Inactivation of p16/CDKN2 and p15/MTS2 genes in different histological types and clinical stages of primary ovarian tumors

To define the involvement of p16/CDKN2 and p15/MTS2 inactivation in ovarian tumorigenesis and the association of these inactivation events with histological types and clinical stages of ovarian tumors, we analyzed homozygous deletion and somatic mutation of p16/CDKN2 and p15/MTS2 genes, as well as hypermethylation of the 5'-CpG island of the p16/CDKN2 gene, in 49 primary ovarian tumors and 6 ovarian carcinoma cell lines. We found homozygous deletions of p16/CDKN2 and p15/MTS2 in 6 (12%) and 5 (10%) primary tumors, respectively. Somatic mutation of p16/CDKN2 was found in only 1 primary tumor, but mutation of p15/MTS2 was not detected in any sample. None of the 28 primary tumors or 6 cell lines was hypermethylated at the 5'-CpG island of p16/CDKN2. The incidence of inactivation of p16/CDKN2 in primary tumors was significantly higher in the advanced stages (7 of 29) than in the early stages (0 of 14). Seven of 9 alterations in p16/CDKN2 and p15/MTS2 were observed in serous (3 of 12), endometrioid (3 of 9) and clear-cell (1 of 4) carcinomas. However, only normal sequences of these genes were detected in mucinous carcinomas. Loss of heterozygosity (LOH) at the IFNA locus was detected in 1 of 19 (5%) tumors, but no change at the D9S171 locus was observed in 17 tumors. These results suggest that: (i) homozygous deletion is the main mechanism of inactivation of p16/CDKN2 and p15/MTS2 in ovarian tumorigenesis; (ii) inactivation of p16/CDKN2 and p15/MTS2 may be the histological type-specific events involved in ovarian tumorigenesis; and (iii) inactivation of p16/CDKN2 is potentially involved in the progression of ovarian tumors in advanced stages.

[Evidence for association between renal cell carcinomas and renal cystic diseases: nationwide survey in Japan]

OBJECTIVE

A scanty evidence previously reported regarding renal cell carcinomas occurring in association with renal cystic diseases prompted us to conduct a nationwide survey in July 1991.

METHODS

A total of 507 hospitals responded to the questionnaire inquiring the clinical and pathological characteristics of renal cell carcinoma associated with renal cystic diseases over the previous 2 years.

RESULTS

Renal cystic diseases were identified in 223 (3.9%) of 5,721 patients with renal cell carcinoma. The patients consisted of 181 men and 42 women who had a mean age of 55.2 +/- 12.5 years (SD). The renal cystic diseases comprised simple renal cysts in 72 patients (32%), acquired cystic diseases of the kidney (ACDK) in 62 (28%), cystic renal cell carcinoma in 56 (25%), multilocular renal cysts in 20 (9%), polycystic kidney in 3 (1.3%), miscellaneous cysts in 9 (4.0%), and unspecified cysts in 1 (0.4%). Simple renal cysts were more common in older patients, while ACDK and multilocular cysts were more predominant in younger patients. They included 71 dialysis patients (32%), of whom 62 (87%) had ACDK. Renal cell carcinoma occurred bilaterally in 12 patients (17%) on dialysis. Young male patients over a longer dialysis period were more susceptible to renal cell carcinoma. Low stage tumor, papillary type and granular cell subtype were more common in those on dialysis than in those without dialysis. In consideration of the Japanese general and dialysis population, we confirmed that dialysis patients with ACDK are more susceptible to renal cell carcinoma and those with polycystic kidney are less so.

CONCLUSION

Renal cystic diseases may be associated with about 4% of renal carcinoma. Young male patients over a longer dialysis period who are diagnosed to have renal cysts should be regularly and closely followed by imaging study.

Cross-linking of intercellular adhesion molecule 1 (CD54) induces AP-1 activation and IL-1beta transcription

Leukocytes adhere to target cells through their integrins and play a crucial role in self-defense, inflammation, and differentiation. Intercellular adhesion molecule-1 (ICAM-1; CD54) is a representative ligand for integrins and is expressed on many cell types, some of which are targets for leukocyte adhesion. Recent studies suggest that adhesion molecules function not only as a cellular glue, but also as a signal transducer. However, it remains to be clearly defined whether engagement of ICAM-1 is able to induce activation signals in target cells. In rheumatoid synovium, synovial cells are known to express abundant ICAM-1 and produce multiple inflammatory cytokines, such as IL-1beta. In this study, we provide the first evidence that ICAM-1 engagement induces activation of the transcription factor AP-1 and transcription of the IL-1beta gene using a specific Ab to cross-link ICAM-1 on a rheumatoid synovial cell line (E11 cells). This evidence includes ICAM-1 cross-linking-dependent induction of 1) in situ IL-1beta transcription and protein synthesis, 2) transiently transfected chloramphenicol acetyltransferase (CAT) reporter plasmids containing both the IL-1beta LPS-responsive enhancer (between -3134 and -2729) as well as multiple copies of an AP-1 site from this enhancer (between -3117 and -3111), and 3) the binding of a Jun/Fos family complex to this AP-1 site. Thus, ICAM-1 not only functions as a glue for integrin binding, but also as a transducer for AP-1 activation signals important for IL-1beta gene transcription.

Cross-linking of intercellular adhesion molecule 1 (CD54) induces AP-1 activation and IL-1beta transcription

Leukocytes adhere to target cells through their integrins and play a crucial role in self-defense, inflammation, and differentiation. Intercellular adhesion molecule-1 (ICAM-1; CD54) is a representative ligand for integrins and is expressed on many cell types, some of which are targets for leukocyte adhesion. Recent studies suggest that adhesion molecules function not only as a cellular glue, but also as a signal transducer. However, it remains to be clearly defined whether engagement of ICAM-1 is able to induce activation signals in target cells. In rheumatoid synovium, synovial cells are known to express abundant ICAM-1 and produce multiple inflammatory cytokines, such as IL-1beta. In this study, we provide the first evidence that ICAM-1 engagement induces activation of the transcription factor AP-1 and transcription of the IL-1beta gene using a specific Ab to cross-link ICAM-1 on a rheumatoid synovial cell line (E11 cells). This evidence includes ICAM-1 cross-linking-dependent induction of 1) in situ IL-1beta transcription and protein synthesis, 2) transiently transfected chloramphenicol acetyltransferase (CAT) reporter plasmids containing both the IL-1beta LPS-responsive enhancer (between -3134 and -2729) as well as multiple copies of an AP-1 site from this enhancer (between -3117 and -3111), and 3) the binding of a Jun/Fos family complex to this AP-1 site. Thus, ICAM-1 not only functions as a glue for integrin binding, but also as a transducer for AP-1 activation signals important for IL-1beta gene transcription.

Construction of biotinylated firefly luciferases using biotin acceptor peptides

A cDNA for a thermostable mutant of Luciola lateralis (a Japanese firefly) luciferase was fused with either a gene for an artificial biotin acceptor peptide No. 84 [P. J. Schatz (1993) Bio/Technology 11, 1138-1143] or a gene for the carboxyl-terminal 87 residues of Escherichia coli biotin carboxyl carrier protein. The fused genes, when introduced into separate E. coli, directed the expression of luciferases that were able to bind with streptavidin. We purified them and showed that their specific activities and thermal stabilities remained unchanged. We also found that more than 95% of each fusion protein was biotinylated, suggesting that the biotin holoenzyme synthetase in the host cells worked efficiently. Using the biotinylated luciferases, we developed a highly sensitive bioluminescent enzyme immunoassay system.

Cloning and expression of pyranose oxidase cDNA from Coriolus versicolor in Escherichia coli

Complementary DNA encoding pyranose oxidase (PROD) was cloned and sequenced for the first time from Coriolus versicolor. The nucleotide sequence revealed an open reading frame encoding a polypeptide composed of 623 amino acid residues. Compared with the experimentally determined N-terminal sequence of the PROD from C. versicolor. 38 amino acids from the N-terminus of the protein appeared to be eliminated during protein maturation. The cDNA was successfully expressed under the control of lacUV5 promoter in Escherichia coli at 25 degrees C, which will be beneficial in industrial production.

Nucleotide sequence of the Escherichia coli solA gene encoding a sarcosine oxidase-like protein and characterization of its product

An Escherichia coli gene, designated solA, was identified between pyrC and htrB around 24.2 min of the genetic map. The solA gene product (SolA, 372 aa) shows strong similarities (at most 42% identities over the entire length) to monomeric sarcosine (N-methylglycine) oxidases from other bacteria. However, only low levels of sarcosine oxidase activity were detected, even when SolA was overproduced. The SolA extracts exhibited much higher (about 200-fold) reactivity toward N-methyltryptophan than toward sarcosine. Thus, SolA appears to have a substrate specificity distinct from that of monomeric sarcosine oxidases, in spite of the strong similarities in the primary structure with such enzymes.

Are there cholinergic and non-cholinergic paradoxical sleep-on neurones in the pons?

Using microiontophoresis on unanesthetized head-restrained cats, we have found two distinct groups of neurones exhibiting tonic discharge specific to paradoxical sleep (PS) (PS-on neurones) in the mesopontine tegmentum, which contains both cholinergic and non-cholinergic neurones. One group is characterized by a broad action potential, slow conduction velocity and an inhibitory response to a potent cholinergic agonist, carbachol, applied iontophoretically during PS. The other is characterized by a short action potential, fast conduction velocity and an excitatory response to applied carbachol. All PS-on neurones were excited by glutamate. The present findings demonstrate the existence of two types of PS-on neurones and suggest their cholinergic and noncholinergic neurochemical properties.

Identification of macrophage migration inhibitory factor in human leukemia HL-60 cells and its induction by lipopolysaccharide

Cytokines play an important role in inflammation and immunity. In this study, we examined the expression and presence of human macrophage migration inhibitory factor (MIF) in human myelomonocytic leukemia cell line, HL-60 by reverse transcription-polymerase chain reaction (RT-PCR) and immunological methods (Western blot analysis and immunohistochemistry), respectively. The RT-PCR showed that MIF mRNA was constitutively expressed, and the expression was further induced by lipopolysaccharide (LPS) stimulation. The expression was upregulated by LPS at the range of 10 pg/ml to 10 ng/ml; however, it decreased at doses higher than 100 ng/ml. The expression reached the maximum 12 hr after the stimulation, but substantially decreased by 24 hr. Western blot analysis and immunohistochemistry using an anti-human MIF antibody revealed the presence of MIF protein in cytoplasm of the cells. The pathophysiological role of MIF in HL-60 cells has not been fully understood; however, the regulation of MIF mRNA expression by LPS suggests the possibility that the cytokine plays an important role in inflammatory events of leukemia.

Demonstration of noradrenaline-immunoreactive nerve fibres in the liver

To demonstrate noradrenaline-immunoreactive nerve fibres in liver tissues, we used an antibody to noradrenaline in the immunostaining of liver tissues from rats, guinea-pigs and humans. The tissue specimens were fixed by perfusion or immersion with cacodylate buffer containing sodium metabisulphate and glutaraldehyde, and cryostat sections were prepared. An indirect peroxidase-labelled antibody method was used for staining noradrenaline. Noradrenaline-immunoreactive nerve fibres were localized around blood vessels in the portal area and around the central vein. There were differences between the species in the intralobular distribution of noradrenaline-immunoreactive fibres. Normal guinea-pig and human liver showed intralobular noradrenaline-immunoreactive fibres while rat liver did not. Noradrenaline-immunoreactive fibres were absent from regenerating nodules in a human cirrhotic liver. This method of demonstrating noradrenaline directly using perfusion- or immersion-fixation is appropriate for studying innervation in normal and damaged livers of various species including humans.

Cloning, sequence analysis, and expression in Escherichia coli of the gene encoding the Candida utilis urate oxidase (uricase)

A urate oxidase (uricase) gene was cloned from Candida utilis with an oligonucleotide probe based on the amino acid sequence of cyanogen bromide-cleaved uricase. The uricase gene contains 909 base pairs and encodes a protein with a predicted mass of 34,193 Da. Candida uricase was similar (49% match in amino acid sequence) to the uricase from Aspergillus flavus. The uricase from Candida utilis has four cysteines and one of them, Cys168, participates in the enzyme activity. This enzyme was expressed to a level of about 20% of total cellular protein in an Escherichia coli cell as a soluble and functional form.

[Brain monitoring with near infrared spectroscopy during carotid endarterectomy]

We evaluated clinical efficacy of near infrared spectroscopy (NIR) as a monitoring system for cerebral oxygenation during anesthesia for carotid artery endarterectomy. NIR proved to be affected significantly by clamping of the external carotid artery. The present study suggests that this monitoring system may be useful for evaluation of cerebral blood flow following declamping of the internal carotid artery, although it has some limitations during clamping of the artery.

A community-based evaluation of the effect of renal transplantation on survival in patients with renal-replacement therapy

The relative effect of renal transplantation on survival was examined in chronic dialysis patients in Okinawa, Japan. Of 3,035 patients (1,722 men and 1,313 women) who were registered by the end of 1994 and followed up until April 1, 1995, 141 (91 men and 50 women) had undergone a renal transplantation during the follow-up period. The type of donor was a cadaver in 38 (26.9%) and a living relative in 103 (73.1%). At the end of the follow-up period, 12 (8.5%) of the patients with a renal transplant had died, 35 (24.8%) had returned to dialysis treatment, and 94 (66.7%) were alive with a functioning graft. In the patients who did not receive a transplant, 1,134 (39.2%) had died and 1,760 (60.8%) were alive and on dialysis. Cox proportional hazard analysis was performed with adjustment for sex, age at first dialysis, presence of diabetes mellitus, year of first dialysis, and predialysis co-morbid conditions. The hazard ratio (95% confidence interval) in the group with a transplant was 0.33 (0.18 to 0.59) when the hazard ratio of the group without a transplant was taken as 1.00. The patient survival rate was better in the former group. Our data provide fundamental evidence supporting the effectiveness of renal replacement as treatment. Whether the life-saving merit of renal transplantation is substantial enough to actively encourage donation remains to be clarified.

Inhibitory effect of acetylshikonin on the activation of NADPH oxidase in polymorphonuclear leukocytes in both whole cell and cell-free systems

The effects of acetylshikonin (AS) on the activation of NADPH oxidase (EC 1.6.99.6) in guinea pig polymorphonuclear leukocytes (PMNs) in both whole cell and cell-free activation systems were investigated. When PMNs were treated with AS before exposure to phorbol myristate acetate (PMA), superoxide (O2-) generation in these cells was significantly reduced, but after exposure of PMNs to PMA, inhibition of O2- generation by AS did not occur. Thiol compounds completely abolished the inhibitory effect of AS on the O2- generating activity of PMNs. In the cell-free system, AS inhibited the activation of NADPH oxidase induced by myristate in a combination of cytosol and membrane fractions obtained from intact PMNs, but did not inhibit the activity of NADPH oxidase already induced. These results suggest that AS inhibits the generation of NADPH oxidase complex in the activation of respiratory burst of PMNs, but does not directly inhibit the activity of NADPH oxidase already generated.

Case report: multiple systemic lymph node metastases from a small hepatocellular carcinoma

Extrahepatic lymph node metastases from hepatocellular carcinoma (HCC) are usually observed in patients with advanced and poorly differentiated HCC. We encountered a patient with multiple, systemic lymph node metastases from a small HCC (18 mm in diameter), which was nodular and had a capsule at the time of resection (a partial hepatectomy of the postero-inferior subsegment of the right lobe of the liver). Widespread lymphadenopathy resembling malignant lymphoma developed 2 months after surgery. A biopsy specimen from a supraclavicular lymph node revealed metastatic HCC. The patient died 2.5 months after the detection of the lymphadenopathy. Lymph node metastases can occur in small HCC less than 2 cm in diameter and may adversely affect the long-term prognosis of patients with these curatively resectable small HCC.

Mechanisms of unilateral spatial neglect in copying a single object

The present study examined 13 patients with typical left unilateral spatial neglect to explore the mechanisms of neglect in copying a single object. All patients identified the figure of a sunflower as a flower that had petals all around the central circle. Besides, in the free viewing of the flowers prepared by the examiner, 10 of the 13 patients could discriminate between the presence and absence of the left-sided petals. When copying the flower, however, they always left the left side unfinished without noticing the incompleteness. Whether perception in the left visual field was impaired or not was irrelevant to the performances in the copying and the free viewing of the flowers. We consider the mechanism of left unilateral spatial neglect in copying a flower as follows. Small leftward shift of attention may take place during the free observation of the stimulus flower. While copying, however, neglect patients pay attention exclusively to the right-sided petals they are drawing. The strong engagement of attention to the right side results in the lack of discovery of the left-sided omission. The close integration of attentional and premotor mechanisms seems to be crucial for the appearance of unilateral spatial neglect in copying a single object.

Demonstration of antigenic and genotypic variation in Orientia tsutsugamushi which were isolated in Japan, and their classification into type and subtype

A total of 40 strains of Orientia tsutsugamushi (34 isolates from patients and trombiculid mites in Japan, and 6 prototype strains of antigenic variants) were examined for classification based on the reactivities with type-specific monoclonal antibodies in indirect immunofluorescence tests, and on the restriction fragment length polymorphism of a polymerase chain reaction (PCR)-amplified 56-kilodalton type-specific antigenic protein gene. By these methods, several antigenic and genotypic variants were found among the strains, and these variants were classified into types and further into subtypes. These results suggest that there are many variants in O. tsutsugamushi, and the methods used here seem to be useful for the systematic classification of the numerous variants. A strain which may be a new type distinguishable from those identified previously was also found in this study. Furthermore, variety in the degree of pathogenicity in mice related to type and/or subtype classification were observed.

15-Cis-β-carotene found in the reaction center of spinach Photosystem I

β-Carotene was extracted from spinach Photosystem I reaction centers (one consisting of the Psa A, B, C, D and E subunits and the other consisting of the Psa A and B subunits alone), and the extract was subjected to high-pressure liquid chromatography using an apparatus equipped with a two-dimensional diode-array detector; all the procedures were performed at ≈ 4 °C in complete darkness. Both 15-cis and all-trans-β-carotene were identified in the extract by means of electronic absorption spectroscopy. Thus, universal presence of 15-cis carotenoid in the reaction centers of purple photosynthetic bacteria and of spinach Photosystem I and Photosystem II has been shown.

[The spread of contrast medium in the epidural space and the analgesic area in epidural anesthesia in elderly patients]

We evaluated the relationship between the spread of contrast medium in epidural space and the analgesia area in epidural anesthesia in elderly patients. The spread of contrast medium was examined radiographically after the injection of iotrolan 5 ml through the epidural catheter and the analgesia area was examined by pin prick following the epidural injection of the same volume of 1% lidocaine. In lumbar group (group L) (n = 10), the radiographic spread was 10.4 (4-17) segments (mean, minimum-maximum) and the analgesic area was 8.5 (4-15) dermatomes. In cervical or thoracic group (group C/T) (n = 10), the radiographic spread was 12.4 (8-17) segments and the analgesic area was 10.4 (6-15) dermatomes. The dose of local anesthetics required to get analgesia per. one dermatome was 0.7 (0.3-1.3) ml in group L and 0.5 (0.3-0.8) ml in group C/T. The spread of contrast medium correlated well with the analgesic area in both groups (group L:Y = 0.79X + 0.31, r = 0.92, group C/ T:Y = 0.80X + 0.52, r = 0.79). The mean dose of local anesthetics required for analgesia was smaller than that of previous reports although individual variations were large. We conclude that the spread of contrast medium is useful for predicting the spread of epidural block.

Differential expression of tenascin in the skin during hapten-induced dermatitis

Tenascin is a large extracellular matrix glycoprotein which is found in limited regions of normal adult tissues including the skin. We investigated the induction of tenascin expression in mouse skin during hapten-induced dermatitis. In the dorsal skin, hapten application first induced a transient expression of tenascin in deeper regions of the skin. Its distribution then spread over the whole dermis corresponding to the infiltration of Mac-2-positive macrophages. In the ear, tenascin was consistently found in the subcutaneous tissue on the inner side, but very little was seen on the outer side. Tenascin did appear transiently, however, on both sides under hapten treatment. In the early phase of allergic contact dermatitis, no apparent induction of tenascin expression was observed in the swollen ear. However, there was an abundant tenascin expression on both sides during healing. Tenascin expressed under normal conditions was mostly the 180-kDa isoform, while the 230-kDa isoform was markedly induced during healing of the dermatitis. These results suggest that tenascin, particularly the larger 230-kDa isoform, may play important roles in the pathogenesis and healing of hapten-induced dermatitis.

Nucleotide sequence diversity of hypervariable region 1 of hepatitis C virus in Japanese hemophiliacs with chronic hepatitis C and patients with chronic posttransfusion hepatitis C

Hemophiliac patients with chronic hepatitis C might be exposed to and become infected with multiple hepatitis C virus (HCV) strains by means of frequent use of blood products, even if they are infected with a single subtype of HCV. To test this hypothesis, we analyzed the genetic diversity of hypervariable region 1 (HVR1) of HCV in chronically infected hemophiliacs and in patients with chronic posttransfusion hepatitis with a single HCV inoculation. The diversity of nucleotide sequences in HVR1 of serum HCV RNA was compared between 21 hemophiliacs infected with a single HCV subtype and 16 patients with posttransfusion HCV infection. The number of HCV quasispecies was determined by fluorescence single-strand conformation polymorphism (SSCP) analysis. Direct sequencing was performed to determine the diversity in HVR1. The number of HCV quasispecies in the blood was 5.2 +/- 2.0 clones in hemophiliacs and 4.0 +/- 2.3 clones in posttransfusion patients, a nonsignificant difference (P = .0943). The number of sites at which the nucleotide was not homogenous in all quasispecies was significantly higher in hemophiliacs (13.0% +/- 7.4%) than in posttransfusion hepatitis patients (2.7% +/- 2.8%; P < .0001). In conclusion, there was a high degree of genetic variation in HVR1 of HCV specimens isolated from hemophiliacs compared with posttransfusion patients. These findings indicate the possibility that multiple infections of a single HCV subtype may occur among patients frequently exposed to blood products; single HCV subtypes may therefore derive from multiple origins.

Prognostic factors for patients with colon or rectal carcinoma treated with resection only. Five-year follow-up report

BACKGROUND

The prognostic factors and natural history of recurrence in patients with colorectal carcinoma who underwent curative resection and no other therapy were analyzed.

METHODS

The object of analysis was the potentially curative resection only subgroup in the randomized clinical trial (RCT) that we performed. Cox's proportional hazards model was used mainly to analyze recurrence rates during the first 5 years after surgery.

RESULTS

The analysis was performed on a subgroup of the RCT (279 patients with colon carcinoma and 293 patients with rectal carcinoma). Five-year disease free survival rates were 76.3% and 56.5% for colon and rectal carcinomas, respectively. The prognostic factors for recurrence for colon carcinoma patients were different from those with rectal carcinoma. For colon carcinoma, only Dukes stage was significant, whereas for rectal carcinoma, Dukes stage, age, location of the tumor, and serosal and venous invasion by cancer cells were prognostic factors. Log-transformed disease free survival rates were linear in Dukes Stage B and biphasic in Dukes Stage C for both colon and rectal carcinoma. The two phases in Dukes Stage C intersected at 2.85 and 3.04 years, respectively. The annual hazard value was high for the first 3 years in both colon and rectal carcinoma.

CONCLUSIONS

We conclude that follow-up of patients with colorectal carcinoma who undergo potentially curative resection is of particular importance in the first 3 years after surgery. Furthermore, the usefulness of adjuvant chemotherapy can be adequately evaluated from data yielded during this postoperative period.

Prognostic factors of colorectal cancer. Results of multivariate analysis of curative resection cases with or without adjuvant chemotherapy

One thousand two hundred fifty-four cases (610 colonic and 644 rectal cancers resected during 2 years from 1984 and followed up for more than 5 years) were entered from 140 institutions in Japan and analyzed by means of Cox's proportional hazards model. The analyzed pathologic variables were the size and depth of invasion, Dukes' stage, venous invasion, lymphatic permeation, and other clinical features, such as the sex and age of the patient and location of the tumor. The extent of dissection, serum carcinoembryonic antigen (CEA) level, and the presence or absence of adjuvant chemotherapy were also analyzed. Adjuvant chemotherapy consisted of three arms for both colonic and rectal cancers. For colonic cancer, arm I was a combination of i.p. (intraportal) and i.v. mitomycin C (MMC) + p.o. 5-fluorouracil (5-FU); arm II was i.v. MMC + p.o. 5-FU; and arm III was surgery only. For rectal cancer, arm IV was a combination of i.a. (inferior mesenteric artery) and i.v. MMC + p.o. 5-FU; arm V was i.v. MMC + p.o. 5-FU; and arm VI was surgery only. As for the factors affecting the disease-free survival of the patient, multivariate analysis disclosed nodal involvement, venous invasion, an elevated CEA level, and the lower part of the rectum. The effect of adjuvant chemotherapy on the patient's survival was proven for rectal cancer but not for colonic cancer. We conclude that these factors should be considered in setting the stage of tumor pre- and postoperatively.

Appearance and disappearance of unilateral spatial neglect for an object: influence of attention-attracting peripheral stimuli

We reported a dramatic phenomenon of appearance and disappearance of left unilateral spatial neglect for the same single object. In experiment 1, four patients with mild neglect who copied a single flower satisfactorily showed left neglect in copying of the same flower when it was accompanied with some peripheral stimuli. In experiment 2, we included three additional conditions to determine the stimulus component crucial for left neglect of the flower: a flower with a stem and a flower with either right or left peripheral stimuli were also used for copying. Overall results showed that neglect was most evident for the flower with the right peripheral stimuli. On the other hand, the presence of left stimuli provoked less severe neglect of the flower, which was as mild as that in the single flower condition. The results were explained in terms of an attentional mechanism underlying unilateral spatial neglect. When copying the flower with peripheral stimuli on both sides or on the right side, the stimuli on the right side might attract the patient's attention. Consequently, he exhibited left neglect on the central flower. On the other hand, neglect was less evident in the other conditions, since the figures did not include such attention-attracting stimuli on the right side.

[A case of effusive-constrictive pericarditis and its surgical treatment]

A 69-year-old male of effusive-constrictive pericarditis with a symptom of right heart failure was reported. The patient underwent surgery, as the medical treatment had not been effective. Through median spritting, very thickened pericardium and calcified epicardium of the right atrium, the right ventricle and the left ventricle were resected as largely as possible. In the space between the pericardium and epicardium, there existed yellow and thick fluid of about 50 ml which was evacuated. After surgery hemodynamic improvement was observed and the patient experienced a smooth postoperative course. Although pathological examinations revealed no special findings except the increased activity of adenosine deaminase of the yellow and thick fluid, tuberculosis was mostly suspected as the cause of the disease.