Intramedullary bone-cement fixation for proximal humeral fracture in elderly patients. A report of 5 cases

We treated 5 proximal humeral fractures associated with advanced osteoporosis with conventional plate and screw fixation augmented by intramedullary bone cement. These osteosyntheses remained stable during a 1-year follow-up and the outcome was similar to that after fractures in younger patients without osteoporosis.

Human PEX19: cDNA cloning by functional complementation, mutation analysis in a patient with Zellweger syndrome, and potential role in peroxisomal membrane assembly

At least 11 complementation groups (CGs) have been identified for the peroxisome biogenesis disorders (PBDs) such as Zellweger syndrome, for which seven pathogenic genes have been elucidated. We have isolated a human PEX19 cDNA (HsPEX19) by functional complementation of peroxisome deficiency of a mutant Chinese hamster ovary cell line, ZP119, defective in import of both matrix and membrane proteins. This cDNA encodes a hydrophilic protein (Pex19p) comprising 299 amino acids, with a prenylation motif, CAAX box, at the C terminus. Farnesylated Pex19p is partly, if not all, anchored in the peroxisomal membrane, exposing its N-terminal part to the cytosol. A stable transformant of ZP119 with HsPEX19 was morphologically and biochemically restored for peroxisome biogenesis. HsPEX19 expression also restored peroxisomal protein import in fibroblasts from a patient (PBDJ-01) with Zellweger syndrome of CG-J. This patient (PBDJ-01) possessed a homozygous, inactivating mutation: a 1-base insertion, A764, in a codon for Met255, resulted in a frameshift, inducing a 24-aa sequence entirely distinct from normal Pex19p. These results demonstrate that PEX19 is the causative gene for CG-J PBD and suggest that the C-terminal part, including the CAAX homology box, is required for the biological function of Pex19p. Moreover, Pex19p is apparently involved at the initial stage in peroxisome membrane assembly, before the import of matrix protein.

[An epidemic of aseptic meningitis caused by echoviruses in Fukuoka Prefecture during April 1997 to August 1998]

An epidemic of aseptic meningitis in Fukuoka Prefecture during April 1997 to August 1998 was studied to determine the serotype of viruses isolated in Fukuoka Prefecture. In Fukuoka Prefecture, bimodal peaks were seen in July and December 1997. Monthly changes of reported aseptic meningitis patients and period of virus isolation revealed that epidemics of the earlier part in 1997 was caused by echovirus 9 (E 9) and the latter part due to echovirus 30 (E 30). E 9 was isolated mainly in Chikugo Area from June to October 1997 but, E 30 was isolated all in areas of Fukuoka Prefecture. Isolation of E 30 continued after January 1998 in Fukuoka Prefecture. Isolation of echovirus 18 started in June 1998. The main serotypes of isolates are changing. The E 30 isolates are serotyped by neutralization with the aid of antiserum pools for enterovirus type differentiation, but serotyping was difficult with commercially available antiserum. The result of neutralization tests with standard serum and an immune albino rabbit serum prepared in our laboratory with the E 30 isolates indicated that the isolates in Fukuoka Prefecture was an antigenic variant.

Effects of the pH-controlled hemoglobin vesicles by CO2 gas

The hemoglobin vesicle (HbV) is a red cell substitute encapsulating purified concentrated Hb in a phospholipid vesicle. In order to improve the oxygen carrying capability of HbV, the pH value of the Hb solution should be adjusted to 7.0 in the HbV preparation, and then the pH value should be adjusted to 7.4 where HbV functions as an oxygen carrier, because the maximum value of [Hb]/[Lipid] was obtained in which the pH of the Hb solution was 7.0, and the metHb formation rate was suppressed in the pH 7.4. Generally, the pH control of the inner aqueous phase of HbV is difficult by changing the pH in the outer phase. We could control the pH of the Hb solution from 7.4 to 7.0 by dissolving CO2 into the Hb solution, and after the preparation of HbV, the pH of HbV is changed to 7.4 by reducing the pressure. The resulting pH-controlled HbV by CO2 gas showed a high [Hb]/[Lipid] value of 1.7 with a low rate of metHb formation.

Subsidence of seizure induced by stereotactic radiation in a patient with hypothalamic hamartoma. Case report

The authors report on a patient who exhibited intractable epilepsy due to an inaccessible hypothalamic hamartoma and subsequently underwent stereotactic radiosurgery. This 25-year-old man had a 24-year history of intractable gelastic and tonic-clonic seizures. Magnetic resonance (MR) imaging performed at examination as well as that performed 30 months earlier demonstrated a nonenhancing and nonprogressive spherical mass, approximately 10 mm in diameter, located on the patient's right side at the floor of the third ventricle. Focal radiation treatment performed with a gamma knife unit administered 36 Gy to the center and 18 Gy to the periphery of the lesion. This treatment resulted in an improvement in seizure control. Before the patient underwent radiosurgery, he suffered from three to six generalized seizures per month in spite of attentive compliance with an anticonvulsant medication regimen. After irradiation of the harmatoma, the frequency of the seizures transiently increased and then subsided 3 months posttreatment. The patient has been free of seizures for the last 21 months, with no neurological or endocrinological complications. Magnetic resonance imaging performed 12 months posttreatment demonstrated complete disappearance of the lesion.

[Analysis of genome types of adenovirus type 7 isolated in Fukuoka Prefecture in 1996]

Adenovirus type 7 (Ad7) was rarely isolated in Japan till 1994, but during April 1995 to August 1996, isolations of Ad7 were reported 230 cases. We isolated Ad7 in January and July 1996 in Fukuoka prefecture. We analyzed its genome type by using 14 restriction endonuclease and studied seroepidemiology of Ad7 infection in Fukuoka prefecture. Isolated Ad7 strains were identical by 14 restriction endonuclease. Between new Ad7 isolates and prototype (Gomen; Ad7p), 4 restriction endonuclease patterns were identical but 10 restriction endonuclease patterns were different. From the result of restriction endonuclease pattern analysis, genome type of Ad7 isolated in Fukuoka may be the same to Ad7c reported by Noda et al. (1996). The alterations in the cleavage sites of 10 restriction endonucleases between new Ad7 isolates and Ad7p were revealed at least 12 sites. Ad7 antibody positive rates in serum specimens collected in Fukuoka Prefecture were 3.6% in 1994 and 9.7% in 1996.

Structural comparisons of cell organelles and nuclei in rat hepatocytes with three different fixation techniques

The morphological properties of cell organelles and nuclei in rat hepatocytes were compared, when the hepatocytes were either chemically fixed in glutaraldehyde and osmium (GA-Os), chemically fixed only in osmium (Os-2h) or physically fixed with a microwave-irradiated osmium (Mw-Os) fixative for a short duration. Judging from the fine structure, the mitochondria and rER were best preserved after physical fixation; because of the smooth surfaces and regular open contours, but both organelles shrank in the two chemical fixatives. The Golgi complexes and peroxisomes of the hepatocytes were not markedly changed by any of the fixative procedures. However the lysosomes and sER were changed to some extent after physical fixation. In the nucleus, the two kinds of chromatins and the nucleolus were best preserved with physical fixation. In conclusion, physical fixation is a very simple and fast procedure that is convenient for routine electron microscopy if some attention is paid to the morphological changes.

Pathological improvement of IgA nephropathy and Henoch-Schönlein purpura nephritis with urokinase therapy

The pathological findings of 13 patients with immunoglobulin A (IgA) nephropathy or Henoch-Schönlein purpura nephritis before and after urokinase (UK) administration were investigated retrospectively. The mean activity index value decreased significantly at the time of the second biopsy compared with that of the biopsy before UK treatment. The mean chronicity index value, which was considered to reflect the renal outcome, before and after UK treatment did not change significantly, although it improved significantly in six patients. Immunofluorescence microscopy showed that the immune deposition of C3 decreased, but that of IgA and fibrin-related antigen were unchanged, by UK therapy. These results suggest that UK may prevent the mesangial proliferation associated with IgA nephropathy and Henoch-Schönlein purpura nephritis not only by its fibrinolytic action, but also by other mechanisms, such as digestion of the mesangial matrices.

[Epidemic of influenza in Kyushu-Okinawa District (April 1994-March 1995)]

The prevalence of influenza in Kyushu-Okinawa District in April 1994- March 1995 was studied as the prevalence of influenza virus, to determine the sero-type of influenza viruses isolated in Kyushu- Okinawa District prefectures and cities. As a result, three sero-types of influenza viruses, i.e. type A/H1N1, type H3N2 and type B, were isolated in Kyushu-Okinawa District in this season, but most of the isolates were type A/H3N2 and type B. Weekly changes of reported influenza patients and period of virus isolation at local public health institutes revealed that influenza epidemics of the earlier part in this season was caused by type A/H3N2 and the latter part due to type B. Type A/H3N2 spread all over Kyushu-Okinawa District in a shorter period (about 2 weeks) through the westside of Kyushu and down south, and type B stayed about one month in northern Kyushu and took about 7 weeks to spread all over Kyushu-Okinawa District. Based on these results, the spread of influenza virus in Kyushu-Okinawa District was visualized on the isopleth maps.

Three-dimensional structure of two different lymphatic spaces in rat testis, and the route of flow fluxes of their lymphatic fluids

In addition to the collecting vessels, two initial lymphatic spaces were observed with light and electron microscopes. In the deep parenchyma, the peritubular lymphatic spaces surrounding the tubules were observed as polygonal piles after a corrosion casting to the testis. They were joined to the adjacent piles through fenestrae to form a loose spongiform structure. In the superficial parenchyma, the peritubular lymphatic spaces communicated to the subtunical lymphatic space on one side. The subtunical lymphatic spaces anastomosed to each other through small bypasses to form a rich network. Near the mediastinum, the peritubular lymphatic spaces bifurcated and narrowed on another side. Microradiography demonstrated two fluxes of the intratesticular lymphatic fluids; fast and slow flows. The fast flow was observed as a shaded line running into the subtunical lymphatic spaces immediately after injection of the contrast media. It remained 1 or 2 minutes and then disappeared. In contrast, the slow flux was observed as a spongiform shade shifting from the anteroposterial quadrant to the posterosuperior portion of the testis. Seven to 15 minutes were needed for the contrast media to reach near the mediastinum. Both lymphatic spaces are functionally discussed with relation to the two different fluxes of the lymphatic fluids.

[Peritumoral hemorrhage after radiosurgery for metastatic brain tumor: a case report]

An unusual case of peritumoral hemorrhage after radiosurgery for the treatment of metastatic brain tumor is reported. This 64-year-old woman had a history of breast cancer and underwent right mastectomy in 1989. She remained well until January 1993, when she started to have headache, nausea and speech disturbance, and was hospitalized on February 25, 1993. Neurological examination disclosed right hemiparesis and bilateral papilledema. CT scan and MR imaging showed a solitary round mass lesion in the left basal ganglia region. It was a well-demarcated, highly enhanced mass, 37mm in diameter. Cerebral angiography confirmed a highly vascular mass lesion in the same location. She was treated with radiosurgery on March 8 (maximum dose was 20Gy in the center and 10Gy in the peripheral part of the tumor). After radiosurgery, she had an uneventful course and clinical and radiosurgical improvement could be detected. Her neurological symptoms and signs gradually improved and reduction of the tumor size and perifocal edema could be seen one month after radiosurgery. However, 6 weeks after radiosurgery, she suddenly developed semicoma and right hemiplegia. CT scan disclosed a massive peritumoral hemorrhage. Then, emergency craniotomy, evacuation of the hematoma and total removal of the tumor were performed on April 24. Histopathological diagnosis was adenocarcinoma. It was the same finding as that of the previous breast cancer. Histopathological examination revealed necrosis without tumor cells in the center and residual tumor cells in the peripheral part of the tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Three-dimensional structures of the neck region of the hamster spermatozoa in the caudal epididymis

Three-dimensional structures of the capitulum and first mitochondria in the neck region of the hamster spermatozoa, were observed with transmission (TEM) and scanning electron microscope (SEM). Some capitula revealed a variable contour even in the caudal epididymis, but most finally developed to form a typical wagonette shape. The final shape of the capitulum is probably produced by the aid of apical protrusion of the right, pyramidal mitochondrium. The right and left first mitochondria were triangular pyramids in contour, while the dorsal and ventral ones were rod-like in shape. The mutual transformations between the capitulum and the first mitochondria are discussed in relation to the completion of the neck region.

Three-dimensional analysis of the atrophic process of rat seminiferous tubules after estradiol treatment

Atrophic changes in the basal portion of the seminiferous tubules caused by daily injections of estradiol have been found by scanning electron microscopy disclosed after a digestion technique using collagenase and trypsin. In the control rat, the smooth basal portion of the epithelium was composed of polygonal Sertoli cells and reticularly-arranged ovoidal spermatogonia. After estradiol treatment, there appeared wavy furrows and ridges, and many folded micro-wrinkles in the complicated basal portion of the seminiferous tubules. The wavy furrows and ridges were repeatedly formed and appeared just like a cornice. These structures ran in an orderly manner perpendicular to the longitudinal axis of the tubules. In contrast, many micro-wrinkles ran in parallel to the longitudinal axis. These two structures had a characteristically similar size and orderly arrangement. They are discussed in relation to the mechanism by which the seminiferous tubules shrink by injections of estradiol.

Spontaneous dissecting aneurysms of the basilar artery presenting with a subarachnoid hemorrhage. Report of two cases

A spontaneous dissecting aneurysm of the basilar artery is a rare disorder, usually presenting with ischemia rather than a subarachnoid hemorrhage (SAH). Two cases are described of a dissecting aneurysm of the basilar artery presenting with an SAH. Vertebral angiography revealed a double lumen to the basilar artery. Magnetic resonance (MR) imaging detected the intramural hematoma. One patient was treated conservatively, and the other underwent operative intervention with wrapping of the aneurysm. The usefulness of MR imaging in the diagnosis and the treatment options are discussed.

Flagellum abnormalities of spermatozoa in seminiferous tubules after a short term vasectomy

Electron microscopic observation was performed to examine whether spermiogenesis in the hamster might be affected by a short term vasectomy. When viewed by light microscopy, spermiogenesis was temporarily inhibited at 2 weeks, though to a limited extent among individuals, and had apparently recovered to the control level at 4 and 8 weeks after vasectomy in all hamsters. It was revealed at the electron microscopic level that mature spermatozoa with an abnormal flagellum were intermingled among numerous normal spermatozoa. The flagellum of the mature spermatozoa was composed of four different components: a mitochondrial sheath, outer dense fiber, fibrous sheath and axoneme. Abnormalities of the mitochondrial sheath were of three types: its discontinuity, displasia and deformation. The appearance of these abnormalities increased with the time after vasectomy and finally reached 52% as the highest value at 8 weeks. Additional noteworthy findings were the bisectioning of the outer dense fibers 2, 4 and 7, the fusion of two or three fibers, and the partial deletion of the fibrous sheath. These defects were characteristic in the vasectomized hamsters. Possible correlating microenvironmental factors are discussed as to how these abnormalities of the four flagellar components occur in the vasectomized hamsters.

CO2 laser-assisted microvascular anastomosis: biomechanical studies and clinical applications

Experiments have been performed using CO2 laser-assisted microvascular anastomoses, and they demonstrated the following features, in comparison with conventional anastomoses: ease in technique; less time consumption; less tissue inflammation; early wound healing; equivalency of patency rate and inner pressure tolerance; but only about 50 percent of the tensile strength of manual-suture anastomosis. Six clinical applications in 16 vessels are reported, using this procedure. The preliminary results of these cases would appear to be the first successful replantations and free tissue transfers using CO2 laser-assisted microvascular anastomoses in man. The procedure offers increased safety and speed in microvascular anastomoses.

Bone marrow and serum concentrations of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, and 1 alpha,25-dihydroxyvitamin D in patients with leukemia and normal subjects

Concentrations of 25-hydroxyvitamin D (25-OH-D), 24,25-dihydroxyvitamin D [24,25(OH)2D], and 1 alpha,25-dihydroxyvitamin D [1,25(OH)2D] in bone marrow and serum of patients with leukemia and normal subjects were assayed. There were highly significant correlations between the bone marrow and serum concentrations of the respective vitamin D metabolites. Especially, the concentrations of 25-OH-D and 1,25(OH)2D in the bone marrow gave very similar values to those in serum. This is a big advantage in controlling the bone marrow levels of vitamin D metabolites in patients with leukemia, because doctors can calculate the bone marrow levels from the serum levels of the respective vitamin D metabolites without bone marrow aspiration. When 1 alpha-hydroxyvitamin D3 (1 alpha-OH-D3) was administered orally to eight patients with leukemia, clinical conditions were improved in seven patients: four complete remissions (CR), one partial response (PR), and two minor responses (MR) without severe hypercalcemia. The results suggest that the therapy with 1 alpha-OH-D3 is fairly effective for curing human leukemia although it is not dramatic.

Interrelationships between germ cell differentiation and transformation of basolateral profile of Sertoli cells during rat spermatogonial cycle

After treatment with either trypsin, 8N HCl or 5N KOH, or with mechanical dissociation, normally hidden aspects of the seminiferous epithelium were exposed to observation by scanning electron microscopy (SEM). These included the basal surface of seminiferous epithelial cells, the basolateral processes of the Sertoli cell, junctions of the processes, and the basal or adluminal recesses. With the progressing stages of the spermatogonial cycle, three kinds of spermatogonia show different profiles and topographic relations. The basolateral processes of the Sertoli cells can be categorized into four types: conical, wedge-shaped, sheet-like and cup-shaped processes. The first two of the basolateral processes are joined together by close contact and/or overlapping junctions to form the floor of the basal recesses, and they encircle small-sized spermatogonia. The sheet-like processes mutually join by seam line junctions to form the ceiling of the basal recesses. During the spermatogonial cycle, the basal recesses first appear as separated lacunae, then form continuous labyrinth-like trenches, and finally make complicated honeycomb-like lacunae. The cup-shaped processes also are joined by close contact and/or overlapping junctions and are tightly attached by the primary spermatocytes with doughnut-like or linear bodies. The cordal arrangement and adluminal shift of the diverse spermatogonia will be discussed along with the cyclic transformations of Sertoli cell processes and their junctions.

Three-dimensional profile of three types of spermatogonia and their topographies in adolescent or adult rats

Stereomorphic profiles of three types of spermatogonia and their topographical distribution in the basal portion of the seminiferous epithelium of adolescent or adult rats were studied mainly with the scanning electron microscope. According to their cytological features, three types of spermatogonia (large-sized and long fusiform or polygonal; medium-sized and elliptical; small-sized and round) were discerned in both groups of rats. The basal areas of the three spermatogonia were relatively smaller in the adolescent rats than in the adult rats. The type of spermatogonia in the adolescent rats varied somewhat depending upon the diameter of the seminiferous tubules, but such a discrimination could not be made in the adult rats. In the adolescent rats, small cells were less frequently observed than large and medium cells. This ratio of appearance was less marked in the adult rats. Clones from the same spermatogonial cells showed similar topography in both groups of rats as follows. The clones of a few medium cells were arranged singularly(As) or in pairs (Apr), but the clones of most medium cells appeared to form single cords (Aal) through intercellular bridges, while those of the small cells formed an open polygonal network as a large syncytium.

Scanning electron microscopic observations of the vas deferens in man and monkey with special reference to spermiophagy in its ampullary region

The vasa deferentia of men and monkeys were studied and compared with special attention to spermiophagy by epithelial cells in the ampullary region. Specimens were obtained from adult men who were subjected to total vasectomy for early prostatic cancer and from healthy adult Japanese monkeys (Macacus fuscatus). The vasa do not differ greatly in gross and microscopic morphology between man and monkey. The mucosal lining of the vas, except for its ampullary region, is generally smooth with occasional infoldings and consists of a pseudostratified columnar epithelium. The free epithelial surface is covered by dense mat of long microvilli (stereocilia) on which a few spermatozoa reside. In contrast to other regions of the vas, the ampullary lumen has a spindle-shaped dilation and complicated infoldings of the mucosa, the mucosa is wider and much more infolded in man than in monkey. The columnar epithelial cells characteristically contain abundant secretory granules in the cytoplasm and bear short, stubby microvilli in the place of stereocilia. Worthy of special mention in the ampullary region of the vas in both species is that various stages of spermiophagy by the epithelial cells are extensively visualized by SEM. The ampullary region may play a role in the removal of excess spermatozoa in addition to the storage of them.