention in the experimental group (OR = 4.27, p =.004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS).

CONCLUSION

We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.

Abnormal cell morphology and cytotoxic effect are induced by 6-0-palmitol-ascorbate-2-0-phosphate, but not by ascorbic acid or hyperthermia alone

A new derivative of ascorbic acid (AsA), 6-0-palmitoyl-ascorbate 2-0-phosphate (Asc2P6Pal) was developed to enhance the antitumor activity of AsA. When Ehrlich ascites tumor cells were treated with 50 microM Asc2P6Pal at 37 degrees C or 42 degrees C for 1 h and then cultured for 20 h, most of cells exhibited some morphological abnormalities, including exudation of intracellular granules together with other contents on the cell membrane surface, resulting in cell fragmentation. The abnormal features were further enhanced by a long term culture for 96 h and heat treatment at 42 degrees C. In contrast, no abnormality was detected for untreated cells or cells treated with AsA (free acid) at 37 degrees C or 42 degrees C. Cells cultured for 96 h after the treatment suffered from inhibition of DNA synthesis and proliferation. This inhibition was markedly enhanced by combination with the hyperthermic treatment at 42 degrees C, but not for a short-term culture of 20 h after the treatment. No effects were seen upon similar treatment with AsA. The abnormal cells produced during culture for 20 h after the treatment were evaluated to be viable, because they failed to be stained with trypan blue and retained most of the DNA synthesizing ability of Asc2P6Pal-untreated cells. However, they appeared and died after a continuous 76 h of culture (96 h).

Intracranial papillary endothelial hyperplasia: occurrence of a case after surgery and radiosurgery

Papillary endothelial hyperplasia (PEH) is considered a form of endothelial proliferation rather than a true neoplasm and is usually located in the skin or subcutis. We report a case of intracranial PEH that occurred after surgery for glioma and subsequent radiosurgery. CT and MR revealed an enhancing extra-axial mass located left posterolateral to the brainstem. Intracranial PEH is rare; to our knowledge, development of an intracranial PEH after surgery and radiosurgery has not been previously reported.

Low-dose succinylcholine facilitates laryngeal mask airway insertion during thiopental anaesthesia

We have assessed the optimal dose of succinylcholine to provide satisfactory conditions for insertion of a laryngeal mask airway (LMA) without causing myalgia during induction of anaesthesia with thiopental. We studied 60 adult patients, allocated randomly to one of three groups: group 1 (n = 20) received normal saline, group 2 (n = 20) received succinylcholine 0.25 mg kg-1 and group 3 (n = 20) received succinylcholine 0.5 mg kg-1. Insertion of the LMA was performed 1 min after administration of succinylcholine or saline. Insertion conditions were significantly better in group 3 compared with groups 1 and 2. The incidence of adverse responses on insertion was significantly higher in groups 1 and 2 than in group 3. Four of 20 patients (20%) in group 3 complained of myalgia, which was higher than that in group 1 (0%) and group 2 (10%), but there were no significant differences between groups on the day of operation. On day 3 after operation, seven patients (35%) in group 3 complained of myalgia, which was significantly higher than that in group 1 (5%) and group 2 (20%). Time from administration of succinylcholine to resumption of spontaneous respiration was significantly longer in groups 2 (194.9 (SD 50.4) s) and 3 (234.2 (34.3) s) than in group 1 (84.7 (32.4) s). There was also a significant difference between groups 3 and 2 for duration of apnoea.

Thallium and FDG uptake by atelectasis with bronchogenic carcinoma

We report a case of bronchogenic carcinoma with atelectasis studied by T1-SPECT and FDG-PET. In the carcinoma, abnormally high uptake of T1 and FDG were detected, but in the region of atelectasis, an abnormally high uptake of T1 with a relatively low uptake of FDG were observed. On quantitative analyses, the T1 retention indexes of the tumor and atelectasis were 29.7 and 42.0. The mean SUVs of FDG of the tumor and the atelectasis were 8.92 and 1.28. T1-SPECT could not distinguish the atelectasis from the carcinoma. FDG-PET was superior to T1-SPECT in this case in detecting malignancy and distinguishing it from atelectasis.

Two cases of chronic tonsillitis studied by FDG-PET

We report two cases of chronic tonsillitis studied by FDG-PET. Symmetrical high FDG uptake by the tonsils was observed in both cases. On histopathologic examination of the resected tonsils, follicular hyperplasia was observed with proliferation of lymphocytes in the germinal centers. Increased glucose metabolism in active inflammation involving lymphocyte proliferation was thought to be a cause of high FDG uptake by tonsils in chronic tonsillitis.

[Blood flow velocity in the central retinal artery of exotoxin-induced uveitis in rabbits]

PURPOSE

Exotoxin-induced uveitis in rabbit eyes was established by intravitreal inoculation of staphylococcal enterotoxin B (SEB). Association between findings of pulsed Doppler assessments and histological features were evaluated.

MATERIAL AND METHODS

Eyes of rabbits were unilaterally inoculated with 50 ng/kg of intravitreal SEB. Pupil diameter, blood flow velocity in the central retinal artery in both eyes and heart rate were measured using an ultrasonic diagnostic apparatus after inoculation.

RESULTS

The pupil diameter and the mean blood flow velocity in central retinal arteries decreased and reached a trough 3-5 hours after the inoculation, then increased. Pulsatility index showed reciprocal fluctuations. Histological features at the early phase after inoculation revealed lymphocytic, plasmacytic, and polynuclear leukocytic infiltrations around the anterior chamber, limbal conjunctivae, ciliary body, and nerve fiber layer of the retina, followed by recovery after about 5 days. At the late phase, recurrent inflammations in the ciliary body and intravitreal space were observed in addition to invasion into the rod and cone layer.

CONCLUSION

Early and late phase uveitis was established by intravitreal SEB. It is considered that the uveitis may be caused by two different regulatory mechanisms.

Intraspinal extradural cysts communicating with adjacent herniated disks: imaging characteristics and possible pathogenesis

We report two cases of intraspinal extradural cysts communicating with an adjacent herniated disk that we term "disk cysts." These cysts were well defined and homogeneous, and were present in the ventrolateral extradural space adjacent to a lumbar herniated disk. They had rim enhancement on contrast-enhanced MR images, and communication with a herniated disk was revealed by diskography.

The effect of cyclic AMP on expression of the major immediate-early genes and replication of human cytomegalovirus in human central nervous system cell lines

The effect of dibutyryl cyclic AMP (dbcAMP) on interaction of human cytomegalovirus (HCMV) with human central nervous system cell lines was examined. Activation of the major immediate-early (IE) promoter (MIEP) of HCMV by dbcAMP was observed in human neuroblastoma IMR-32 cells, but not in glioma 118MGC and astrocytoma U373-MG cells. The 19 bp repeat element in the enhancer of the MIEP was most likely to be the cis-element that responded to dbcAMP in IMR-32 cells as we expected. In IMR-32 cells activation of the MIEP led to enhanced synthesis of the major IE proteins and infectious HCMV.

Ultrasonographic evaluation of portal blood flow using transhepatic carbon dioxide injection

BACKGROUND/AIMS

The evaluation of portal blood flow in hepatic mass is important for the diagnosis of hepatocellular carcinoma. We have designed a new method to easily evaluate portal blood flow in hepatic mass using ultrasonography with injection of carbon dioxide into the intrahepatic portal vein by direct puncture with a fine needle.

METHODOLOGY

We evaluated 29 masses in the liver of 20 patients ultrasonically with injection of carbon dioxide into the intrahepatic portal vein.

RESULTS

Of 29 space-occupying lesions (SOLs), 13 were found to have portal blood flow and 16 were found to have no portal flow by this method. All 15 SOLs which had no portal flow were histologically confirmed to be hepatocellular carcinoma. Of 13 SOLs with portal flow, 5 were confirmed to be hepatocellular carcinoma. For 7 of 9 SOLs in which both this method and arterial portographic computed tomography were performed, the results were in agreement.

CONCLUSIONS

Ultrasonographic evaluation of portal blood flow using transhepatic carbon dioxide injection appears to be useful for the evaluation of portal flow in mass and may aid in the diagnosis and management of mass in patients with liver disease.

The effect of head posture on direction and stability of mandibular closing movement

This study investigated the effects of head posture on mandibular habitual closing movement. Ten healthy subjects were examined. Head posture was evaluated as a sagittally viewed inclination of the head, and was changed from 25 degrees forward bending up to 30 degrees backward bending in 5 degrees increments. The mandibular opening and closing movement was measured at each head posture. As the head bended forward, the closing path approached the maximum intercuspal position from the anterior region, and as the head was bent backward, the closing path approached the maximum intercuspal position from the posterior region. However, the limit of this relationship was found when the head was bent forward to some extent. There was also a correlation between the head posture and the stability of the closing movement. The forward bending of the head decreased the stability of the closing path, and conversely, the backward bending increased the stability of the closing path. It was concluded that the head posture affects the direction and stability of the mandibular closing movement. Possible underlying reasons for these findings are masticatory muscle activity and the tension and resistance of inframandibular soft tissue varying with the change of head posture.