Effect of vitamin E on lipid metabolism and atherosclerosis in ESRD patients

BACKGROUND

Oxidative stress is enhanced in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). Bioincompatibility represents an important source of reactive oxygen species. HD patients exhibit altered anti-oxidative defences and anti-oxidative vitamins such as vitamin E and C are altered in uremia. Frequently, HD patients also suffer from atherosclerotic cardiac disease. We have previously reported that low density lipoprotein (LDL) of HD patients is rich in malondialdehyde (MDA), an end product of lipid peroxidation. MDA rich LDL is thought to be an atherogenic lipoprotein due to its enhancement of macrophage foam cell formation.

METHODS

We conducted a controlled study for two years comparing the effects of a vitamin E coated cellulose membrane dialyzer and an ordinary cellulose membrane dialyzer on lipid metabolism and the progress of atherosclerosis. LDL-MDA and oxidized LDL (ox-LDL) were measured in HD patients using these two types of dialyzers. Plasma vitamin E and lipid concentrations were also evaluated. The aortic calcification index (ACI) was evaluated by CT scan to assess the progress of atherosclerosis before and for every year after treatment.

RESULTS

Use of a vitamin E coated cellulose membrane dialyzer for six months, one year and two years resulted in a significant reduction in LDL-MDA and ox-LDL compared to the ordinary cellulose membrane dialyzer. Treatment with a vitamin E-coated dialyzer significantly reduced the percentage increase in ACI after 24 months compared to the control. There were no significant changes in plasma vitamin E and lipid concentrations between the two groups.

CONCLUSIONS

These results suggest that the oxidative stress could be one of the stimulating factors of abnormal lipid metabolism and atherosclerosis in ESRD patients.

Involvement of MCP-1 and M-CSF in glomerular foam cell formation in ExHC rats

BACKGROUND

An increase in glomerular macrophages (MO) is considered a potential effector mechanism by which hypercholesterolemia exacerbates glomerular injury. To investigate the mechanism underlying recruitment of MO into glomeruli, the expression of glomerular monocyte chemoattractant protein-1 (MCP-1) and macrophage colony-stimulating factor (M-CSF) mRNA were examined using a lipid-induced glomerular injury rat model.

METHODS

Eight-week-old male ExHC rats, a strain susceptible to hyperlipidemia, were divided into the following 4 groups: a control group (C), a high cholesterol diet group (HH), a high cholesterol diet/standard diet group (HN), which were fed a high cholesterol diet for the first 4 weeks and a standard diet for the following 4 weeks, and a probucol-treatment group (PT). Both MCP-1 and M-CSF mRNA expression in glomeruli were analyzed using the RT-PCR method. An additional experimental group (M) fed a high cholesterol diet was administered M-CSF daily for 4 weeks.

RESULTS

The expression of MCP-1 mRNA in glomeruli increased accompanied by an increased total serum cholesterol level in HH and HN. However, M-CSF mRNA expression was significantly suppressed at 1 or 2 weeks and gradually increased to almost basal levels. In the PT group, MCP-1 mRNA expression was suppressed. The early suppression of M-CSF mRNA expression was inhibited in PT. Renal histology showed a significant increase in foam cells in glomeruli in HH and HN rats at 4 weeks. HH rats showed increased and expanded foam cells at 8 weeks. In HN rats, however, foam cells decreased significantly after the transfer to a standard diet from a high cholesterol diet. The MCP-1 mRNA expression was suppressed after the transfer. In the PT group, foam cell formation was also suppressed. Foam cells were identified as MO. M-CSF-treatment significantly suppressed foam cell formation in glomeruli when compared with the untreated group levels.

CONCLUSION

These findings suggest that hypercholesterolemia stimulated the expression of MCP-1 in glomeruli and attracted the MO into glomeruli. They also suggest that the reduction of hypercholesterolemia after the change in diet or treatment with probucol suppressed glomerular injury by suppressing the glomerular MCP-1 expression. M-CSF may suppress the recruitment of MO into glomeruli and foam cell formation at an early stage of hypercholesterolemia-induced glomerular injury.

Post-traumatic brain stem distortion: a case report

BACKGROUND

Primary traumatic brain stem injury (BSI) lesions are found most frequently in the dorsal or dorsolateral midbrain, whereas distortion of the brain stem itself is exceedingly rare.

CASE REPORT

We present a 20-year-old woman with a rare brain stem injury caused by a violent motor vehicle collision. Magnetic resonance imaging at 2 months after injury revealed marked brain stem distortion with loss of the normal shape at the midbrain and pons, which were displaced anteriorly in association with the fracture of the clivus. Moreover, the medulla oblongata showed a loose winding configuration. At discharge about 5 months after injury, the Glasgow Outcome Scale was severe disability.

CONCLUSION

This BSI was caused by reciprocal actions of fracture of the clivus and the direct effect on the brain stem caused by acceleration or rotational forces.

[Plasma nicotinic acid levels in hemodialysis patients after the administration of niceritrol]

Lp(a) has recently begun to attract attention as a risk factor of atherosclerotic disease, especially of ischemic heart disease. The Lp(a) concentration in the serum was shown to be important for chronic hemodialysis patients who have high mortality due to cardiovascular disease. Nicotinic acid derivatives, which are recognized for their capacity to lower the serum Lp(a) concentration, are effective against a high Lp(a) concentration in hemodialysis patients. In this study, niceritrol which is a nicotinic acid derivative was tested on hemodialysis patients and healthy controls by investigating the serum nicotinic acid level. Serum nicotinic acid concentration was also measured by the severity of renal dysfunction of patients untreated by niceritrol. The blood nicotinic acid concentration in healthy controls (n = 4) was changed after 2 hrs by the administration of niceritrol from 9.8 +/- 1.4 ng/ml to 192.7 +/- 23.1 ng/ml then slowly decreased. Chronic hemodialysis patients who take niceritrol every day showed the highest nicotinic acid serum concentration (500-1,000 ng/ml) on the day without hemodialysis and the serum level decreased with dialysis for 4 hrs to 25-80%. There was no significant difference in the nicotinic acid level in the serum between healthy controls (n = 10), chronic glomerulonephritis patients (n = 7), chronic renal failure patients (n = 8) and chronic hemodialysis patients (n = 17). Lp(a) concentration in the serum, however, was increased with greater severity of renal dysfunction, The side effect was not observed in any cases administered niceritrol. These data suggest nicotinate derivatives are effective for hemodialysis patients. High nicotinic acid level in the serum after treatment with niceritrol was lowered by dialysis. It is plausible that the nicotinate level in patients without niceritrol treatment did not influence the Lp(a) concentration, because there was no increase in the nicotinate level of the serum even if the patients had renal dysfunction.

Non-traumatic aneurysms of the cavernous sinus causing massive epistaxis--report of three cases

Three cases of non-traumatic intracavernous aneurysms that gave rise to massive epistaxis and required operative intervention, are reported. This is a rare but serious cause of epistaxis, because delayed diagnosis and management can lead to repeated bleedings and even to death. It is important, therefore, to diagnose the source of epistaxis and treat it as soon as possible. In our three patients, an emergency angiography enabled us to diagnose an aneurysm in the cavernous sinus. These aneurysms were located in the C3 or C4 portion of the internal carotid artery and were 3-5 mm in diameter. The projections of these aneurysms were infero-medial, antero-inferior, and lateral, respectively. All three patients underwent emergent surgery. Neck clipping of the aneurysm was performed in two patients, and gradual occlusion of the internal carotid artery in the third patient. Emergency surgery successfully prevented further episodes of epistaxis in all three patients.

Corneomandibular reflex in ALS

To clarify the diagnostic value of corneomandibular reflex (CMR) in ALS, the authors examined the prevalence of CMR and other pathologic reflexes in 42 patients with ALS and 110 patients with stroke. A total of 30 of 42 ALS patients had positive CMR. Compared with the patients with hemiparesis or pseudobulbar palsy after stroke, the ALS patients showed a significantly higher frequency of CMR but no other pathologic reflexes. CMR is a sensitive indicator of upper motor neuron involvement in ALS.

Reduced expression of the alphabeta T-cell antigen receptor by alveolar T-cells

A previous study revealed that reduced expression (modulation) of the CD3 antigen is a common characteristic of alveolar T-cells in health and disease. As CD3 molecules are noncovalently bound to T-cell antigen receptors (TCR), it was hypothesized that modulation of TCR was also a feature of alveolar T-cells. To demonstrate this, lymphocytes from bronchoalveolar lavage fluid were stained with an anti-alphabeta TCR antibody and analysed by flow cytometry. The expression of alphabeta TCR by alveolar T-cells was evaluated by calculating mean fluorescence intensity (MFI) and was compared with alphabeta TCR expression by autologous blood T-cells. As anticipated from a previous study, modulation of TCR was observed not only in healthy volunteers but also in patients with pulmonary sarcoidosis, other pulmonary diseases, and nonpulmonary diseases. There were no significant differences in MFI of alveolar T-cells among the study groups. The degree of modulation assessed by the difference of MFI between blood and alveolar T-cells was greater for CD4+ cells than for CD8+ cells owing to the higher MFI of CD4+ blood T-cells. Coculture of alveolar macrophages with blood T-cells in vitro induced partial modulation of TCR. These results demonstrate the ubiquity of modulation of T-cell receptors on alveolar T-cells and suggest, in contrast to a previous report by other investigators that it is caused by some nonantigenic mechanism possibly inherent in the alveolar milieu. The implications of this phenomenon in in vivo immune responses of the lung need to be examined.

Successful pregnancy and delivery in a case of systemic lupus erythematosus treated with immunoadsorption therapy and cyclosporin A

A 32-year-old woman diagnosed as systemic lupus erythematosus (SLE) became pregnant. During pregnancy she was treated with a daily dosage of prednisolone 15 mg. However, because the exanthema became worse, she was hospitalized on January 14, 1997 in order to receive immunoadsorption therapy. Before delivery we implemented the immunoadsorption therapy twice and cyclosporin A (CsA) was administered simultaneously. She gave birth in her 37th week. The baby weighed 2260 g at the time of delivery and had no deformities. The mother also had no side effects. The success of pregnancy and childbirth in our case, without any side effects, shows the possibility that the combination of CsA and immunoadsorption therapy may be considered safe to control a pregnancy complicated by SLE.

Healthy dietary habits, body mass index, and predictors among nursing students, northeast Thailand

This study aimed to assess body mass index (BMI) of nursing students, and examine the links between health behavior in terms of healthy dietary habits, positive health habits, dieting and BMI. A structured questionnaire was used for obtaining information on dietary habits, positive health habits, demographic characteristic including body weight, and height by administering self-answering questionnaires to all of nursing students in the 1st, 2nd, 3rd, and 4th year-classes of the College of Nursing located in northeast Thailand. Three hundred and eleven female nursing students with an average age of 19.9 (SD = 1.4), had an average BMI of 20.3 kg/m2 (SD = 1.9). Most of the subjects (82.6%) were in the acceptable weight category (BMI > 18.5-24.99 kg/m2), 5.1% underweight (BMI < or = 18.5 kg/m2), and 2.3% overweight. (BMI > or = 25.0 kg/m2). About half of them (50.8-66.2%) practiced healthy dietary habits in terms of avoiding eating fat/cholesterol, enriched fiber foods, while one-fourth practiced daily fruit consumption. Positive health habits in terms of having breakfast, and taking exercise over the last two weeks, were practiced by 49.5% and 59.8%, respectively. Persistent health problem occurred 13.5% amongst the subjects. The univariate analyses revealed significant associations between dieting with the BMI; perception of body size with the BMI; the enriched fiber food consumption with dieting; and the avoidance of fat/cholesterol with dieting. It suggests that the choice of food was predominantly attributable to dieting. Results from multiple logistic regression analysis showed that dietary belief, dieting, and exercise had effects on the strength of the association (p = 0.0191, 0.0024, 0.0165; Odds ratios = 0.97, 2.21, 1.87, respectively). The results and implications are discussed.

[A case of dural arteriovenous fistula in the transverse and sigmoid sinus which developed over five years]

We report a case of dural arteriovenous fistula (dAVF) of the transverse and sigmoid sinus which developed over five years. The patient was a 64-year-old man, who had a history of congestive heart failure and transient ischemic attack (TIA). No abnormal lesions were detected in the cerebral angiograms five years prior to the time the etiology of his TIA was investigated. He suddenly suffered from left hemiparesis and the CT scan showed right parietal subcortical hemorrhage. Right carotid angiogram demonstrated dAVF of the transverse and sigmoid sinus supplied by the right occipital and ascending pharyngeal arteries. We thought the reason for the subcortical hemorrhage in this patient was due to the disturbance of venous return in the right cerebral hemisphere. We underwent direct embolization of the right transverse sinus by interlocking detachable coils. Postoperative cerebral angiograms demonstrated the disappearance of dAVF and he was discharged. Whether dAVF is a congenital anomaly or not, has been controversial. Since the dAVF in this case had newly developed over five years, it is suggested that dAVF is an acquired lesion.

Isolation and identification of metallothionein isoforms (MT-1 and MT-2) in the rat testis

It has been a long-lasting controversial issue as to whether or not the male genital organs, such as the testis and prostate, contain metallothioneins (MTs), a group of cysteine-rich heavy-metal-binding proteins that play a role in detoxifying heavy metals such as cadmium (Cd). Earlier studies reported that the rodent testis lacks MTs and concluded that this is why the testis is very susceptible to Cd, although other indirect experimental evidence suggests that MTs are present in this organ. A deficiency of MTs in the testis was originally suspected on the basis of amino acid composition analysis, since MT-like proteins isolated as Cd-binding proteins did not have a characteristic MT structure. In the present study, we demonstrate that the rat testis indeed expresses Cd-binding proteins with sequences identical to those previously described for MT-1 and MT-2, the major isoforms. To confirm that MT-1 and MT-2 are present in the rat testis, we purified and isolated Cd-binding proteins by homogenization using Cd-containing buffer, followed by sequential purification using Sephadex G-75 gel filtration chromatography and anion HPLC column chromatography, which yielded Cd-binding protein-1 (Cd-BP-1) and -2 (Cd-BP-2). After pyridylethylation, Cd-BP-1 and Cd-BP-2 were subjected to specific protein fragmentation by acids and endopeptidases, which revealed that these Cd-binding proteins have the same primary structures as MT-1 and MT-2 respectively. Thus we believe that the present results clearly resolve the long-standing debate about the presence of MTs in the testis, at least in the rodent.

Second primary tumours in more than 2-year disease-free survivors of small-cell lung cancer in Japan: the role of smoking cessation

Patients with small-cell lung cancer who survive more than 2 years have a significantly increased risk (relative risk of 3.6) of developing a second primary tumour. The cessation of cigarette smoking after successful therapy is associated with a significantly decreased risk of a second primary tumour.

Meningeal enhancement surrounding meningiomas on Gd-DTPA MRI

Meningeal enhancement (ME) using Gd-DTPA MRI was studied in 25 of 35 patients with meningiomas, and its clinical importance on associated MRI and histologic findings of ME was evaluated. ME extended 0.5-4.3 cm (mean: 1.5 cm) from the tumor attachment site, and was classified morphologically into two patterns: that extending with a gentle curve from the tumor attachment site to the dura, and that extending linearly. Tumor parenchyma was differentiated from ME based on time-dependent changes in signal intensity on Gd-DTPA MRI. Histologic examination was performed in tissue from regions of ME of 15 patients. Tissue corresponding to regions of ME consisted of two layers: an outer dura mater layer and an inner layer of hyperplasic loose fibrous tissue with dilated capillaries. Meningeal tumor cell clusters were observed in the fibrous tissue of 4 patients. These clusters were observed at a maximum distance of 1.4 cm from the tumor attachment site. It is thought that meningeal tumor cell clusters may represent a potential cause of local recurrence. Therefore, resection of the dura at least 2 cm from the tumor attachment site may be required to prevent local recurrence.

Purification, characterization, and gene analysis of catechol 2,3-dioxygenase from the aniline-assimilating bacterium Pseudomonas species AW-2

Catechol 2,3-dioxygenase (C23D; EC 1.13.1.2) was purified to homogeneity from a cell extract of Pseudomonas sp. AW-2 grown on aniline, and the purified C23D was characterized. The molecular mass estimated by gel filtration was 110 kDa. The enzyme dissociated into four identical subunits each with the molecular mass of 33 kDa. The enzyme had high activity for 3-methylcatechol as well as catechol, and differed from the enzyme from Pseudomonas putida mt-2, which carries the TOL plasmid, in optimal pH for catechol, extradiol cleavage activities for 3-methylcatechol and 4-methylcatechol, and immunochemical properties. The amino acid sequence deduced from a C23D gene, alnE, from Pseudomonas sp. AW-2 was 85.7% identical to that of 3-methylcatechol 2,3-dioxygenase from toluidine-assimilating Pseudomonas putida UCC22. AlnE was 44.1% identical to the C23D encoded by xylE in P. putida mt-2. Because XylE has low activity for 3-methylcatechol, these results suggest that the differences in substrate specificity for 3-methylcatechol among the C23Ds reflected their sequence similarity.

Expression of RANTES by bronchoalveolar lavage cells in nonsmoking patients with interstitial lung diseases

Emphasis has recently been placed on the roles of chemotactic cytokines called chemokines to explain the accumulation of inflammatory cells in the lung that may precede or accompany pulmonary fibrosis in interstitial lung diseases. We hypothesized that RANTES, a member of the C-C chemokines, is one such chemokine. Bronchoalveolar lavage was done in 20 patients with sarcoidosis, 10 patients with interstitial pneumonia associated with collagen vascular disease (CVD-IP), 10 patients with idiopathic pulmonary fibrosis (IPF), and eight healthy volunteers (HV), all of whom were never-smokers. We semiquantitated the spontaneous RANTES mRNA expression by a competitive reverse transcription-polymerase chain reaction (RT-PCR) technique, and measured the levels of RANTES protein by enzyme-linked immunosorbent assay. In all disease groups the expression of RANTES mRNA by bronchoalveolar lavage fluid (BALF) cells and the levels of RANTES protein in BALF were significantly increased compared with those in HV. Patients with sarcoidosis and CVD-IP had a significant positive correlation between the expression of RANTES mRNA by BALF cells and BALF lymphocytosis. The amounts of RANTES mRNA expressed by peripheral blood mononuclear cells and the levels of RANTES protein in serum did not differ among all study groups. Our study demonstrates the adaptability of a semiquantitative RT-PCR method for determining cytokine mRNA expression in vivo. Our results suggest that RANTES may be one of the chemokines that are involved in the mechanism for the accumulation of inflammatory cells in the lung of some distinct interstitial lung diseases.

Cornell Medical Index score observed among Japanese nursing students

Purpose of this study was to survey subjective health problems occurring among Japanese nursing students. Data collected with the self-administered Cornell Medical Index Health Questionnaire Japanese version (JCMI) from 102 Japanese first year nursing students were analyzed. The total CMI score (section A-R) ranged from 2-108 with an average of 23.1 (SD = 15.9). The mean CMI for physical (section A-L) and psychological health complains (section M-R) were 15.7 (SD = 11.8) and 7.3 (SD = 6.1), respectively. Two-way analysis of variances with multiple comparison of means revealed significant relationships between age and psychological health complaints and both physical and overall health complaints. The older nursing students reported more physical and overall health complaints than the youngest. The nursing students who reported more complaints about psychological health also reported significantly more physical and overall health complaints. A comparison of Fukamachi's and Brodman's criteria for classification of neurotic traits is discussed. Findings from this study support the hypothesis that psychological health is somewhat reacted to physical health.

Experimental study for identification of the facial colliculus using electromyography and antidromic evoked potentials

OBJECTIVE

The facial colliculus is a reliable landmark for a surgical approach via the fourth ventricle. Our aim is to elucidate the most suitable electrophysiological methods for identification of the facial colliculus. We evaluated the usefulness of facial electromyography and antidromic evoked potentials of the facial nerve. The effect of stimulation on cardiorespiratory function is also studied.

METHODS

We localized the facial colliculus by facial electromyography and antidromic facial evoked potentials in adult dogs. To determine the most effective stimulus pattern, intensity was varied, and both monopolar and bipolar electrical stimulation were tried. To confirm the cardiorespiratory effect of the stimulation, systemic blood pressure, heart rate, respiratory rate, and thoracic excursion were measured. After administration of atropine sulfate, changes in vital signs were recorded.

RESULTS

A stable facial electromyographic wave form was produced by 0.1-mA monopolar stimulation of a small portion of the fourth ventricular floor (4 mm2). Using 0.1-mA bipolar stimulation, the same wave form was obtained. As saline was gradually added around the electrodes, the amplitude of the response gradually decreased; however, the response with monopolar stimulation was more stable than that with bipolar stimulation. Stimulation of the facial colliculus with greater than 2 mA caused transient hypotension and bradycardia; respiratory arrest occurred with 3 mA stimulation. Administration of atropine sulfate (0.01 mg/kg) decreased these responses. Antidromic facial evoked potentials were recorded only at "hot points" that existed within 2 mm of the facial colliculus.

CONCLUSION

Our study resulted in three findings. First, the most suitable electrophysiological stimulation of the fourth ventricular floor for identification of the facial colliculus was 0.1-mA monopolar stimulation. Second, significant alteration in cardiorespiratory function appeared with greater than 1-mA stimulation. Third, a recording of an antidromic facial evoked potential can identify the facial colliculus more safely than direct stimulation of the facial colliculus. Both orthodromic and antidromic methods were useful for identification of the facial colliculus in brain stem surgery.

Cisplatin-based combination chemotherapy for elderly patients with non-small-cell lung cancer

PURPOSE

To compare the response rates, toxicities and survival durations of elderly patients (70 years of age or more) with those of younger patients (less than 70 years of age) with non-small-cell lung cancer (NSCLC) treated with cisplatin-based chemotherapy.

PATIENTS AND METHODS

We analyzed retrospectively the data of 203 assessable patients entered on a prospective randomized trial of cisplatin-based combination chemotherapy. Chemotherapy consisted of three dosage regimens: (1) vindesine and cisplatin (VP); (2) mitomycin, vindesine and cisplatin (MVP); or (3) etoposide and cisplatin alternating with vindesine and mitomycin (EP/VM).

RESULTS

A greater proportion of elderly patients had localized disease and more squamous cell carcinoma than non-elderly patients. The overall response rates were 44% in the elderly group and 28% in the non-elderly group. In the EP/VM arm, the response rate was significantly better in the elderly group than in the non-elderly group. The frequency of grade 4 leukocytopenia in the MVP and EP/VM arms in the elderly group was significantly greater than in the non-elderly group (P < 0.05). No differences were found in nonhematological toxicities between the two groups. There was no difference in overall survival between the groups.

CONCLUSION

Elderly patients treated with mitomycin-containing regimens have higher hematologic toxicities than younger patients. The results of this study are consistent with the previously reported pharmacologic data on mitomycin suggesting altered pharmacokinetics in elderly patients. The improved response rate in the elderly patients was probably because more elderly patients had earlier disease, squamous cell carcinoma and better performance status. Cisplatin-based chemotherapy was tolerable for most elderly NSCLC patients with good performance status.

Motor neuron disease following generalized fasciculations and cramps

We report a case of motor neuron disease in which fasciculations and cramps progressed generally before the development of muscle wasting. After involvement of the upper and lower motor neurons became clinically manifest, widespread fasciculations and cramps persisted and accompanied pseudotetany. The present case suggests that spinal cord pathology of motor neuron disease can cause the abnormal excitability of the motor neurons, resulting in the development of generalized fasciculations and cramps.

A high level of accumulation of 2-hydroxymuconic 6-semialdehyde from aniline by the transpositional mutant Y-2 of Pseudomonas species AW-2

Four transpositional mutants of aniline-assimilating Pseudomonas sp. AW-2 produced 2-hydroxymuconic 6-semialdehyde (HMS) from aniline and accumulated it in a cultural medium. Among the four mutants, strain Y-2 produced the greatest amount of HMS (0.77 mg/ml) from 1 mg/ml of aniline hydrochloride in a 15-h growing culture. The conversion rate of aniline to HMS was 70% on a molar basis. Resting cells of strain Y-2 produced 0.65 mg/ml of HMS during 4h of incubation in a reaction mixture containing 1 mg/ml of aniline hydrochloride (conversion rate, 60%). Transposon Tn5-Mob was found to be inserted into the gene of HMS dehydrogenase in strain Y-2 by sequence analysis.

Aggregation of Thy-1 glycoprotein induces thymocyte apoptosis through activation of CPP32-like proteases

Mouse thymocytes are known to undergo apoptosis by ligating some unique anti-Thy-1 monoclonal antibodies (mAbs), G7 and KT16. However, the precise mechanisms of Thy-1-mediated apoptosis are as yet unclear. We investigated Thy-1-mediated apoptosis using our previously generated anti-Thy-1 mAb, MCS-34, which was similar to G7 because both antibodies recognized both Thy-1.1 and Thy-1.2 and bound Thy-1A epitope. Unlike G7, MCS-34 alone could not induce apoptosis in thymocytes; however, it could induce apoptosis when it was cross-linked with second antibodies. Thus, MCS-34 could not aggregate by itself, but G7 could. In the course of investigating the apoptosis-related molecules that were involved in the thymocyte apoptosis induced by cross-linking of MCS-34 or by G7 ligation, we found that CPP 32-like proteases were activated during the apoptosis. Furthermore, the expression of bcl-2 and bcl-XL proteins was decreased in these apoptosis processes. Whereas the ligation of MCS-34 alone could not generate apoptosis signals that led to the activation of CPP32-like proteases and the decrease in bcl-2 and bcl-XL expression, the aggregation of Thy-1 glycoprotein might be crucial to signal thymocyte apoptosis. These results indicate that MCS-34 is a useful anti-Thy-1 mAb for analyzing the Thy-1-mediated signals since MCS-34 can control the level of apoptosis by using second antibodies.

[Treatment of skull base meningioma encasing the main cerebral artery]

We reviewed the clinical findings, the surgical problems and results in fifteen operated cases of skull base meningioma encasing the main cerebral arteries. The fifteen cases of meningiomas are summarized as follows; The patients' age ranged from 18 to 76 years old with an average age of 48 years old. Thirteen were in female and two in males. Of 15 cases, four cases were sphenoid ridge meningiomas (all clinoidal types), three cases were planum sphenoidale, two cases were tuberculum sellae, olfactory groove and cerebellar tentorium, one case was a cerebello-pontine angle and foramen magnum meningioma. Twelve cases (80%) had a large tumor of 50mm in maximum diameter. Major advances in imaging modalities, especially magnetic resonance imaging (MRI), have enabled precise preoperative information about vascular encasement and location of the encased vessels within the tumor. Preoperative tumor embolization was performed in 2 patients, STA-MCA anastomosis was performed in one patient with severe stenosis of the internal carotid artery encased in the tumor. In 5 cases with the presence of interfacing arachnoid membranes between the tumor and cerebral vessels, the tumor was totally removed. In the 10 patients without interfacing arachnoid membranes, total removal was achieved in 4 of the 10 patients by the sacrifice of the encased artery and in one patient injuring the arterial wall consequently. In the remaining 5 patients, the tumor could not be removed totally. One patient showed a recurrence on follow-up ranging from 0.5 to 13 years. In conclusion, greater difficulty with dissection of such tumors was encountered in patients who did not have an arachnoid plane between the encased artery and the tumor. In those cases, to avoid the devastating sequelae injuring the encased cerebral vessels and its surrounding perforators, we considered that total removal should not be carried out.

Classification of catechol 1,2-dioxygenase family: sequence analysis of a gene for the catechol 1,2-dioxygenase showing high specificity for methylcatechols from Gram+ aniline-assimilating Rhodococcus erythropolis AN-13

Gram+ aniline-assimilating Rhodococcus erythropolis AN-13 (AN-13) produces catechol 1,2-dioxygenase (C12O) showing high enzymatic activities for 3- and 4-methylcatechols [Aoki et al. (1984) Agric. Biol. Chem. 48, 2087-2095]. A 3.0 kb Sau3AI fragment carrying a gene encoding C12O(catA) was cloned by selection of transformants showing C12O activity from a gene library of AN-13. Furthermore, we specified a 1.6 kb SalI fragment containing catA from the Sau3AI fragment by subcloning. Sequence analysis revealed that the 1.6 kb SalI fragment carried a 855 bp open reading frame (ORF) encoding the entire AN-13 catA, preceded by a potential ribosome binding site (RBS). From comparison of the deduced amino acid (aa) sequence of C12O from AN-13 with other C12O reported previously, it was found that the AN-13 enzyme shares 56.0% aa sequence identity with C12o from Arthrobacter sp. mA3 (mA3) [Eck and Belter (1991) Gene 123, 87-92] compared with less than 36.4% aa sequence identities with others. In conclusion, we classified all C12O including the AN-13 enzyme into three subfamilies on the basis of similarity of aa sequences, numbers of aa residues, and substrate specificity.

CODE chemotherapy with and without granulocyte colony-stimulating factor in small-cell lung cancer

Sixty-three patients with extensive-stage small-cell lung cancer were randomized to receive either cyclophosphamide, vincristine, doxorubicin and etoposide (CODE) alone or CODE plus recombinant human granulocyte colony-stimulating factor (rhG-CSF). rhG-CSF administration in support of CODE chemotherapy resulted in increased mean total received dose intensity for all drugs (P = 0.03) with a significant improvement in survival (P = 0.004).

A pilot study of concurrent whole-brain radiotherapy and chemotherapy combined with cisplatin, vindesine and mitomycin in non-small-cell lung cancer with brain metastasis

We have evaluated the feasibility, toxicity, and tumour response of concurrent whole-brain radiotherapy (WBRT) and chemotherapy with cisplatin, vindesine and mitomycin in the treatment of 33 patients with brain metastasis from non-small-cell lung cancer (NSCLC). The imaging response demonstrated that 25 patients (75.8%) responded to brain lesions, including five complete responders, and the response rate to primary lesion was 18%. The treatment improved at least one grade of performance status in 30% and of neurological functions in 55% of the patients. The major toxicity was leucopenia (> or = grade 3, 84.4%). Median survival was 9.7 months and the 1-year survival rate was 40%. Concurrent WBRT and chemotherapy can be safely administered to patients with brain metastasis from NSCLC, with a remarkable response rate, improvement of neurological functions and encouraging survival duration.

Olfactory evoked potentials: experimental and clinical studies

Olfactory evoked potentials (OEPs), obtained by electrical stimulation of the olfactory mucosa, were recorded in dogs and humans to develop an objective method for evaluating olfactory functions. In dogs, OEPs were recorded from the olfactory tract and the scalp. The latency of the first negative peak was approximately 40 msec. A response was not obtained after stimulation of the nasal mucosa and disappeared after sectioning of the olfactory nerve. With increasing frequencies of repetitive stimulation, the amplitude was reduced, suggesting that the response was synaptically mediated. These results demonstrate that evoked potentials from the olfactory tract and the scalp following electrical stimulation of the olfactory mucosa originate specifically from the olfactory system. In humans, a stimulating electrode with a soft catheter was fixed on the olfactory mucosa. The OEPs from the olfactory tract, recorded with a negative peak of approximately 27 msec, had similar characteristics to OEPs found in dogs. The OEPs from the olfactory tract in humans also originate specifically from the olfactory system. The authors postulate that OEPs obtained by electrical stimulation of the olfactory mucosa may prove useful for intraoperative monitoring of olfactory functions.

Partial monosomy 10q and partial trisomy 9q with anal atresia due to maternal translocation: t(9;10)(q32;q26)

We report a case of a boy with a partial deletion of the long arm of chromosome 10 and partial duplication of the long arm of chromosome 9 due to maternal balanced translocation. The karyotype was 46,XY,-10, +der(10)t(9;10)(q32;q26)mat. Our patient had imperforate anus and as this finding is usually not observed in association with trisomy 9q, it suggests that partial monosomy of the long arm of chromosome 10 might be associated with anogenital anomalies.

Dose-escalation study of oral etoposide and carboplatin in patients with advanced lung cancer

A dose-escalation study of daily etoposide and carboplatin was carried out on 23 patients with advanced lung cancer using a starting dose of 40 mg/m2/day etoposide given orally for 21 days and 250 mg/m2 carboplatin given intravenously (IV) on day 1. A total of 41 courses were given. Myelosuppression was the major dose-limiting toxicity. The maximum tolerated dose was reached at the fourth level with 40 mg/m2/day etoposide for 21 days and 400 mg/m2 carboplatin on day 1, once every 4 weeks. Non-hematological toxicities were generally mild or reversible. The recommended doses of this combination chemotherapy are 40 mg/m2/day etoposide for 21 days and 350 mg/m2 carboplatin on day 1. The response rate for non-small cell lung cancer and small cell lung cancer was 16.7% and 60% (95% confidence intervals of 3.6% to 41.4%, and 14.7% to 94.7%), respectively. A phase II study is necessary to define the efficacy and safety of this combination chemotherapy.

Aneurysm formation and rupture at the site of anastomosis following bypass surgery. Case report

Four years after undergoing a superficial temporal artery-middle cerebral artery bypass procedure, this patient presented with a ruptured aneurysm at the anastomosis site. The ruptured aneurysm caused subarachnoid and intracerebral hemorrhages and was treated by surgically clipping its neck. Characteristics of the aneurysm included: 1) a relatively large size (8 x 6 x 6 mm): 2) a thickened wall; 3) a location apart from the suture line; 4) a projection in a direction consistent with hemodynamic stress; and 5) a time interval from bypass surgery to rupture that lasted 4 years. These features, along with the well-known fact that hemodynamic stress can cause aneurysms, led the authors to believe that this aneurysm was a true one. The authors present a case of this unusual complication following bypass surgery and provide a brief review of the literature.

Deletion polymorphism in the angiotensin I converting enzyme (ACE) gene as a genetic risk factor for sarcoidosis

BACKGROUND

Genetic control of serum angiotensin I converting enzyme (SACE) levels has been suggested. A study was undertaken to elucidate the role of this polymorphism in sarcoidosis.

METHODS

Three hundred and forty one unrelated healthy controls and 103 consecutive patients with sarcoidosis participated in the study. SACE levels and an insertion/deletion (I/D) polymorphism in intron 16 of the ACE gene were studied in each subject and new reference intervals for SACE activity for each genotype were determined. The difference in genotype and allele frequencies between controls and patients was analysed and odds ratios were calculated to estimate the relative risk.

RESULTS

A significant association was seen between ACE gene polymorphism and SACE levels in both patients and controls. The new reference intervals for each genotype discriminated abnormal SACE levels in patients more accurately, especially those with genotype II. In women the frequencies of allele I were 0.68 (allele D 0.32) in controls and 0.58 (allele D 0.42) in patients, and the difference between the two female groups was significant (p < 0.05). Thus, an excess of genotype ID or DD was observed in female patients (odds ratio 2.18; 95% confidence interval 1.18 to 4.01; p = 0.01).

CONCLUSIONS

These findings suggest that ACE gene polymorphism is associated with SACE levels in both patients with sarcoidosis and controls. ACE gene polymorphism should be further evaluated as a candidate marker for an increased risk of sarcoidosis.

Susceptibility of metallothionein-null mice to paraquat

Using transgenic mice in which metallothionein (MT)-I and MT-II genes, we have studied a putative role of MT as a free radical scavenger against paraquat, a free radical generator. Male mice were injected s.c. with paraquat (PQ) at a single dose of 40 or 60 mg/kg of body weight (b.w.). Two of the six MT-null mice died within 16 h at the dose of 60 mg PQ/kg. b. w. PQ administration increased hepatic MT concentration in the normal mice (C57BL/6J), but not in the MT-null mice. The lipid peroxidation (LP) determined by thiobarbituric acid-reactive substance formation was increased by PQ in the liver of normal and MT-null mice, and the enhanced level was greater in the MT-null mice than in the C57BL/6J mice. Administration of PQ significantly increased blood urea nitrogen only in the MT-null mice, indicating renal damage. Without paraquat administration, the hepatic concentration of non-protein sulphydryl compounds was less in the MT-null mice than in the C57BL/6J mice, and the basal level of LP was higher in the MT-null mice than in the C57BL/6J mice. The present results support the notion that MT plays an antioxidative role against paraquat insult under physiological conditions.

Determinants of myelosuppression in the treatment of non-small cell lung cancer with cisplatin-containing chemotherapy

Data on 16 potential risk factors for myelosuppression were assessed in 134 patients who received either vindesine and cisplatin (VP) or mitomycin C, vindesine and cisplatin (MVP) for inoperable stage III or IV non-small cell lung cancer in a randomized trial. Determinant factors for myelosuppression were evaluated by using univariate analysis and the logistic regression model. Recursive partitioning and amalgamation (RPA) was also used to define patient subgroups frequently suffering from severe bone marrow toxicity. Overall, 33 (25%) of 134 patients experienced at least one episode of grade 4 leukopenia. In univariate analysis, age, body surface area, serum creatinine, and pretreatment hemoglobin concentration were associated with severe leukopenia. A multivariate analysis using the logistic regression method showed that only raised creatinine level was an independent predictor for grade 4 leukopenia (P = 0.049). The RPA model generated three distinct subgroups based on age, body surface area and regimen. The three subgroups were distinguished by the frequency of severe (grade 4) leukopenia (50%, 25%, and 2.4%, respectively) (P < 0.001). Grade 4 leukopenia occurred more frequently in patients in class 3 (age > or = 65 years and treatment with MVP). The RPA model was useful in identifying the risk factors for myelosuppression induced by cisplatin-based chemotherapy, and in defining patient subgroups with elevated risk of toxicity.

Treatment of ruptured cerebral aneurysm in moyamoya disease

BACKGROUND

Direct surgical intervention to treat ruptured cerebral aneurysms in patients with moyamoya disease has rarely been attempted and few of these patients have demonstrated full recovery following treatment.

METHODS

To clarify the particular operative problems encountered in performing aneurysmal surgery in patients with moyamoya disease, we present two cases and review 10 cases in the literature.

RESULTS

The first patient had a newly formed internal carotid artery aneurysm, which enlarged within a period of approximately 2 years. The second patient had multiple basilar artery aneurysms. Both patients had their aneurysms successfully clipped and were discharged without any neurologic deficits.

CONCLUSIONS

Aneurysmal surgery in moyamoya disease presents three problems unlike those encountered in uncomplicated aneurysmal surgery: (1) the ordinary approach is prohibited by the presence of moyamoya vessels, (2) careful consideration is required to preserve collateral circulation, and (3) acute surgery is necessary to prevent cerebral vasospasm due to massive subarachnoid hemorrhage.

Bilateral internal carotid artery disease secondary to cervical radiation. A case report

A patient with radiation-induced bilateral carotid artery disease is presented. A fifty-six-year-old man was admitted to hospital for evaluation of recurrent transient ischemic attacks. He had received cervical radiation for pharyngeal squamous cell carcinoma five years earlier. The radiation was directed at the cervical fields bilaterally and the anterior cervical field using x-rays for a total of 120 Gy. Computed tomography of the brain obtained at admission revealed a low-density area in the right parietal lobe. Carotid arteriograms revealed a completely occluded right internal carotid artery and a severely narrowed left internal carotid artery. There was good collateral supply from the posterior communicating arteries to the internal carotid arteries, bilaterally. The patient was medically treated with anticoagulant and antiplatelet therapy and has been free of subsequent cerebral ischemic attacks.

Reduced retention of cadmium in the liver of metallothionein-null mice

The distribution of cadmium (Cd) in the organs of mice was studied using metallothionein (MT)-null transgenic mice. When mice were administered with Cd chloride at a single subcutaneous dose of 1.0 mg Cd/kg body weight, Cd accumulated mainly in the liver and kidney by 6 h after injection without any significant difference between the MT-null mice and control (C57BL/6J) mice. MT was not detected in these organs of MT-null mice both before and after Cd administration whereas MT was induced mainly in these organs of the control mice. There was a marked elimination of Cd from the liver of MT-null mice by 21 days after administration, compared with a relatively slow Cd elimination in the C57BL/6J mice. Under the condition that no significant liver or kidney damage was observed, MT was considered to play a significant role in the retention of Cd in the liver but not in the uptake of this metal.

Binaural interaction of stapedius reflex

It is known that stapedius reflex (SR) shows bilateral interaction and that its center is located in the brainstem. In the present study, the pattern of SR was compared in two different conditions, either with binaural acoustic stimuli or with monaural stimuli using the impedance measurement method. When the sound source was placed in front of the head model, the amplitude of impedance change was higher in the binaural hearing condition than in the monaural condition, suggesting bilateral superposition. When the sound source was placed laterally to the head model, the amplitude of impedance change was higher in the ipsilateral ear than in the contralateral ear in the binaural condition. In the monaural condition, the amplitude of impedance change in the ipsilateral ear was as high as that obtained in the ipsilateral ear in the binaural condition, whereas it was markedly low in the contralateral ear. It is assumed that sense of sound direction cannot be well maintained without binaural interaction of SR.

Multimodal evoked potentials in Alzheimer's disease and Binswanger's disease

Somatosensory evoked potentials (SEPs), brainstem auditory evoked potentials (BAEPs), visual evoked potentials (VEPs), and auditory event-related potentials (ERPs) were studied in 15 patients with Alzheimer's disease (AD), eight patients with Binswanger's disease (BD), and 15 normal subjects. Patients with BD showed significant prolongation of the interpeak latency between N13 and N20 (N13-N20) and N20-P40 of SEPs as compared with the normal controls, whereas patients with AD only demonstrated significant prolongation of N20-P40. The interpeak latency between waves I and V of BAEPs in patients with both AD and BD was significantly longer than that of controls. There were no significant differences in P100 latency of VEPs among these three groups. Both groups with dementia showed significant prolongation of N200 and P300 latencies of ERPs compared with normal controls. In addition, patients with AD showed significant prolongation of P200 latency. We conclude that these two dementing diseases have different electrophysiologic features that may be related to their underlying pathogenetic mechanisms. Furthermore, the measurement of multimodal evoked potentials may be helpful in the differential diagnosis of AD and BD.

Pneumocephalus caused by fistulas of the mastoid air cells treated with a temporoparietal fascial flap

Using a temporoparietal fascial flap and hydroxyapatite ceramics, we treated a patient for complications after a neurosurgical operation for glossopharyngeal neuralgia. These consisted of pneumocephalus and cerebrospinal fluid rhinorrhea resulting from fistulas of mastoid air cells associated with a subcutaneous dead space. By means of the temporoparietal fascial flap, we were able to fill the dead space and reinforce the repaired dural and mastoid lesion as well. Hydroxyapatite ceramics were also useful for closing the mastoid air cell fistulas.

Preservation of the arteries around an aneurysm: practical use of oxycellulose. Technical note

The authors describe an intraoperative technique, in which oxycellulose is placed between an aneurysm and its surrounding arteries, allowing a space to be secured for inserting the clip blades without occlusion of the arteries. This method is useful in preserving the blood vessels, especially perforating arteries, around the aneurysm.

[A case of integrative visual agnosia]

We report a 78-year-old right-handed man with integrative visual agnosia (Humphreys et al.) that was associated with bilateral medial occipito-temporal infarction. The patient showed superior altitudinal hemianopsia, alexia, prosopagnosia, cerebral achromatopsia, and object agnosia. Elementary perception and information processing supposed to be executed by the stream to the parietal lobe were intact, since he was able to perceive the position and speed of moving object (catching the flying ball). He could not categorize neither real objects nor line drawings by sight. However, copying and matching of them was accurate, suggesting that his agnosia was an associative type (Lissauer). Detailed neuropsychological examinations revealed that his agnosia was due to a disturbance in integrating local form features into a perceptual whole. In addition, this patient showed difficulty in retrieval of objects from memory. However, it is unlikely that this disturbance itself was a cause of this particular form of agnosia.

[Traumatic carotid-cavernous aneurysm after removal of cancer of the upper jaw: a case report]

A case of a traumatic carotid-cavernous aneurysm after removal of cancer of the upper jaw was reported. A 63-year-old male complaining of massive epistaxis from the left nostril was admitted to our clinic. He had suffered from cancer of the left upper jaw and had been treated with radical operation. During the surgical procedure, massive bleeding which was considered to be from the left internal carotid artery, suddenly occurred. The hemorrhage was somehow controlled by packing with oxidized cellulose. He experienced recurrent massive epistaxis after admission. Cerebral angiograms revealed an anterior-medially projecting aneurysm arising from the cavernous portion of the left internal carotid artery. He had a good cross circulation from right to left on compression of the left carotid artery. This aneurysm at the carotid-cavernous portion was produced as a result of injury during an operation for cancer of the upper jaw. To prevent disastrous bleeding from the aneurysm, the aneurysm was then successfully treated by the trapping of extra-and intracranial carotid ligation in combination with left STA-MCA anastomosis. There was no recurrence of epistaxis after the operation. However, a low-grade fever persisted before operation and a blood culture showed MRSA sepsis after the operation. Intensive chemotherapy was performed for this MRSA sepsis, he died of the accompanying DIC. Although aneurysmal epistaxis following a severe closed head trauma is a well-known phenomenon, an iatrogenic carotid-cavernous aneurysm presenting with recurrent massive epistaxis is rare. Several comments were made about the iatrogenic carotid cavernous aneurysm, and the necessity of early diagnosis and treatment was emphasized.

Association between high serum total IgE levels and D11S97 on chromosome 11q13 in Japanese subjects

The genetic linkage of atopy to chromosome 11q13 through maternally derived alleles has been previously reported. Linkage analysis in Japanese families did not confirm the existence of a major gene for atopy at this locus under the model of autosomal dominant inheritance. However, we observed a significant association between serum total IgE levels and genetic markers at this locus both in 14 Japanese atopic families and in 120 unrelated Japanese subjects. We detected eight alleles at the D11S97 locus and eight alleles in the CA/GT repeat region in the fifth intron of the Fc epsilon RI beta gene. A significantly increased frequency of the D11S97/PstI 0.96 kb allele was observed in the chromosomes of the subjects with high serum total IgE levels both in the family study (p < 0.001) and in the population study (p < 0.05). However, multipoint linkage analysis again did not show any evidence for the existence of a major gene regulating atopy on chromosome 11q13 with location scores to -35 under the model of maternal inheritance. Evidence against linkage was confirmed by the non-parametric linkage analysis, using the affected pedigree member method. Also, there was no substitution of isoleucine for leucine in the fourth transmembrane domain of Fc epsilon RI beta (Leu181), which was reported to be responsible for a subset of atopy in the British population. Therefore, the association of serum total IgE levels with chromosome 11q13 indicates that a gene or genes at this locus may contribute to the expression of high IgE levels in the Japanese population as well as in the British population, but the heterogeneity of the genetic regulation of serum total IgE levels is evident between the two populations.

Transthird ventricular approach for a high basilar bifurcation aneurysm. Report of three cases

Three cases of ruptured aneurysm at the basilar bifurcation accompanied by megadolichobasilar anomaly were successfully treated using a transthird ventricular approach. A translamina terminalis approach was used to enter the third ventricle. In two cases, the floor of the third ventricle had been partly destroyed by aneurysm rupture, and a small split in the third ventricular floor was necessary to gain a wide operative field. In the third case, an intact floor was opened along the midline. Clipping was accomplished in all three cases after preserving the perforating arteries. Postoperatively, no complications from splitting the floor were observed. Key surgical points and the prospective view of the transthird ventricular approach are discussed.

Phase II study of concurrent radiotherapy and chemotherapy for unresectable stage III non-small-cell lung cancer. Southern Osaka Lung Cancer Study Group

PURPOSE

To evaluate the response rate, toxicity, and 2-year survival rate of concurrent radiotherapy and chemotherapy for unresectable stage III non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Between July 1989 and October 1990, 65 patients with histologically or cytologically proven unresectable stage III NSCLC without T3N0-1M0 disease were entered onto this study. Sixty-one patients were eligible for response, survival, and toxicity analysis. Chemotherapy consisted of vindesine (3 mg/m2 on days 1, 8, 29, and 36), cisplatin (100 mg/m2 on days 1 and 29), and mitomycin (8 mg/m2 on days 1 and 29). Radiotherapy was administered for 3 weeks (2 Gy given 13 times, five fractions per week), followed by 10-day rest periods and then the previous schedule of radiotherapy repeated for 3 weeks.

RESULTS

Of 61 eligible patients, 53 (86.9%) had a partial response (PR). The median response duration was 39.1 weeks (range, 8.4 to 163+). The median survival time was 16 months and the 2-year survival rate was 36.7%. Of 53 responding patients, 10 (16.4%) are alive and disease-free after 2 years. The major toxicity was leukopenia (> or = grade 3, 95%). Other toxicities of > or = grade 3 included thrombocytopenia (45%), anemia (28%), nausea/vomiting (16%), fever (11%), and esophagitis (6%). Treatment-related death occurred in two patients. One patient died of pulmonary toxicity (interstitial pneumonitis) and the other of esophagobronchial fistula with pulmonary infection.

CONCLUSION

Concurrent radiotherapy plus chemotherapy with mitomycin, vindesine, and cisplatin (MVP) can be safely administered to patients with stage III NSCLC, with excellent response rates and 2-year survival rates.