A severe hepatic disorder with myelodysplastic syndrome, treated with cytarabine ocfosfate, in a dog

An 8-year-old female Shih Tzu was presented with weight loss and vomiting. Alanine aminotransferase was high and abdominal radiographs revealed hepato- and splenomegaly. Mild anaemia, neutrophilia with left shift, eosinophilia, a thrombocytosis with dysplastic features of eosinophils and platelets, were detected. The animal was initially considered to have hepatitis and was treated accordingly, but clinical signs persisted. Histological examination of liver biopsy samples showed disruption of the hepatic lobule, with extensive infiltration by haemopoietic cells. Further investigation of the bone marrow suggested a diagnosis of myelodysplastic syndrome. The animal was treated with cytarabine ocfosfate, a prodrug of cytosine arabinoside, and appeared to recover.

Differentiation of exudate from transudate ascites by Doppler sonography

BACKGROUND

We investigated whether the addition of Doppler sonography (US) increases the diagnostic confidence of US for estimating the nature of ascites.

METHODS

Of the 127 cases reviewed in this study, there were 42 cases of transudate and 85 of exudate ascites. We reviewed the US, power Doppler, and pulsed Doppler images of these cases.

RESULTS

With US, the transudate ascites was imaged as free of echo in 38 of 42 cases (90.5%). The exudate ascites was imaged as free of echo in 22 of 85 cases (25.9%) and with internal echo spots in 63 of 85 cases (74.1%). With Doppler US, we obtained distinct pulsed signals from the transudate ascites in only two of 36 cases (5.6%). In contrast, we obtained distinct Doppler signals from the exudate ascites in 66 of 79 cases (83.5%). Those 66 cases included 16 of the 22 cases with echo-free ascites.

CONCLUSION

The presence or absence of echo spots within the ascites helped differentiate transudate from exudate ascites, as reported in the literature. However, the addition of Doppler US contributed to the differentiation of echo-free exudate (Doppler signals present) from echo-free transudate (Doppler signals absent) ascites.

Appendiceal mucocele: sonographic findings

BACKGROUND

Appendiceal mucocele (AM) is a relatively rare disease, and its sonograms (US) have not been sufficiently analyzed.

METHODS

We studied the US findings of five patients with AM, with special attention to AM size, shape, internal echoes, and the mode of back echoes.

RESULTS

All five cases showed an elongated mass in the lower right abdomen. Internal echoes were present in all cases and M-mode US confirmed the movement of those echoes. The echogenecity of the lesion changed according to the frequency of the transducer used. Only one case showed posterior echo enhancement, and no case showed lateral shadowing.

CONCLUSION

AM appears as an elongated echo-poor mass without posterior echo enhancement. The cyst wall is less distinct than what one would expect for a cyst. When encountering such a mass in the lower right abdomen, one should strongly suspect an AM. In such cases, appropriate diagnostic and therapeutic strategies are especially necessary to prevent rupture that results in development of pseudomyxoma peritonei.

Dilatation of the cystic duct in patients with obstructive jaundice

BACKGROUND

It is well known that obstructive jaundice causes biliary dilatation, but sonographic (US) findings of the cystic duct in patients with obstructive jaundice are rarely reported.

METHODS

We reviewed US findings in 25 such patients.

RESULTS

US findings of dilated cystic duct could be divided roughly into two patterns: tortuous and tubular. The former pattern was a tortuously dilated cystic duct arising from the gallbladder neck, running predominantly deeply, turning anteromedially, and then joining the posterior face of the common hepatic duct. The latter pattern was a straight dilated cystic duct running parallel with the common hepatic duct, giving the appearance of a septated bile duct.

CONCLUSION

A better understanding of the US findings of dilated cystic duct translates into improved biliary US diagnosis.

Retroperitoneal cyst: sonographic findings

BACKGROUND

Retroperitoneal cyst (RC) is a relatively rare disease, and its sonographic (US) findings have not been analyzed sufficiently.

METHODS

We studied US findings of five patients with RC, with special attention to location, size, shape, internal echoes, the presence or absence of lateral shadowing, and the mode of back echoes.

RESULTS

In all cases, the cyst was situated behind (four cases) or lateral to (one case) the pancreas: behind or lateral to the pancreatic head in two cases, behind the pancreatic body in one case, and behind the pancreatic tail in two cases. Four cases showed a round mass (three cases) or multiple round mass (one case). Internal echoes were present in those cases and showed a "pseudo-solid" pattern. In those cases, M-mode US confirmed the movement of those internal echoes. In the remaining case, the lesion was imaged as an irregularly shaped multilocular mass. No case showed posterior echo enhancement, and no case showed lateral shadowing. No blood flow signals from the lesion were seen.

CONCLUSION

Unlike ordinary cysts, RC usually is imaged as a round mass behind the pancreas, with dense internal echoes without lateral shadowing or posterior echo enhancement, which presents a "pseudo-solid" pattern. A diagnosis of RC should be considered when encountering a mass with such US findings.

Potential remedy against Echinococcus multilocularis in wild red foxes using baits with anthelmintic distributed around fox breeding dens in Hokkaido, Japan

The effect of bait-delivered anthelmintic to reduce the prevalence of Echinococcus multilocularis in wild red foxes was evaluated in Koshimizu, in the eastern part of Hokkaido, Japan. The study area (200 km2) was divided into baited and non-baited sections. The anthelmintic baits were distributed around fox den sites in the baited section every month for 13 months. After 1 year of the anthelmintic bait distribution, the prevalence of E. multilocularis in foxes, evaluated either by the parasite egg examination (from 27.1 to 5.6%) or coproantigen ELISA (from 59.6 to 29.7%), decreased in the baited section contrasting to that in the non-baited section (parasite egg: from 18.8 to 24.2%; ELISA: from 41.9 to 45.8%). The prevalence of E. multilocularis in grey red-backed vole Clethrionomys rufocanus, caught around fox dens, born after bait distribution also decreased and was significantly lower than that in non-baited section. However, within the study periods, the coproantigen-positive rate in fox faeces sporadically increased, while egg-positive rate constantly decreased. Since coproantigen ELISA can detect pre-patent infection, this observation indicates that reinfection pressure in the baited section was still high even after the 13 months of anthelmintic bait distribution. Therefore, the bait distribution longer than our study period is required for the efficient control of E. multilocularis in wild red fox population.

Abdominal lymphoma: differentiation from pancreatic carcinoma with Doppler US

BACKGROUND

Marked lymphadenopathy around the pancreas due to lymphoma (abdominal lymphoma) occasionally can mimic a total pancreatic carcinoma on ultrasonography (US). We investigated whether US and color Doppler US allowed differentiation between those pathologies.

METHODS

We analyzed the US and color Doppler results of 12 cases of abdominal peripancreatic lymphoma and 21 cases of total pancreatic carcinoma.

RESULTS

With regard to shape, echogenicity of the lesion, and mode of vascular involvement, there was no difference between groups. With regard to maximal velocities and resistive indices of the involved vessels, there was no difference between groups. However, the presence of turbulent flows in the involved vessels was seen exclusively in the pancreatic carcinoma group.

CONCLUSION

The presence or absence of turbulent flow in the involved vessels is a very important finding for differentiating abdominal lymphomas from total pancreatic carcinomas.

Accessory hepatic duct: sonographic findings

Accessory hepatic ducts are relatively rare biliary anomalies. They have been reported only sporadically, and very few reports have described their sonographic (US) findings. Our experience with two such cases suggested that a diagnosis of an accessory hepatic duct should be considered when US shows a fine tubular structure or an anechoic or hypoechoic oval mass with acoustic shadowing at the level between the hepatic hilus and the common bile duct. A good knowledge of the US findings will determine the diagnostic and therapeutic strategies.

Primary carcinoid tumor of the liver: report of two cases with an emphasis on US findings

Primary carcinoid tumor of the liver is rare, and its sonographic (US) findings have rarely been reported. We present two histologically proven cases. Both patients were asymptomatic and huge masses, found incidentally by US, were echogenic with many cystic areas. Lesions were markedly hypervascular on color Doppler US and angiography. Thus, primary carcinoid tumor of the liver should be considered when US detects this type of mass in asymptomatic patients.

Mesenteric lipoma: report of a case with emphasis on US findings

Mesenteric lipoma (ML) is a relatively rare disease that has been very infrequently reported. We present the clinical data and medical imaging results of an asymptomatic case with ML incidentally detected by sonography (US). On US the lesion was imaged as a well-demarcated hypoechoic mass with multiple linear echoes. The mass also changed location under probe compression. The lesion was imaged as a clearly demarcated non-enhanced homogeneous fat-density mass on CT. Color Doppler US and angiography confirmed the avascular nature of the mass. Knowledge of the US findings in this case is useful for the diagnosis of ML.

Emphysematous cholecystitis: sonographic findings

BACKGROUND

Emphysematous cholecystitis (EC) is a rare but life-threatening complication of acute cholecystitis, and an early diagnosis is required to prevent delay in patient management. Because sonography (US) is the first choice for diagnosing gallbladder diseases, US findings of EC should be understood more precisely.

METHODS

We reviewed US findings of 11 surgically proven cases of EC (with small amounts of gas in three cases and large amounts in eight cases) and compared those with patients' clinical data.

RESULTS

(1) In cases with small amounts of gas, US showed an echogenic line with a distinct ring-down artifact or a "powder snow-like" speckled posterior echo. (2) In cases with large amounts of gas, US showed a wide spiculated echogenic band with a powder snow-like speckled posterior echo or a speckled acoustic shadowing. In all cases, the presence of gas prevented visualization of the gallbladder wall. (3) US did not differentiate gas localized to the gallbladder wall and gas extending to the surrounding hepatic tissue. (4) Two diabetic cases showed gas throughout the intrahepatic bile ducts. In those cases, the time from diagnosis to recovery was relatively long.

CONCLUSION

Our series showed some characteristic US patterns of EC. A good understanding of its US findings and appropriate emergent management will reduce the serious morbidity and mortality rates caused by EC.

Mechanism of selective inhibition of respiratory syncytial virus by a benzodithiin compound (RD3-0028)

RD3-0028, a compound with a benzodithiin structure, was found to be a potent inhibitor of respiratory syncytial virus (RSV) replication. Its action is specific; no activity is seen against influenza A virus, measles virus, herpes simplex virus type 1 or 2, or human cytomegalovirus. A time-dependent drug addition experiment indicated that the antiviral activity occurs in the late stage of the RSV replication cycle, since this compound completely inhibited syncytium formation even when added up to 16 hr after the infection of cell monolayers at an MOI of 3. RD3-0028 had no direct virucidal effect on RSV. Western blotting analysis showed that RD3-0028 significantly decreased the amount of RSV proteins released into the cell culture medium. Moreover, five independent isolates of the RSV long strain were selected for growth in RD3-0028 (5-20 microg/ml). These resistant viruses were more than 80-fold less sensitive to RD3-0028 than the long strain. The F gene segment of each of these viruses was sequenced and in each case the mutant RNA segment contained at least one sequence alteration, converting asparagine 276 to tyrosine (F1 protein). These results suggest that RD3-0028 inhibits RSV replication by interfering with intracellular processing of the RSV fusion protein, or a step immediately thereafter, leading to loss of infectivity.

Segmental chronic cholecystitis: sonographic findings and clinical manifestations

BACKGROUND

In chronic cholecystitis, the gallbladder (GB) wall is usually evenly involved, whereas marked segmental thickening of the GB wall (segmental cholecystitis) seldom is reported. We wanted to define its clinical manifestations and sonographic (US) findings.

METHODS

We reviewed the clinical and US data of 13 cases and compared these results with those of 30 patients with chronic cholecystitis with evenly thickened GB walls (usual-cholecystitis group).

RESULTS

(a) All cases of segmental cholecystitis showed the portion distal to the kinking to be markedly thickened. (b) The thickened portion corresponded to the fundus in three cases, the body and fundus in seven cases, and the fundus, body, and infundibulum in three cases; and the thickened distal portion contained many stones in 11 cases. (c) There was no difference in the maximal diameters of the GB walls between the segmental-cholecystitis group and the usual-cholecystitis group. However, there was a significant difference in the minimal diameters of the GB walls between groups.

CONCLUSION

Knowledge of the US findings and clinical presentations of segmental cholecystitis can help in the development of appropriate diagnostic and therapeutic strategies.

Pharmacokinetics of a benzodithiin (RD3-0028) following aerosol treatment in rat

1. RD3-0028, a benzodithiin compound, has potent antiviral activity against respiratory syncytial virus (RSV) in cell culture. The compound also inhibits growth of RSV and improves pathologic changes of interstitial pneumonia in the immunosuppressed mouse when delivered by small-particle aerosol. 2. In the present study, the absorption, distribution and excretion of 14C-RD3-0028 were compared in rat following either a single aerosol treatment or oral administration. 3. The plasma concentration was maintained at the same level from 5 min to 1 h, and decreased with a half-life of 2.2 +/- 0.1 h for 1-8 h. 4. The excretion of radioactivity in the urine and faeces at 24 h after aerosol treatment was 89.3 and 4.5%, respectively, indicating that almost all the radioactivity was rapidly excreted in the urine. The excretion of total radioactivity was 98.9% within 168 h. 5. The concentrations of radioactivity in the lung and trachea following aerosol treatment were higher than those in other tissues, and were detected even at 72 h. 6. These results suggest that the aerosol treatment might be useful for delivering RD3-0028 to the respiratory tract of RSV-infected patients.

Gallbladder perforation: color Doppler findings

Gallbladder (GB) perforation is a life-threatening complication of acute cholecystitis, and early diagnosis prevents delay in patient management. We present two cases of GB perforation diagnosed by color Doppler ultrasonography. Each clearly showed a flow signal passing through the perforated site, leading to prompt and successful surgical treatment. This interesting observation suggests that color Doppler ultrasonography is useful in the diagnosis of GB perforation.

Efficient and versatile synthesis of novel 2alpha-substituted 1alpha,25-dihydroxyvitamin D(3) analogues and their docking to vitamin D receptors

Novel 2alpha-substituted 1alpha,25-dihydroxyvitamin D(3) analogues with 2alpha-alkyl and 2alpha-hydroxyalkyl groups were systematically synthesized from D-xylose. Their conformation on binding to the ligand binding domain (LBD) of the vitamin D receptor was analyzed. It has been found that the 2alpha-hydroxypropyl group best fits the cavity of the LBD, and the binding activity is three times higher than that for the natural hormone.

[Phase I study with irinotecan hydrochloride (CPT-11) for advanced neuroblastoma]

A Phase I trial of irinotecan hydrochloride (CPT-11) was performed to determine the maximum tolerated dose (MTD), the dose-limiting toxicities, and the incidence and severity of other toxicities in children with advanced neuroblastoma. Three children received 11 courses of CPT-11 administered as a 90-min i.v. infusion, daily for 3 days every 21 days. Doses ranged from 100 mg/m2 to 220 mg/m2. Two peaks in the total number of instances of diarrhea was observed, 25 stools at 3 days and 32 stools at 10 days. Myelosuppression was well controlled and of brief duration. One child achieved a clinical complete response (CR) and 2 had a partial response (PR). The MTD of CPT-11 administration was 180 mg/m2 for 3 days. These results indicate the usefulness of CPT-11 for the treatment of advanced neuroblastoma. Further investigation is necessary to establish its role in combination chemotherapeutic regimens.

Modulation of synaptic transmission in hippocampal CA1 neurons by a novel neurotoxin (beta-pompilidotoxin) derived from wasp venom

We examined the effects of beta-pompilidotoxin (beta-PMTX), a neurotoxin derived from wasp venom, on synaptic transmission in the mammalian central nervous system (CNS). Using hippocampal slice preparations of rodents, we made both extracellular and intracellular recordings from the CA1 pyramidal neurons in response to stimulation of the Schaffer collateral/commissural fibers. Application of 5-10 microM beta-PMTX enhanced excitatory postsynaptic potentials (EPSPs) but suppressed the fast component of the inhibitory postsynaptic potentials (IPSPs). In the presence of 10 microM bicuculline, beta-PMTX potentiated EPSPs that were composed of both non-NMDA and NMDA receptor-mediated potentials. Potentiation of EPSPs was originated by repetitive firings of the presynaptic axons, causing summation of EPSPs. In the presence of 10 microM CNQX and 50 microM APV, beta-PMTX suppressed GABA(A) receptor-mediated fast IPSPs but retained GABA(B) receptor-mediated slow IPSPs. Our results suggest that beta-PMTX facilitates excitatory synaptic transmission by a presynaptic mechanism and that it causes overexcitation followed by block of the activity of some population of interneurons which regulate the activity of GABA(A) receptors.

Anoplin, a novel antimicrobial peptide from the venom of the solitary wasp Anoplius samariensis

A novel antimicrobial peptide, anoplin, was purified from the venom of the solitary wasp Anoplius samariensis. The sequence was mostly analyzed by mass spectrometry, which was corroborated by solid-phase synthesis. Anoplin, composed of 10 amino acid residues, Gly-Leu-Leu-Lys-Arg-Ile-Lys-Thr-Leu-Leu-NH2, has a high homology to crabrolin and mastoparan-X, the mast cell degranulating peptides from social wasp venoms, and, therefore, can be predicted to adopt an amphipathic alpha-helix secondary structure. In fact, the circular dichroism (CD) spectra of anoplin in the presence of trifluoroethanol or sodium dodecyl sulfate showed a high content, up to 55%, of the alpha-helical conformation. A modeling study of anoplin based on its homology to mastoparan-X supported the CD results. Biological evaluation using the synthetic peptide revealed that this peptide exhibited potent activity in stimulating degranulation from rat peritoneal mast cells and broad-spectrum antimicrobial activity against both Gram-positive and Gram-negative bacteria. Therefore, this is the first antimicrobial component to be found in the solitary wasp venom and it may play a key role in preventing potential infection by microorganisms during prey consumption by their larvae. Moreover, this peptide is the smallest among the linear alpha-helical antimicrobial peptides hitherto found in nature, which is advantageous for chemical manipulation and medical application.

Renal arteriovenous malformation: sonographic findings

BACKGROUND AND METHODS

Renal arteriovenous malformation (RAVM) is a relatively rare congenital disease. Although sonography (US) currently is the first diagnostic tool for examining the kidney, its US and color Doppler findings have seldom been reported. We reviewed the clinical manifestations and US results of five cases of RAVM to clarify the role and limitations of US in the diagnosis.

RESULTS

The lesions were solitary in all cases, and the affected side was the right in four cases and the left in one case. In four cases, the patients complained of hematuria, but the remaining case had no symptoms. US did not detect the lesion, but in all cases color Doppler US showed a focal vascular lesion with posterior color spots. US reexamination with knowledge of the Doppler results did not show any focal lesion.

CONCLUSION

US was not diagnostic for RAVM, and color Doppler US should be performed immediately in patients with hematuria.

Localized gallbladder carcinoma: sonographic findings

Our study of color (seven cases) and contrast (three cases) Doppler results of seven cases with gallbladder carcinoma localized in the gallbladder wall (TNM stage T1) showed that the presence or absence of blood flow signals distinguishes gallbladder carcinoma in stage T1b (muscular involvement) from tumefactive biliary sludge and that injection of contrast medium markedly increased diagnostic confidence. Thus, when color Doppler sonography is ambiguous, contrast-enhanced Doppler sonography is the next line of investigation. However, actual color Doppler sonography is still not fully capable of displaying fine blood flow signals from gallbladder carcinoma in stage T1a (mucosal involvement), and greater Doppler sensitivity is mandatory for this purpose.

Ciliated hepatic foregut cyst: case report with an emphasis on US findings

Ciliated hepatic foregut cyst (CHFC) is a rare mass, and its medical imaging findings are seldom reported. We present a histologically proven case of CHFC. The patient was asymptomatic, and a mass was found incidentally by sonography (US) in segment IV. The lesion was almost anechoic on fundamental US but filled with dense echoes with distinct posterior echo enhancement on second harmonic imaging. The lesion was avascular on color Doppler US and angiography. Thus, when US detects a mass in segment IV, the possibility of a CHFC should be considered regardless of the US results.

Synthesis and biological evaluation of all A-ring stereoisomers of 5,6-trans-2-methyl-1,25-dihydroxyvitamin D(3) and their 20-epimers: possible binding modes of potent A-ring analogues to vitamin D receptor

BACKGROUND

The secosteroid 1 alpha,25-dihydroxyvitamin D(3) (1) has a wide variety of biological activities, which makes it a promising therapeutic agent for the treatment of cancer, psoriasis and osteoporosis. Insight into the structure-activity relationships of the A-ring of 1 is still needed to assist the development of more potent and selective analogues as candidate chemotherapeutic agents, as well as to define the molecular mode of action.

RESULTS

All possible A-ring stereoisomers of 5,6-trans-2-methyl-1,25-dihydroxyvitamin D(3) (6a-h) and their 20-epimers (7a-h) were designed and efficiently synthesized. The dependence of the affinities for vitamin D receptor (VDR) and vitamin D binding protein (DBP), as well as the HL-60 cell differentiation-inducing activity, upon the stereochemistry of the A-ring and at C20 in the side chain was evaluated.

CONCLUSIONS

The binding affinities and potency of the 5,6-trans and 5,6-cis analogues were enhanced by a 2-methyl substituent in a certain orientation. Molecular docking studies based upon the X-ray crystal structure of VDR suggested that the axial 2-methyl group would be accommodated in a pocket surrounded by hydrophobic amino acid residues in the ligand binding domain, resulting in enhanced interaction.

Tissue specific metabolism of 1alpha,25-dihydroxy-20-epi-vitamin D3 into new metabolites with significant biological activity: studies in rat osteosarcoma cells (UMR 106 and ROS 17/2.8)

In a recent study, we investigated the metabolism of 1alpha,25-dihydroxy-20-epi-vitamin D3 (1alpha,25(OH)2-20-epi-D3), a potent synthetic vitamin D3 analog in the isolated perfused rat kidney and proposed that the enhanced biological activity of 1alpha,25(OH)2-20-epi-D3 is in part due to its metabolism into stable bioactive intermediary metabolites derived via the C-24 oxidation pathway (Siu-Caldera et al. [1999] J. Steroid. Biochem. Mol. Biol. 71:111-121). It is now well established that 1alpha,25(OH)2D3 and its analogs are metabolized in target tissues not only via the C-24 oxidation pathway but also via the C-3 epimerization pathway. As the perfused rat kidney does not express the C-3 epimerization pathway, we could not identify other possible bioactive metabolites of 1alpha,25(OH)2-20-epi-D3 such as 1alpha,25(OH)2-20-epi-3-epi-D3, derived via the C-3 epimerization pathway. Therefore, we studied the metabolism of 1alpha,25(OH)2-20-epi-D3 in rat osteosarcoma cells (UMR 106) which express both the C-24 oxidation and the C-3 epimerization pathways. Our results indicate that 1alpha,25(OH)2-20-epi-D3 is metabolized in UMR 106 cells into several metabolites which included not only the previously known metabolites of the C-24 oxidation pathway but also three new metabolites which were labeled as metabolites X, Y1, and Y2. Metabolite X was unequivocally identified as 1alpha,25(OH)2-20-epi-3-epi-D3. Even though definite structure identification of the metabolites, Y1 and Y2 was not achieved in our present study, we determined that the metabolite Y1 is produced from 1alpha,25(OH)2-20-epi-D3 and the metabolite Y2 is produced from 1alpha,25(OH)2-20-epi-3-epi-D3. We also noted the production of both 1alpha,25(OH)2-20-epi-3-epi-D3 and the two metabolites Y1 and Y2 in different rat osteosarcoma cells (ROS 17/2.8) which express only the C-3 epimerization pathway but not the C-24 oxidation pathway. Furthermore, we investigated the metabolism of 1alpha,25(OH)2-20-epi-D3 in the isolated perfused rat kidney in an earlier study. The results of this study indicated that the rat kidney unlike rat osteosarcoma cells did not produce either 1alpha,25(OH)2-20-epi-3-epi-D3 or the metabolites Y1 and Y2. Thus, it appears that the metabolites Y1 and Y2, like 1alpha,25(OH)2-20-epi-3-epi-D3, are produced only in specific tissues. Preliminary biological activity of each new metabolite is assessed by measuring its ability to generate VDR-mediated gene transcription. 1alpha,25(OH)2-20-epi-3-epi-D3 was found to be almost equipotent to 1alpha,25(OH)2-20-epi-D3 while the metabolites, Y1 and Y2 were found to be less active. The metabolite Y1 when compared to the metabolite Y2 has higher biological activity and its potency is almost equal to 1alpha,25(OH)2D3. In summary, we report for the first time tissue specific metabolism of 1alpha,25(OH)2-20-epi-D3 into several bioactive metabolites which are derived not only via the previously established C-24 oxidation and C-3 epimerization pathways but also via a new pathway. (c) 2001 Wiley-Liss, Inc.

Osteosarcoma as a second malignancy after treatment for neuroblastoma

A 4-month old girl was diagnosed as having stage IV neuroblastoma of the right adrenal gland. Preoperative chemotherapy was given, followed by local surgical excision. Postoperatively, irradiation of the tumor bed and adjuvant chemotherapy was given for 11 months. Nine years after cessation of chemotherapy, the patient developed left hip-joint pain. Biopsy of the ischium showed chondroblastic osteosarcoma. Limb salvage surgery was performed after preoperative chemotherapy. Postoperatively, adjuvant chemotherapy was given for 14 months. Twenty-two months after treatment for the secondary osteosarcoma, the patient has been remained in disease-free condition without any evidence of relapse. A second osteosarcoma occurring outside the radiation field after treatment for neuroblastoma is quite rare. This unusual case emphasized the need for close monitoring for development of second malignant neoplasms in survivors of neuroblastoma even in the absence of a known predisposing factor, such as radiation therapy.

Duodenal carcinoma: sonographic findings

BACKGROUND

Duodenal carcinoma is a relatively rare tumor and its sonographic (US) findings have rarely been reported.

METHODS

We reviewed the clinical data and US results of 15 patients with histologically proven duodenal carcinoma to pinpoint the contribution of US to the diagnosis.

RESULTS

US was useful for not only detecting the duodenal carcinoma (13 of 15, 86.7%), which altered the endoscopic procedure in nine patients, but also for evaluating vascular involvement (marked portal invasion in four cases and inferior vena cava invasion in two cases). Four of the eight carcinomas arising from the second or third portion showed this vascular invasion.

CONCLUSION

After reviewing the clinical data and US results of 15 cases of duodenal carcinoma, we found that US was useful for detecting duodenal carcinoma and determining vascular invasion. Thus, US contributed significantly to alter the endoscopic procedure and patient management.

Peripheral bone metastasis from hepatocellular carcinoma: sonographic findings

BACKGROUND AND METHODS

We reviewed medical and radiologic records of five patients with bone metastasis from hepatocellular carcinoma (HCC) to evaluate the role of sonography (US) in the diagnosis of this bone metastasis.

RESULTS

The metastatic lesions were clearly visualized by US as expansive, homogeneous, soft tissue masses with bony destruction, and color Doppler US showed fine vessels within the lesions. After treatment, US showed a decrease in tumor size with an increase in echogenicity and a decrease in blood flow. Hepatic US at the time of bone metastasis showed a portal tumor thrombus in all cases.

CONCLUSION

When US detects a portal venous tumor thrombus in HCC patients, attention should be directed not only to the liver but also to bone to improve patient care. US is useful not only in detecting the metastatic lesion but also in evaluating the treatment effect.

Breed differences in allele frequency of the dopamine receptor D4 gene in dogs

We previously reported that the dog dopamine receptor D4 (DRD4) gene is polymorphic as observed in humans, and four alleles were identified based on the number and/or order of the 12 and 39 bp sequences located in the homologous region of human DRD4. To assess the diversity of the DRD4 gene in dogs we examined the allelic variations in four breeds (beagle, golden retriever, Shetland sheepdog, and shiba) employing the polymerase chain reaction (PCR). As a result, we found three novel alleles and determined the DNA sequences of these alleles. The beagle shared four alleles, including 396, 435, 447a, and 447b, with the 435 (52.6%) and 447a (39.5%) alleles being common. The golden retriever had the 435 and 447a alleles, and the 435 allele was frequent (73.3%). In the Shetland sheepdog, the 435, 447a, and 498 alleles were observed, of which the 447a allele was most frequent (82.5%). The shiba had five alleles-447a, 447b, 486, 498, and 549-and the 447b allele was most common (55.4%). These findings suggest that the allele frequency varied among the four dog breeds, and analysis of the DRD4 polymorphism may therefore be useful for elucidating the relationships among dog breeds.

Splenic lymphoma: differentiation from splenic cyst with ultrasonography

BACKGROUND AND METHODS

Lymphoma can be nearly anechoic and mimic a cyst on ultrasonography (US). To investigate whether this phenomenon occurs at the level of the spleen, we analyzed the US findings of 38 cases of splenic lymphoma and 16 cases of splenic cyst.

RESULTS

(1) With regard to shape, echogenicity of the lesion, and mode of posterior echo, there was no difference between splenic lymphomas and splenic cysts. However, the boundaries of the lesions were indistinct in splenic lymphomas and distinct in splenic cysts. (2) Blood flow signals and vascular penetration were seen exclusively in splenic lymphomas.

CONCLUSION

The mode of boundary echo (distinct or indistinct) distinguishes splenic lymphomas from splenic cysts. Color Doppler US increases the diagnostic confidence of US.

Liver tumors in fatty liver: difficulty in ultrasonographic interpretation

BACKGROUND

Fatty liver and liver tumors are very frequent diseases. Sonography (US) currently is the initial diagnostic tool for hepatic exploration. However, there is a marked paucity of US findings of tumors in fatty liver.

METHODS

We studied the US findings of 41 lesions (31 patients) with this combination, with special attention paid to internal echoes, marginal echoes, and especially the mode of back echoes, and compared them with the US results of 64 lesions (38 patients) without fatty liver.

RESULTS

Comparing the group having liver tumor without fatty liver with the group having liver tumor with fatty liver showed that (a) the number of hypoechoic lesions increased (29 of 41, 70.7%, vs. 16 of 64, 25.0.%), (2) the tumor margin appeared indistinct (32 of 41, 78.0%, vs. nine of 64, 14.1%), and (c) the lesions showing posterior echo enhancement increased (34 of 41, 82.9%, vs. eight of 64, 12.5%).

CONCLUSION

Liver tumors in fatty liver are expected to show unusual patterns on US, so we should consider this difficulty when interpreting these US findings and we should not make a conclusion without including other imaging modalities.

Inhibitory effect of different UV lamps on the infectivity of taeniid eggs

The expanding distribution of alveolar echinococcosis in Hokkaido, Japan necessitates a search for control measures, particularly for killing Echinococcus eggs; and UV radiation is a potential tool. To determine the effective UV lamp and its optimum duration of exposure to inhibit the infectivity of taeniid eggs, three UV lamps (UVA, UVB and UVC) with peak emissions at different wavelengths were used to irradiate eggs of Taenia taeniaeformis. Irradiation was done in durations of 30, 90, 270, 810, 2,430 and 7,290 s. Infectivity of the irradiated eggs was tested by oral inoculation into rats. The inhibitory effect of the UV lamps at different exposure durations was determined by the reduction in the larval cyst establishment and by the delay of larval development. The UVC lamp (narrow peak at 254 nm) was found to be the most effective lamp at an exposure duration of more than 2,430 s (2,430 mJ/cm2), attaining 100% reduction. Also, shorter exposure durations produced a significant effect on the development of irradiated eggs in a greater percentage of small cysts (> 1 mm) among the metacestodes. Irradiation delayed the development of some cysts, as observed in histopathological sections. UVA and UVB lamps were not able to attain 100% reduction. It is concluded that the UVC lamp can be used as a tool in sterilizing taeniid eggs and is thus a promising method to control echinococcosis, although it may require a higher intensity of exposure.

Isolation and sequence determination of peptides in the venom of the spider wasp (Cyphononyx dorsalis) guided by matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry

Micro-scale (sub-pmol) isolation and sequence determination of three peptides from the venom of the solitary spider wasp Cyphononyx dorsalis is described. We isolated two novel peptides Cd-125 and Cd-146 and a known peptide Thr(6)-bradykinin from only two venom sacs of solitary spider wasp Cyphononyx dorsalis without bioassay-guided fractionation, but instead guided by MALDI-TOF MS. The MALDI-TOF MS analysis of each fraction showed the purity and molecular weight of the components, which led to the isolation of the peptides virtually without loss of sample amount. The sequences of the novel peptides Cd-125 (Asp-Thr-Ala-Arg-Leu-Lys-Trp-His) and Cd-146 (Ser-Glu-Thr-Gly-Asn-Thr-Val-Thr-Val-Lys-Gly-Phe-Ser-Pro-Leu-Arg) were determined by Edman degradation together with mass spectrometry, and finally corroborated by solid-phase synthesis. The known peptide Thr(6)-bradykinin (Arg-Pro-Pro-Gly-Phe-Thr-Pro-Phe-Arg) was identified by comparison with the synthetic authentic specimen. This is the first example for any kinins to be found in Pompilidae wasp venoms. The procedure reported here can be applicable to studies on many other components of solitary wasp venoms with limited sample availability.

Mycotic abdominal aneurysm: report of a case with emphasis on the presence of gas echoes

Mycotic abdominal aneurysm is a relatively rare disease and its sonographic (US) findings have rarely been reported. We present a case of mycotic aneurysm of the common iliac artery in which the initial US showed a slightly wall-thickened abdominal aorta with gas echoes in the wall, a second US 6 days later showed a rapid increase in aortic size, and an emergent surgical intervention showed a mycotic aneurysm. This interesting observation suggested that the presence of gas echoes is a useful US finding indicating the beginning of a mycotic aneurysm and, when encountering this US finding, that emergent treatment should be considered to prevent delay in patient management.

Choledochal cyst due to anomalous pancreatobiliary junction in the adult: sonographic findings

BACKGROUND

Adult cases of choledochal cyst due to anomalous pancreaticobiliary duct junction have been rarely reported. At present, sonography (US) is the first tool for diagnosing biliary disorders. The aim of this study was to reevaluate the US findings of choledochal cysts due to anomalous pancreaticobiliary duct junction in adults.

METHODS

We reviewed the clinical manifestations and US findings of 12 such adult cases confirmed by endoscopic retrograde cholangiopancreatic ductography (ERCP). Patients were assigned to three groups: (a) associated with biliary carcinoma (two cases), (b) associated with choledocholithiasis (one case), and (c) not associated with other abdominal diseases (nine cases).

RESULTS

Patients in group c were asymptomatic, and the lesions were detected incidentally detected by US. In contrast, patients in group a sought medical care because of symptoms such as jaundice and those in group b sought medical attention because of abdominal pain. The diameter of a dilated bile duct on US was considerably less than that of ERCP (ERCP: 26-58 mm, mean = 37.6 mm; US: 13-32 mm, mean = 21.8 mm). Its diameter changed significantly under probe compression when the dilated bile duct took a purely cystic form but changed very little when it took a tubular form.

CONCLUSION

Unlike cases in children, adult cases of choledochal cyst are generally asymptomatic. Careful US observation of the bile duct is thus expected to detect asymptomatic adult choledochal cysts cases. Cyst diameter can change significantly under probe compression, so it is important not to compress the bile duct during routine US examination.

[A case of Churg-Strauss syndrome in which positive rheumatoid factor and MPO-ANCA preceded the development of clinical symptoms of vasculitis]

A 52-year-old man in whom bronchial asthma had been diagnosed in 1995 was admitted for the treatment of Churg-Strauss syndrome in June 1997. Positive tests MPO-ANCA and rheumatoid factor preceded the symptoms of vasculitis for several months. A skin biopsy revealed infiltration of eosinophils in the vessel walls, and the diagnosis of Churg-Strauss syndrome was confirmed. After systemic administration of corticosteroids, the symptoms other than mononeuritis improved markedly, and his MPO-ANCA and rheumatoid factor became negative. Rheumatoid factor and MPO-ANCA may be useful for the early diagnosis of Churg-Strauss syndrome in patients with bronchial asthma in which a well-controlled disease develops into an intractable condition.

Novel wasp toxin discriminates between neuronal and cardiac sodium channels

Pompilidotoxins (PMTXs), derived from the venom of solitary wasp has been known to facilitate synaptic transmission in the lobster neuromuscular junction, and a recent further study from rat trigeminal neurons revealed that the toxin slows Na+ channel inactivation without modifying activation process. Here we report that beta-PMTX modifies rat brain type II Na+ channel alpha-subunit (rBII) expressed in human embryonic kidney cells but fails to act on the rat heart alpha-subunit (rH1) at similar concentrations. We constructed a series of chimeric mutants of rBII and rH1 Na+ channels and compared modification of the steady-state Na+ currents by beta-PMTX. We found that a difference in a single amino acid between Glu-1616 in rBII and Gln-1615 in rH1 at the extracellular loop of D4S3-S4 is crucial for the action of beta-PMTX. PMTXs, which are small peptides with 13 amino acids, would be a potential tool for exploring a new functional moiety of Na+ channels.

AT oligonucleotides inducing B lymphocyte activation exist in probiotic Lactobacillus gasseri

This study determined oligonucleotide sequences of mitogenic DNA derived from lactic acid bacteria (LAB). The chromosomal DNA, which was purified from 12 out of 16 strains of Lactobacillus acidophilus group LAB, induced proliferation of splenic lymphocytes. When DNA from L. gasseri JCM1131T was cloned and amplified using PCR, the mitogenic activities of B lymphocytes were significantly increased by 108 of 321 DNA clones. Ten high homologous nucleotide sequences were found as possible DNA sequences of mitogens, and were then chemically synthesized (sOL-LG1 to sOL-LG10). Two nucleotide sequences (sOL-LG7 and sOL-LG10) that consist of only A and T nucleotides (AT oligonucleotides) were characterized as B lymphocyte specific mitogens because they resulted in proliferation of B lymphocytes but not of T lymphocytes. sOL-LG7 preferentially bound to large B lymphocytes and enhanced the expression of the CD86 antigen more than the CD69 antigen on B lymphocytes. The findings show that mitogenic AT oligonucleotides are likely to restrict pre-activated subsets of B lymphocytes. This study demonstrated that novel AT oligonucleotides triggering B lymphocyte mitogenic responses exist in the nucleoids of L. gasseri and proposed that they have potential as applicants for the production of new functional foods, "Bio-Defense Foods".

Trandolaprilat, an angiotensin-converting enzyme inhibitor, is not excreted in bile via an ATP-dependent active transporter (cMOAT)

Trandolapril is the prodrug of an angiotensin-converting enzyme (ACE) inhibitor. It has been proposed that its active metabolite, trandolaprilat, is mainly excreted in bile, but this has not been clearly demonstrated. Recently it has been reported that temocaprilat, an active metabolite of the ACE inhibitor temocapril, is effectively excreted in bile via an ATP-dependent active transporter (canalicular multispecific organic anion transporter: cMOAT). To investigate whether trandolaprilat has the pharmacological ability to affect the cMOAT system in a manner similar to temocaprilat. The lipophilicity of trandolaprilat and temocaprilat was measured to determine the n-octanol-water partition coefficients. The dose-dependent inhibition of the up-take of [3H]-estradiol-17beta-D-glucuronide and [3H]-2,4-dinitrophenyl-S-glutathione, which are good substrates for cMOAT, in canalicular membrane vesicles (CMVs) prepared from Sprague-Dawley rats was determined in the presence of trandolaprilat and temocaprilat. The partition coefficient of trandolaprilat (log Po/w - 1.1) was about 30 times higher than that of temocaprilat (log Po/w - 2.5). The uptake of [3H]-estradiol-17beta-D-glucuronide and [3H]-2,4-dinitrophenyl-S-glutathione was dose-dependently inhibited by the presence of temocaprilat, but trandolaprilat had no effect on the transport of [3H]-estradiol-17beta-D-glucuronide or [3H]-2,4-dinitrophenyl-S-glutathione into CMVs even at concentrations as high as 200 microM. It could be concluded that trandolaprilat has a higher lipophilicity than temocaprilat. But the hepatobiliary excretion system via cMOAT may not contribute to the excretion of trandolaprilat in bile.

Macronodular deformity of the spleen

BACKGROUND AND METHODS

Macronodular splenic deformity without a focal lesion has rarely been reported. We present three such cases and discuss the possible pathomechanism.

RESULTS

There was one case of macronodular deformity of unknown cause. In this case, the liver was elongated anteriorly over the dome of the spleen, and the markedly deformed spleen mimicked a round lesion in the left lobe of the liver. Color Doppler ultrasonography showed the major intra- and perisplenic vessels to be patent. There were two cases of macronodular deformity associated with extended portal thrombosis. In both cases, portal thrombosis extended throughout the intrahepatic and extrahepatic portal systems, and this portal flow disturbance was presumed to be the cause of the splenic deformity.

CONCLUSION

Although very rare, thrombosis should be sought throughout the portal system when ultrasonography shows a markedly deformed spleen. Marked splenic deformity, especially in cases with an elongated liver, may mimic a liver tumor. A good understanding of its sonographic appearance may help sonographers prevent a hazardous misdiagnosis.

Systematic studies on synthesis, structural elucidation, and biological evaluation of A-ring diastereomers of 2-methyl-1alpha,25-dihydroxyvitamin D(3) and 20-epi-2-methyl-1alpha,25-dihydroxyvitamin D(3)

All possible A-ring diastereomers of 2-methyl-1alpha,25-dihydroxyvitamin D(3) (2) and 20-epi-2-methyl-1alpha,25-dihydroxyvitamin D(3) (3) were synthesized by palladium-catalyzed coupling reaction of A-ring 'enyne' synthons with CD-ring portions. The A-ring synthons were rationally synthesized via a novel and practical route, starting with methyl (R)-(+)- and (S)-(-)-3-hydroxy-2-methyl-propionate, in good yields. X-ray crystallographic analysis of 2alpha-methyl-1alpha,25-dihydroxyvitamin D(3) (2b) and conformational analysis of the A-ring of 2alpha-methyl-(2b) and 2beta-methyl-1alpha,25-dihydroxyvitamin D(3) (2f) were carried out, and the results are described. All A-ring diastereomers (2 and 3), thus synthesized, were biologically evaluated both in vitro and in vivo. The biologic potency was highly dependent on the stereochemistry of the A-ring substituents. In particular, 2b showed 4-fold higher vitamin D receptor [VDR] binding activity than the natural hormone, and its 20-epimer (3b) exhibited exceptionally high activity, 12-fold more potent in VDR binding, 7-fold in calcium mobilization, and 590-fold in induction of human promyelocytic leukemia (HL-60) cell differentiation as compared with the natural hormone. Further, the 20-epi-2beta-Me-1beta, 3alpha(OH)(2) isomer (3g) had significant biologic potencies compared to the natural hormone despite having 1beta-OH configuration. The transcriptional activities on human osteocalcin gene promoter, including VDRE in transfected mammalian cells, were also evaluated. Finally, there was a clear contrast between the effects of the 2-methyl group on the HL-60 cell differentiation- and apoptosis-inducing activities of 2 and 3.

Preliminary cryocrystallography analysis of an eumenine mastoparan toxin isolated from the venom of the wasp Anterhynchium flavomarginatum micado

Mastoparans are tetradecapeptides found to be the major component of vespid venoms. These peptides present a wide spectrum of biological activities, such as mast cell degranulation, hemolytic activity and also reveals antimicrobial activity. A mastoparan toxin isolated from the venom of Anterhynchium flavomarginatum micado has been crystallized. At room temperature these crystals diffracted to 2.8 A resolution. However, upon cooling to cryogenic temperature around 85 K, the original resolution limit could be improved to 2.0 A. Crystals were determined to belong to the space group P3(1) (P3(2)). This is the first mastoparan to be crystallized and it will provide further insights in the conformational significance of mastoparan toxins, with respect to their potency and activity in G protein regulation.

Highly potent cell differentiation-inducing analogues of 1alpha,25-dihydroxyvitamin D3: synthesis and biological activity of 2-methyl-1,25-dihydroxyvitamin D3 with side-chain modifications

Eight 2-methyl substituted analogues of 20-epi-22R-methyl-1alpha,25-dihydroxyvitamin D3 (5) and 20-epi-24,26,27-trihomo-22-oxa-1alpha,25-dihydroxyvitamin D3 (6: KH-1060) were convergently synthesized. Preparation of the CD-ring portions with modified side chains of 5 and 6, followed by palladium-catalyzed cross-coupling with the A-ring enyne synthons (20a-d), (3S,4S,5R)-, (3S,4R,5R)-, (3S,4S,5S)- and (3R,4R,5S)-3,5-bis[(tert-butyldimethylsilyl)oxy]-4-methyloct-1-en-7-yne, afforded two sets of four A-ring stereoisomers of 20-epi-2,22-dimethyl-1,25-dihydroxyvitamin D3 (7a-d) and 20-epi-24,26,27-trihomo-2-methyl-22-oxa-1,25-dihydroxyvitamin D3 (8a-d). The biological profiles of the hybrid analogues were assessed in terms of affinity for vitamin D receptor (VDR) and HL-60 cell differentiation-inducing activity in comparison with the natural hormone. The combined modifications of the A-ring at the 2-position and the side chain yielded analogues with high potency.

Pancreatic uncinate carcinoma: sonographic findings

BACKGROUND

Pancreatic carcinoma arising from the uncinate process (pancreatic uncinate carcinoma) is relatively rare. We wished to define its clinical manifestations and sonographic findings.

METHODS

Clinical and sonographic data of eight cases were reviewed.

RESULTS

The common bile duct and the pancreatic duct were not dilated until a very late stage. The lesion mimicked a mesenteric tumor in two cases. The superior mesenteric vessels were compressed anteriorly. Computed tomography was useful, not only for confirming the pancreatic uncinate origin of the lesion but also for determining precisely the mode of mesenteric vascular involvement.

CONCLUSION

Knowledge of these unusual sonographic findings can determine the diagnostic strategy in pancreatic uncinate carcinoma.

Pancreatic metastasis: sonographic findings

BACKGROUND

Pancreatic metastasis is a relatively rare pathologic condition. Its ultrasound (US) findings have been infrequently reported, and there has been no previous report describing its color Doppler findings.

METHODS

We reviewed the US findings of 13 such cases.

RESULTS

The pancreatic metastasis consisted of a single hypoechoic nodule in four cases and multiple hypoechoic nodules in nine cases. US showed a slight dilatation of the main pancreatic duct in two cases of pancreatitis, and a marked biliary dilatation in one case of jaundice. The US results prompted introduction of appropriate treatment in these cases. Color Doppler US was useful for confirming the absence of flow abnormalities in the arterial and portal systems around the pancreas. In a patients with renal carcinoma metastasis, it showed many fine blood flow signals in the metastatic lesions.

CONCLUSION

The role of US in the diagnosis of pancreatic metastasis consists of associated complications such as biliary dilatation or pancreatitis and detection of isolated lesions. Additional information provided by color Doppler US may increase diagnostic confidence.

Structure-specific control of differentiation and apoptosis of human promyelocytic leukemia (HL-60) cells by A-ring diastereomers of 2-methyl-1alpha,25-dihydroxyvitamin D(3) and its 20-epimer

1alpha,25-dihydroxyvitamin D(3) (1alpha,25(OH)(2)D(3)) has been shown to modulate not only proliferation and differentiation but also apoptosis of malignant cells, indicating that it would be useful for the treatment of hyperproliferative diseases such as cancer and psoriasis. Little information is available concerning structural motifs of the 1alpha,25(OH)(2)D(3) molecule responsible for modulation of differentiation and apoptosis. We synthesized all possible A-ring diastereomers of the 2-methyl-1alpha,25(OH)(2)D(3) and its 20-epimer and evaluated their biological activities in human promyelocytic leukemia (HL-60) cells. Surprisingly, the potent analogues could be clearly divided into two groups: (i) those bearing the 1alpha- and 3beta-hydroxyl groups on the A-ring were potent inducers of differentiation and growth inhibitors of HL-60 cells and (ii) those bearing the 1beta-hydroxyl group together with either 3alpha- or 3beta-hydroxyl groups on the A-ring were potent stimulators of apoptosis in these cells. We have clearly identified for the first time the structural motifs on the basis of the stereochemistry of both hydroxyl groups at positions 1 and 3 of the A-ring of the 1alpha,25(OH)(2)D(3) molecule responsible for the induction of differentiation and apoptosis of HL-60 cells. These findings provide useful information not only for structure-function studies of 1alpha,25(OH)(2)D(3) analogues but also for the development of therapeutic agents for the treatment of leukemia and other cancers.

Characterization of UDP-glucuronosyltransferases (UGTS) involved in the metabolism of troglitazone in rats and humans

UDP-glucuronosyltransferases (UGTs) involved in troglitazone glucuronidation in rats and humans have been characterized to support the previous toxicity study on troglitazone in Gunn rats and to examine whether the UGT polymorphism or inhibition of bilirubin metabolism is related to the clinically reported rare cases of liver failure. The experiments using Gunn rats revealed that UGT1 enzymes are not involved in troglitazone glucuronidation and that the responsible enzyme in rats was suggested to be UGT2B2, an androsterone UGT, by inhibition studies. In humans, contribution of UGT1A1 was estimated to be about 30% of the total troglitazone glucuronidation by UGTs, using human liver microsomes and recombinant UGTs. Other UGT1 and UGT2 enzymes seem to be responsible for the rest of the troglitazone glucuronidation in humans. The multiplicity of UGTs involved in troglitazone glucuronidation in humans may allow even patients lacking bilirubin UGT (UGT1A1) activity to produce troglitazone glucuronide. These observations suggest that the polymorphism of UGT is not the reason behind the liver failure induced by the troglitazone treatment, and troglitazone does not inhibit bilirubin glucuronidation in clinical treatment. In addition, the increased bilirubin level in the blood of patients who have troglitazone-induced liver failure is a consequence of liver injury and not due to inhibition of bilirubin glucuronidation by troglitazone.

Synthesis, biological evaluation, and conformational analysis of A-ring diastereomers of 2-methyl-1,25-dihydroxyvitamin D(3) and their 20-epimers: unique activity profiles depending on the stereochemistry of the A-ring and at C-20

All eight possible A-ring diastereomers of 2-methyl-1, 25-dihydroxyvitamin D(3) (2) and 2-methyl-20-epi-1, 25-dihydroxyvitamin D(3) (3) were convergently synthesized. The A-ring enyne synthons 19 were synthesized starting with methyl (S)-(+)- or (R)-(-)-3-hydroxy-2-methylpropionate (8). This was converted to the alcohol 14 as a 1:1 epimeric mixture in several steps. After having been separated by column chromatography, each isomer led to the requisite A-ring enyne synthons 19 again as 1:1 mixtures at C-1. Coupling of the resulting A-ring enynes 20a-h with the CD-ring portions 5a,b in the presence of a Pd catalyst afforded the 2-methyl analogues 2a-h and 3a-h in good yield. In this way, all possible A-ring diastereomers were synthesized. The synthesized analogues were biologically evaluated both in vitro and in vivo. The potency was highly dependent on the stereochemistry of each isomer. In particular, the alpha alpha beta-isomer 2g exhibited 4-fold higher potency than 1 alpha,25-dihydroxyvitamin D(3) (1) both in bovine thymus VDR binding and in elevation of rat serum calcium concentration and was twice as potent as the parent compound in HL-60 cell differentiation. Furthermore, its 20-epimer, that is, 20-epi-alpha alpha beta 3g, exhibited exceptionally high activities: 12-fold higher in VDR binding affinity, 7-fold higher in calcium mobilization, and 590-fold higher in HL-60 cell differentiation, as compared to 1 alpha,25-dihydroxyvitamin D(3) (1). Accordingly, the double modification of 2-methyl substitution and 20-epimerization resulted in unique activity profiles. Conformational analysis of the A-ring by (1)H NMR and an X-ray crystallographic analysis of the alpha alpha beta-isomer 2g are also described.

Liver tumors in children and young patients: sonographic and color Doppler findings

BACKGROUND

Liver tumors are a relatively rare pathologic condition in children and young patients. The aim of the present study was to categorize the sonographic (US) and color Doppler results of liver tumors in these patients.

METHODS

We retrospectively reviewed the US findings of 23 such cases: malignant tumor (13 cases)-hepatoblastoma (four cases), hepatocellular carcinoma (HCC; four cases), and hepatic metastasis (five cases); benign tumor (10 cases)-hepatocellular adenoma (four cases), focal nodular hyperplasia (two cases), mesenchymal hamartoma (two cases), cystadenoma (one case), and hemangioendothelioma (one case).

RESULTS

There was no specific US findings for each tumor type. HCC usually developed on a normal liver and was imaged as multiple nodules. Color Doppler US helped in differentiating multiple metastatic nodules (hypovascular) from multiple HCC nodules (hypervascular). Presence of intratumoral cystic areas was usually suggestive of benign tumors. Follow-up US was useful for detecting small nodules in high-risk groups (congenital biliary atresia, glycogen storage disease). Color Doppler US helped in diagnosing portal thrombus or intratumoral shunt.

CONCLUSION

Although there were no highly specific findings, US and color Doppler results contributed, to a certain degree, to the diagnosis of liver tumors in children and young adults by showing intratumoral cystic areas or vascularity.