[Trans-urethral whole layer core biopsy of invasive bladder tumor]

We have developed a percutaneous whole layer core biopsy (WLCB) of bladder tumor and applied it successfully to stage invasive bladder tumor since April, 1985. We report here a modified method, trans-urethral WLCB (TU-WLCB) and present its clinical results. The patient was placed in the lithotomy position under caudal anesthesia, and a 20 F rigid nephroscope was introduced transurethrally. A newly developed 18-gauge (1.2 mm), 350 mm-long biopsy needle (Crown Core Cut Biopsy Needle) was advanced to the tumor through the nephroscope. A longitudinal transabdominal US was used to measure the distance between the needle tip and the outer layer of the bladder tumor. Because the needle advances 2.5 cm when fired by spring-loaded BIP Biopsy Gun (BIP, Germany), biopsy is performed by advancing the needle tip until the outer layer of tumor is slightly pierced under US guidance. Specimens of all 11 trans-urethral WLCB cases included the muscle layer and adipose tissue, and pathological staging were possible. TU-WLCB could be applied safely to tumors located at posterior wall and covered with the peritoneum. Serious complications were not observed so far. Thus, TU-WLCB may become a reliable technique to stage and evaluate neoadjuvant therapy for invasive bladder cancer.

A case of linear IgA bullous dermatosis with atypical clinical and ultrastructural manifestations

We report a case of linear IgA bullous dermatosis which presented with atypical clinical and ultrastructural findings. The patient initially manifested small, subepidermal blisters scattered only in the seborrheic region. On follow-up, grouped vesicles developed in a circular form similar to dermatitis herpetiformis. They subsided after treatment with diaminodiphenyl sulphon. Immunofluorescent study showed predominant linear IgA deposits accompanied with IgG and C3 along the basement membrane zone. These deposits existed at the floor of the blister. Ultrastructurally, immunoreactants were demonstrated beneath the lamina densa while separation occurred at lamina lucida.

Detection of anti-desmocollins I and II autoantibodies in two cases of Hallopeau type pemphigus vegetans by immunoblot analysis

Pemphigus foliaceus (PF) sera react with a 150 kDa antigen, desmoglein (DG), while pemphigus vulgaris (PV) sera react with a 130 kDa PV antigen. Recent molecular cloning studies have revealed that both DG and PV antigen are members of the cadherin family of cell adhesion molecules and that PV antigen shows very high homology to DG. We have recently noticed that other desmosoal cadherin molecules, desmocollins I and II (DC I/II), are also recognized by some pemphigus antibodies. In the present study we report two cases of Hallopeau type pemphigus vegetans. Immunoblot study revealed that the sera of these cases reacted not only with the PV antigen but also with both DG (PF antigen) and DC I/II. Although the significance of these findings is not known at present, further studies for the antigen profile for more Hallopeau type pemphigus vegetans patients may unravel the pathogenesis of this rare type of pemphigus.

Saponins from Barringtonia acutangula

Three monodesmosidic glucuronide saponins of barringtogenol C, named barringtosides A, B and C have been isolated as their methyl esters from the dried seeds of Barringtonia acutangula. On the basis of chemical and spectral evidence, the structures of these new saponins were elucidated to be as follows: barringtoside A, 3-O-beta-D-xylopyranosyl(1-->3)-[beta-D-galactopyranosyl(1-->2)]-beta-D- glucuronopyranosyl barringtogenol C; barringtoside B, 3-O-beta-D-xylopyranosyl(1-->3)-]beta-D-galactopyranosyl(1-->2)]-beta-D- glucuronopyranosyl-21-O-tigloyl-28-O-isobutyryl barringtogenol C; barringtoside C, 3-O-alpha-L-arabinopyranosyl(1-->3)-[beta-D-galactopyranosyl(1-->2 )]-beta-D - glucuronopyranosyl barringtogenol C.

[Tumor blood flow measured by dynamic CT]

A method of measuring tumor blood flow by dynamic CT (DCT) was devised, and the reliability of data obtained by the new method was investigated. The subjects were 16 patients with superficial tumors who underwent measurement of tumor blood flow by both the new DCT-based method and 15O gas positron emission tomography (PET). The results showed that tumor blood flow as measured by the new DCT-based method was about 1.2 times greater than that measured by PET, and both data yielded a straight line passing almost through the origin (proportional relationships); the correlation coefficient was 0.836. On the basis of these studies, it was concluded that the newly devised DCT-based method yields reliable data in the measurement of tumor blood flow.

[Portal-transfer of an orally administered anti-cancer agent analysis of the time course of portal blood and systemic blood levels of preoperatively administered UFT]

The transfer of an orally administered anti-cancer agent, UFT, into the portal vein was examined in 21 patients with hepatic metastasis of colorectal cancer (synchronous metastasis in 9 and metachronous metastasis in 12 cases) encountered at our department. The time course of tegafur, 5-FU and uracil levels in portal blood was traced for maximum 6 hrs, starting 2 hrs after the final oral dose of UFT. The portal blood tegafur level was 11.89 +/- 4.31 micrograms/ml at 2 hrs after the final dose and decreased gradually thereafter, reaching to 8.48 +/- 8.42 micrograms/ml at 6 hrs after the final dose. Unlike the portal blood tegafur level, the portal blood 5-FU level did not show any similar tendency; it remained almost unchanged at 0.018 +/- 0.006 microgram/ml and approximately equal to the serum 5-FU level throughout the observation period.

[Evaluation of clinical usefulness of 11C-methionine positron emission tomography (11C-MET-PET) as a tool for liver functional imaging]

We studied 11C-MET-PET in 17 clinical cases, 10 patients with obstructive jaundice and 7 normal volunteers, and analyzed its efficacy for the evaluation of hepatic functional reserve in major hepatectomy candidates. Differential absorption ratio (DAR) of 11C was compared to the hepatic protein synthesis rate (HPS), which is measured as the incorporation rate of 3H-labeled leucine in protein fraction, using needle biopsied liver specimen obtained from each hepatic segment. In the cases of normal liver function, DAR was well correlated with HPS. Also in jaundice cases with two exceptions, low HPS segment was demonstrated as low DAR segment. Consequently, MET-PET images could clearly provide functional liver imaging. After injection to 11C-MET, the increase in rate of radioactivity of 11C in plasma protein fraction was higher in jaundice cases than in normal volunteers, which is in accord with the results of our former study that cholestatic liver has accelerated protein synthesis rate. In summary, since 11C-MET-PET could demonstrate liver functional imaging, it might be a possible tool for liver function assessment in major hepatectomy candidates.

[Clinical application of AMI-25 (superparamagnetic iron oxide) for the MR imaging of hepatic tumors: a multicenter clinical phase III study]

We performed phase III clinical study of AMI-25 (Superparamagnetic iron oxide) for hepatic tumors in 163 cases at the 17 institutions in Japan. In overall evaluation, 141/159 cases (88.7%) were evaluated "useful" or "very useful" for clinical usefulness. For efficacy including the signal to noise ratio (S/N) of liver and the tumor-liver contrast to noise ratio (C/N), 89.6% of hepatocellular carcinomas and 95.0% of metastatic liver cancers were evaluated "effective" or "very effective", respectively. The mild adverse reactions were shown in 10 cases (6.1%), but they disappeared within 25 minutes. The serum iron and ferritin increased and the unsaturated iron binding capacity (UIBC) decreased, but they were showing a tendency to go back to their normal ranges. The AMI-25 (10 mumoles Fe/kg) was proved to be useful and safe contrast agent for the liver tumors in MRI.

The effect of long-term medical therapy on the outcome of filtration surgery

Long-term medical therapy and laser trabeculoplasty have been implicated as risk factors in the outcome of glaucoma filtration surgery. A retrospective analysis was performed of patients undergoing primary trabeculectomy during three key periods: before use of beta-blockers and laser trabeculoplasty (1975 and 1976), after introduction of beta-blocker therapy but before use of the laser (1980), and after common use of beta-blockers and laser (1985 and 1986). A total of 150 patients were included in the analysis. Eyes treated with laser trabeculoplasty at some time before filtration surgery had a decreased probability of successful filtration surgery (intraocular pressure less than 21 mm Hg, 75% vs 91% at one year, P = .05; 50% vs 86% at five years, P = .01). It is unknown whether laser was detrimental to subsequent filtration surgery or merely acted as a selection factor in identifying patients who would have less successful surgical outcomes. Preoperative use of topical medication did not influence the outcome of surgery. Patients having bilateral filtration surgery had similar outcomes between fellow eyes despite the longer use of therapy in the second eye (mean of 1.8 years between operations). In the subgroup of eyes with low preoperative intraocular pressures (less than 21 mm Hg), surgery was successful in reducing pressure to a lower level in 70% of eyes at one year (preoperative pressure, 17.8 mm; one-year postoperative pressure, 13.3 mm, P = .007).

Intrapelvic two-dimensional time-of-flight magnetic resonance angiography in healthy and diseased subjects

We evaluated the use of magnetic resonance angiography (MRA) based on two-dimensional (2D) time-of-flight (TOF) technique in the pelvic vasculature. In the initial phase of this study, MRA was performed in 10 normal subjects for determination of the optimum imaging parameters. Systemically varied scan parameters included flip angle ranging from 20 degrees to 90 degrees by 10 degrees increments and repetition time (TR) of 30, 40, and 50 ms. The optimum imaging parameters for intrapelvic MR angiography were found to be flip angle of 90 degrees, pulse sequence of 30/4.9 (TR ms/TE ms). Using these imaging parameters, 70-100% of the second division branches of the internal iliac artery could be visualized in each subject. In the second phase of this study, we evaluated the use of MR angiography in patients with intrapelvic vascular disease by comparing its accuracy in evaluating the iliac arteries with that of conventional angiography. In patients with atheromatous disease, the MR angiographic determination was consistent with that of conventional angiography in 23 of 28 visualized arterial segments (82%). In eight lesions in patients with non-stenotic vascular disease or hypervascular pelvic tumours, all lesions were demonstrated clearly with MR angiography. 2D TOF technique with high flip angle excitation is suitable for the evaluation of main iliac branches and diseased vessels.

Differential expression of transforming growth factor-alpha (TGF-alpha) and EGF receptor in transitional area of psoriatic epidermis

We investigated the localization of TGF-alpha and EGF receptor in psoriatic plaques, especially the clinically-determined transitional zone from uninvolved to involved psoriatic skin by immunohistochemistry. TGF-alpha was not increased in the transitional area compared with normal epidermis. It started to increase within the edge of psoriatic plaques. In contrast, EGF receptor increased up to the suprabasal layers even in the uninvolved skin adjacent to psoriatic plaques, compared with normal epidermis. Slight epidermal hyperplasia was also observed in the clinically-determined transitional area. This result suggests that the increase of EGF receptor precedes that of TGF-alpha in psoriatic plaque formation.

An in vivo-in vitro replicative DNA synthesis (RDS) test using rat hepatocytes as an early prediction assay for nongenotoxic hepatocarcinogens screening of 22 known positives and 25 noncarcinogens

To evaluate the applicability of an in vivo-in vitro replicative DNA synthesis (RDS) test using rat hepatocytes, we conducted the RDS test with 22 nongenotoxic (Ames-negative) hepatocarcinogens and 25 noncarcinogens under our standardized conditions and judgement criteria. Compared to controls (RDS incidence of under 1.0%), the RDS test gave positive results for 18 hepatocarcinogens (positive sensitivity: 82%), and negative results for 20 noncarcinogens (negative specificity: 80%), and thus the overall concordance was 81%. These findings strongly suggest that the RDS test is an extremely useful method for early detection of nongenotoxic hepatocarcinogens.

Disparity between sensory nerve activity and psychophysical responses for air-puff stimulation of the index finger and palm in man

Air-puff stimuli were delivered to five successive sites over the index finger and palm to obtain psychophysical responses and to record sensory nerve action potentials (SNAPs) from the median nerve at the wrist for elucidating psychoneural correlations across different locations of the glabrous hand. Magnitude estimations at each location evoked uniform subjective magnitudes for all stimulus locations. The time-integral of all SNAP components was the largest at the finger tip and the smallest at the most proximal site over the palm in agreement with the reported receptor density gradient across the finger and palm. Thus, the constant magnitude estimations with different quantities of peripheral afferent inputs across areas imply that the central nervous system plays a major role in shaping subjective magnitude estimation across different locations.

Large scale clinical evaluation of bowel contrast agent containing ferric ammonium citrate in MRI

Clear identification of bowel has been thought to be essential in diagnosis by abdominal MRI. We have completed the clinical phase III trial of a new oral contrast agent (FerriSeltz) which is a ferric ammonium citrate based bowel contrast agent. FerriSeltz is a powder that is dissolved in 300 ml water to create a grape-flavored effervescent drink. We have evaluated the usefulness of FerriSeltz, and compared groups receiving 600 mg and 1200 mg of ferric ammonium citrate, the use and nonuse of parasympathetic blockers, and patients with and without fasting in 174 patients who underwent abdominal MRI using this agent. FerriSeltz was found to brighten the stomach and duodenum, contribute to the improvement in diagnostic efficacy, be safe as a bowel contrast agent in abdominal MRI, and be associated with an extremely low incidence of side effects (only mild diarrhea in one of 169 patients). No significant differences were found in the contribution to the improvement in diagnostic efficacy between the two dosage groups, the use and nonuse of parasympathetic blockers, or patients with and without fasting. We concluded that ferric ammonium citrate based compound (FerriSeltz) is a promising bowel contrast agent in abdominal MRI.

Transfer action of alpha-D-xylosidases from Aspergillus flavus MO-5 on p-nitrophenyl-alpha-D-xylopyranoside

The transfer action of alpha-D-xylosidase I and II from Aspergillus flavus MO-5 on p-nitrophenyl-alpha-D-xylopyranoside (alpha-p-NPX) was investigated, as compared with that of commercial alpha-D-xylosidase (from Bacillus sp.). In reaction mixtures with various concentrations of alpha-p-NPX, both enzymes (I and II) liberated p-nitrophenol and xylose at low concentrations, and showed transfer products in addition to hydrolyzates at high concentrations. IP-1 and IP-3, IIP-1 and IIP-2, and CP-1 and CP-3 were main transfer products by alpha-D-xylosidase I, alpha-D-xylosidase II, and commercial alpha-D-xylosidase, respectively. They were isolated by active charcoal column chromatography and silica gel column chromatography. Their structures were analyzed by enzymatic digestion, methylation analysis, and 13C-NMR analysis. As the results, IP-1, IIP-2, and CP-1 were found to be the same structure, p-nitrophenyl-4-O-(alpha-D-xylopyranosyl)-alpha-D-xylopyranoside. Then, it was proved that the structure of IIP-1 was p-nitrophenyl-3-O-(alpha-D-xylopyranosyl)-alpha-xylopyranoside. On the other hand, IP-3 and CP-3 were found to be the same structure, D-xylopyranosyl-alpha-1,4-D-xylopyranose without a p-nitrophenyl group. We found that alpha-D-xylosidase I showed alpha-1,4 xylosyl transfer action as well as commercial alpha-D-xylosidase, and alpha-D-xylosidase II showed alpha-1,3 xylosyl transfer action in addition to alpha-1,4 xylosyl transfer action on alpha-p-NPX.

Surgical strategy for papillary carcinoma of the thyroid in an iodine rich area: decision on the operation table

In iodine rich areas the incidence of papillary carcinoma of the thyroid is extremely high but its prognosis is favorable. When papillary carcinoma is confined to one lobe, our standard surgical procedure has been total lobectomy with isthmusectomy rather than total thyroidectomy. Our followup study of 185 such patients reveals considerable difference in the outcome between the 85 patients with gross thyroid capsular invasion and the 100 patients without, regardless of the presence of cervical lymph node metastasis. In the latter group, the tumor could be completely resected in all patients; although 4 cases had recurrence and required reoperation, 3 patients are alive and well and one died of other disease. In contrast, 20 patients in the former group had incomplete resection of the tumor, 4 patients developed recurrence and needed to be reoperated and 7 patients eventually died of thyroid cancer. One hundred thirty three patients (71.9%) underwent modified neck dissection at the time of surgery to find lymph node metastasis in 37 of 59 cases (62.7%) without gross thyroid capsular invasion and 64 of 74 cases (86.5%) with such invasion. The difference is statistically significant (P < 0.05). From these results we conclude that for papillary thyroid cancer in iodine rich areas total lobectomy with isthmusectomy is the treatment of choice when gross thyroid capsular invasion is not recognized on the operation table. However, when gross thyroid capsular invasion is recognized, total or near total thyroidectomy has to be performed.

Resting energy expenditure in patients undergoing transhiatal or transthoracic oesophagectomy for carcinoma of the thoracic oesophagus

Resting energy expenditure (REE) was studied in five patients undergoing transhiatal and in 14 undergoing transthoracic oesophagectomy for carcinoma. All resections were performed with an intention to cure. REE was measured by indirect calorimetry before operation and on days 1, 3, 5 and 7 after surgery. Following transthoracic oesophagectomy, REE increased significantly on days 1, 3, 5 and 7 after operation, and on day 7 the value was significantly higher (P < 0.05) than that obtained after transhiatal surgery. Energy expenditure following transhiatal oesophagectomy is lower than that after transthoracic oesophagectomy; this may be a result of reduced surgical stress.

Aroma glycosides from Hovenia dulsis

From the fresh leaves of Hovenia dulsis var. tomentella, two new aroma glycosides named kenposide A and B have been isolated together with the known glycoside, icariside C1. Their structures were determined on the basis of chemical and spectral evidence.

Growth inhibition of human keratinocytes by 1,25-dihydroxyvitamin D3 is linked to dephosphorylation of retinoblastoma gene product

Human keratinocyte is one of the target cells for 1,25(OH)2D3, a biologically active form of vitamin D3. It induces the differentiation and growth inhibition of human keratinocytes. In order to understand the inhibitory mechanism of 1,25(OH)2D3, we examined its effect on cell cycle kinetics and retinoblastoma gene product (pRB), one of tumor suppressor gene products, in normal human keratinocytes. Cell cycle analysis demonstrated that 10(-6) M of 1,25(OH)2D3 induced cell cycle arrest in both G1/G0 (63.4% +/- 1.4 versus 52.7% +/- 1.2 in control, p < 0.05) and G2 + M (21.5% +/- 0.6 versus 10.9% +/- 0.8 in control, P < 0.05) phase. Addition of 10(-6) M of 1,25(OH)2D3 increased dephosphorylated pRB in a time dependent manner from 23% at 0 h to 58% at 48 h. Since the phosphorylation of pRB is supposed to be essential for the progression from G1 to S phase, the inhibition of pRB phosphorylation could be responsible for the G1/G0 growth arrest induced by 1,25(OH)2D3 in normal human keratinocytes.

[Genetic analyses of the genotypes of ABO and cisAB blood groups]

The genotypes of genomic DNAs of 20 normal subjects with ABO blood group and 12 subjects with cisAB blood group were analysed using polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) and a combination of PCR-RFLP and direct sequencing method, respectively. To identify the codon 87, 249 bp DNA fragment was amplified by PCR and digested with Bst EII and Kpn I. To identify the codon 176, 506 bp DNA fragment was amplified by PCR and digested with Bss HII and Ban I. To identify the codon 235, 266 and 268, 506 bp DNA fragment was amplified by PCR and determined by direct sequencing. Analyses of the digested DNA fragments of codon 87 and 176 in 20 normal subjects with ABO blood group revealed the ratio of homotype (AA, 20%; BB, 20%) and heterotype (AO, 80%; BO, 80%) in subjects with phenotype A or B. Same results were obtained in subjects with phenotype AB or O. The analyses of nucleotide sequence at codons 87, 176, 235, 266 and 268 in 12 subjects with cisAB blood group (6 cisA2B3, 3 cisA2 B and 3 cisA1B3) revealed chimera structure of A allele and B allele on the same gene. These results indicate the usefulness of PCR-RFLP method for determining the genotype of A and B bloods group, and a combination of PCR-RFLP and direct sequencing for determining the genotype of cisAB blood group.

Sudden death from tourniquet shock

A fatal case of tourniquet shock is reported. The deceased, a 58-year-old tractor driver, died 12 h after his rescue from an overturned tractor. A 'roll-bar' on the tractor had pinned his left arm for approximately 24 h before his rescue. Histological observations revealed the typical findings of tourniquet shock.

Antisweet natural products. VIII. Structures of hodulosides VI--X from Hovenia dulcis Thunb. var. tomentella Makino

From the Fresh leaves of Hovenia dulcis Thunb. var. tomentella Makino, five five new dammarane glycosides named hodulosides VI-X (1-5) were isolated. Their structures were determined on the basis of chemical and spectral evidence. Hodulosides VII-X showed antisweet activities.

Characterization of pigmented granules in minocycline-induced cutaneous pigmentation: observations using fluorescence microscopy and high-performance liquid chromatography

We describe a technique to facilitate histopathological detection and quantitative measurement of trace amounts of tissue minocycline. In a patient with minocycline-induced hyperpigmentation, a series of biopsies were taken from the affected skin over a period of 54 months, and examined for tissue minocycline deposition. Frozen sections treated with 1 M MgCl2-ethanol yielded minocycline-specific yellowish fluorescence, the location of which corresponded to clumps of granular deposits in the dermis. A decrease in the number of fluorescent granules correlated with the clinical resolution of hyperpigmentation and a significant decrease in the tissue minocycline level. Our data also provide further support for the concept that the pigment granules contain insoluble complexes of minocycline chelated with iron. The fluorescence technique is simple, sensitive, and reproducible.