[Evaluation of the liver uptake rate measured by 99mTc-GSA SPECT to assess liver function]

Whether the global liver uptake rate of 99mTc-GSA directly measured by SPECT is useful as a new index of liver function was evaluated in comparison with biochemical test results (PT%, ChE, Alb, ICG R15, KICG) and Child classification. 99mTc-GSA SPECT was performed in 157 patients with diffuse hepatic disease or hepatobiliary tumor, and two indices, namely the global liver uptake rate measured by SPECT 15 minutes after intravenous injection of 99mTc-GSA (LUS 15) and liver uptake per volume (liver uptake density) were examined. Both LUS 15 and liver uptake density were significantly correlated with biochemical test results and Child classification. In particular, close relationships between LUS 15 and ICGR15 (r = -0.720, p < 0.0001), LUS 15 and KICG (r = -0.750, p < 0.0001), and between LUS 15 and ChE (r = 0.720, p < 0.0001), indicate that LUS 15 is a useful index to evaluate liver function. Moreover, the local liver uptake rate measured by SPECT represented regional liver function and was considered a useful index to predict the function of the remnant liver after invasive treatment such as surgery.

Quinolone resistance mutations in the GrlB protein of Staphylococcus aureus

Two altered GrlB proteins (one with an Asp-432-->Asn alteration and one with an Asn-470-->Asp alteration) of Staphylococcus aureus were purified as fusion proteins to maltose-binding protein. The 50% inhibitory concentrations of levofloxacin were 14 and 3.4 microg/ml against topoisomerase IV containing GrlB proteins with alterations at positions 432 and 470, respectively. These results suggest that the alteration of Asp to Asn at position 432 may be responsible for quinolone resistance.

Cytoplasmic diversity in leaf beet cultivars as revealed by mitochondrial DNA analysis

Mitochondrial (mt) DNA restriction fragment length polymorphisms are convenient markers for identifying cytoplasmic variation among plant cultivars. In an attempt to detect new cytoplasmic genotypes useful for sugarbeet breeding, we have compared the hybridization patterns of mtDNA from three groups of cultivated beets, viz. leaf beet, garden beet, and fodder beet. Utilized as probes were the two sugarbeet mtDNA clones that were capable of distinguishing normal fertile and different sources of male-sterile cytoplasms from one another. The analysis allowed the identification of four chondriome types among 14 leaf beet cultivars examined. Two out of the four chondriome types were found to be different from the previously described fertile or male-sterile chondriome type. Our results thus indicate that leaf beet cultivars and landraces make up the primary cytoplasmic gene pool of the sugarbeet.

Inhibitory activities of quinolones against DNA gyrase and topoisomerase IV purified from Staphylococcus aureus

In order to clarify the mechanism of action of quinolones against Staphylococcus aureus, GrlA and GrlB proteins of topoisomerase IV encoded by genes with or without mutations were purified separately as fusion proteins with maltose-binding protein in Escherichia coli. The reconstituted enzymes showed ATP-dependent decatenation and relaxing activities but had no supercoiling activity. The inhibitory effects of quinolones on the decatenation activity of topoisomerase IV were determined by quantitative electrophoresis with kinetoplast DNA as a substrate. The 50% inhibitory concentrations (IC50s) of levofloxacin, DR-3354, DU-6859a, DV-7751a, ciprofloxacin, sparfloxacin, and tosufloxacin against topoisomerase IV of S. aureus FDA 209-P were 2.3, 97, 0.45, 1.5, 2.5, 7.4, and 1.8 microg/ml, respectively, and were correlated well with their MICs. The IC50s of these drugs were from 2 to 20 times lower than those for the DNA gyrase. These results support genetic evidence that the primary target of new quinolones is topoisomerase IV in quinolone-susceptible strains of S. aureus. Three altered proteins of topoisomerase IV containing Ser-->Phe changes at codon 80 or Glu-->Lys changes at codon 84 of grlA, or both, were also purified. The inhibitory activities of quinolones against the topoisomerase IV which contained a single amino acid change were from 8 to 95 times weaker than those against the nonaltered enzyme. These results suggest that the mutations in the corresponding genes confer quinolone resistance.

Two types of micturitions of ileal neobladder

Eight patients were evaluated clinically, radiologically, and urodynamically to determine the outcome of continent urinary diversion with ileal neobladder performed to treat the recurrent superficial bladder cancer after cystectomy with subcapsular prostatectomy. The mean age of the patients was 55.3 years. After descending dissection of the urinary bladder without ligation or dissection of Santorini's plexus, the prostate was cut to the bladder neck distally for 2 cm under the subcapular prostatectomy. One patient who had a short 3 cm intestinal segment between the pouch and the urethra, had severely prolonged micturition with peristalsis in this short segment, and required a re-operation. Micturition was good in the other seven patients, all with detubularized neobladder directly to the prostate capsule in anastomosis. Pressure flow studies performed on these seven patients revealed two types of micturition; "fast bladder" and "intermittent flow", the latter resembling detrusor sphincter dyssynergia.

[Functional MRI using interleaved EPI]

One of main purposes of functional MRI is to identify functional map on human brain. We considered spatial resolution was a important factor and investigated influences of it on signal changes and activated region size. Functional images were acquired with Echo-Planar imaging (EPI) and interleaved EPI (IEPI). IEPI is superior in spatial resolution but inferior in signal to noise ratio (SNR) to EPI. As a result of Student's t-test analysis, activated region sizes of IEPI reduced to less than half those of EPI while IEPI had larger signal increase than EPI. We confirmed that the reduction was caused by low SNR and our estimation analysis could prevent it.

[Somatotopical mapping of the human somatosensory cortex with echo-planar MRI]

The somatotopical organization of the somatosensory cortex was analyzed. Echo-planar imaging was used to obtain functional images, and magnetic field strength was 1.5T. Natural stimulation at a frequency of 3 Hz (scrubbing or tapping) was applied to one of the three cutaneous areas: toes, fingertips, and tongue tip. The focal bands which show the significant signal increases were located on the contralateral post-central gyrus, and these changes of signal intensity originate from the cortical parenchyma because there were no major veins in the central sulcus. The focal bands which respond to each stimulation sites were anatomically distinct and located medially-to-laterally in the order of toes, fingertips, and tongue tip.

[Contamination levels to room air arising from the use of 99mTc-gas and prevention from the contamination]

99mTc-gas (TECHNEGAS) is a 99mTc-labeled micro-aerosol which is considered to have different behavior from 133Xe or 81mKr gas. In order to estimate contamination levels to room air arising from the use of 99mTc-gas, filtered expired air during administration and 1, 2, 3, 5, 10 min after the administration were collected in each polyethylene bag. Radioactivities of the polyethylene bags, used filter and the lung were measured with 3-head scintillation camera. The activity of the expired air diminished within 6-10 min and about 5% of whole discharged 99mTc-gas was released to room air. The activity of the used filter was two times of the lung. According to these results, it is recommended that the 99mTc-gas may be administrated in a exclusive room. The administrated patient and used filter must be remain in the exclusive room.

A novel two-base mutation in the Cu/Zn superoxide dismutase gene associated with familial amyotrophic lateral sclerosis in Japan

We have identified a novel two-base mutation in exon 1 of the Cu/Zn superoxide dismutase (SOD1) gene (TGC to TTT), which resulted in Cys6 to Phe substitution in a Japanese family with amyotrophic lateral sclerosis (ALS). This is the first case of familial ALS-associated two-base change of the SOD1 gene. Similar to several mutations in exon 1 of the SOD1 gene such as Ala4 to Val, Ala4 to Thr and Val14 to Met, affected members of the present family showed a rapid progression of motor dysfunction. Although Ala4, Cys6 and Val7 reside in the middle of the first beta-strand of the SOD1, a family with a mutation of Val7 to Glu associates with slow progression of the disease. These findings suggest that clinical courses are variable with each mutation, even in the same exon.

Clinical evaluation of the results of open or transurethral surgery for prostate hypertrophy

We evaluated the outcome of surgery for prostate hypertrophy through measurement of the urine flow rate and the Boyarsky symptom score. The study covered 108 patients admitted to Showa University School of Medicine, Fujigaoka Hospital. Thirty-eight had been admitted for retropubic prostatectomy and the remaining 70 patients for transurethral resection of the prostate. Their ages ranged from 48 to 84 years, with an average age of 64.4 years. The urine flow rate was measured before and after prostatic operation using Dantec Urodyn 1000. The symptom scores were calculated according to the Boyarsky symptom score. The Student's t test was used for statistical analysis. Frequency (daytime, nighttime) was the most common preoperative symptom (97.2%, 96.3%), followed by impairment of stream (88.0%), and intermittency (78.7%). Frequently observed symptoms tended to raise the symptom scores. The period of admission, age and prostatic size did not correlate with the preoperative urine flow rate and symptom score. Significant improvements in the urine flow rate occurred after the operation. Frequency (daytime, nighttime) was the most common postoperative symptom (82.7%, 81.1%), followed by urgency (37.0%), then terminal dribbling (32.2%). Of 39 patients who were evaluated by symptom score and urine flow simultaneously, 6 patients (15.1%) failed to show improvement in 1 of the 2 evaluations, while 9 (23.1%) patients failed to show improvement in either. The irritative symptoms (frequency, urgency) tended not to show significant postoperative improvement.

[Cystic ectopic pituitary adenoma: report of a case]

A 68-year-old man was admitted with suprasellar cystic tumor with obstructive hydrocephalus, and complaining of slowly progressive memory disturbance, gait disturbance and urinary incontinence. Neurological examination revealed bilateral visual disturbance and disorientation. Skull X-ray films revealed no dilatation of sella turnica and mild erosion of the dorsum sellae. A cystic suprasellar tumor was revealed extending upward to the third ventricular floor and the solid part of the tumor was homogeneously enhanced with Gd-DTPA on MRI. The T1-weighted sagittal MR image revealed a normal pituitary gland and the diaphragma sellae below the tumor. The tumor was totally removed via a bifrontal basal interhemispheric approach, and the tumor was attached to the pituitary stalk and was not contiguous with the pituitary gland. The histological diagnosis was sinusoidal type of chromophobe and non-functioning adenoma. Postoperative MRI revealed a preserved normal pituitary gland and the stalk. To our knowledge, only 11 cases of suprasellar ectopic pituitary adenoma have been reported. We reviewed their neuroradiological features and discussed the pathogenesis. In particular, cystic and nonfunctioning suprasellar ectopic pituitary adenoma may be difficult to distinguish from craniopharyngioma.

[Investigation of discrepancy between 99mTc-HMPAO and 133Xe rCBF SPECT; a comparative study with X-ray CT findings]

To investigate the discrepancy between 99mTc-hexamethylpropyleneamine oxime (HMPAO) and 133Xe rCBF SPECT, the findings of thirty patients with reasonable rCBF reduction on 133Xe SPECT were compared with HMPAO SPECT and X-ray CT. The subjects did not include the cases of acute and subacute CVD. Both SPECT were performed within two weeks by ring-type dynamic SPECT (HEADTOME, Simadzu, Japan). In comparison between the SPECT findings by 133Xe and 99mTc-HMPAO, the subjects were classified into three groups as follow. Group A: Similar findings in the both SPECT were noted in 6 cases (20%). Group B: Smaller findings on HMPAO SPECT than that by 133Xe were in 11 cases (37%). Group C: No findings of rCBF reduction on HMPAO SPECT were in 13 cases (43%). The rCBF of the lesion measured by 133Xe SPECT in the group C was 24-35 ml/100 g/min. The density of HMPAO in the lesion did not correlate with the rCBF value. Only the severity of CT findings tend to correlate with the density of HMPAO. These results suggest that the reduction of HMPAO density depends directly on some kind of neural injury rather than the rCBF value. The injury may be caused by the flow reduction under the threshold of each neural cell. So the correlation between HMPAO density and actual rCBF might show like sigmoid curve. Then the HMPAO SPECT might directly reflect the regional extraction and fixation ratio, and the reduction of blood flow cause the minute neural-injury in the lesion of moderately reduced rCBF.

Distribution of IS901 in strains of Mycobacterium avium complex from swine by using IS901-detecting primers that discriminate between M. avium and Mycobacterium intracellulare

The presence of the mycobacterial insertion sequence IS901 was studied by PCR with reference strains of Mycobacterium avium complex; 122 veterinary strains of mycobacteria, mainly M. avium complex, isolated from swine; and 15 clinical strains. Four kinds of DNA extraction methods for PCR were compared. Use of the commercial extraction matrix allowed for the faster and easier preparation of PCR-amplifiable DNA than use of NaOH heating extraction or sodium dodecyl sulfate extraction of pretreated mycobacteria. It also provided more effective protection than boiling extraction against the destruction of DNA. Four reference strains of serovars 1 to 3 possessed IS901. Nine reference strains of serovars 1, 4 to 6, 8 to 11, and 21 possessed only IS901 insertion sites. A novel PCR product was found in the other reference strains of serovars 7, 12 to 17, 19, and 20 and two clinical strains of serovar 15. It is suggested that the primers that amplified the insertion portion of IS901 divided the M. avium complex into M. avium, Mycobacterium intracellulare, and other mycobacteria. None of the 110 strains of M. avium complex isolated from swine possessed IS901. It is suggested that the absence of IS901 might be characteristic of swine-derived strains of M. avium complex.

Functional mapping of the human colour centre with echo-planar magnetic resonance imaging

Clinical studies of cerebral achromatopsia have suggested a colour centre in the human fusiform gyrus. By using functional magnetic resonance imaging, we examined whether the fusiform gyrus shows activity correlated with the perception of colour. We tested three stimulus conditions in which the subject maintained fixation: (i) a circular array of six coloured circles; (ii) the same as (i) except that each circle is equiluminant grey with its colour counterpart; and (iii) the same as (i) plus a clockwise shift of circles to neighbouring positions every 1 s. After termination of the stimulus, the subject perceived an after-image of circles with complementary colours in (i), but not in (iii). In condition (i), we found a focal signal increase in the posterior part of the fusiform gyrus. In condition (ii), the activation in the same locus during the stimulation period was weaker than that in (i). In condition (iii), the signal intensity after termination of the stimulus was weaker than that in (i). The colour effect and after-effect on activation of the fusiform gyrus observed here suggest its critical role in human colour perception.

Mitochondrial gene variation and phylogenetic relationships in the genus Beta

Restriction fragment length polymorphisms (RFLPs) for three mitochondrial genes, coxI, coxII and atpA, were used to determine mitochondrial (mt) DNA diversity in 21 accessions of the genus Beta representing wild and cultivated species. On the basis of distribution of the RFLP patterns these Beta genotypes were assigned into six distinct chondriome groups. A high degree of heterogeneity was found to exist between the mitochondrial genomes of the sugarbeet cultivar and the wild species of Procumbentes section. The polymorphic fragments from wild Beta species were cloned and subjected to fine mapping. We found that most of the RFLPs are due to sequence rearrangements rather than point mutations. Our data also suggest that the close linkage between coxII and coxI is taxonomically localized to an evolutionary lineage that led to Vulgares and Corollinae species but not to Procumbentes species. This linkage is most likely to have arisen via the mutation(s) that inserted the DNA segment containing coxI downstream of coxII in the common ancestor of Vulgares and Corollinae species. The results are discussed with regard to the taxonomic and phylogenetic relationships of the Beta species.

Functional mapping of the human somatosensory cortex with echo-planar MRI

The somatotopical organization of the human somatosensory cortex was analyzed with echo-planar imaging at 1.5 Tesla, utilizing deoxyhemoglobin as an endogenous contrast medium. Scrubbing stimulation at a frequency of 3 Hz was applied to one of three cutaneous areas: toes, fingertips, and tongue tip. Parasagittal echo-planar slices were obtained every 2 s. We found focal bands of increased signal intensity (4% on average) during the stimulation, with a rise time of 2-6 s. These activated bands were located on the contralateral postcentral gyrus. The cortical responses from the three stimulation sites were anatomically distinct and organized medially-to-laterally in the order of toes, fingertips, and tongue tip.

[Expression of PCNA/cyclin, p53, C-erbB-2 versus histological grade in transitional cell carcinoma of urinary bladder]

It is important to know the proliferating ability and the malignant potential of tumor tissues. We have examined the expression of PCNA/cyclin, p53 and C-erbB-2 in transitional cell carcinoma of the human urinary bladder by an immunohistochemical method, and compared the results with the histological grade, stage and survival rate. Immunohistochemical studies, using monoclonal and polyclonal antibodies, on these proteins were performed with formaline fixed-paraffin sections of tumor tissue from 40 patients with bladder cancer. Generally, a higher grade and higher stage tumors expressed PCNA/cyclin, p53 and C-erbB-2 with a greater frequency than the tumors with a lower grade and lower stage and strongly stained cases had a lower survival rate than weakly stained cases. These findings suggest that the detection of each antigen is useful for estimating the malignant potential of transitional cell carcinoma as the adjuvant studies, because of its applicability to paraffin-embedded tissue sections and its simple, rapid technique.

[Studies on skin irritation with urostomy--the gross and histologic evaluation of the attached area with urostomy]

The degree of damage on the peristomal skin of 42 patients who accepted the urostomy was visually and histologically evaluated. The incidence of damages on the areas of the skin where the materials was applied was 85.7%. The occurrence of non-active lesions (mainly permanent pigment change) was statistically more significant than the active lesions (mainly redness) [p < 0.05]. The incidence of skin lesions using the skin barrier agents was significantly lower statistically than the incidence with the adhesive medication indicating a superior treatment for the skin condition [p < 0.05]. Although the gross appearances were normal, the microscopic and electron microscopic evaluations detected chronic damages indicating comparatively evident changes. The results suggest that these histological evaluations are useful in examining the damage on peristomal skin.

Intracranial vertebral artery dissection in Wallenberg syndrome

PURPOSE

To assess the prevalence of vertebral artery dissection in Wallenberg syndrome.

METHODS

Sixteen patients (12 men, 4 women; mean age at ictus, 51.6 years) with symptoms of Wallenberg syndrome and an infarction demonstrated in the lateral medulla on MR were reviewed retrospectively. The study items were as follows: (a) headache as clinical signs, in particular, occipitalgia and/or posterior neck pain at ictus; (b) MR findings, such as intramural hematoma on T1-weighted images, intimal flap on T2-weighted images, and double lumen on three-dimensional spoiled gradient-recalled acquisition in a steady state with gadopentetate dimeglumine; (c) direct angiographic findings of dissection, such as double lumen, intimal flap, and resolution of stenosis on follow-up angiography; and (d) indirect angiographic findings of dissection (such as string sign, pearl and string sign, tapered narrowing, etc). Patients were classified as definite dissection if they had reliable MR findings (ie, intramural hematoma, intimal flap, and enhancement of wall and septum) and/or direct angiographic findings; as probable dissection if they showed both headache and suspected findings (ie, double lumen on 3-D spoiled gradient-recalled acquisition in a steady state or indirect angiographic findings); and as suspected dissection in those with only headache or suspected findings.

RESULTS

Seven of 16 patients were classified as definite dissection, 3 as probable dissection, and 3 as suspected dissection. Four patients were considered to have bilateral vertebral artery dissection on the basis of MR findings.

CONCLUSIONS

Vertebral artery dissection is an important cause of Wallenberg syndrome.

Difference in binding sites of autoantibodies against 230- and 170-kD bullous pemphigoid antigens on salt-split skin

The purpose of this study is to clarify a relationship between bullous pemphigoid autoantibodies against two major BP antigens, 230 kilodalton (kD) (BPAG1) and 180 kD (BPAG2) and their binding sites, using immunoblot analysis and indirect immunofluorescence on salt-split skin. Of the 135 sera obtained from patients in whom bullous pemphigoid had previously been diagnosed by clinical and immunopathologic criteria, all 52 sera recognizing only BPAG1 stained only the epidermal side of split skin (epidermal pattern). Of 24 sera recognizing only BPAG2, 20 showed the epidermal pattern and four stained both the epidermal and dermal sides (combined pattern). Of 42 recognizing both BPAG1 and BPAG2, 35 showed the epidermal pattern and seven showed the combined pattern. Of 17 that reacted with neither antigen, nine showed the epidermal pattern, four showed the combined pattern, and four stained only the dermal side (dermal pattern). Two of the four cases that showed a dermal pattern were retrospectively identified as epidermolysis bullosa acquisita. Immunoelectron microscopy confirmed that a serum with combined pattern bound to both intracellular and extracellular sites of hemidesmosomes. Our results suggest that autoantibodies that react solely with BPAG1 bind exclusively to the epidermal side of salt-split skin and never show either a combined or a dermal pattern, and that most antibodies against BPAG2 bind to the epidermal side. The combined pattern suggests the presence of autoantibodies against the extracellular epitopes of BPAG2 that are separated from the epidermis during the salt-splitting process.

[A case of transitional cell carcinoma of the prostate]

A 46-year-old man was admitted to our hospital with the complaint of gross hematuria and renal failure. The patient had undergone right nephrectomy 10 years earlier suffering from nephrotuberculosis, and the remaining left side manifested severe hydronephrosis and vesicoureteral reflux (VUR). After the immediate nephrostomy, renal function was recovered and hematuria was improved preservatively. By the rectal examination, a goose egg size and stony hard prostate was detected. The needle biopsy of the prostate revealed pathologically transitional cell carcinoma (TCC) G2, and the image findings showed stage of T4N0M0 of the prostatic carcinoma. Modified pelvic exenteration was performed, and specimens were examined by the step section method. The diagnosis was TCC, G2 > G3 and stage of pT4N0 in the right lobe of the prostate. This case is she 20th reported case in Japan. We emphasize the importance of the mapping of dissected specimens and the reviewed literature.

Prenatal diagnosis of epidermolysis bullosa: first successful trial in Asia

Prenatal diagnosis of epidermolysis bullosa (EB) using fetal skin biopsy specimens has been successfully performed in Europe and America, but this technique has not previously been attempted in Asia. For the first time in Asia, we attempted to make a prenatal diagnosis of EB in a high-risk fetus by fetal skin biopsy. A skin biopsy was obtained from the fetus at risk of gravis type junctional epidermolysis bullosa of Herlitz. The biopsy specimen was studied by electron microscopy and immunohistochemistry using various monoclonal antibodies against the epidermal basement membrane zone (BMZ). There were no ultrastructural abnormalities in the BMZ, including the hemidesmosomes. Indirect immunofluorescence showed normal expression of GB3 antigen. The pregnancy was continued, and a normal, healthy infant was born. The prenatal diagnosis of epidermolysis bullosa is now available in Tokyo. This clinical diagnostic service is available to families from various parts of Asia.

[Evaluation of bladder tumor staging by submucosonography]

Submucosonography to stage tumors of the esophagus and stomach is well reported. Here we report our experience with a modified procedure to evaluate the stage of bladder tumor cystoscopically and compare the results of staging by other methods. The evaluation was carried out on accuracy 10 patients (10 bladder tumors). A water soluble contrast medium (CM: lohexol 33 mg/ml) was injected into the submucosa of the bladder cystoscopically. Usually the injected point was one centimeter to the urethral margin of the tumor and up to three points were selected. Within 30 minutes after the injection, the lateral and frontal X-ray pictures were taken. The accuracies of staging by submucosonography were compared with the results of other methods, i.g., ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI). By submucosonography, three categories depending on the diffusion of CM were classified as follows. Type I: (diffuse type) without disturbance of diffusion. Type II: (borderline type) between type I and III. Type III: (defect type) local disturbance of diffusion. Overall accuracies of each were 70.0% (submucosonography), 62.5% (US), 44.4% (CT), 66.7% (MRI) respectively. The accuracies of submucosonography were high in stage Ta, above stage T2 and low in stage T1.

Cryofixed, freeze-dried and paraffin-embedded skin enables successful immunohistochemical staining of skin basement membrane antigens

Conventional chemical fixation and paraffin-embedding procedures give good preservation of morphology, although the antigenicity of many proteins in the tissue sample is destroyed. On the other hand, fresh frozen sections can preserve the antigenicity, but provide poor morphological preservation. To overcome this dilemma, cryofixation and freeze drying were used on human skin tissue, applying methodology which has only been used to study lymphoid tissue. First, fresh human skin was cryofixed in liquid isopentane (-160 degrees C) cooled by liquid nitrogen. The skin was then freeze-dried at -40 degrees C and 10(-2) atmospheric pressure for 72 h, followed by embedding in paraffin. Sections 4 microns thick taken from this cryofixed, freeze-dried, and paraffin-embedded skin were stained with hematoxylin-eosin or used for immunolabeling with antibodies against basement membrane antigen, including type IV and type VII collagen, bullous pemphigoid antigen, epidermolysis bullosa acquisita antigen, and GB3 antigen. The morphological preservation of these sections was as good as that of routine formalin-fixed and paraffin-embedded skin sections. The basement membrane was clearly immunostained with all antibodies used, and the intensity of the reaction was as strong as that seen in frozen sections. Evaluation of antigen distribution in conjunction with the detailed skin structure was therefore possible in the same sections.

[Clinical evaluation of the bladder tumor marker "Tu-MARK-BTA"]

Bladder tumor antigen (BTA) is a tumor marker isolated from the urine of individuals with TCC of the bladder. This antigen can be detected by the Tu-MARK BTA test, a simple and rapid slide latex agglutination test performed on freshly voided urine. Sensitivity and specificity of BTA were calculated, and the correlation with pathological grade, histological stage, and urinary findings were statistically evaluated (chi 2-test) in 110 patients (72 male, 38 female; age: 16-91, mean age 54.4) examined between September, 1989 and April, 1990 including 46 TCC of the bladder (primary 28, secondary 18; grade 1:10, grade 2:27, grade 3:9, pTis: 2, pTa: 2, pT1: 23, pT2: 5, pT3: 4, pT4: 2), and 64 benign diseases. Sensitivity was 45.6%, specificity was 60.9%. In bladder tumor cases a correlation was seen between BTA and stage (p less than 0.02), and between BTA and grade (P less than 0.05). The positive ratio was higher in T1-T4 (55.9%) than in Tis.Ta (p less than 0.02). A high positive ratio of BTA was seen in bladder tumor cases with hematuria (70%, p less than 0.01) and pyuria (86.7%, p less than 0.01). This method is easy and rapid and the values are highly correlated with stage. Therefore, it should be useful for not only screening but followup of bladder tumor. Furthermore, BTA in combination with urine cytology is a more useful way for diagnosing TCC of the bladder.

[Immunohistochemical studies on bladder tumours. Evaluation by CEA, ferritin, beta 2-MG, keratin and glycogen]

The focus of my study was the immunohistological expressions of bladder tumour cells when stained by several antigens, those being; Carcinoembryonic antigen (CEA), Ferritin, Beta 2 Microglobulin (beta 2-MG), Keratin and Glycogen. There were 59 cases of bladder cancer studied using the Peroxidase-antiperoxidase technique (PAP) of staining. Specimens were formalin-fixed, paraffin embedded, and then sectioned. Some correlation was found between histological grade, stage and CEA incidence but was not found in the Ferritin or beta 2-MG. Keratin and Glycogen were detected in all cases. These staining patterns were mosaic according to higher grade and stage. It is believed this demonstrates that immunohistochemical expressions of staining with CEA, Keratin, and Glycogen may be a sensitive indicator of histological grade, stage.

[Immunohistochemical studies on bladder tumours. Immunohistochemical evaluation on intravesical therapy for bladder tumours]

The focus of my study was the immunohistochemical studies of tumour cells induced by ADM intravesical instillation therapy when stained by several antigens, those being; Carcinoembryonic antigen (CEA), Ferritin, Beta 2 Microglobulin (beta 2-MG), Keratin and Glycogen before and after the therapy. Then I discussed as to their value in indicating therapeutic efficacy. There were 18 cases of bladder cancer studied using the Peroxidase-antiperoxidase technique (PAP) of staining. Data indicated a 44.4% response rate following therapy with intravesical ADM. Immunohistochemical evaluation showed improvement as indicated by not staining with CEA. Also observed was no change and slightly diffuse staining with Keratin: and a decrease in all layers of Glycogen expression: However this could not be observed with the Ferritin or beta 2-MG. It is believed this demonstrates that immunohistochemical expressions of staining with CEA, Keratin, and Glycogen may be a sensitive indicator of a therapeutic response to intravesical ADM.

[Single drug chemotherapy with 5-FU oral administration of bladder cancer]

58-year-old male with bladder cancer complicated acute myocardial infarction (aMI) were treated by 5-FU 300 mg/day orally for approximately one and a half months as single drug chemotherapy preoperatively. CT studies showed PR in bladder lesion and an improvement of bilateral hydronephrosis also. Biochemical evaluations as Thymidylate synthase inhibition and FdUMP were made on biopsy and operative specimens of urinary bladder. Clinical trials with 5-FU oral administration in bladder cancer were not held widely. Although its effectiveness and safety has been accepted in several fields. It was useful for a conservative operation case as single drug chemotherapy.

T cell receptor gene rearrangement analysis in mycosis fungoides and disseminated lymphocytoma cutis

A cDNA from the CT beta 2 region of the T cell receptor gene was used as a probe to investigate the clonal composition of T cells in the skin lesions of 3 patients with mycosis fungoides (MF) and 1 patient with disseminated lymphocytoma cutis (DLC). All of these skin lesions showed helper/inducer T cell dominant infiltration. Clonal T cell populations, as evidenced by rearranged DNA bands, were demonstrated in all the skin lesions of the 3 patients with MF, but not in the lesion of the patient with DLC. The patients with MF appeared to have the same gene rearrangement pattern in DNA obtained from separate lesions, providing evidence that the T cells in both sites were derived from the same clone. Our results show that this gene rearrangement analysis helps to diagnose difficult cases of lymphoproliferative disorders.

A case of linear IgA bullous dermatosis of childhood: immunoelectron microscopic and IgA subclass studies

A 2-year-old girl developed small tense bullae on the diaper area, face and extremities. Immunofluorescent studies revealed linear deposits of IgA, IgM and C3 at the basement membrane zone (BMZ). In addition, IgA2 deposits, as well as IgA1, were clearly demonstrated in the lesional skin. However, in circulation, only IgA1 anti-BMZ antibodies were found. Immunoelectron microscopic study showed IgA deposits just underneath the basilar surface of the basal cells, which seemed to be associated with hemidesmosomes. The survey of the literature suggests that the involvement of IgA2 is extremely rare in this disease.

[Megakaryocyte proportion versus nucleated cells in the peripheral blood showing leukoerythroblastosis]

Megakaryocytes in the peripheral blood in which leukoerythroblastosis was recognized were studied by electron microscopy on the vertically cut section of the buffy coat of the blood, and percentages of them in 10,000 nucleated cells distributed from the top of the bottom of the buffy coat were counted. In 15 of 31 patients, percentages of peripheral blood megakaryocytes ranging from 0.01% to 0.64% were seen. There was difference of the result among diseases shown peripheral blood megakaryocytes. Namely, in patients with myelofibrosis and CML, in whom extramedullary hematopoiesis was predominant, many cases ascertained peripheral blood megakaryocytes were demonstrated. Because of this result, the extramedullary hematopoiesis appears to play an important role to the presentation of megakaryocytes in the peripheral blood. On the other hand, patients indicating both megakaryocytes and abnormal sideroblasts in the peripheral blood had sideroblastic anemia marrow. This result seems to show that a part of megakaryocytes are directly flowed out from the marrow into the blood simultaneously accompanied with abnormal sideroblasts.

[Matas procedure in the treatment of spontaneous carotid cavernous sinus fistula: a complication of retinal hemorrhage]

We herein report three cases of the dural internal type of spontaneous carotid cavernous sinus fistula (SCCF) which seemed to be improved by the Matas procedure. Sequential cerebral angiography revealed that thrombosis formation in the peripheral side of the draining vein resulted in a closure of the fistula. During this course of spontaneous regression, retinal findings were transiently exacerbated in some cases. The retinal hemorrhage seemed to be induced by central retinal vein occlusion and hypoxic retinopathy which preceded the spontaneous regression of SCCF. It was confirmed that the Matas procedure should be tried as the first choice for the treatment of SCCF, particularly in the dural internal type. However, fundus findings must be carefully monitored.

[The diagnostic value of immunoglobulin G in the cerebrospinal fluid of brain tumor patients, particularly in malignant tumors]

The diagnostic value of immunoglobulin G in cerebrospinal fluid (CSF-IgG) has been evaluated in patients with brain tumors. The (CSF-IgG) level in patients with malignant brain tumors was found to be significantly elevated when compared to the level in control patients without a disorder of the central nerve system. Especially significant was high level of CSF-IgG found in patients whose tumor had invaded into ventricles. The CSF-IgG level was found to decrease to a normal range by a total or subtotal resection of the tumor, but not by partial resection. On the other hand, CSF which contained large amount of IgG inhibited the lymphocyte proliferative response to phytomitogen. These results suggest that CSF-IgG seems to correlate with the tumor volume, and is important as a tumor marker in patients with a malignant brain tumor.

[The analysis of prognostic factors on postsurgical pyuria of benign prostatic hypertrophy]

The outcome of postsurgical pyuria in benign prostatic hypertrophy was studied in 87 patients, and the factors that might affect the outcome were determined. No significant differences were found between operation method and duration until normalization of pyuria, which was 75.5 +/- 46.0 days for transurethral resection of the prostate, 72.7 +/- 30.6 days for suprapubic prostatectomy and 69.3 +/- 32.7 days for retropubic prostatectomy. Prognostic factors were statistically analyzed preoperatively, at operation, and postoperatively. The definite prognostic factors were preoperative diabetes mellitus, preoperative pyuria, preoperative bacteriuria, and postoperative hypoproteinemia. The probable prognostic factors were old-age, preoperative indwelling catheters, heavy prostate tissue, postoperative bacteriuria, postoperative anemia and postoperative complications.

[Clinical studies of efficacy of piperacillin against complicated urinary tract infections]

Clinical efficacy of piperacillin against 74 cases with complicated urinary tract infection was examined. Piperacillin was administered at the dose of 4 g (2 g twice daily) through intravenous drip infusion. The overall clinical value was rated in "excellent", in 9 cases, "moderate" in 34 cases and "poor" in 31 cases with a total efficacy of 58.1%. In the analysis of clinical values based on background, its efficacy was statistically significantly lower in the patients at a higher age, those with complication of diabetes mellitus, and those with indwelling catheter. In operated cases compared to non-operated cases, it was suggested to be more effective for improving the disturbances in urinary flow as a result of the removal of the underlying conditions by the operation. As to bacteriological efficacy, 64 out of 95 strains (67.4%) isolated were eradicated following its administration. Microbes which appeared after its dosing belonged to 9 classes of 18 strains, of which 5 strains (27.8%) of Serratia were identified. Side effects were 2.5% (3/119), no serious cases appeared. Changes in laboratory examination results were elevated GOT (2.5%), GPT (1.7%), and ALP (0.8%) values, all being transient hanges.

Correlations between iron content and isoferritin profiles of normal and malignant tissues

Isoelectric focusing profiles of ferritins isolated from livers of anemic rats and 3'-methyl-4-dimethylaminoazobenzene-induced hepatomas were more acidic than their normal counterparts, and exhibited patterns similar to those of heart ferritin. Iron administration induced a shift to more basic components for the normal and tumor ferritins. The isoferritin patterns reflected the subunit populations of the protein, as the more acidic components had greater proportions of H-type subunits and iron induced an increase in L subunits with concomitant increases in more basic isoferritins. For both normal and malignant tissues there was a direct correlation between iron content of the tissue and subunit composition. The apparently unique isoferritin patterns in the tumor tissue may, therefore, be ascribed primarily to the lower iron contents.

[Combination chemotherapy of mitomycin C and cytosine arabinoside in the intravesical treatment for superficial bladder tumors: report 2. Evaluation of prophylactic intravesical infusion therapy]

Combined chemotherapy of Mitomycin C (20 mg to 30 mg) and Cytosine Arabinoside (200 mg) was given by intravesical infusion to 25 patients with superficial bladder tumor who underwent transurethral treatment for prevention of postoperative recurrence. The prophylactic effect of this therapy was evaluated as follows. 1) The postoperative recurrence rates by the actuarial method were 4.0% in six months, 8.1% in one year, 22.2% in two years, 37.4% in three years and 37.4% in five years. 2) The prophylactic effect on recurrence tended to be marked on primary tumors, solitary tumors, low grade tumors and relatively large tumors. 3) The correlation of doses and the recurrence rate was significantly observed: prophylactic effect tended to increase in proportion to increase of doses of both Mitomycin C and Cytosine Arabinoside.

[Combination chemotherapy of mitomycin C and cytosine arabinoside in superficial bladder tumors. 1. Evaluation of intravesical infusion therapy]

A combined chemotherapy of Mitomycin C (20-30 mg) and Cytosine Arabinoside (200 mg) was given intravesical by to 37 patients with superficial bladder tumor. The antitumor effect of the therapy was evaluated as follows. 1) The results were: remarkably effective in 12 cases (32.5%); effective in, 14 cases (37.8%); non-effective in 11 cases (29.7%), with overall rate of 70.3%. 2) The antitumor effect tended to be evident in multiple tumors, small tumors, and tumors of low malignancy. 3) Side effects were found in 35.1% of the cases including 24.3% of bladder irritating symptom. 4) The follow-up period ranged from 12 to 60 months with an average of 36.6 months. Recurrence rate was 27.0%. There was a tendency that recurrence occurred more frequently in cases of multiple tumors and small tumors than in other cases.