Age-dependent susceptibility in mumps-associated hydrocephalus: neuropathologic features and brain barriers

Central nervous system susceptibility to viral infection is often age dependent for unclear reasons. In this study, we examined the age-dependent susceptibility of the brain in mumps virus-induced hydrocephalus in hamsters, and evaluated the relationship between neuropathologic features and brain barriers using glial fibrillary acidic protein and zonula occludentes 1 (ZO-1) immunohistochemistry. In a group intracerebrally inoculated with mumps virus at 2 days of age, pathologic findings such as periventricular edema, ependymal cell loss, and ventricular dilation were more prominent and the distribution of mumps virus antigen was wider than in a group inoculated at 30 days of age. ZO-1-immunoreactive tight junctions in the hydrocephalic brains of the 2-day group were severely damaged in the choroid plexus and ependyma, and in white matter capillaries as early as 3 days after inoculation. These changes were not apparent in the hydrocephalic brains of the 30-day group. Prominent cortical dissemination of virus in the 2-day group was related to underdeveloped perivascular glial foot processes in brain parenchyma. Periventricular edema in the 2-day group was linked to ependymal and blood-brain barrier tight-junction permeability. Our results suggest that tight junctions in the early postnatal period are more immature and fragile than in the adult. We concluded that brain susceptibility in mumps virus-induced hydrocephalus is intimately related to the maturity of brain barriers.

[Use of BiPAP during weaning from mechanical ventilation in a patient with chronic obstructive pulmonary disease and acute respiratory failure]

In a 65-year-old man with chronic obstructive pulmonary disease and acute respiratory failure, bi-level positive airway pressure device (BiPAP) was used as part of weaning from mechanical ventilation. As an outpatient, he had had dyspnea of grade V (Hugh-Jones) and was hypercapnic (PaCO2 of 70 torr) and hypoxemic (PaO2 of 60 torr), while he was receiving oxygen at 2 L/min via nasal cannula. Acute respiratory failure developed due to pneumonia, and mechanical ventilation was begun. However, he could not be weaned with a standard weaning technique (T-piece). On the fifth day of mechanical ventilation, he was extubated and treatment with BiPAP was begun. He did not complain of dyspnea even though PaCO2 did not decrease, which indicates that BiPAP reduced the work of breathing. Use of BiPAP might make reintubation unnecessary when acute ventilatory failure develops soon after extubation in patients with COPD.

Usefulness of ED036 kit for measuring serum PIVKA-II levels in small hepatocellular carcinoma

As a tumor marker for hepatocellular carcinoma (HCC), serum protein induced by vitamin K absence or antagonist-II (PIVKA-II) has high specificity, yet its sensitivity is relatively low, marking it less suitable to serve as an adjunct in the diagnosis of small HCC. Recently, the ED036 kit (Eisai, Tokyo, Japan), whose detection limit is approximately ten times superior to that of a conventional kit (Eitest MONOP II, Eisai) has been developed. In this study, serum PIVKA-II levels in serum samples from 83 patients with benign chronic liver diseases (CLD) and 129 patients with HCC were measured with those two kits. With the ED036 kit, the cut-off value was set at 40 mAU/ml. For PIVKA-II measured with the ED036 kit, sensitivity was 45.0%, specificity 92.8%, and accuracy 63.7%, when we discriminated patients with HCC from those with CLD without HCC. While maintaining a high specificity, of 92.8%, the ED036 kit showed a significantly higher sensitivity than the conventional kit (45.0% versus 27.9%; P < 0.0001). With patients who had HCC consisting of a single nodule 30 mm or less in diameter, the positivity rate for serum PIVKA-II with the ED036 kit was significantly greater than the rate with the conventional kit (21.4% versus 9.5%; P < 0.005). Thus, the ED036 kit was thought to be more useful than the conventional kit as a tumor marker for small HCC.

Adenosquamous carcinoma of the liver: clinicopathologic characteristics and cytokeratin profile

BACKGROUND

The clinicopathologic characteristics, biologic behavior, and histogenesis of primary adenosquamous carcinoma (ASC) of the liver have yet to be fully clarified.

METHODS

Eight cases of ASC of the liver were analyzed both clinicopathologically and immunohistochemically using antibodies of cytokeratin (CK) 7, CK 8, CK 18, CK 19, and CK 903 (CK 5, CK 10, CK 11, and CK 14). The survival curve of the 6 patients with surgically resected ASC was compared with that of the 32 patients with common cholangiocarcinoma (CC).

RESULTS

Most ASCs had invasive pathologic features, including venous invasion, lymphatic permeation, and intrahepatic metastases. There were lymph node metastases from 7 tumors (88%), and most of the metastases were adenocarcinoma. All adenocarcinoma (AC) components were positive for both CK 7 and CK 19. The squamous cell carcinoma (SCC) components were positive for CK 7 in all cases but were positive for CK 19 in only 5 cases (62.5%). The ACs were positive for CK 903 in only 3 cases (37.5%), whereas all SCCs were positive for CK 903. Almost all ACs were positive for both CK 8 and CK 18, whereas the SCCs were positive for CK 8 in only 3 cases (37.5%) and for CK 18 in no cases. All 6 patients with surgically resected ASC died of the disease within 1 year postoperatively. Their survival curve was significantly worse than that of the 32 patients with common CC (P < 0.001). The two patients on whom autopsy was performed also died within 1 year after diagnosis.

CONCLUSIONS

ASC tended to have more aggressive biologic behavior and a poorer prognosis than common CC. The authors' immunohistochemical analysis of CK expression indicated that most of the ASCs of the liver that were studied developed from a squamous transformation of the preexisting CC.

[Long-term follow up of idiopathic thrombocytopenic purpura in childhood]

Sixty children with idiopathic thrombocytopenic purpura (ITP) were followed up for 15 to 208 months (mean 120 months) from their first visit. Of these 65% (39 cases) were suffering from acute ITP and 47% of the patients were male. Of the 21 patients with chronic ITP 43% (9 cases) entered remission within five years from the onset of the disease. Conversely patients with chronic ITP for more than five years did not enter remission. Four patients with chronic disease were diagnosed to be other diseases (i.e. three cases were aplastic anemia, the other was Evans' syndrome) after one to four years from the onset. Four patients with chronic ITP for more than five years from the onset are now doing well without any severe bleeding problems. The patients who recovered have had neither problems nor complications. None of the patients died of a cerebral hemorrhage or severe bleeding. We consider that long term outcome of ITP in childhood would be better than that of adult cases.

Distinct regulation of two hydroxysteroid sulfotransferases, ST2A1 and ST2A2, by growth hormone: a unique type of growth hormone regulation in rats

In the present study, changes in the mRNAs of two major forms of hydroxysteroid sulfotransferases (STs), ST2A1 and ST2A2, have been determined in different growth hormone (GH) states. Hepatic ST2A1 mRNA was detected in both sexes of mature Sprague-Dawley rats. The level was 5 times higher in the females than in the males. ST2A1 mRNA was undetectable in GH-deficient animals, such as hypophysectomized rats and spontaneous dwarf rats. Continuous infusion of GH (mimicking the female secretory pattern) increased hepatic levels of ST2A1 mRNA in both GH-deficient animals. ST2A2 mRNA was detected only in the livers of mature female rats and in both sexes of GH-deficient animals. Intermittent injection of GH (mimicking male secretory pattern) strongly suppressed hepatic levels of ST2A2 mRNA in both GH-deficient animals. These results indicate that pituitary GH independently regulates both ST2A1 and ST2A2 at the pretranslational levels. These differences in GH responses between ST2A1 and ST2A2 are in good agreement with their female-dominant and female-specific modes of expression in normal rats. Furthermore, the present study demonstrates a unique response of ST2A2 to the secretory pattern of GH among the drug-metabolizing enzymes in rat livers, in which ST2A2 mRNA levels are suppressed by the male secretory pattern but not by the female secretory pattern of GH.

Right hepatic lobectomy in elderly patients with hepatocellular carcinoma

BACKGROUND/AIMS

The outcome of hepatectomy in elderly patients with hepatocellular carcinoma have been reported, however neither the morphological nor functional hepatic regeneration in elderly patients have been fully investigated.

MATERIALS AND METHODS

Fifty-six patients with hepatocellular carcinoma, who underwent a right hepatic lobectomy over an 8-year period, were classified into three groups according to their age; group 1 (n = 7), more than 70 years of age; group 2 (n = 40), patients from 50 to 69 years of age and group 3 (n = 9), under 50 years of age. There were no significant differences regarding backgrounds or intra-operative parameters among the three groups. The perioperative hepatic function, postoperative complications and the regeneration rate of the remnant left lobe at 1 month after operation were compared.

RESULTS

No differences were found in the regeneration rate, however, the levels of the hepaplastin test and lecithin:cholesterol acyltransferase at 7 days after hepatectomy in group 1 (31.3%, 8.8 U) were significantly lower than those in groups 2 and 3 (37.4%, 18.4 U; 47.9%, 29.4 U, respectively). The incidence of hospital death due to hepatic failure in group 1 (42.9%) was also significantly higher than that of group 2 (5.0%) or group 3 (0%).

CONCLUSION

The decline of postoperative protein synthesis regardless of the voluminal regeneration is a characteristic of the elderly. This phenomenon might thus be an important promoter of postoperative hepatic failure which remains unpredictable using any type of examination. Therefore, at this time, a major hepatectomy is not recommended as a viable treatment alternative in the elderly.

A recurrent translocation, t(16;21)(q24;q22), associated with acute myelogenous leukemia: identification by fluorescence in situ hybridization

Chromosome fluorescence in situ hybridization (FISH) analyses were performed on bone marrow cells in 3 adult patients with MDS or AML with a (16;21)(q24;q22) translocation. FISH analyses with AML1 probes at 21q22 proved in all 3 patients splitting of the AML1 gene at a region spanning exons 5 and 6 and the translocation of its 5' segment to distal 16q. Chromosome painting FISH analysis in patient 1 proved the translocation of the distal 21q segment to 16q, but it failed to prove the presumed translocation of the distal 16q segment to 21q, most likely because of its small size.

Skipping of exon 14 and possible instability of both the mRNA and the resultant truncated protein underlie a common cholesteryl ester transfer protein deficiency in Japan

Among the Japanese population, a G-to-A mutation at the beginning of intron 14 of the human cholesteryl ester transfer protein (CETP) gene is a frequent cause of CETP deficiency characterized by markedly increased HDL cholesterol. The resulting abnormalities responsible for null CETP deficiency were studied in detail. The CETP mRNA transcripts amplified by polymerase chain reaction from the monocyte-derived macrophages of two homozygous patients were both found to be normal except for the whole deletion of exon 14. The deletion causes a shift of reading frame and introduces a premature termination codon downstream. Examination of the macrophage RNA from heterozygotes suggested the increased instability of the abnormal mRNA in the cytoplasm, because the amount of the aberrant transcript was nearly one third that of a normal transcript in the cytoplasm, while they were equal in the nucleus. Although this indicated the synthesis of a mutant CETP that lacks about 15% at its carboxy terminus, immunoblot analysis demonstrated that the abnormal CETP was virtually absent in both the media and cell lysates of transfected COS-1 cells, which massively expressed the mutant CETP mRNA. These results elucidate the primary abnormality due to the common CETP splicing mutation to be the exon skipping of mRNA, which decreases the level of mRNA and produces a truncated protein that should be rapidly degraded intracellularly.

The difference of means of two indirect unpaired groups in receptor autoradiography

We present an approximate method to compare the difference of the means of two groups of populations by indirect unpaired data. This indirect data structure occurs in receptor autoradiography, where the tissue distribution of receptors is visualized in the form of ligand bindings. This visualization is indirect because we can only observe and measure nonspecific bindings in one autoradiograph and total bindings in another autoradiograph. The distribution of receptors is obtained by subtracting the nonspecific bindings from the total bindings. Besides the reasoning of our method, an example is given using our experimental data.

Forelimb muscle contraction induced by cerebral cortical stimulation after callosotomy: a myographic study in the mouse

The effect of callosotomy upon motor control by the cerebral cortex on the forelimb was examined in the mouse. On the 10th day after callosotomy in the rostral or caudal part of the corpus callosum, the forelimb area of the cerebral motor cortex was stimulated intracortically with a microelectrode and muscle contraction of the forelimb was recorded by electromyography. Muscle contraction was observed in the contralateral forelimb in the mice of which callosal fibers were cut in the caudal part of the corpus callosum including the splenium corporis callosi as well as in the normal mice. On the other hand, muscle contraction was observed in the ipsilateral forelimb in the mice of which callosal fibers were incised in the rostral part of the corpus callosum including the genu, rostrum and trunk. The latency of the muscle contraction was about 0.5 msec in the both groups of the callosotomized mice, as well as in the normal mice.

[Trial of analysis of esophageal wall motion using optical flow method on esophagogram]

Several studies have indicated that the analysis of esophageal motion provides a valid means of identifying esophageal diseases. Although this motion can be seen on esophagogram, its quantification leaves much room for improvement. This study presents a computer method to quantify the apparent motion (optical flow) observed on sequences of esophagogram. This method computes at every point of a sequence of digitized images the two-dimensional velocity vector which characterized its motion from one image to the next image. The information on motion of the esophagus can be displayed by superimposing the local velocity vector on the original image.

Decreased cortical glucose metabolism correlates with hippocampal atrophy in Alzheimer's disease as shown by MRI and PET

OBJECTIVE

To investigate the relation between atrophy of the hippocampus and parahippocampal gyrus (the % hippocampal area) and cerebral metabolic rate for glucose (CMRGlc) in Alzheimer's disease.

METHODS

13 patients with probable Alzheimer's disease by NINCDS-ADRDA criteria (six men; seven women, mean age 71 years, mini mental state 13.8 (SD 4.6)) and age matched controls were studied. T1 weighted MRI (0.5T) images were used for evaluation of the hippocampal area. With a digitiser system, a percentage of the hippocampal area to the brain (the % hippocampal area) was calculated. Eight patients received another T1 weighted MRI (1.5T) for further evaluation of the minimum thickness of the hippocampus. Regional CMRGlc (rCMRGlc) was measured using PET and the FDG technique.

RESULTS

The hippocampal area in patients with Alzheimer's disease was significantly lower than that of controls (P < 0.01). All the cortical rCMRGlc values in patients with Alzheimer's disease were lower than those of controls (P < 0.01). A significant correlation (P < 0.05) was found between the % hippocampal area and rCMRGlc in the temporal lobe, temporoparieto-occipital (TPO) region, and frontal lobe in Alzheimer's disease. There was a significant correlation between minimal hippocampal thickness and ipsilateral TPO metabolism on both sides.

CONCLUSION

The ipsilateral correlation between hippocampal atrophy and decreased TPO metabolism in Alzheimer's disease suggests a functional relation and the asymmetries show that Alzheimer's disease is an asymmetric disease in its early stages.

cDNA cloning of nuclear localization signal binding protein NBP60, a rat homologue of lamin B receptor, and identification of binding sites of human lamin B receptor for nuclear localization signals and chromatin

We previously purified and characterized a nuclear localization signal (NLS) binding protein, NBP60, in rat liver nuclear envelopes. In this study, we cloned and sequenced the cDNA of rat NBP60, and predicted an amino acid sequence comprising 620 amino acids. The sequence revealed that NBP60 is a rat homologue of lamin B receptor (LBR), and is 79 and 63% identical in amino acids to human and chicken LBR, respectively. Using three fusion proteins containing different parts of the amino-terminal domain of human LBR, it was shown that the stretch comprising amino acids 1 to 89, which contains a Ser-Arg rich region (RS region), binds to nucleoplasmin and that the binding was inhibited by a common NLS-peptide. These results suggested that the amino-terminal domain of LBR contains an NLS-binding site. Furthermore, it was shown that the stretch comprising amino acids 1 to 53, which does not contain the RS region or the predicted DNA-binding site, binds to Xenopus laevis sperm chromatin.

Distribution of fiber types determined by in situ hybridization of myosin heavy chain mRNA and enzyme histochemistry in rat skeletal muscles

We analyzed fiber types in rat skeletal muscles using a novel combination of in situ hybridization of myosin heavy chain (MyHC) mRNA, and enzyme histochemistry for succinate dehydrogenase (SD), which displayed metabolic properties. The fiber types were classified into the four major subtypes of I(beta/slow), IIA, IIX and IIB, and their intermediate types coexpressed two MyHC mRNAs: I and IIA, IIA and IIX, or IIX and IIB. The distribution of fiber types differed markedly in each skeletal muscle. The superficial region of limb muscles was composed mainly of fast-twitch fibers with oxidative-glycolytic and glycolytic activities, such as type IIX and type IIB. In contrast, the deep region was composed almost exclusively of type I and type IIA fibers both with oxidative activity. In this region, type IIA/IIX hybrid fibers were noted more frequently than type I/IIA and IIX/IIB hybrid fibers. In axial muscles, slow-twitch fibers and fast-twitch fibers composed predominantly of type IIB were distributed dispersively. The diaphragm and masseter showed a high proportion of type IIX and type IIB, respectively, to adapt to tissue-specific functional requirements and more frequently contained type IIX/IIB hybrid fibers than other observed muscles.

Urinary excretion of prostaglandins and renal function after hepatic resection

BACKGROUND/AIMS

The leading postoperative complication associated with hepatic resection is the accumulation of fluid in the abdominal cavity, which usually develops approximately one week after surgery. This study was undertaken to investigate the role of renal prostaglandins in modulating renal sodium and water retention in patients who underwent hepatic resection.

METHODS

Urinary excretion of thromboxane B2 and 6-keto-prostaglandin F1 alpha as well as renal function were investigated serially in 7 patients with hepatocellular carcinoma who underwent hepatic resection. We administered 60 mg of OKY 046, a selective thromboxane A2 synthetase inhibitor, for 6 hours by continuous drip infusion from the commencement of surgery.

RESULTS

Urinary sodium excretion was reduced from 165 mEq/day pre-operatively to 73 mEq/day on postoperative day 6 (p = 0.0181), however, there was no decline in urinary osmorality. OKY 046 administration inhibited intrarenal thromboxane A2 production, on the other hand, it significantly increased the production of intrarenal prostaglandin I2 (from 147 +/- 19 to 6339 +/- 1861 pg/mg creatinine, p = 0.0017) on the day of surgery. The level of thromboxane A2 was significantly increased to 2440 +/- 1099 pg/mg creatinine (p = 0.006, vs. pre-operative value), whereas the level of prostaglandin 12 was significantly reduced to 687 +/- 163 pg/mg creatinine (p = 0.0181, vs. the value on the day of surgery) on postoperative day 6.

CONCLUSIONS

Urinary thromboxane A2 synthesis might contribute to sodium and water retention after hepatic resection. These results suggest that combined use of OKY 046 and diuretics prevent ascites formation after hepatic resection.

[Treatment of thoracic esophageal carcinoma which invades adjacent structure--significance of resection and combined therapy]

From January 1980 to December 1994, a total of 64 cases of thoracic esophageal carcinoma which invaded adjacent structure (A3) were resected and 35 cases were unresected in Kagoshima University Hospital. Adjacent structures were mainly trachea/bronchus, aorta or pulmonary vein. Combined resections were performed in 22 cases (34.4%), and no tumors remained in 12 cases (18.8%). One year survival rates and 50% survival time of the no residual tumor group were 25.7% and 8.5 months, while the rates of the residual tumor group were 15.7% and 5.1 months. But, there was no significant difference of survival rates according to the amount of residual tumor. On the other hand, 1-year survival rates and 50% survival time of unresected group were 3.1% and 4.5 months. As a postoperative adjuvant therapy, radiation was the most effective modality. As a result, operations should be done at first for the A3 carcinoma in which a complete combined resection is expected. On the other hand, radiation or chemotherapy should be selected for the cases in which the tumor may remain, even though combined resection is done.

Controlled release of cisplatin incorporated into biodegradable poly-d, l-lactic acid

Using a melt-pressing technique, we produced a small solid cylinder containing cisplatin (CDDP) embedded in poly-d, l-lactic acid (CDDP-PLA). The in vitro release of CDDP from the polymer was examined in an immersion system. CDDP was released continuously for more than four weeks with no initial burst. Drug distribution for CDDP-PLA was compared with CDDP solution (CDDP-SOL) by subcutaneous administration into the back of rats. In the CDDP-PLA group, a high concentration of CDDP was maintained in the subcutaneous tissues near the implants for 20 days. However, in the CDDP-SOL group, the concentration of CDDP was low by 10 days after drug administration. CDDP-PLA may become a useful tool in locoregional chemotherapy as a solid type of drug delivery system with longlasting release.

The characteristics of hepatocellular carcinoma with a high level of serum lactic dehydrogenase: a case report

Hepatocellular carcinoma (HCC) remains one of the most important malignancies in Japan (1, 2). Lactic dehydrogenase (LDH), which is a glycolyticenzyme, and exists in various types of human tissue and neoplasms, has also been reported to demonstrate a high level (especially LDH 5) in the serum of patients with HCC (3-10). We herein report the findings of a 68-year-old male patient with hepatocellular carcinoma (HCC), whose serum lactic dehydrogenase (LDH) level more closely correlated with the clinical course than the alpha-feto-protein level (AFP). Both the AFP and LDH levels were high before the operation (AFP 1402 ng/ml; LDH 638 IU/L) (LDH1 11%; LDH2 24%; LDH3 34%; LDH4 19%; LDH5 12%). The levels of the serum LDH and AFP one week after the right hepatic lobectomy both decreased to 423 IU/L and 331 ng/ml, respectively. In addition, the LDH isozyme pattern returned to normal. Six weeks after the operation, the serum LDH increased to 3504 IU/L, however, the AFP levels remained low at 43.4 ng/ml, and the CT findings demonstrated multiple recurrent nodules in the whole remnant liver. At eighty-one days after the operation, the patient died due to a rupture of the recurrent HCC. Immunohistochemical observations were performed using the peroxidase labeled streptavidin-biotin technique with slight modifications and using two monoclonal antibodies for AFP and for Ki-67. Most portions of the primary tumor consisted of poorly to undifferentiated HCC. The portion of undifferentiated HCC did not stain for AFP antibody, but the portion of poorly differentiated HCC stained positively for it. It was thus speculated that LDH was mainly produced in the portion of undifferentiated HCC. In addition the undifferentiated HCC were strongly positive for Ki-67, while, in contrast, the poorly HCC was only weakly positive for Ki-67. Based on the above findings, HCC with a high serum level of LDH appears to show both a rapid growth and highly malignant tumors.

[Preventive use of diltiazem to suppress supraventricular tachyarrhythmia in the patients after esophagectomy]

We investigated the efficacy of preventive use of diltiazem to suppress supraventricular tachyarrhythmia such as paroxysmal atrial tachycardia (PAT) and atrial fibrillation (Af) in the patients who underwent transthoracic esophagectomy. We divided 52 patients into 2 groups; the diltiazem group (n = 26) and the control group (n = 26). In the diltiazem group continuous intravenous infusion of diltiazem (1-3mcg.kg-1.min-1) was started when the patient's heart rate remained over 110.min-1 without any predisposing factor. On the other hand, in the control group we did not use it preventively. In both groups, we did not restrict the use of antiarrhythmic agents if necessary. We recognized PAT or Af in the control group (54%) more often than in the diltiazem group (19%). PAT or Af seldom occurred after the 4th post-operative day in the both groups. Serum diltiazem concentrations of 9 patients after about 10 hours infusion showed great variation (between 30 and 250 ng.ml-1). In 7 of them the diltiazem concentration increased as the duration of infusion was prolonged. However, we did not observe bradyarrhythmia. We consider that the continuous diltiazem infusion is effective in suppressing supraventricular tachyarrhythmia after esophagectomy.

Synchronous and metachronous carcinomas of the esophagus and head and neck

We retrospectively analyzed the clinicopathologic findings, treatment and outcome of 22 patients with synchronous or metachronous carcinomas of the esophagus and head and neck. The patients with metachronous cancers in whom esophageal cancer occurred first had either an early-stage esophageal carcinoma or only one positive lymph node. Similarly, five of 10 patients with metachronous cancers in whom head and neck cancer was the first tumor had early-stage esophageal carcinomas. The esophageal lesion was mucosal carcinoma in four patients which was found by endoscopy with the iodine dye method. In the patients with synchronous cancers either one or both carcinomas were advanced, and the prognosis of these patients was poor compared with those of patients with metachronous carcinomas. Accordingly, endoscopic surveillance for early detection of metachronous lesions are encouraged.