Patient with unusual alternating hemiplegia

A patient with unusual alternating hemiplegia in childhood is reported. The frequency of hemiplegic episodes was lower than that in other reported patients. Interictal positron emission tomography revealed decreased cerebral blood flow in the left hemisphere. After cerebral angiography, postanesthetic irritability occurred which evolved into coma with hemiplegic episodes. We believe that cerebral angiography in a child with alternating hemiplegia may cause hemiplegic episodes and coma. The episodes disappeared almost completely for 6 years after treatment with flunarizine, thus indicating the benefit of the medication for the treatment of alternating hemiplegia.

Pneumatosis cystoides intestinalis: CT findings

Two patients with primary pneumatosis cystoides intestinalis are presented. In both cases, the sigmoid colon was involved and there were no major complications. On computed tomography (CT), at lung window settings, the gas cysts in the colonic wall were clearly delineated. CT was useful in confirming the intramural gas cysts in patients with primary pneumatosis cystoides intestinalis.

The complete primary structure of the long form of mouse alpha 1(IX) collagen chain and its expression during limb development

Type IX collagen is a newly discovered collagen molecule that is associated with Type II-containing collagen fibrils in cartilage, vitreous and embryonic cornea. It consists of three distinct chains: alpha 1(IX), alpha 2(IX) and alpha 3(IX). The alpha 1(IX) chain has been to be synthesized in two different forms, which are generated by alternative transcription and splicing. In this manuscript we describe the isolation and sequencing of a cDNA coding for the entire coding region of the long form of mouse alpha 1(IX) chain. Nucleotide sequence analysis of this cDNA determined for the first time the primary structure of the entire long form of the mouse alpha 1(IX) chain. RT-PCR was used to examine collagen gene expression during limb development from day 10 to 18 in mouse embryos. Collagen I and II mRNA levels gradually increased all through the developmental stages. Collagen X expression increased further after day 16 in limb development, whereas the alpha 1(IX)mRNA level dropped at this time. This could be due to active bone formation relative to cartilage synthesis in the embryonic limb bud around day 16 in mouse development.

Fibril formation in the rough endoplasmic reticulum of lymphoma cells. A case report with histopathologic, immunohistochemical, electron and immunoelectron microscopic studies

Signet ring cell lymphoma (SRCL) is a relatively new and infrequently described entity, characterized by an intracytoplasmic mass displacing the nucleus at the periphery. We present here a case of a Japanese female aged 73 with a retroperitoneal mass diagnosed as SRCL at autopsy. The neoplastic lymphoid cells showing signet ring appearance, due to the displacement of the nucleus to one side by intracytoplasmic eosinophilic inclusions, were immunoreactive for LCA, L26 and lambda light chains but PAS-negative. A small number of tumor cell nuclei demonstrated proliferating cell nuclear antigen-positive, but signet ring cells were negative. Ultrastructural study disclosed that fibrillary, lamellar or homogenous materials within rough endoplasmic reticulum of the tumor cells were selectively labeled by gold particles to anti-lambda antibody. A periodicity of 20-25 nm was observed in the fibrillary inclusions arranged haphazardly. The morphologic appearances of the case and the differential diagnosis are preceded by a review of the literature.

Changes in magnetic resonance images in human skeletal muscle after eccentric exercise

To investigate the time-course of changes in transverse relaxation time (T2) and cross-sectional area (CSA) of the quadriceps muscle after a single session of eccentric exercise, magnetic resonance imaging was performed on six healthy male volunteers before and at 0, 7, 15, 20, 30 and 60 min and 12, 24, 36, 48, 72 and 168 h after exercise. Although there was almost no muscle soreness immediately after exercise, it started to increase 1 day after, peaking 1-2 days after the exercise (P < 0.01). Immediately after exercise, T2 increased significantly in the rectus femoris, vastus lateralis and intermedius muscles (P < 0.05) and decreased quickly continuing until 60 min after exercise. At and after the 12th h, a significant increase was perceived again in the T2 values of the vastus lateralis and intermedius muscles (P < 0.01) [maximum 9.3 (SEM 2.8)% and 10.9 (SEM 2.2)%, respectively]. The maximal values were exhibited at 24-36 h after exercise. In contrast, the rectus femoris muscle showed no delayed-stage increase. Also, in CSA, an increase after 12 h was observed in addition to the one immediately after exercise in the vastus lateralis, intermedius and medialis and quadriceps muscles as a whole (P < 0.01), reaching the maximal values at 12-24 h after exercise. The plasma creatine kinase activity remained unchanged up to 24 h after and then increased significantly 48 h after exercise (P < 0.05). Beginning 12 h after exercise, the subjects whose T2 and CSA increased less than the others displayed a faster decrease in muscle soreness.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute change of exercised muscle using magnetization transfer contrast MR imaging

We evaluated the acute changes in exercised muscle using magnetization transfer contrast (MTC) MR imaging with a short repetition time sequence. Ten volunteers performed supine ankle dorsiflexion exercise. MTC gradient-recalled echo (GRE) images were obtained before and after exercise at 1.5 T. The effect of MTC was assessed by dividing the signal intensity on MTC GRE images by that on conventional GRE images (M(s)/M0). The signal intensity, M(s)/M0 and cross-sectional area of exercised muscle were all greater at 1-2 min after exercise than immediately after exercise. We propose that this additional increase in these parameters after exercise was due to physiological reflow or hyperemia. Since the M(s)/M0 showed a good correlation with free water content in exercised muscle, this ratio may provide a quantitative variable for evaluating dynamic change of water-macromolecule interaction in skeletal muscle.

Hemodynamic changes after ligation of a major branch of the portal vein in rats: comparison with rats with portal vein constriction

In chronic portal-hypertensive rat models, such as portal vein constriction or cirrhosis, the portal blood flow that effectively perfuses the hepatocytes is substantially reduced because of anatomical or functional shunts. It is possible therefore that a feedback mechanism from the liver to the splanchnic bed is responsible for the splanchnic hyperemia observed in chronic portal hypertension. To investigate the possible role of such a feedback mechanism, we examined the chronological changes in both portal and systemic hemodynamics in rats after ligation of a major branch of the portal vein that supplies about 80% of the liver circulation. Rats submitted to sham surgery and portal vein-constricted rats were also studied. Blood flow and portal-systemic shunting were measured by radioactive microsphere techniques. For 7 days after portal-branch ligation, transient portal hypertension resulted from an elevated portal resistance. However, no significant changes in portal venous inflow or splanchnic arteriolar resistance were found in the portal branch-ligated rats, whereas in the portal vein-constricted rats significant hyperdynamic changes in these parameters were noted. On the other hand, transient hyperdynamic changes occurred in the systemic circulation during the period from the fourth to the sixth day after portal-branch ligation, similar to those observed in the portal vein-constricted rats. The lack of hyperdynamic changes in the portal territory of the portal branch-ligated rats suggests that the splanchnic hyperemia found in chronic portal-hypertensive states is unlikely to be caused by a feedback mechanism from the ischemic hepatic parenchyma.(ABSTRACT TRUNCATED AT 250 WORDS)

[Operative cases of diverticular disease of the colon: in comparison with colo-rectal cancers]

From January 1986 through December 1992, 9 cases of diverticular disease of the colon have been surgically operated in our department. In 56% of the cases, diverticula were located in the left side, in 33% in the right side, and in 11% in the both sides. 67% cases had a complication of hypertension, 33% cases had hypoproteinemia, and 78% cases had anemia. Moreover, 67% cases had hyperlipidemia. Only one case had a minor leakage in the anastomosis after colectomy, which was cured by intravenous hyperalimentation. These results suggest that such a complication should be taken into consideration in the surgical treatment of diverticular disease of the colon, although the disease is in itself a benign disease.

Identification of a novel collagen chain represented by extensive interruptions in the triple-helical region

We have isolated mouse cDNA clones that encode a newly discovered collagenous polypeptide. Four overlapping cDNA clones contained an open reading frame of 1140 amino acid residues of collagenous and non-collagenous domains. The predicted polypeptide consists of 10 collagenous domains of various length that are interrupted by 11 noncollagenous domains. The overall structural arrangement differed significantly from reported collagen chains of 17 different types. Northern-blot analyses showed hybridization of the cDNA to 5.6kb and 4.8kb mRNA species in liver and kidney that are due to utilization of the two poly (A) signals.

cDNA isolation and partial gene structure of the human alpha 4(IV) collagen chain

A novel collagen IV chain, alpha 4(IV), has recently been identified in basement membranes. We describe part of the primary structure of the human alpha 4(IV) polypeptide for the first time, which has been determined by cloning and sequencing of cDNAs encoding 241 amino acid residues of the COL domain and 231 residues of the NC1 domain. We also characterized a genomic DNA fragment containing 4 exons coding for the entire NC1 domain. Among five known alpha chains of collagen IV, the alpha 4(IV) chain is distinct from the other four chains. However, it is more similar to the alpha 2(IV) chain than to the alpha 1(IV), alpha 3(IV) and alpha 5(IV) chains in terms of amino acid sequence homology, domain structure of polypeptides and exon/intron structure of the genes, suggesting the presence of two phylogenetically distinct subclasses of collagen IV alpha chains; one composed of alpha 2 and alpha 4 chains and the other of alpha 1, alpha 3 and alpha 5 chains.

Characterization of growth and differentiation of normal human submandibular gland epithelial cells in a serum-free medium

Parenchymal tissue of human submandibular glands was cultured in a serum-free medium consisting of a 1:9 mixture of Dulbecco's modified Eagle's medium and MCDB 153 supplemented with 10 ng/ml epidermal growth factor, 10 microM dexamethasone and 1 microgram/ml insulin. Cultivation of the tissue in this medium resulted in propagation of loosely arranged epithelioid cells on plastic, without the necessity of a matrix. Epidermal growth factor significantly enhanced mitogenesis of cultured cells, which expressed specific high- and low-affinity receptors for epidermal growth factor. The epithelioid cells were found to represent the undifferentiated ultrastructure of ductal cells. Immunocytochemically, cultured epithelioid cells expressed antigens specific to basal cells of the intra- and interlobular ducts in situ, including cytokeratins 3 and 6 and cytokeratins 13 and 16, vimentin, and alpha-smooth muscle actin. Moreover, cytoplasm of the cells was immunostained using antibody against the basement membrane component, type IV collagen. These results suggested that cultured epithelioid cells are undifferentiated ductal cells, which have the characteristics of basal cells of the intra- and/or interlobular ducts. Cultured epithelioid cells maintained the characteristics for serial passage until the time that the cultures were confluent. On the other hand, several stratified foci developed on the confluent monolayer. The stratified cells were strongly positive for cytokeratins 3 and 6, but negative for vimentin, alpha-smooth muscle actin and type IV collagen. Moreover, the stratified cells were strongly stained with the antibody against epithelial membrane antigen. This antibody stained the luminal membrane domain of salivary epithelial cells. Electron micrograph of the vertical section through the foci revealed stratified cell layers with a gradual transition from basal cells to squamous epidermoid cells. This result suggests that cultured epithelioid cells, which have the characteristics of basal cells of the intra- and/or interlobular duct, have the potential to differentiate into luminal duct cells.

[Ligature and excision method with diathermy for haemorrhoidectomy: in comparison with conventional method]

The usefulness of ligature and excision method with diathermy (group D) for haemorrhoidectomy was evaluated in comparison with conventional ligature and excision method with scalpel and scissors (group S) from several parameters. Intraoperative bloodloss and hospitalization days in group D were significantly smaller than those in group S. Moreover, post-operative woundal bleeding and edema in group D were significantly smaller than those in group S. As regards post-operative pain, although there were no significant differences between the two groups, the values in group D were slightly improved as compared with group S. These results indicate the usefulness of diathermic method for haemorrhoidectomy because of its better cost-efficacy as compared with conventional method with scalpel and scissors.

Serum cathepsin B levels, urinary excretion of cathepsin B and tissue cathepsin B content in the patients with gastric cancer

Serum cathepsin B levels and urinary excretion of cathepsin B in the patients with gastric cancer were significantly higher than those in the control non-cancer patients. Moreover, cancer tissue cathepsin B content was significantly higher than that in the normal tissue. After radical curative operations for gastric cancers, both serum cathepsin B levels and urinary excretion of cathepsin B were restored to the control values. These results suggest a possible role of lysosomal enzyme, cathepsin B in the pathogenesis of tumor growth, and also suggest that these parameters might be possible indicators for tumor malignancy.

Magnetic resonance imaging-histologic correlation of small hepatocellular carcinomas adenomatous hyperplasias

RATIONALE AND OBJECTIVES

Hepatocellular carcinomas (HCCs) usually consist of components of different histologic grade. Using surgically resected specimens, the authors obtained high-resolution magnetic resonance (MR) images and studied the relationship between histologic grade of HCCs and MR signal intensity.

METHOD

In vitro MRI was performed on 15 small (less than 20-mm diameter) HCCs and 2 patients with adenomatous hyperplasia (AH) within 1 hour of surgical resection. In these 17 lesions, 24 macroscopic nodular components corresponding to MR images were recognized pathologically. The difference in MR signal intensity was examined by using tumor/phantom (T/P) signal-intensity ratio. In addition, the correlations between signal intensity on MRI and histologic criteria for grading HCC were studied.

RESULTS

On T2-weighted images, grade II HCCs had significantly greater T/P values than grade I HCCs (P < .01). There is the correlation (r = .88, P < .001) between nucleocytoplasmic (N/C) ratio and signal intensity of small HCCs and AHs on T2-weighted images.

CONCLUSION

The N/C ratio is an important factor relating the signal intensity to the histologic grade of these lesions on T2-weighted images.

A case of pancreatic cancer with the sign of Leser-Trélat

A case of 79-year-old man with pancreatic cancer associated with the sign of Leser-Trélat was presented. Abdominal CT scanning was performed and a pancreatic tail tumor involving the spleen and the greater omentum as well as ascitic retention were detected. Ba-enema study showed the stenosis of the sigmoid colon, suggesting the peritoneal disseminations. Absolute non-curative operation of side-to-side transverso-sigmoidostomy was performed for colonic stenosis, and biopsy of the disseminated omental tumor was performed, which was histologically diagnosed as well differentiated papillary adenocarcinoma compatible with pancreatic cancer. The postoperative course was uneventful and at present the patient was followed at outpatient clinic. To our knowledge, this case is the first report with pancreatic cancer associated with the sign of Leser-Trélat in Japan.

[Pharmacokinetics and clinical studies on flomoxef in neonates and premature infants. A study of flomoxef in the perinatal collaboration research group]

We investigated pharmacokinetics and clinical effects of flomoxef sodium (6315-S, FMOX) in neonates and premature infants. These results are summarized as follows: 1. Pharmacokinetics (1) Plasma concentration (Ct) and half-lives (T1/2) were determined upon after intravenous one-shot injection (i.v.) of FMOX to neonates of different day-age groups (0-3 (n = 25), 4-7 (n = 18), 8-28 (n = 32) days of birth). At a dose of 10 mg/kg. i.v., mean C30 (30 minutes concentration) values were 21.2, 21.8 and 21.3 micrograms/ml, respectively, in the different groups mentioned above, and the mean T1/2 values were 3.37, 1.85 and 1.63 hours. At 20 mg/kg i.v., mean C15 (15 minutes concentration) values were 54.4, 51.4 and 50.7 micrograms/ml, and mean T1/2's were 2.99, 2.32 and 1.79 hours, respectively. At a dose of 40 mg/kg i.v., mean C15 values were 104.0, 95.9 and 99.2 micrograms/ml, and the mean T1/2's were 3.40, 1.20 and 1.80 hours, respectively. (2) Plasma concentrations and T1/2 after intravenous one-shot injection of FMOX in premature infants in group (0-3 (n = 14), 4-7 (n = 10), 8-28 (n = 13) days of birth). Mean C15's at doses of 10, 20 and 40 mg/kg in the different groups of infants were 24.0, 28.6, 21.7 and 54.0, 54.6, 55.5 and 98.2, 93.0, 106.0 micrograms/ml, and T1/2's were 4.10, 2.53, 2.57 and 4.28, 2.27, 3.02 and 4.66, 2.86, 2.09 hours, respectively. Mean Cmax values were clearly dose dependent, and mean T1/2 values tended to be longer in premature infants compared to neonates. (3) Urinary recovery rate of FMOX after intravenous injection in neonates and premature infants. Mean urinary recovery rates of FMOX in the first 6 hours after i.v. (one-shot) at doses of 10, 20 and 40 mg/kg to neonates and premature infants were 38.9-62.8% in the neonates and 30.7-61.5% in the premature infants. (4) Plasma concentrations and urinary recovery rates upon 1 hour drip infusion of 20 mg/kg in the neonate groups (or the premature infant groups) as follows: Mean C50 values were 31.0, 32.7 and 23.4 micrograms/ml, and T1/2 were 2.94, 3.68 and 2.25 hours, respectively. The recovery rates were 35.2-52.9% in the first 6 hours after administration. 2. Clinical studies The number of clinically evaluable cases in the FMOX treatment of premature infants was 199, in which the causative pathogens were identified in 71 cases (A group) and not identified in 128 cases (B group).(ABSTRACT TRUNCATED AT 400 WORDS)

[Differentiation of bronchogenic carcinoma from benign nodule by MR imaging: quantitative evaluation]

To distinguish benign from malignant nodules with MR imaging, 39 pulmonary nodules (23 bronchogenic carcinomas, nine tuberculomas and seven other benign lesions) were studied. MR equipment of 1.5 Tesla was used, and relative signal intensities of pulmonary nodules on T 2- and T 1-weighted images before and after administration of gadopentate dimeglumine were evaluated. On T 2-weighted images, the relative signal intensity of bronchogenic carcinomas to subcutaneous fat was 5.48 +/- 1.69, that of tuberculomas was -2.56 +/- 2.22 and that of other benign lesions was -0.88 +/- 3.37; the difference between tuberculomas and bronchogenic carcinomas was statistically significant (p < 0.05). On T 1-weighted images before and after administration of gadopentate dimeglumine, the relative signal enhancement of bronchogenic carcinomas was 17.6 +/- 2.0, that of other benign lesions was 20.0 +/- 5.2 and that of tuberculomas was -0.0074 +/- 0.763; the difference between tuberculomas and bronchogenic carcinomas as well as benign nodules was statistically significant (p < 0.001). The relative signal intensity on T 2-weighted images and the ratio of signal enhancement to noise could differentiate tuberculomas from bronchogenic carcinomas and other benign lesions. However, bronchogenic carcinomas and other benign lesions could not be differentiated by MR imaging.

Isolation of adenovirus type 11 from the brain of a neonate with pneumonia and encephalitis

We describe a fatal case of adenovirus pneumonia accompanied by encephalitis in a neonate who showed lethargy on the 6th day and died on the 12th day. Adenoviral particles as well as viral intranuclear inclusions were noted in pulmonary alveolar epithelium cells. Neuropathological examination revealed diffuse oedema, perivascular cuffing and gliosis in the white matter. Adenovirus type 11 was isolated from lung, hilar lymph node, and brain tissue. This is the first instance of adenovirus isolation from brain tissue in a newborn infant. The virological and neuropathological findings suggest the invasion of neural tissue by adenovirus and substantiate the significance of neurological symptoms observed in neonatal adenovirus infection.

Decreased type VI collagen gene expression in cultured Werner's syndrome fibroblasts

Gene expression of collagens VI, I, and III in Werner's syndrome was studied by measuring messenger RNA (mRNA) and protein production levels in four fibroblast strains from patients with Werner's syndrome and comparing them with age-matched healthy subjects. Levels of type VI collagen mRNA were decreased in all Werner's syndrome fibroblast strains and the decreases were in parallel in all three chains (alpha 1, alpha 2, and alpha 3) of type VI collagen. A coordinate increase of the alpha 1(I) and alpha 1(III) collagen mRNA levels was observed in three of the four Werner's syndrome fibroblast strains. However, no qualitative abnormality of these mRNA transcripts in Werner's syndrome fibroblasts were found by Northern blot analysis. Changes in type VI and type I collagen mRNA correlated well with production levels of corresponding proteins, as determined by immunologic assays. These data suggest that there are changes in expression of multiple connective tissue constituents in Werner's syndrome fibroblasts.

Determination of trace amounts of phosphate in water after preconcentration using a thermally reversible polymer

A method for concentrating and determining phosphate in natural waters, using poly(N-isopropylacrylamide) (PNIPAAm); a thermally reversible polymer, is described. Poly(N-isopropylacrylamide) is soluble in water below 31 degrees C but shrinks abruptly on heating above 31 degrees C, becoming insoluble. With phase separation of PNIPAAm from aqueous solution at 45 degrees C, a molybdophosphate-Malachite Green aggregate (P-Mo-MG), formed by reaction of a Mo-MG reagent, obtained by mixing ammonium molybdate and Malachite Green, was incorporated in PNIPAAm and the resulting solid stuck to the walls of the reaction vessel. After discarding the supernatant solution by decantation, the P-Mo-MG aggregate was dissolved in a small volume of methylcellosolve together with PNIPAAm. The absorbance (lambda max = 627 nm) was proportional to the concentration of phosphate with an apparent molar absorptivity of 2.6 x 10(4) m2 mol-1. This method makes possible the rapid determination of trace amounts of phosphate in water using simple apparatus. The detection limit was 2 nmol dm-3 of phosphate. The method was successfully applied to the determination of phosphate in natural water samples such as tap water, mineral water and rain water.

Cholangioscopic extraction of intrahepatic stones associated with biliary strictures using a rendezvous technique

Two patients with a severe biliary stricture of one intrahepatic duct and associated intrahepatic stones were successfully treated after dilatation of their stricture by a new endobiliary rendezvous technique with the aid of percutaneous transhepatic cholangioscopy (PTCS). The strictured bile duct was approached from a contralateral percutaneous tract via PTCS and from the diseased duct by introducing a guidewire. This guidewire was then extracted through the other side using a PTCS-guided biopsy forceps to form a communication between both sides which could be used as a pathway for subsequent dilatation. Our technique allows the extraction of intrahepatic stones even in the presence of biliary strictures.

Rapid expression of collagen type X gene of non-hypertrophic chondrocytes in the grafted chick periosteum demonstrated by in situ hybridization

We investigated the spatiotemporal localization of collagen Type I, II, and X mRNAs in the subcutaneously grafted chick periosteum by in situ hybridization. Five days after transplantation, we noted three types of histological findings in the grated tissue. (a) Developing trabecular bone exhibited proliferation of spindle-shaped fibroblastic cells and polygonal osteoblasts with moderate signals for collagen Type I mRNA. (b) Developing cartilage contained ovoid chondrocytes with a moderate level of both collagen Type I and II mRNAs. Differentiating chondrocytes with increased collagen Type X mRNA developed during the course of endochondral ossification. (c) An atypical mass of cartilage weakly stained with alcian blue was composed of a large number of non-hypertrophic chondrocytes exhibiting high signals for collagen Type X mRNA. At Day 9, we observed the typical histological features of both membranous and endochondral ossification. However, sparsely distributed chondrocytes with high signals for collagen Type X mRNA were also demonstrated in osteoid and/or woven bone. The phenotype of chondrocytes showing rapid expression of collagen Type X gene derived from grafted periosteum seems to participate in the important role of endochondral bone formation in the early stage of fracture repair.