Blast-wave-sphere interaction using a laser-produced plasma: an experiment motivated by supernova 1987A

We present x-ray shadowgraphs from a high Mach number ( approximately 20) laboratory environment that simulate outward flowing ejecta matter from supernovae that interact with ambient cloud matter. Using a laser-plastic foil interaction, we generate a "complex" blast wave (a supersonic flow containing forward and reverse shock waves and a contact discontinuity between them) that interacts with a high-density (100 times ambient) sphere. The experimental results, including vorticity localization, compare favorably with two-dimensional axisymmetric hydrodynamic simulations.

Comparison of the upper gastrointestinal effects of etodolac and aspirin in healthy dogs

Fifteen healthy castrated male dogs were separated into three treatment groups that were administered etodolac, aspirin and a placebo orally, respectively. All treatments were continued for 28 days. The animals were examined endoscopically on days 0, 3, 7, 10, 14, 17, 21, 24 and 28. There were no gastrointestinal mucosal lesions in either the etodolac or the placebo group, whereas some gastric lesions developed in the aspirin group after day 17. We considered that etodolac could be used for long-term treatments in dogs with fewer side-effects on the gastric mucosa than aspirin.

Distribution and characterization of vanilloid receptors in the rat stomach

The cloned vanilloid receptor-1 (VR1) is recognized as a common molecular target for protons, noxious heat, and vanilloids. The presence of VR1 in the dorsal root, trigeminal, and nodose ganglia has been firmly established, but it is unclear in the gut, despite this VR1 may be important for gastric mucosal homeostasis. In this study we used an antibody and a radioligand to show the distribution of vanilloid receptors (VRs) in rat stomach and to characterize it. The deafferentiation of capsaicin-sensitive nerves in rats was induced by consecutive injections of capsaicin. VR1-immunopositive nerve endings were predominantly found in the mucous neck cells of the proliferation zone, and around blood vessels in the submucosa. Radioreceptor assay using [3H]-resiniferatoxin (RTX) revealed the existence of high affinity and single-class binding site in the membrane fractions of the mucosa. Capsaicin completely inhibited the specific binding of [3H]-RTX. Both the VR1 immunoreactivity and the receptor density of [3H]-RTX binding sites significantly reduced by the application of capsaicin for prolonged periods of time in the mucosa of rats. Our results indicate that VRs are expressed in the rat stomach, and suggest that they may be involved in mucosal protection by increasing cell proliferation and blood flow.

Clinical significance of noninvasive assessment of left ventricular diastolic function by Doppler echocardiography

Transmitral flow velocity pattern obtained by the pulsed Doppler technique reflects left ventricular (LV) diastolic function, but an increase in left atrial pressure pseudonormalizes the flow pattern and masks diastolic dysfunction. We propose an index to assess LV diastolic function using color M-mode Doppler echocardiography and the base-line shift technique. This index, flow propagation velocity, represents the average velocity of early diastolic LV filling flow from the mitral orifice to mid-ventricle. In patients with ischemic heart disease and dilated cardiomyopathy including those with pseudonormalized transmitral flow pattern, flow propagation velocity had a good correlation with the time constant of early diastolic LV pressure decay (Tau), indicating that flow propagation velocity is a useful noninvasive parameter of diastolic function which does not pseudonormalize. We also found a significant correlation between flow propagation velocity and Tau in hypertrophic cardiomyopathy patients in contrast to inadequate or no correlation between each of the conventional parameters and Tau. In addition, our recent data suggest that flow propagation velocity was distinctly decreased even in the patients with hypertension who did not show significant increase in LV mass index. Flow propagation velocity is a unique noninvasive parameter of LV diastolic function, which can sensitively and accurately detect the diastolic impairment in patients with different types of cardiac diseases with various loading conditions.

Pathological features of mucinous carcinoma of the breast are favourable for breast-conserving therapy

AIM

The effectiveness of breast-conserving therapy for mucinous carcinoma has not been well documented. We examined clinical and pathological features of cases to determine whether patients with mucinous carcinoma were suitable candidates for this treatment.

METHOD

Cases of pure type (n=52) and mixed type (n=24) mucinous carcinomas were reviewed with emphasis on the risk factors associated with local recurrences after breast-conserving therapy.

RESULTS

Large pure mucinous carcinomas had a low incidence of extensive intraductal spreading (EIS). An inverse correlation existed between the incidence of EIS and tumour size (P<0.05). Comedo type EIS was infrequent (11%) in pure mucinous carcinoma. Incidences of lymphatic vessel invasion (4%) and nodal involvement (4%) were lower in pure mucinous carcinoma than in mixed carcinoma (P<0.05). No nodal involvement occurred in patients with pure mucinous carcinoma less than 3 cm in diameter.

CONCLUSIONS

Patients with pure mucinous carcinomas, except those invading the local skin, are suitable candidates for breast-conserving therapy. Most pure mucinous carcinomas, including a large tumour up to 5 cm in diameter, can be treated with this therapy.

Comparisons of sleep patterns between mothers in post-partum from 9 to 12 weeks and non-pregnant women

In order to evaluate two patterns of interrupted and non-interrupted sleep for the post-partum mothers from 9 to 12 weeks after delivery, we compared them with sleep patterns of non-pregnant women. Subjects were 10 primipara and 12 non-pregnant women. Their polysomnographic recordings were made using a Medilog recorder at home. In interrupted sleep, low sleep efficiency, decreased total sleep time, and a decreased percentage of stage 2 were significantly observed compared with non-pregnant women. Sleep parameters of non-interrupted sleep, except for increased percentage of stage 4, did not show any significant differences from non-pregnant women. Mothers' sleep fluctuated between interrupted sleep similar to the early post-partum sleep from 1 to 6 weeks and non-interrupted sleep with increased stage 4.

Tubular carcinoma of the breast: a histologic subtype indicative of breast-conserving therapy

We reviewed the clinical and pathologic features of pure tubular carcinoma of the breast with particular emphasis on the reported risk factors associated with local recurrences and survival following breast-conserving therapy. Of 1653 cases of invasive breast cancer, 12 (0.7%) were identified as pure tubular carcinoma. Clinical/pathologic features of pure tubular carcinoma were compared with those of T1 invasive carcinoma of all other histologic types (T1 IC). Of the 12 patients with pure tubular carcinoma (median tumor diameter 1.4 cm; range 0.5-3.0 cm), a multicentric association was identified in one patient while a multifocal association was seen in two. One patient had nodal metastatic disease out of the ten who underwent axillary dissection. No lymphatic vessel invasion was identified in any tumors (P < 0.1 vs T1 IC). In addition, extensive intraductal spread was not present in any tumors (P < 0.05 vs T1 IC). This study shows that patients with pure tubular carcinoma are appropriate candidates for breast-conserving therapy based on the clinical/ pathologic features. When a multifocal association is suspected preoperatively, either a wide local excision or a quadrantectomy which includes other lesions is thus recommended.

High density collimated beams of relativistic ions produced by petawatt laser pulses in plasmas

Under optimal interaction conditions ions can be accelerated up to relativistic energies by a petawatt laser pulse in both underdense and overdense plasmas. Two-dimensional particle in cell simulations show that the laser pulse drills a channel through an underdense plasma slab due to relativistic self-focusing. Both ions and electrons are accelerated in the head region of the channel. However, ion acceleration is more effective at the end of the slab. Here electrons from the channel expand in vacuum and are followed by the ions dragged by the Coulomb force arising from charge separation. A similar mechanism of ion acceleration occurs when a superintense laser pulse interacts with a thin slab of overdense plasma and the pulse ponderomotive pressure moves all the electrons away from a finite-diameter spot.

Generation of one-cycle laser pulses by use of high-amplitude plasma waves

The dynamics of a short laser pulse located in the density trough of a background plasma wave is investigated and a scheme is proposed to compress the pulse duration by use of a high-amplitude plasma wave. The threshold amplitude of the plasma wave, at which the compressing effect just balances the dispersive spreading of the laser pulse, is estimated for certain pulse profiles. Numerical simulations are conducted with particle-in-cell codes, where a pump pulse is used to generate a high-amplitude plasma wave and a signal pulse copropagates behind. It is shown that the signal pulse can be compressed by the plasma wave from ten laser cycles to about one cycle within a millimeter in tenuous plasma only a few percent of the critical density.

Usefulness of early diastolic flow propagation velocity measured by color M-mode Doppler technique for the assessment of left ventricular diastolic function in patients with hypertrophic cardiomyopathy

Flow propagation velocity (FPV) of left ventricular (LV) filling flow has been shown to be a useful index for the evaluation of LV diastolic function, which is relatively independent of preload in myocardial infarction and dilated cardiomyopathy, but the usefulness of FPV for hypertrophic cardiomyopathy (HCM) has not yet been determined. In 23 HCM patients and 26 control subjects, peak transmitral flow velocities in early diastole (E) and during atrial contraction (A), E/A ratio, deceleration time of E velocity, and isovolumic relaxation time were measured with the conventional Doppler technique, and FPV was measured from color M-mode Doppler images of LV filling flow. The time constant of LV isovolumic pressure decay (tau) was measured by a micro-manometer-tipped catheter in all HCM patients and 13 control subjects. Flow propagation velocity was significantly lower and deceleration time was significantly greater in HCM patients than in the control subjects, though no significant differences were observed in the other noninvasive indexes. Tau was significantly prolonged in HCM patients compared with that of control subjects (54+/-12 cm/s and 32 +/-7 cm/s, respectively; P<.0001). While the conventional indexes did not correlate with tau among the 36 patients in whom invasive studies were performed, FPV correlated well with tau (r = -0.76, P<.0001). Flow propagation velocity is a useful noninvasive index for the assessment of LV diastolic function in patients with HCM.

Sensitizing effects of gallium citrate on hyperthermic cell killing in vitro

The lethal effects of gallium citrate in combination with heat were studied using four cell lines, L5178Y, FM3A, P388 and HeLa. Cells were incubated with different concentrations (0.2 2 mM) of gallium citrate at 37 degrees C for 24 h and heated at a range of temperatures from 40-44 degrees C for various time periods up to 6 h in the absence of gallium citrate. Survival and cell viability were determined by clonogenic assay and the dye-exclusion test, respectively. All of the cell lines tested were insensitive to heat below 41 degrees C, but were very sensitive to heat above 43 degrees C. Gallium citrate was cytotoxic to these cell lines at different levels: P388 and HeLa were far more sensitive than L5178Y and FM3A. The killing effects of heat at 41 degrees C were greatly enhanced by gallium citrate in L5178Y and P388 cells. The Arrhenius analysis for the lethal effect of heat, determined by clonogenic assay, in L5178Y cells showed that the transition temperature was remarkably decreased for the gallium-treated cells from approximately 43 degrees C to 41 degrees C. The mechanism for this decrease in the transition temperature may be attributable to the additional effects of gallium citrate on energy metabolism. Preincubation with 0.05 mM gallium citrate at 37 degrees C for 7 days also enhanced heat sensitization at 41 degrees C in L5178Y. This preincubation condition may correspond to the condition for the continuous infusion of gallium that is clinically used for cancer treatment. In contrast, treatment with gallium did not greatly enhance the sensitivity of FM3A or HeLa cells to heat at 41 degrees C, but the effects of gallium were significant.

Axillary lymph node metastases in patients with small carcinomas of the breast: is accurate prediction possible?

OBJECTIVES

To find out whether macroscopic classification of the tumour margin is predictive of axillary lymph node metastases and to identify a combination of clinical and pathological findings by which axillary node status can be predicted accurately in small carcinomas (T1) of the breast.

DESIGN

Retrospective study.

SETTING

Municipal referral centre, Japan.

SUBJECTS

All 1003 patients with T1 invasive carcinoma of the breast who had axillary lymph node dissection between January 1970 and December 1996 as part of their treatment.

MAIN OUTCOME MEASURES

The association between the incidence of axillary lymph node metastases and 10 clinical and pathological factors (age, palpability and size of tumour, macroscopic classification of tumour margin, clinical axillary status, radiating spiculation on a mammogram, histological type, lymphatic invasion, oestrogen and progesterone receptor status) were analysed.

RESULTS

Clinical axillary node status, macroscopic classification of tumour margin, lymphatic invasion, and age of the patient were significant predictors of axillary lymph node metastases (p < 0.01 in each case). Among 47 patients aged 65 or more whose tumours had well-defined margins and with a clinical N0 status in the axillae, the incidence of histological axillary lymph node metastasis was only 6% (n = 3) whereas it was 65% in 57 patients with tumours of ill-defined margins whose axillae were N1 or N2.

CONCLUSIONS

Macroscopic classification of tumour margins is an independent predictor of axillary lymph node metastases for patients with small carcinomas of the breast. However, even with combinations of the examined predictors of axillary node metastases, the subgroup of patients at minimal risk of metastasis was less than 5% in T1 breast cancer, whereas three-quarters of the patients had clear axillary lymph nodes. Most patients with T1 breast cancer will need surgical staging of the axillae by methods such as sentinel node biopsy.

Feed-out of rear surface perturbation due to rarefaction wave in laser-irradiated targets

We report experimental results on hydrodynamic perturbation transfer from the rear to the front of laser-irradiated targets. Flat polystyrene foils with rear-surface perturbations were irradiated by partially coherent light. We observed phase inversion of the rear surface after the shock breakout at the rear surface. Perturbations on the laser-irradiated surface arose due to the rippled rarefaction wave. Experimental results were well reproduced by a simple model with unperturbed hydrodynamic quantities calculated from the one-dimensional simulation.

Mothers' wakefulness at night in the post-partum period is related to their infants' circadian sleep-wake rhythm

The relationship between a post-partum mother's wakefulness at night and her infant's circadian sleep-wake rhythm was examined. The subjects were seven primipara and their infants. Actigraphic recordings for the mothers and their infants were made over three to five continuous days during Weeks 3, 6, 9 and 12. A 24-h peak of autocorrelograms of the infants' movements appeared in two cases at Week 6, in six cases at Week 9, and in seven cases at Week 12. The mothers' night-time movements significantly decreased from Week 3 to Week 12. Mothers' wakefulness during night sleep in the post-partum period is related to their infants' obtaining circadian sleep-wake rhythm.

Parametric instabilities of intense lasers from interaction with relativistic hot plasmas

The stimulated Raman scattering (SRS) and relativistic modulational instability (RMI) of intense lasers in relativistic hot plasmas are studied, using the waterbag distribution in momentum space. Two cases are considered: a single hot electron distribution and a cold plasma attached with a hot electron tail. It is shown that both high temperatures and hot electron tails can significantly reduce the instability growth rates, shift the unstable regions in the wave-vector space, and change the Raman scattering frequency spectra from the cold plasma theory. In particular, at low-light intensities, there exists a cutoff thermal velocity beyond which SRS is completely suppressed. At high-light intensities, no clear cutoff thermal velocity is found owing to the merging of SRS with RMI.

Overexpression of trigger factor prevents aggregation of recombinant proteins in Escherichia coli

To examine the effects of overexpression of trigger factor (TF) on recombinant proteins produced in Escherichia coli, we constructed plasmids that permitted controlled expression of TF alone or together with the GroEL-GroES chaperones. The following three proteins that are prone to aggregation were tested as targets: mouse endostatin, human oxygen-regulated protein ORP150, and human lysozyme. The results revealed that TF overexpression had marked effects on the production of these proteins in soluble forms, presumably through facilitating correct folding. Whereas overexpression of TF alone was sufficient to prevent aggregation of endostatin, overexpression of TF together with GroEL-GroES was more effective for ORP150 and lysozyme, suggesting that TF and GroEL-GroES play synergistic roles in vivo. Although coexpression of the DnaK-DnaJ-GrpE chaperones was also effective for endostatin and ORP150, coexpression of TF and GroEL-GroES was more effective for lysozyme. These results attest to the usefulness of the present expression plasmids for improving protein production in E. coli.

Analysis of Helicobacter pylori binding site on HEp-2 cells and three cell lines from human gastric carcinoma

Helicobacter pylori (H. pylori) is a pathogen responsible for chronic gastritis and peptic ulcer diseases. It colonises the gastric mucus layer and adheres to the gastric epithelial cell surface. As this adherence is the first step of infection, it is important to study the adherence mechanism. The aim of this study was to analyse the specific binding assay of H. pylori to HEp-2 cells and three gastric phenotype cell lines, AGS, MKN-45 and AZ-521. H. pylori NCTC 11637 grown on agar plates was harvested and used in experiments. H. pylori was inoculated to pre-cultured cell monolayers. Adhered bacteria were labelled with an anti-H. pylori antibody and an FITC-conjugated secondary antibody and quantified by using a fluorescent plate reader. Microbial adherence to HEp-2 cells increased with incubation time and incubated concentration of H. pylori. No further increase was obtained with four or more hours of incubation or with a concentration of 4 x 10(7) bacteria/well or more. Scatchard analysis revealed a linear plot and the Bmax value was 88.3. Similar adherence patterns were obtained when AGS, AZ-521 and MKN-45 cells were used for adherence assays, but they had a lower binding affinity than HEp-2 cells and AZ-521. MKN-45 cells had less receptors than HEp-2 and AGS cells. In conclusion, H. pylori adhered to the cell surface could be quantified by this assay method. H. pylori adhesion to cell surfaces has a single population of binding site and one type of binding site on HEp-2, AGS, AZ-521 and MKN-45 cells.

Laparoscopic distal pancreatectomy with preservation of the spleen

We describe a case of chronic pancreatitis treated by laparoscopic distal pancreatectomy with conservation of the spleen involving the resection of the splenic vessels. A proximal ligation of the splenic artery and vein was performed, followed by transection of the body of the pancreas. Retroperitoneum was dissected to the left by mobilizing the stump of the transected pancreas. The entire distal pancreas was freed posteriorly. The distal splenic artery and vein were ligated and divided individually adjacent to the tail of the pancreas at the hilum of the spleen. The points of this operation were to ligate the splenic artery and vein at both sides of the resected pancreas and to save the spleen with the blood supply continuing through the short gastric vessels and the splenocolic ligament. This operation with splenic preservation is more suitable for a patient who is a candidate for laparoscopic distal pancreatectomy, which will minimize the operation time, preserve the useful immunologic role of the spleen, and obtain the intact resected specimen. Furthermore, this procedure is useful in chronic pancreatitis patients because it avoids the difficult dissection of the posterior pancreas off of the splenic vessels.

Sialylated MUC1 mucin expression in normal pancreas, benign pancreatic lesions, and pancreatic ductal adenocarcinoma

BACKGROUND/AIMS

Pancreatic cancer has the poorest prognosis of all gastrointestinal cancers. Because sialylated mucin influences the biologic behavior of carcinoma cells, we investigated sialylated MUC1 mucin expression in patients with pancreatic ductal adenocarcinoma.

METHODOLOGY

The expression of sialylated MUC1 mucin was examined in 55 pancreatic ductal adenocarcinomas, 2 normal pancreas specimens, 3 chronic pancreatitis specimens, 1 ductal hyperplasia of the pancreas, 3 mucinous cystadenomas, and 2 liver metastases from pancreatic ductal adenocarcinoma. Expression was assessed by immunohistochemistry with a new monoclonal antibody (mAb) (MY.1E12).

RESULTS

Sialylated MUC1 mucin was expressed in the cancer cell membrane in all the ductal carcinomas. The reaction product was seen at the apical aspect of cells when these were in tubule formation. This pattern was also detected in mucinous cystadenomas. However, it was seen diffusely in the cell membrane in single cancer cells or small clusters of cells without tubule formation and in metastatic liver tumors. Namely, invading or metastatic cancer cells expressed this type of mucin throughout the entire cell membrane. The expression of sialylated MUC1 mucin was not observed in specimens from normal pancreas, chronic pancreatitis, or ductal hyperplasia of the pancreas. In normal pancreas and these lesions, expression of sialylated Mession of sialylated MUC1 was limited to acini and secreted mucin.

CONCLUSIONS

Sialylated MUC1 mucin, which is expressed throughout the cancer cell membrane, may be a factor in the metastatic potential of pancreatic ductal adenocarcinoma.

Surgical approach to ossification of the thoracic yellow ligament

BACKGROUND

Symptomatic ossification of the yellow ligament (OYL) at the lower thoracic level is uncommon. Although wide laminectomy has, until now, been the primary treatment for this disease, we propose a less invasive technique based on a new method of three-dimensional computed tomography (CT).

METHODS

The clinical features and radiologic imaging findings of 37 patients with OYL (mean age, 54 years) were analyzed. The surgical approach was selected based on the position of the depicted OYL on 3D CT scan in each patient.

RESULTS

The male-to-female ratio was 3:1. Involvement of the upper thoracic region was seen 11 times; of the middle region 8 times, and of the lower region 40 times (several patients had involvement in more than one region). About half of the patients complained of gait disturbance on admission caused by the markedly enlarged OYL. No postoperative complications were found. Neurologic deterioration was observed in only one patient.

CONCLUSIONS

OYL should be treated as early as possible, using the least invasive technique available. By using 3D CT, we were able to perform limited surgery consisting of foraminotomy or extended partial laminectomy at the affected level after confirming the anatomic location of the OYL. In laterally extended OYL, it is necessary to decompress the radicular artery in order to prevent ischemic damage to the spinal cord.

Effect of itraconazole on the pharmacokinetics of digoxin in guinea pigs

The effect of itraconazole (ITZ) on the pharmacokinetics of digoxin (DGX) was investigated in guinea pigs. The plasma concentrations of DGX in guinea pigs following treatment with ITZ (20 mg/kg intraperitoneally (i.p.)) after intravenous (i.v.) administration of DGX (0.125 mg/kg) were significantly higher than in the controls. The percentage cumulative excretion (6.9%) of DGX in bile of the ITZ-treated group up to 6 h after administration of DGX was significantly reduced (p < 0.05) compared with 10.5% in the control. The percentage cumulative excretion (3.1%) of DGX in urine of the ITZ-treated group up to 6 h after administration was also one third that in the controls. The total, biliary, renal and metabolic clearances for DGX in the ITZ-treated group were significantly reduced, while the V(dss) was unaffected. The plasma unbound fraction of DGX (ranged 47-58%) in the ITZ-treated group was generally similar to that in the controls (50-57%). The blood-to-plasma concentration ratio of DGX (range 1.28-1.42) in the absence of ITZ did not change in the presence of ITZ. Based on these results, the pharmacokinetic interaction between DGX and ITZ may be due not only to a reduction in the renal clearance but also to a reduction in the metabolic clearance of DGX by ITZ.

Analyses of mothers' sleep logs in postpartum periods

In order to investigate mothers' sleep-wake patterns from five to 12 weeks in the postpartum period, we analyzed continuous sleep logs. Data for 341 days from seven mothers were analyzed for each postpartum week. There were significant differences in total sleep time and wake time at night. Wake time at night gradually decreased from the fifth to the twelfth week. These results from continuous sleep logs support the results of our previous polysomnographic findings based on intermittent measurements. A transition from interrupted sleep to noninterrupted sleep was observed from the ninth to twelfth week of postpartum. The mothers' sleep-wake patterns are discussed focusing on their relationships to the infants' sleep-wake patterns and feeding rhythm.

Changes in sleep patterns of young women from late pregnancy to postpartum: relationships to their infants' movements

We studied changes in the sleep patterns of ten young women from late pregnancy (36 weeks) to the sixth postpartum week, focusing on the relationship between the women's sleep patterns and their infants' movements. The mothers' polysomnograms and their infants' ankle actigrams were simultaneously recorded using a Medilog 9000 at home in three sessions, during the first, third, and sixth postpartum weeks. The mother-infant pairs slept in close proximity. Two subjects had difficulty with their infants and were dealt with as a separate group. Analysis for the eight subjects who adapted well to the postpartum period showed that wake time after sleep onset increased significantly during the postpartum period compared with late pregnancy given responsibility for feeding. Stage 3 + 4 and Stage REM did not change across the four sessions (pregnancy, first, third, and sixth postpartum weeks), but Stage 2 decreased significantly from pregnancy to postpartum. There was a high synchronization between infants' movements and mothers' wakefulness. Eight mothers did not complain of sleep disturbance, while the two mothers who had difficulty with their infants did. We suggest that mothers who tolerate well sleep interruption arising from feeding and maintain their Stages 3 + 4 and REM should not be considered as suffering from sleep disturbance. Mothers who have difficulty with their infants and complain of sleep disturbance should be considered as suffering from sleep disturbance.

Benzodiazepine effects on human sleep EEG spectra: a comparison of triazolam and flunitrazepam

The effects of 0.5 mg triazolam (TRI) and 4 mg flunitrazepam (FNZ) on the sleep electroencephalogram (EEG) were studied in eleven (six for TRI, and five for FNZ) healthy young male subjects. C3 EEG channel data of one baseline night, three drug nights and two withdrawal nights were recorded and their analyzed using a fast Fourier transformation (FFT) method. Changes in the 0.5 Hz to 40 Hz power spectrum showed that: 1) both TRI and FNZ increased higher frequency activity and reduced lower frequency activity on the drug nights; 2) on drug nights, NREM sigma frequency power was more strongly enhanced by TRI than FNZ, while the beta power of both NREM and REM was more strongly enhanced by FNZ than TRI; 3) NREM alpha power increased on the second night of withdrawal from both TRI and FNZ; 4) the power spectra for both NREM and REM sleep returned to baseline levels by the fourth night of withdrawal from either TRI or FNZ. These findings suggest that 0.5 mg TRI and 4 mg FNZ have both common and differing pharmacological effects on the central nervous system. Such differences could be caused by differences in the dose, half-life or systemic distribution of these two drugs.

Composite glandular-neuroendocrine carcinoma of the hilar bile duct: report of a case

We report herein an unusual case of a composite glandular-neuroendocrine carcinoma of the hilar bile duct. A 71-year-old Japanese woman was admitted to our hospital suffering from general fatigue, progressive jaundice, and a high fever. Computed tomography and angiography findings revealed a solid hypervascular mass in the hepatic hilus. Thus, a subsegmentectomy of the liver (S4, S5) and bile duct resection with lymph node dissection were performed. A tumor measuring 6.0 x 3.0 cm was found to be located in the bile duct of the hepatic hilus. Histologically, the tumor was composed of well-differentiated adenocarcinoma and small cell neuroendocrine carcinoma cells, with a histological transition between the two components. Grimelius' method revealed the presence of diffuse positive tumor cells in neuroendocrine carcinoma. The neuroendocrine tumor cells were also diffusely immunoreactive to chromogranin A. To the best of our knowledge, only 22 previous cases of composite glandular-neuroendocrine carcinoma in the biliary tract have been reported; however, this is the first case report of a clearly composite tumor of the hilar bile duct.

Chaperone coexpression plasmids: differential and synergistic roles of DnaK-DnaJ-GrpE and GroEL-GroES in assisting folding of an allergen of Japanese cedar pollen, Cryj2, in Escherichia coli

Plasmids that can be used for controlled expression of the DnaK-DnaJ-GrpE and/or GroEL-GroES chaperone team were constructed in order to facilitate assessment of the effects of these chaperone teams on folding or assembly or recombinant proteins in Escherichia coli. A typical pACYC184-based plasmid which was obtained could express the major DnaK-DnaJ-GrpE and GroEL-GroES chaperone teams from separate promoters when L-arabinose and tetracycline, respectively, were added in a dose-dependent fashion. The model protein used to determine whether this system was useful was an allergen of Japanese cedar pollen, Cryj2, which was unstable when it was produced in E. coli K-12. The effects of chaperone coexpression on the folding, aggregation, and stability of Cryj2 were examined in the wild type and in several mutant bacteria. Coexpression of the DnaK-DnaJ-GrpE and/or GroEL-GroES chaperone team at appropriate levels resulted in marked stabilization and accumulation of Cryj2 without extensive aggregation. Experiments performed with mutants that lack each of the chaperone proteins (DnaK, DnaJ, GrpE, GroEL, and GroES) or heat shock transcription factor sigma 32 revealed that both chaperone teams are critically involved in Cryj2 folding but that they are involved in distinct ways. In addition, it was observed that the two chaperone teams have synergistic roles in preventing aggregation of Cryj2 in the absence of sigma 32 at certain temperatures.

[Metastasis of small cell lung cancer to the parotid gland as the initial clinical manifestation, followed by metastases to the pituitary gland and lumber spinal cord]

The patient was a 48-year-old woman. In January 1995, she noted swelling in the left parotid gland, and saw an otorhinolaryngologist. Needle biopsy showed small cell carcinoma, and she was subsequently admitted to our hospital. Chest radiography revealed a tumor shadow in the hilus of the right lung. Bronchial biopsy revealed small cell carcinoma of the lung (T 4 N 3 M 1, stage IV). Chemotherapy, with a CDDP-VP-16 regimen, achieved no response. She later developed bitemporal hemianopsia and abducens nerve palsy. Brain MRI revealed metastasis in the pituitary gland. Chemotherapy and radiotherapy were efficacious for only a few months. She also developed pain and numbness in the left leg, attributable to intramedullary metastasis (L 1/2, L 4/5) shown on MRI. It is extremely rare for a metastasis to the parotid gland to be the initial clinical manifestation of a small cell lung cancer which later develops widespread metastases to the pituitary gland and lumbar spinal cord.

[Relationships between wakefulness of mothers and their infants' movements during night sleep of postpartum 6 weeks]

Relationships between wakefulness of mothers and their infants' movements during night sleep in postpartum period were studied under conditions in daily life. Subjects were ten primiparae, aged 23-31 yrs (mean age, 26.8 yrs), who had a normal course of pregnancy and delivery. Eight of their infants were breast-fed, and two were formula-fed. Mother's polysomnograms, (EEG, EOG, EMG, and ECG) and actigrams of infants' legs were simultaneously recorded using Medilog 9000 at home in the 1st, 3rd and 6th postpartum weeks. Mothers' sleep stages and their infants' movements were visually scored by an epoch of one minute. The infants' movements were classified into four states, MOV0, MOV1, MOV2, and MOV3. We defined MOV0 as no activities during one epoch, MOV1 as less than 20 seconds activities, MOV2 as from 20 to 40 seconds activities and MOV3 as from 40 to 60 seconds activities. The average times of wakefulness on the mothers were 102.6 min (SD = 23.5), 84.8 min (SD = 52.8) and 79.4 min (SD = 40.5) for 1st, 3rd and 6th postpartum weeks, respectively. There were no significant differences among them. The mothers' wakefulness coincided with the infants' movements MOV3 was 86.9% for total epochs of MOV3, while deep sleep of the mothers was observed during epochs of MOV0 and MOV1. This trend did not change across the postpartum weeks. The time-lag between the mothers' wakefulness and their infants' movements was calculated. In 85.4% of 48 times of mother's awakenings for feeding their infants, their infants began to move before their mothers woke up. In 63.4% of the cases, the mothers woke up within two minutes after their infants began to move. In the present study, eight of the ten mothers satisfactorily adapted themselves to the life style in the postpartum period, while two had difficulties in adaptation. In conclusion, ten mothers' wakefulness during night sleep in postpartum period was related to their infants' movements, and its relationship did not change through the 1st, 3rd and 6th weeks of delivery.

Synergistic roles of HslVU and other ATP-dependent proteases in controlling in vivo turnover of sigma32 and abnormal proteins in Escherichia coli

Production of abnormal proteins during steady-state growth induces the heat shock response by stabilizing normally unstable sigma32 (encoded by the rpoH gene) specifically required for transcription of heat shock genes. We report here that a multicopy plasmid carrying the hslVU operon encoding a novel ATP-dependent protease inhibits the heat shock response induced by production of human prourokinase (proUK) in Escherichia coli. The overproduction of HslVU (ClpQY) protease markedly reduced the stability and accumulation of proUK and thus reduced the induction of heat shock proteins. In agreement with this finding, deletion of the chromosomal hslVU genes significantly enhanced levels of proUK and sigma32 without appreciably affecting cell growth. When the deltahslVU deletion was combined with another protease mutation (lon, clpP, or ftsH/hflB), the resulting multiple mutations caused higher stabilization of proUK and sigma32, enhanced synthesis of heat shock proteins, and temperature-sensitive growth. Furthermore, overproduction of HslVU protease reduced sigma32 levels in strains that were otherwise expected to produce enhanced levels of sigma32 due either to the absence of Lon-ClpXP proteases or to the limiting levels of FtsH protease. Thus, a set of ATP-dependent proteases appear to play synergistic roles in the negative control of the heat shock response by modulating in vivo turnover of sigma32 as well as through degradation of abnormal proteins.

Anaplastic carcinoma showing rhabdoid features combined with mucinous cystadenocarcinoma of the pancreas

A 52-year-old Japanese woman presented with complaints of back pain, loss of appetite, and weight loss; her diagnosis was a mass in the pancreatic tail. A distal pancreatectomy combined with lymph node dissection was performed. The tumor measured 10.0 x 9.5 x 8.0 cm and consisted of a cystic mass and a solid area. Histologically, the cystic mass represented a typical mucinous cystadenocarcinoma, whereas the solid portion was composed of anaplastic tumor cells with round eosinophilic intracytoplasmic inclusions, as seen in malignant rhabdoid tumor of the kidney. The hyaline-like intracytoplasmic inclusions were weakly positive for periodic acid-Schiff and were resistant to diastase. There was a gradual transition between the mucinous cystadenocarcinoma and the anaplastic carcinoma showing rhabdoid features. Additionally, the tumor cells of the anaplastic carcinoma were immunoreactive to both epithelial membrane antigen and vimentin. These findings suggest that the anaplastic carcinoma with rhabdoid features developed from the mucinous cystadenocarcinoma of the pancreas.

Retrospective analysis of 70 operations for gallbladder carcinoma

BACKGROUND

The clinical course of patients with carcinoma of the gallbladder depends on the depth of tumour invasion. This study was conducted to clarify the prognostic factors affecting survival and appropriate surgical strategy based on depth of invasion of gallbladder carcinoma according to the pathological tumour node metastasis (pTNM) classification.

METHODS

A total of 70 patients who underwent surgical resection were reviewed retrospectively with regard to the type of operation, histopathological findings of the resected gallbladder carcinoma and clinical follow-up after operation.

RESULTS

Twelve patients with pT1 gallbladder carcinoma fared favourably following cholecystectomy or extended cholecystectomy. In 13 of 26 patients with pT2 gallbladder carcinoma, lymph node metastasis was evident: pN1 in eight and pN2 in five. The 3-year survival rate of patients with pT2 gallbladder carcinoma was 28 per cent after cholecystectomy, 91 per cent after extended cholecystectomy and 67 per cent after hepatectomy. In 21 of 28 patients with pT3 or pT4 gallbladder carcinoma, surgical margins were affected by malignant cells. The 1-year survival rate of patients with pT3 or pT4 gallbladder carcinoma was 24 per cent, even after hepatectomy. Significant prognostic factors were age, macroscopic type, histological grade, depth of invasion, lymph node metastasis, pathological stage, lymphatic invasion, venous invasion, perineural invasion and involved surgical margins.

CONCLUSION

Cholecystectomy was adequate for pT1 gallbladder carcinoma. Extended cholecystectomy or hepatectomy with extrahepatic bile duct resection and lymph node dissection (pN1 and pN2) were justified for pT2 gallbladder carcinoma. The survival of patients with more advanced gallbladder carcinoma remains dismal.

[Intraoperative and follow-up color Doppler echocardiography for evaluating the surgical results of aortic valvuloplasty in a patient with bicuspid aortic valve]

A 21-year-old man underwent aortic valvuloplasty for aortic regurgitation due to bicuspid aortic valve. After the initial procedure for valvuloplasty of the anterior cusp, transesophageal color Doppler flow imaging revealed a significant regurgitant jet directed posteriorly as observed preoperatively. After an additional valvuloplastic procedure for the anterior cusp, the size of the regurgitant signal was reduced and directed to the center of left ventricular outflow tract. The surgery was then completed. On the 5th postoperative day, an aortic regurgitant murmur reappeared and color Doppler echocardiography showed a mild but significant regurgitant jet directed toward the interventricular septum, which may have been due to contraction of the anterior cusp treated by valvuloplasty. Aggravation of the aortic regurgitation in the early stage after plastic surgery is important and requires consideration in the intraoperative assessment.

Granular cell tumors of the breast: a report of two cases

Granular cell tumors (GCT) are rare neoplasms, and only 173 cases of benign GCT of the breast have been documented. We report herein the cases of two patients with this tumor and discuss the methods of diagnosis and treatment. The first patient was a 60-year-old woman who presented with a firm ill-defined mass in her left breast. Mammography showed a dense shadow with spicula and skin thickness, and ultrasonography revealed a hypoechoic mass with an irregular border. Radical mastectomy was performed under the wrong preoperative diagnosis of breast cancer. The second patient was a 31-year-old woman who presented with an elastic-hard mass in her left breast. Mammography showed a well-demarcated dense mass, and ultrasonography revealed a well-defined hypoechoic mass with a large depth-width ratio. Fine-needle aspiration cytology (FNAC) showed a large number of histiocytic cells with abundant granular cytoplasm. An excisional biopsy was performed, and histological examination confirmed a diagnosis of GCT. GCT is benign, but often misdiagnosed as breast cancer both clinically and radiologically. Therefore, histological examination is essential for making a correct diagnosis, while FNAC is also useful. Local resection is still the treatment of choice, and surgeons should do their utmost to avoid performing needless radical mastectomy.

Cutaneous metastases from pancreatic cancer

Cutaneous metastases originating from pancreatic cancer are relatively rare. Five cases of metastatic pancreatic cancer to the skin are presented and discussed with a review of 17 previous case reports. In 20 cases, the cutaneous metastases were present prior to the diagnosis of pancreatic cancer. The most common site of cutaneous metastases originating from pancreatic cancer was the umbilicus. Although such cases are rare, it is important to note that metastatic lesions in the skin may be the first sign and one type of distant metastases originating from pancreatic cancer.

Arthroscopic internal fixation of fractures of the intercondylar eminence of the tibia

We treated a 53-year-old man with a fracture of intercondylar eminence of the tibia. He had a nondisplaced (type I) fracture at the first examination and was treated by long leg cast. However, 4 weeks later, it was found that the fracture was displaced, which suggests that nondisplaced fracture of intercondylar eminence may displace later. We recommend primary arthroscopic fixation for type I fractures of the intercendolar eminence of the tibia, because it is difficult to reduce the fragment arthroscopically once it is displaced. This report describes a new technique of arthroscopic reduction and internal fixation for the fractures intercondylar eminence of the tibia.

The differences of self-ratings of sleep quality associated with epinephrine and wake time during 4 hour sleep

The present study examined the differences of self-ratings of 4 h sleep in three states: L-WE, where the percentage of waking time and urinary epinephrine are low (< 20% waking time); H-W, where the percentage of waking time and epinephrine levels increase along the basal regression line as determined by a previous study (20-100% waking time and < 7 ng/min); H-E, where epinephrine levels increase more than expected from the basal regression line for the two parameters (> 7 ng/min). Eight healthy male subjects participated twice in a 4 h polysomnograph experiment with four types of sleep onset (total of 64 observations). In group L-WE (52 observations for eight subjects), there were no excessively negative feelings on sleep latency, sleep depth, and feelings of sleep compared with usual sleep according to the questionnaire. Subjective sleep diagrams in group L-WE were similar to polysomnographic findings. Thus, group L-WE was thought objectively and subjectively to have a good sleep state. Groups H-W (eight observations for four subjects) and H-E (four observations for two subjects) had negative feelings regarding sleep depth and feelings of sleep compared with usual sleep. Approximately half the group H-W underrated their sleep compared with objective diagrams, while all cases in group H-E remarkably underrated their sleep in the subjective diagrams. The state of remarkable adrenal medullary secretory activity seen in group H-E and that of the slightly increased activity shown in group H-W were included in poor sleep states objectively and subjectively.

Flunitrazepam effects on human sleep EEG spectra. II: Sigma and beta alterations during NREM sleep

Flunitrazepam (FNZ) is known to enhance the higher EEG frequencies, including sigma (10-15 Hz) and beta (20-28 Hz). Both sigma and beta frequency bands show an inverse relationship with delta (0.3-3 Hz) during NREM periods, as we have previously reported. It is not known whether generation of these two EEG frequencies is mediated by the same or different neuronal mechanisms. In this report, we compare alterations of delta, sigma and beta EEG induced by FNZ (4 mg) orally administered to five healthy male subjects for seven consecutive nights. Sleep EEG on the baseline night (BLN), and the fourth and seventh drug nights (4DN, 7DN) was subjected to fast Fourier transform (FFT) analysis. On drug nights, sigma was enhanced without regard to delta amount, but beta was enhanced only during epochs containing low delta. Thus, sigma and beta EEG were altered differently by the same pharmacological agent. These results suggest that sigma and beta EEG are mediated by different neuronal mechanisms.

Lack of effect of vancomycin and gentamicin on auditory function in guinea pigs

The dispositions of vancomycin (VCM) and gentamicin (GM) in plasma and perilymph after single and multiple administrations and the effects of multiple administrations of VCM or GM alone and the combination of both drugs on auditory function were studied in male guinea pigs. The pharmacokinetic parameters of VCM and GM obtained from plasma drug concentration-time data after single and multiple (22 days) intramuscular administrations of VCM (200 mg/kg of body weight) alone and GM (50 mg/kg) alone were not significantly different from those after combined administration of VCM (200 mg/kg) and GM (50 mg/kg). There was no change in the penetration ratio of VCM and GM into perilymph between administration of VCM or GM alone and the combination of both drugs. Furthermore, the hearing threshold of guinea pigs was not affected by VCM or GM alone or the combination of both drugs within the range of therapeutic VCM and GM levels in plasma in humans.