[Bronchogenic carcinoma associated with right aortic arch and postaortic left brachiocephalic vein--report of a case]

61-year-old male was admitted to our hospital for surgical treatment of bronchogenic squamous cell carcinoma arising from left B8. The patient had right aortic arch with aberrant left subclavian artery and postaortic left brachiocephalic vein. Intraoperatively, left ligamentum arteriorsus forming vascular ring between the left subclavian artery and the pulmonary artery was found, however the ligamentum arteriorsus was not divided because no symptom of esophago-tracheal compression was observed. The left brachiocephalic vein was located between the ascending aorta and the arterial ligament. The lower lobe of the left lung was resected, and lymph nodes in the left side of the mediastinum were dissected easily because the aortic arch was positioned on the other side. Preoperative assessment of the type of branching and the course of arteries and veins is important for safe operation.

Classification of the ophthalmic artery that arises from the middle meningeal artery in Japanese adults

In a study of Japanese adults, we found that the orbital branch (OB) passing through the superior orbital fissure frequently anastomosed with the lacrimal artery or the ophthalmic artery (12/20). However, the OB passing through the meningo-orbital foramen (mof) only associationaly anastomosed with branches of the ophthalmic artery (4/79). Furthermore, the OB in the orbit, excluding the lacrimal gland as previously reported. We examined 116 cases in which the OB passed through the mof in 129 adult Japanese cadavers (45.0% in 258 sides). The OB passing through the mof was always distributed to the periorbital region and the area that it supplied was limited to the periorbita in about half of those cases. In another half of the cases (58/116), the area supplied included the lacrimal gland.

[Study for clinical usefulness of CEA, TPA, CA15-3 and BCA225 in breast cancer]

CEA, TPA, CA15-3 and BCA225 are the most frequently assayed as tumor markers for breast cancer. The aim of the present study was to reinvestigate the clinical usefulness of these markers in patients with breast cancer (primary: 28, recurrent: 15). In the cases of primary breast cancer, including all stages, positive rates of CEA, TPA, CA15-3 and BCA225 were 18%, 25%, 11% and 18%, respectively, while in the advanced cases of stage III+IV, positive rate of both CEA and TPA increased to approximately 40%. The positive rate of combination assays using four tumor markers was 46% in the cases of primary breast cancer including all stages and was 73% in the cases of advanced primary breast cancer (stage III+IV). In the cases of recurrent breast cancer, the positive rates of CEA, TPA, CA15 3 and BCA225 were 60%, 60%, 67% and 60%, respectively. When all of those tumor markers were used for assays, all of the patients with recurrent breast cancer studied showed elevated serum levels of at least one of these tumor markers. We retrospectively analyzed serum levels of tumor markers in 15 patients who relapsed breast cancer after surgical resection. In 2 patients elevation of some of four tumor markers occurred before the recurrent tumor was detected with RI scintillation and computed tomography. These results suggested that combination assays using CEA, TPA, CA15-3 and BCA225 should be helpful for detecting the recurrence of breast cancer, and also detecting the advanced primary breast cancer.

Expression of leukaemia inhibitory factor (LIF) receptor in human placenta: a possible role for LIF in the growth and differentiation of trophoblasts

Leukaemia inhibitory factor (LIF) is a cytokine that displays multiple activities in various tissues and is essential for blastocyst implantation in mice. In the human uterus, LIF is expressed in endometrial tissue and the decidua. To elucidate the role it plays, the mRNA levels for two LIF receptor (R) subunits, LIF-R and gp130, were examined in human endometrium, placenta and decidua by Northern blot hybridization. The expression of LIF-R gene was detected in the chorionic villus during the first trimester, in term placenta, and at lower levels in the decidua. The expression of LIF-R gene was not detectable in non-pregnant endometrium. The expression of the gp130 gene was detected in all tissues examined. During pregnancy, there was no significant change in the mRNA concentration of LIF-R in the placenta, while that of gp130 increased after the second trimester. The human choriocarcinoma cell line, BeWo, was found to express LIF-R and gp130. LIF inhibited forskolin-induced human chorionic gonadotrophin (HCG)-beta production by BeWo in a dose-dependent manner, and it ameliorated forskolin-induced growth suppression. These findings suggest that LIF plays a regulatory role in trophoblast growth and differentiation during pregnancy in human placenta.

Somatostatinoma of the pancreas associated with von Hippel-Lindau disease

A 39-year-old man was admitted because of lumbago, vomiting and massive gastrointestinal bleeding. Oliguria developed a few days later, which was followed by hyperkalemia and cardiac arrest. Autopsy disclosed multiple renal cell carcinomas with diffuse metastasis to the liver, adrenal gland, psoas muscle and vertebrae. In addition, a somatostatinoma was found in the pancreas. From these findings and past history of cerebellar hemangioblastoma and spinal hemangioma he was diagnosed to have von Hippel-Lindau disease. Von Hippel-Lindau disease with islet cell tumor is very rare and is reported here with a review of literature.

[New tactile sensor for thoracoscopic detection of intrapulmonary nodules]

We have developed a new tactile sensor which can be used for thoracoscopic detection of invisible intrapulmonary nodules. We applied this new device for consecutive ten cases to excise twelve intrapulmonary nodules thoracoscopically from August 1994 to January 1995. In this report, one of ten cases was presented. The patient was a forty-three-year-old female and admitted with an indeterminate nodule on chest X-ray and computed tomography. When the sensor probe quantifying the hardness of objects by the changes in resonance frequency of the sensor (delta f) passed above the nodule, a sudden jump was evoked in delta f curve on the computer screen. The nodule was resected thoracoscopically and proved pathologically to be adenocarcinoma. Thoracoscopic procedure was then converted to open thoracotomy and lobectomy with lymph node dissection was performed.

CAM--a novel immunosuppressive agent

This is an initial study of the immunosuppressive efficacy of CAM, a derivative of mycophenolic acid, in a rat heart allograft model when the major histocompatibility complex was fully incompatible, and its effect in improving heart allograft survival compared with mycophenolate mofetil (MMF, RS-61443). CAM or MMF was administered orally from day 1 following the allografting for 40 days. The median survival times (MST) were 6 days in rats with no immunosuppressive drug (control group; n = 6), 83 days with CAM 10 mg/kg (n = 6), and > 100 days with both 20 mg/kg (n = 7), and 30 mg/kg (n = 10). With MMF, in contrast, MST was 9, 17, 35, days with 10, 20, 30 mg/kg/day, respectively. All grafts in the CAM 30 mg/kg-treated group survived for more than 100 days after grafting, and, furthermore, CAM was also more effective than MMF in prolongation of the heart graft survival in rats at each dose. Rats with long-surviving cardiac allografts (30 mg/kg; CAM) accepted skin grafts from the donor-strain but rejected them from the third-party strain, suggesting that donor-specific tolerance was induced by CAM. In the tolerant rats, proliferative response against donor-type alloantigen was not impaired as compared with naive WKAH rats. In contrast, CML assay showed that T cells obtained from the rats bearing permanently accepted F344 heart grafts had less cytotoxic activity to the donor-type target, and the frequency of CTL precursor against donor-type alloantigen was also reduced.

Mirrorless optical bistability in a semiconductor-doped-glass plate as a result of oblique incidence

A procedure to obtain optical bistability in a third-order nonlinear film (or parallel plate) of low refractive index without any external mirrors is investigated both theoretically and experimentally. If an s-polarized light is incident obliquely at a large angle of incidence on the film, the generation of optical bistability can be expected because of the resulting increase in the reflectivity at the surfaces. Arigorous analysis of the stationary transmission characteristics of the nonlinear film is done for both positive and negative nonlinear coefficients with a plane-wave model. In the experimental demonstration, a CdS(x)Se(1-x)doped glass (Hoya Y-52) plate and a cw Ar(+) laser are used as the nonlinear material and the light source, respectively. It is shown that three operations of optical bistability, optical limiting, and differential gain can be easily obtained through adjustment of the angle of incidence as an initial detuning. The measured nonlinearity is thermal, and the magnitude and sign of the nonlinear refractive index are determined.

Apoptosis and nuclear levels of p53 protein and proliferating cell nuclear antigen in human hepatoma cells cultured with tumor promoters

Anticancer drugs etoposide and mitomycin C increased nuclear p53 protein and decreased proliferating cell nuclear antigen (PCNA) of PLC/PRF/5 human hepatoma cells. These changes were followed by DNA fragmentation and apoptosis. Teleocidin antagonized both apoptosis and alterations of nuclear p53 protein and PCNA induced by these anticancer drugs. In contrast, thapsigargin antagonized only drug-induced nuclear accumulation of p53 protein. Therefore, the inhibition of apoptosis appears not to be the common mechanism of tumor promotion. Both tumor promoters suppressed the increase in nuclear p53 protein, suggesting that an inadequate DNA repair due to the reduced nuclear accumulation of p53 protein might be playing important role in enhancing carcinogenesis.

Takayasu's arteritis in prepulseless stage manifesting lymph node swelling and hepatosplenomegaly

A 17-year-old male had fever of unknown origin (FUO) for 3 months with positive c-reactive protein, lymph node swelling, and hepatosplenomegaly. Biopsy specimens of the liver and lymph node disclosed nonspecific inflammation. Lymph node swelling and hepatosplenomegaly subsided gradually, while vascular murmur and pulselessness appeared. Computerized tomography and magnetic resonance imaging showed thickened arterial wall, while angiography disclosed arterial narrowing. From these findings he was diagnosed to have Takayasu's arteritis. The therapy with prednisolone was effective. Takayasu's arteritis is rarely manifested by hepatosplenomegaly and lymphadenopathy in its prepulseless stage.

Clonal and non-clonal karyotypically abnormal cells in haemophagocytic lymphohistiocytosis

We studied chromosomes in bone marrow (BM) or peripheral blood cells of nine patients with haemophagocytic lymphohistiocytosis (HLH); three of them had a family history of HLH and four others underwent concurrent Epstein-Barr virus (EBV) infection. In addition to a large population of normal mitotic cells, karyotypically abnormal clonal cells were found in two patients, abnormal clonal cells and a nonclonal (single) abnormal cell in one, and nonclonal abnormal cells in three. All the six patients with chromosome abnormalities died of progressive disease; one of them also had EBV infection and EBV-associated clonal proliferation. Two of three patients with EBV infection and only normal mitotic cells in BM completely recovered from the disease. Although HLH did not show histological and/or haematological evidence of a neoplastic disease, clonal chromosome abnormalities and the fatal clinical outcome found in some of the patients suggest that the disease may be heterogenous and include malignancy. HLH patients with karyotypically abnormal clonal cells in BM should warrant more intensive chemotherapy than that presently being applied to them and should be considered as candidates for BM transplantation.

Changes in kinetic properties of oxytocin receptors in longitudinal muscle membranes of rat uterus during gestation

Receptors of oxytocin were found to occur in the membrane fraction obtained from longitudinal muscle of pregnant rat uterus. The affinity of the membrane receptor for oxytocin increased through an increase in the association rate and a decrease in the dissociation rate during gestation. The membrane oxytocin receptor concentrations rose almost three-fold from Day 15 to Day 21. A transition of oxytocin receptors from a single class of independent sites to site-site interacted multiple binding sites, which most likely exhibit positive cooperativity during the last seven days of gestation, was observed. These results suggest that changes in the dynamics of uterine oxytocin receptors also play an important role in the onset of labor.

[Simple determination methods for blood grouping from biological stains. 1. Immunologic gold colloid aspiration test and dot ELISA test by membrane aspiration method for determining ABO blood groups from saliva specimens]

Two immunologic tests using nitrocellulose membrane and an aspiration device were applied to determine the ABO blood groups and secretor status from saliva specimens. First, immunologic gold colloid membrane aspiration test (IMAT) was performed with orange-red colloidal gold particles (GP) sensitized with anti-A or anti-B antibody or anti-H lectin (A chicken antiserum to O secretor saliva was also used as an anti-H reagent in some experiments). The boiled saliva specimens were serially diluted and dotted to the nitrocellulose membrane, which was equipped to a disposable aspiration kit, and the antibody- or lectin-coated GP was aspirated through the membrane. The stained saliva changed red by the immunologic binding of the GP. Test results could be obtained within some minutes. Detection limits of IMAT shown by saliva dilution were 1:100 to 1:10,000 for secretor salivas, whereas those for non-secretor salivas were 1:10 or lower. Second, a revised dot ELISA was performed by using the membrane aspiration device. The requisite time for this test (Dot ELISA-A) was 40 to 45 minutes, whereas that for conventional dot ELISA was 3 to 4 hours. The detection limits of the dot ELISA-A shown by the saliva dilutions were 1:1,000 to 1:100,000 for secretor salivas, whereas those for non-secretor salivas were 1:1,000 or below.

Comparison of ultrastructure of germinating pea leaves prepared by high-pressure freezing-freeze substitution and conventional chemical fixation

High-pressure freezing-freeze substitution (HPF-FS) methods were applied to germinating pea leaves. Good ultrastructural preservation without visible freezing damage was obtained up to 200 microns in thickness. Compared to conventional chemical fixation (CF), cellular membranes were smoother without undulation, and organelles appeared more turgid. The matrices of cytoplasm and organelles were denser and more homogeneous. The features imply that HPF-FS samples retain more substances and ultrastructure closer to the living state. There were differences in membrane stainability among organelles in HPF-FS specimens, which were not seen after CF. Bundles of microfilaments were observed frequently after HPF-FS.

Presence of alternative 5' untranslated sequences and identification of cells expressing ctk transcripts in the brain and testis

From a mouse brain cDNA library, two species of the Csk-type tyrosine kinase (ctk) gene containing different 5' untranslated sequences were cloned. Using the common as well as specific nucleotide sequences of the two clones as probes, we examined the expression of ctk in various mouse tissues by Northern blot analysis. The results indicated that both species of ctk were expressed in the brain, testis and bone marrow. By in situ histochemistry of the brain, ctk transcript was detected in neurons throughout the entire brain, especially those of the cortex, the hippocampus and the cerebellum. This distribution pattern is similar to that of the Src family kinases including Yes, Src, Fyn and Lyn. In the testis, the major transcript (0.7 kb) was shorter than that expressed in the brain and the bone marrow (2.0 kb). A subsequent Northern blot analysis of fractionated germ cell populations and in situ histochemistry revealed that the short and long transcripts were expressed in germ cells and somatic cells, respectively, and that the expression level was quantitatively regulated during germ cell development. These results suggest that Ctk is involved in the regulation of neural function and differentiation of male germ cells through interactions with member(s) of the Src family kinases.

[The left-sided atrioventricular replacement of corrected transposition of the great arteries through a left thoracotomy]

In a 17-year-old female with dextrocardia and corrected transposition of the great arteries, whose VSD and PFO had been surgically closed through median sternotomy two years previously, the left-sided atrioventricular valve replacement was performed for its severe insufficiency. The left anterolateral thoracotomy was chosen to have good visual field and to prevent unnecessary dissection of the adhesion. The postoperative course was uneventful.

[Comparison of MICs of new quinolones obtained using agar-dilution and broth-microdilution procedures]

Minimum inhibitory concentrations (MIC) of new quinolones against both Gram-positive and Gram-negative bacteria obtained using agar-dilution and broth-microdilution procedures were compared. A primary regression curve and a correlation coefficient (r) between 2 MICs for each of ofloxacin, ciprofloxacin, tosufloxacin, sparfloxacin or balofloxacin were calculated. For the 5 quinolones, average correlation coefficients were 0.891 for the Gram-positive bacteria tested, and 0.865 for the Gram-negative bacteria. The range of, correlation coefficients for the Gram-positive bacteria for these drugs was from 0.835 to 0.919, and that for the Gram-negative bacteria was from 0.815 to 0.865. From these data, it is clear that there is a good correlation between the 2 MICs of the new quinolones obtained using the agar-dilution and the broth-microdilution procedures. It was also shown that the value of the slope of the regression curves were nearly the same for the 5 quinolones tested. However, some particular strains of Morganella morganii, Pseudomonas cepacia, Xanthomonas maltophilia, Pseudomonas aeruginosa and Streptococcus pneumoniae exhibited different correlation coefficients from other strains.

Inhibitory effect of dexamethasone and progesterone in vitro on proliferation of human renal cell carcinomas and effects on expression of interleukin-6 or interleukin-6 receptor

Interleukin-6 (IL-6) has been suggested as an autocrine growth factor of human renal cell carcinomas. Since steroids are known to inhibit IL-6 gene expression, we investigated their effects on the growth of renal cell carcinoma. Dexamethasone inhibited proliferation of 2 of 4 renal cell carcinoma cell lines in a dose-dependent manner. In one of these 2 cell lines, IL-6 gene expression was also inhibited, but not in the other. The inhibitory effect of dexamethasone on cell proliferation was not reversed by the exogenous IL-6. In 1 of the 2 remaining cell lines, the inhibition of IL-6 gene expression was observed, although there was no inhibition of cell proliferation. Thus, inhibition of growth by dexamethasone did not correlate with an inhibitory action of dexamethasone on IL-6 mRNA expression. Progesterone inhibited the growth of 1 cell line without concomitant inhibition of IL-6 gene expression. Expression of IL-6 receptor mRNA was not altered. A dose-dependent increase in mRNA expression of gp130, the transducer of IL-6 signal, was induced by dexamethasone and progesterone in 2 and 1 of the 4 cell lines, respectively. These data suggest that, in some renal cell carcinomas, steroids may inhibit cell proliferation by a mechanism independent of their effects on mRNA expression of IL-6 and IL-6 receptors. Dexamethasone may be useful, not only for palliation of paraneoplastic syndrome caused by overproduction of IL-6, but also for inhibition of growth of renal cell carcinomas.

Severe hyponatremia and hyperkalemia induced by trimethoprim-sulfamethoxazole in patients with Pneumocystis carinii pneumonia

An antimicrobial agent trimethoprim-sulfamethoxazole (Tmp-Smx) does not usually cause electrolyte disturbances at regular doses, and few cases of Tmp-Smx-induced electrolyte imbalance have been reported in the English-language literature to date. Recently, however, we treated two patients with Pneumocystis carinii pneumonia who developed severe hyponatremia and hyperkalemia on administration of high-dose Tmp-Smx. These electrolyte disturbances were attributable to the direct effect of Tmp-Smx on the renal distal tubules, were reversible, and corrected by infusion of a sodium-enriched and potassium-free liquid. Therefore, it is suggested that even after electrolyte disturbances have occurred, high-dose Tmp-Smx therapy may be continued for severe infectious diseases under appropriate electrolyte correction.

Cutaneous ciliated cyst: a case report and histochemical, immunohistochemical, and ultrastructural study

A 19-year-old woman with a cutaneous ciliated cyst on her buttock is reported. Histological, histochemical, and electron microscopic studies revealed ciliated cells, mucinous cells showing merocrine secretion, and areas of squamous metaplasia in the cyst wall. This is the first case of cutaneous ciliated cyst that contained non-ciliated mucinous cells as a component.