Simultaneous quantitative analyses of c-erbB-2 protein, epidermal growth factor receptor, cathepsin D, and hormone receptors in breast cancer

The overexpression of c-erbB-2 protein (ErbB2), epidermal growth factor receptor (EGFR), and/or cathepsin D (CD) in breast cancer is known to be a poor prognostic factor. Eighty frozen breast cancer specimens obtained at the initial operation were examined for ErbB2, EGFR, and CD by immunohistochemical assay (ICA) and enzyme immunoassay (EIA). Estrogen and progesterone receptors (ER and PgR) were measured simultaneously by EIA. The mean values +/- 1SD for ErbB2, EGFR and CD were 141 +/- 400 U/mg membrane protein (range: 0-3385), 4.88 +/- 4.33 fmol/mg membrane protein (range: 0-21.1), and 47.1 +/- 32.8 pmol/mg cytosol protein (range: 4.7-182), respectively. The percentage of specimens positive for ErbB2, EGFR, and CD was 12.5, 38.8, and 35%, when the tentative cutoff value were used as 200 U/mg protein, 5 fmol/mg protein, and 50 pmol/mg protein, respectively. These E1A results were correlated with ICA, EGFR and ER were negatively correlated. Although the prognostic value of ErbB2 and EGFR was superior to hormone receptors, ErbB2 and EGFR were interior as predictors compared with lymph node involvement and tumor size. Quantitation of ErbB2, EGFR, and CD can be performed readily using the same specimen in which hormone receptors are measured.

Leiomyosarcoma of the colon presenting as acute suppurative peritonitis

A surgical case of leiomyosarcoma arising from the ascending colon, presenting as acute suppurative peritonitis, is herein described. A 70-year-old woman complaining of lower abdominal pain presented to our clinic on October 12, 1994. She was admitted with a tentative diagnosis of peritonitis. At emergency laparatomy, purulent intraabdominal fluid was present, and a fist-sized mass was seen in the ascending colon just proximal to the hepatic flexure. A right hemicolectomy was thus performed based on a diagnosis of perforating colon cancer. The histologic findings were consistent with leiomyosarcoma with abscess formation in and around the tumor. Five mitotic figures per field were observed at 10x magnification. Immunohistochemical studies revealed immunoreactivity for alpha-smooth muscle antigen (alpha-SMA), vimentin, and desmin. After reviewing the clinicopathologic characteristics of colon leiomyosarcoma as described in 78 Japanese cases and 70 cases from the foreign literature, we thus propose that colon leiomyosarcoma frequently arises from the transverse colon. In addition, our case also represents the only reported case in Japan in which an adult patient underwent a successful operation for perforated leiomyosarcoma of the colon.

[A resected case of bronchogenic cyst of the left hemidiaphragm with elevated serum CA19-9]

A rare case of bronchogenic cyst of the left hemidiaphragm is reported. A 53-year-old woman referred to our institution for an abnormal shadow on chest roentgenogram. Chest X-ray showed a 6 x 6 cm mass in the left lower lung filed. The margin of the mass was clear and the surface was smooth. The lateral view showed a mass on the diaphragm with the extrapleural sign. Chest CT demonstrated the mass as a multi loculated cyst. Celiac angiography demonstrated the branch of the inferior diaphragmatic artery at the margin of the mass. Her serum CA19-9 level was 470 U/ml. The patient underwent surgical exploration. Operative findings showed the smooth surface mass was on the diaphragm covered with pleura. Resected tumor was large as 7.5 x 6.5 x 4.0 cm. The surface was smooth and white-yellowish, and the cut surface presented a multi loculated cyts. Histopathological examination showed a bronchogenic cyst. CA19-9 in the cyst fluid was elevated as 445,900 U/ml. The serum CA19-9 level returned to normal after the operation.

[Association between sleep apnea syndrome and coronary artery disease]

Patients with sleep apnea syndrome often suffer from cardiovascular disease, but the incidence of coronary artery disease (CAD) with coronary spasm in these patients is not known. In the present study, 14 of 37 men with sleep apnea syndrome diagnosed by all-night polysomnography were suspected to also have CAD, based on the results of non-invasive clinical examinations. Coronary angiography confirmed the diagnosis of CAD either organic stenosis or coronary spasm in 8 of the 14 patients. Those 8 did not differ significantly from the 21 patients without CAD, with regard to coronary risk factors or to the severity of their sleep apnea (apnea index, 4% desaturation ratio, and nadir of SaO2). Eleven patients received intracoronary injections of acetylcholine, which induced coronary spasm in 4 (36.4%) and coronary contraction in 2 (18.2%). Coronary spasm was induced in 4 of the patients with CAD (50.0%). Although the pathophysiologic link between sleep apnea syndrome and CAD is still unclear, these results suggest that patients with this syndrome frequently suffer from CAD, particularly from coronary spasm.

The internal biliary fistula--reappraisal of incidence, type, diagnosis and management of 33 consecutive cases

To reevaluate the current features of spontaneous internal biliary fistulas, we reviewed 1,929 consecutive patients who had been treated for biliary tract diseases during the recent 12-year period. Thirty-three patients had internal biliary fistulas and the incidence was 1.9%. Of 33 patients, 20 were women and 13 were men with the average age 63 years, and their mean duration of illness was 4 years. A total of 37 fistulas were found and the most common type was choledochoduodenal (62%), followed by cholecystoduodenal (19%), cholecystocholedochal (11%) and cholecystocolonic (8%) fistulas. Internal biliary fistulas of thirty-one patients were caused by biliary stones and those of two patients by malignant tumors. All of the 17 bile samples examined were bacteria positive and the majority of calculi were brown pigment stones. All of the choledochoduodenal fistulas were correctly diagnosed by endoscopic retrograde cholangiography. In 14 patients with cholecystoenteric or cholecystocholedochal fistulas, direct evidence of the internal fistula was obtained only in 7 patients (50%) preoperatively. Pneumobilia, a small atrophic gallbladder adherent to the neighboring organs and a history of spontaneous disappearance of jaundice in elderly patients may indicate the presence of a cholecystoentric fistula. Since the preoperative diagnostic rate for internal biliary fistula involving the gallbladder is still low, care is necessary before and at the time of surgery especially during laparoscopic cholecystectomy for elderly patients with cholelithiasis.

PACAP type I receptor gene expression in the paraventricular and supraoptic nuclei of rats

We have examined the distribution of pituitary adenylate cyclase-activating polypeptide (PACAP) type I receptor gene expression in the rat paraventricular (PVN) and supraoptic nuclei (SON) using in situ hybridization histochemistry. PACAP type I receptor gene was expressed moderately in the whole area of the PVN and the SON. In particular, PACAP type I gene transcripts were found in both the magnocellular and the parvocellular parts of the PVN. The results are consistent with the hypothesis that neurosecretory cells in the PVN and the SON might be modulated by PACAP through PACAP type I receptor.

Deconjugation of bilirubin accelerates coprecipitation of cholesterol, fatty acids, and mucin in human bile--in vitro study

To examine the initial step of brown pigment gallstone formation, sterile human gallbladder bile samples were incubated with or without beta-glucuronidase in vitro. Enhanced bilirubin deconjugation achieved by adding beta-glucuronidase significantly accelerated the formation of a precipitate that contained bilirubin (28.2 +/- 3.8% of dry weight), cholesterol (14.3 +/- 5.2%), free fatty acids (12.0 +/- 1.3%), and glycoprotein (10.0 +/- 6.7%). Both the composition and scanning electron microscopic appearance of the precipitate were similar to these features in brown pigment gallstones. The cholesterol saturation index and nucleation time in the supernatant did not change with various incubation periods. The weight ratios of bilirubin to cholesterol in the precipitates correlated with those in bile (r = 0.76; P = 0.017). Gel chromatography of the precipitate showed high molecular weight glycoprotein to be the major constituent. Bilirubin, cholesterol, fatty acids, and mucin were found to coprecipitate in accordance with bilirubin deconjugation, which process may play an important role in an early stage of the formation of brown pigment gallstones.

Inhibitory effect of cyclosporin A on prolactin synthesis in GH3 cells

Cyclosporin A (CsA), a potent immunosuppressant, is known to have various effects on the endocrine system, including the pituitary gland, the adrenal cortex, the testes, and the pancreatic islets. In this study, the effects of CsA on prolactin (PRL) synthesis and release were investigated in GH3 cells, a clonal strain of rat pituitary tumor. After incubation of confluent GH3 cells with various concentrations of CsA for 24 hr, the PRL content of the media decreased in a dose-dependent manner: by 28.5% with 100 ng/ml CsA (p < 0.01); and 45.8% with 2,000 ng/ml CsA (p < 0.001), compared with control. However, no significant change was observed in the intracellular PRL content. After removal of CsA from the medium, GH3 cells fully recovered normal secretory activity within 24-48 hr, thus indicating that the inhibitory effect of CsA on PRL secretion was reversible. Northern blot analysis revealed a decrease in the PRL mRNA level in cells treated with CsA. In conclusion, these data suggest that CsA inhibits PRL secretion by reducing the rate of biosynthesis. A possible site of action is on PRL gene expression at the level of mRNA transcription.

Significance of serum delta bilirubin during obstructive jaundice in dogs

BACKGROUND

delta-Bilirubin, a nonenzymatic covalently bound complex with albumin, is nonenzymatically formed in serum and has a long half-life irrespective of hepatorenal function. The aim was to examine if delta-bilirubin reflects the duration of obstructive jaundice and efficacy of biliary drainage.

MATERIALS AND METHODS

Obstructive jaundice was developed in 17 dogs either for 4 (short term; n = 9) or 11 (long term; n = 8) days and then external biliary drainage was performed. Serum total, direct, and delta-bilirubin fractions were analyzed by high-performance liquid chromatography.

RESULTS

delta-Bilirubin was not detectable in serum before biliary obstruction. The serum total and direct bilirubin levels increased rapidly and reached a plateau within 2 days after the biliary obstruction, whereas the concentration and proportion of delta-bilirubin gradually increased and significantly correlated with the duration of obstructive jaundice. Before biliary drainage, the proportion of delta-bilirubin was 28.9 +/- 2.4% in the short-term and 42.5 +/- 2.4% in the long-term obstruction group. The decline indices of serum total, direct, and total minus delta-bilirubin in the short-term group (-0.17, -0.19, and -0.26, respectively) were significantly (P < 0.05) greater than those in the long-term obstruction group (-0.10, -0.10, and -0.13). The decline index of delta-bilirubin itself was similar between the groups.

CONCLUSIONS

The concentration and proportion of delta-bilirubin in serum reflect the duration of jaundice. Because delta-bilirubin is not excreted into bile and urine and is not toxic to organs, a decline index of total bilirubin minus delta-bilirubin, the excretable bilirubin fraction might be better to assess the efficacy of biliary drainage.

[Glutamate transporter and neuronal cell death]

Glutamate transporters play an important role in keeping extracellular glutamate concentrations below the neurotoxic levels. We cloned a human glutamate transporter hGluT-1. In ischemic states, glutamate efflux via glutamate transporters and the extracellular glutamate concentrations are rapidly increased. These phenomenon enlarges the area of neuronal cell death. We showed that L-CCG-III, IV and glutamate block the reverse uptake (efflux) of glutamate in the hGluT-1 expressing HeLa cells. In amyotrophic lateral sclerosis, a glutamate transporter GLT1 was decreased. Decrease of the glutamate transporter will cause the elevation of extracellular glutamate concentrations and will lead to the neuronal injury. Bromocriptine enhances glutamate uptake 1.5 times than in its absence in the hGluT-1 expressing HeLa cells. Enhancing the removal of extracellular glutamate may produce similar effect as those achieved by glutamate-receptor antagonists. At two neuronal death conditions, we showed new possibilities of preventing neuronal cell death by the glutamate transporter regulators.

Neurological basis of skill learning

Skill-learning, i.e., anterograde memory of 'procedures' has been separated from conventional declarative memory, or event- or data-related memory. This type of memory requires a concerted activity of various neural structures which are not assigned to the acquisition of declarative memory. We employed mirror reading task as a paradigm of skill acquisition memory and tried to elucidate possible neurological mechanisms involved in the procedural memory process. Ten normal control subjects, 10 early, non-treated Parkinson's, and 9 relatively early spinocerebellar degeneration patients participated in our study. The results showed a clear dissociation between declarative memory and mirror reading skill acquisition capacity. Thus, the Parkinson's patients as well as the spinocerebellar patients showed retardation in acquiring mirror reading skills, while both groups showed normal performance in auditory verbal learning tests and word recognition tests. The facts suggest a possible role of the nigro-striatal system and fronto-ponto-cerebellar system in forming these skill-related memory.

Adrenomedullin-sensitive receptors are preferentially expressed in cultured rat mesangial cells

By using cultured rat mesangial cells, we compared the effects on cyclic nucleotide levels of adrenomedullin with those of the structurally related peptides, calcitonin gene-related peptide (CGRP) and amylin. Adrenomedullin potently increased cAMP levels 7-fold in a time- and concentration-dependent manner. Its EC50 was 3 x 10(-9) M. CGRP was less potent (2-fold) with an EC50 of 10(-7) M, and amylin had no effect on cAMP levels. All three peptides failed to increase cGMP levels. Treatment of cells with near maximal concentrations of adrenomedullin (10(-7) M) and CGRP (10(-6) M) had no additive effect on cAMP levels. Human adrenomedullin-(22-52)-NH2, a putative adrenomedullin receptor antagonist, inhibited the production of cAMP elicited by adrenomedullin (IC50: 7 x 10(-8) M) and CGRP (IC50: 5 x 10(-8) M). Human CGRP-(8-37), a CGRP receptor antagonist, conversely, reduced the cAMP elevation caused by these peptides with a lower potency (IC50: 10(-6) M for both peptides). This demonstrated that human adrenomedullin-(22-52)-NH2 was a more effective antagonist for adrenomedullin- and CGRP-specific receptors than human CGRP-(8-37). Results suggest that receptors sensitive to adrenomedullin are preferentially expressed in cultured rat mesangial cells. Immunohistochemical study showed almost no immunoreactive adrenomedullin and CGRP, if any, in the cells. Adrenomedullin may regulate mesangial function as either a paracrine or circulating hormone via a cAMP- but not a cGMP-dependent mechanism.

Microsatellite instability in sporadic human breast cancers

Human breast-cancer specimens from 100 patients were analyzed for microsatellite instability (referred to as replication error; RER) at 12 genomic loci on 7 chromosomes, and results were correlated with clinicopathologic characteristics. In 42 of 100 breast-cancer patients, we investigated whether RER was associated with the amplification of oncogenes and/or suppression of tumor-suppressor genes. Of the 100 patients, 8 (8%) were RER-positive at one or more chromosomal loci. The majority of RER-positive patients had early-stage disease with ER-positive tumors, suggesting that RER occurs early in breast tumorigenesis. However, no significant correlation was observed between RER and oncogenes or tumor-suppressor genes. Thus, the mechanism of RER in sporadic human breast cancer may be independent of the multi-step carcinogenesis caused by the alterations of oncogenes and tumor-suppressor genes.

Expression of epidermal growth factor, epidermal growth factor receptor and transforming growth factor-alpha in the human fetal inner ear

The expression of epidermal growth factor (EGF), EGF receptor and transforming growth factor (TGF)-alpha was analyzed in the human fetal inner ear using immuno-histochemical methods. EGF receptor was observed only in 9.5-week-old fetal vestibular epithelia. In 14- and 16-week-old fetuses, EGF receptor could not be detected. TGF-alpha was observed strongly in the 9- and 11-week-old vestibular epithelia, whereas only trace amounts were detectable in the 14- and 16-week-old vestibular epithelia. These findings suggest that EGF and TGF-alpha probably have a mitogenic effect in the sensory epithelia of the fetal inner ear, especially at early stages of development.

[An operative case of suture-granuloma which resulted from an intra-pulmonary treatment 10 years ago and manifested hemoptysis]

We experienced a 27-year-old male patient with recurrent hemoptysis manifested by granuloma which resulted from surgical repair that was performed for right pneumothorax using unabsorbable sutures (braided silk) before 10 years. The patient had been suffering from fever and cough for three months before hemoptysis. Chest X-ray and CT scan films showed a mass shadow in the lateral side of the right lung field. Furthermore, bronchoscopy revealed bleeding in B3 of the right lung. The patient underwent right upper lobectomy, which disclosed that hemoptysis was due to a granuloma (2.3 x 3.2 cm in size) formed around sutures. The granuloma was caused not only by foreign body reaction but also by transbronchial infection.

[Malignant paraganglioma with intracranial metastasis: a case report]

We report a case of malignant paraganglioma with intracranial metastasis. A 26-year-old man presented with leg pain. On admission a metastatic bone tumor was found. General examination revealed metastatic lesions in the lung, liver, orbits, ethmoid sinus, anterior mediastinum, and brain. An MRI of the head showed multiple lesions in the skull bone and intracranial space. A biopsy was performed on the right temporal tumor, resulting in a diagnosis of malignant paraganglioma. The tumor origin could not be determined. The tumor resection was not indicated because of multiple metastasis. Both chemotherapy and radiotherapy were given to the patient, but a satisfactory outcome was not obtained.

Proadrenomedullin N-terminal 20 peptide (PAMP) reduces inward currents and Ca2+ rises induced by nicotine in bovine adrenal medullary cells

It has been recently reported that proadrenomedullin N-terminal 20 peptide (PAMP), which is secreted with adrenomedullin and catecholamines from the adrenal medulla, inhibits catecholamine release stimulated with nicotine. In the present study, to elucidate anticholinergic mechanisms of PAMP we employed the whole-cell patch-clamp and the intracellular Ca2+ imaging techniques in cultured bovine adrenal medullary cells. PAMP inhibited nicotinic currents and [Ca2+]i rises induced by nicotine in a dose-dependent manner (10(-9)-10(6) M). These inhibitions were selective, since PAMP alone did not induce any ionic currents, moreover it did not affect voltage-dependent Ba2+ currents or high K+ (50 mM)-induced [Ca2+]i rises. The onset of the inhibitory effect of PAMP (10(-6) M) was very rapid and reached a steady-state level within 10 sec. The effect of PAMP (10(-6) M) lasted for about 10-15 min. Desensitization process of the nicotinic current fitted to a single exponential function with a time constant of 6.4 +/- 0.3 sec. When PAMP (10(-6) M) simultaneously added with nicotine (10(-5) M), the desensitization process was facilitated and fitted to two exponentials with time constants of 0.46 +/- 0.08 and 2.5 +/- 0.8 sec. From the present results, the inhibition by PAMP of nicotinic currents which was well associated with that of nicotine induced [Ca2+]i rises leads to the attenuation of catecholamine release probably, at least in part, due to the facilitation of the desensitization process of the nicotinic currents.

Relationship between the pathogenicity of the pine wood nematode, Bursaphelenchus xylophilus, and phenylacetic acid production

Phenylacetic acid (PA), a toxin produced by three strains of bacteria accompanying the pine wood nematode, Bursaphelenchus xylophilus, was found to be formed in a culture of the nematode. An animal nutrient, nutrient broth (NB) medium, was more suitable for PA production of the accompanying bacteria than a vegetable nutrient, potato sucrose malt extract (PSM) medium. It is presumed that dead nematodes in the PSM medium provided the bacteria with nutrient for PA production. In the culture of virulent isolate OKD-3, more PA was detected than in that of less-virulent isolate OKD-1. PA production of the accompanying bacteria can dominate the pathogenicity of the nematode.

Granulomatous mastitis diagnosed and followed up by fine-needle aspiration cytology, and successfully treated by corticosteroid therapy: report of a case

A 36-year-old woman presented to our hospital with a rapidly growing lump in her left breast. Fine-needle aspiration (FNA) cytology of the mass revealed many epithelioid cells admixed with multinucleated Langhans-type giant cells, neutrophils, lymphocytes, and stromal cells, leading to a diagnosis of granulomatous mastitis. This report describes the clinical course of this patient in whom granulomatous mastitis was successfully treated with corticosteroid therapy. Special reference is made to the usefulness of FNA cytology in the diagnosis and follow-up of this disease.

Giant intracranial aneurysms in two sisters: case report

BACKGROUND

It is rare for intracranial aneurysms to present with cranial nerve palsy caused by the space-occupying effect of the lesion. Herein we discuss two sisters with familial intracranial aneurysms, both of whom presented with cranial nerve palsy.

CASE DESCRIPTION

Two female siblings presented with ocular movement and facial sensory disturbances caused by the space-occupying effect of giant aneurysms at the cavernous portion of the internal carotid arteries. The aneurysms were located at the identical site in both patients. Proximal occlusion of the internal carotid artery was effective in both cases, resulting in the promotion of thrombosis within the aneurysms in order to reduce their space-occupying effect.

CONCLUSION

This is considered to be the first known case of siblings, both suffering from giant internal carotid artery aneurysms.

ASA physical status and age are not factors predicting morbidity, mortality, and survival after pancreatoduodenectomy

To evaluate the effects of age and physical status on postoperative complications, American Society of Anesthesiologists-Physical Status score (ASA score) and age were analyzed in patients undergoing pancreatoduodenectomy (PD). Medical records and follow-up results of 69 patients who had undergone PD from 1980 to 1993 at one institution were examined. Clinical variables affecting morbidity and mortality rates were analyzed, and compared between two-aged groups (> or = 70 years (n = 18) and < 70 (n = 51)). Univariate Cox regression analysis of 69 patients showed that ASA score and age were not significant factors affecting postoperative morbidity, mortality, and survival. The clinical variables including ASA score, gender, operative time, blood loss, stage, and location of carcinoma were similarly distributed between the two-aged groups. The mortality rate in patients less than 70 years of age was 5.9 per cent (3/51), whereas there was no mortality in patients more than 70 years of age. The morbidity, mortality, and cumulative survival rates were statistically similar in the two age groups. The results suggest that ASA-physical status and age are not limiting factors for PD and do not predict survival. The procedure is safe and worthwhile even in patients more than 70 years of age with the ASA score up to III.

Identification of type I and type II serine/threonine kinase receptors for growth/differentiation factor-5

Growth/differentiation factor-5 (GDF-5) is a member of the bone morphogenetic protein (BMP) family, which plays an important role in bone development in vivo. Mutations in the GDF-5 gene result in brachypodism in mice and Hunter-Thompson type chondrodysplasia in human. BMPs transduce their effects through binding to two different types of serine/threonine kinase receptors, type I and type II. However, binding abilities appear to be different among the members of the BMP family. BMP-4 binds to two different type I receptors, BMP receptors type IA (BMPR-IA) and type IB (BMPR-IB), and a type II receptor, BMP receptor type II (BMPR-II). In addition to these receptors, osteogenic protein-1 (OP-1, also known as BMP-7) binds to activin type I receptor (ActR-I) as well as activin type II receptors (ActR-II and ActR-IIB). Here we investigate the binding and signaling properties of GDF-5 through type I and type II receptors. GDF-5 induced alkaline phosphatase activity in a rat osteoprogenitor-like cell line, ROB-C26. 125I-GDF-5 bound to BMPR-IB and BMPR-II but not to BMPR-IA in ROB-C26 cells and other nontransfected cell lines. Analysis using COS-1 cells transfected with the receptor cDNAs revealed that GDF-5 bound to BMPR-IB but not to the other type I receptors when expressed alone. When COS-1 cells were transfected with type II receptor cDNAs, GDF-5 bound to ActR-II, ActR-IIB, and BMPR-II but not to transforming growth factor-beta type II receptor. In the presence of type II receptors, GDF-5 bound to different sets of type I receptors, but the binding was most efficient to BMPR-IB compared with the other type I receptors. Moreover, a transcriptional activation signal was efficiently transduced by BMPR-IB in the presence of BMPR-II or ActR-II after stimulation by GDF-5. These results suggest that BMPR-IB mediates certain signals for GDF-5 after forming the heteromeric complex with BMPR-II or ActR-II.