Neurocutaneous vascular hamartomas mimicking Cobb syndrome. Case report

The authors report the rare case of a patient with neurocutaneous vascular hamartomas mimicking Cobb syndrome. An 8-year-old boy was admitted to the authors' hospital with progressive urinary disturbance and upper back pain. Multiple skin nevi had been noted at the child's birth. Radiological examination revealed multiple cavernous angiomas in the spinal cord in the same metamere in which the skin nevi had been observed and also in the left cerebral hemisphere. His symptoms gradually improved without surgical intervention. Four years later he was readmitted because of a cerebral hemorrhage involving the left cerebral peduncle. Nonsurgical treatment was chosen because his symptoms promptly improved. To the best of the authors' knowledge, this is the first case of multiple cavernous angiomas in the brain and spinal cord associated with skin nevi. The authors discuss this clinical entity and the significance of the disease.

Characterization of the antinociceptive effects of TRK-820 in the rat

We have already reported that TRK-820, (-)-17-cyclopropylmethyl-3, 14b-dihydroxy-4, 5a-epoxy-6b-[N-methyl-trans-3-(3-furyl)acrylamido]morphinan hydrochloride, a new selective kappa-opioid receptor agonist, has affinity for kappa-subtype opioid receptors other than the kappa(1)-opioid receptor. It would be of interest to examine whether the different kappa-opioid receptor subtype properties of TRK-820 participate in its antinociceptive action in the inflamed paw test and the formalin test. TRK-820 produced a potent antinociceptive effect, which was inhibited by the selective kappa-opioid receptor antagonist nor-binaltorphimine, but not by the mu-opioid receptor antagonist naloxone in the mechanical paw pressure test. TRK-820 also produced a potent antinociceptive effect in rats with adjuvant-induced arthritis. TRK-820 and morphine, a prototype mu-opioid receptor agonist, were equally effective in inhibiting the nociceptive responses in the arthritic rats and in the normal rats, while ICI-199441, 2-(3, 4-dichlorophenyl)-N-methyl-N-[(1S)-1-phenyl-2-(1-pyrrolidinyl)ethyl]- acetamide, a kappa-opioid receptor agonist, was about 5-fold less potent in the arthritic rats than in the normal rats. In the formalin test TRK-820 had a very similar antinociceptive potency to that of ICI-199441, unlike in the arthritic rats in which TRK-820 was 2.5 times more potent than ICI-199441. It is concluded that TRK-820 produced a potent antinociceptive action via the stimulation of kappa-opioid receptors in rats. TRK-820 has a unique antinociceptive profile different from that of the other kappa-opioid receptor agonists such as ICI-199441 in arthritic rats.

Exchange transfusion with albumin-heme as an artificial O2-infusion into anesthetized rats: physiological responses, O2-delivery, and reduction of the oxidized hemin sites by red blood cells

Human serum albumin (HSA) incorporating synthetic hemes, the tetrakis(o-pivalamido)phenylporphinatoiron(II) derivative (FeP), is an artificial hemoprotein (HSA-FeP) which is able to reversibly bind and release dioxygen under physiological conditions (in aqueous media, pH 7.4, 37 degrees C) like hemoglobin and myoglobin. Physiological responses to exchange transfusion with HSA-FeP solution [[HSA], 5 g/dL; FeP/HSA, 4 (mol/mol)] into rats after hemodilution and hemorrhage (Hct, about 10%) has been evaluated. The declined mean arterial pressure (MAP) and blood flow after a 70% exchange with HSA and the further 40% bleeding of blood were significantly recovered up to about 90% of the baseline values by the injection of HSA-FeP. Furthermore, the renal cortical O(2)-tensions and skeletal tissue O(2)-tensions were also increased, indicating the in vivo O(2)-delivery of HSA-FeP. Autoxidation of ferrous Fe(II)P to ferric Fe(III)P was retarded in the blood stream; the half-lifetime of the dioxygenated FeP [tau(1/2)(O(2))] in vivo was 4.1 h [cf. 1.0 h (in vitro)]. It has been found that autooxidized Fe(III)P was certainly reduced in the whole blood suspension. Physiological concentrations of ascorbic acid continuously provided by red blood cells probably rereduces Fe(III)P, leading to the apparent long lifetime of the dioxygenated species of FeP.

Study on the concentration of circulating primordial germ cells (cPGCs) in early chick embryos

Experiments were conducted to elucidate the factor that influences the concentration of circulating primordial germ cells (cPGCs) in two-day old chick embryos. The concentration of cPGCs was observed to be highest at stage 14 (66.9 +/- 23.2 microliters) and decreased thereafter. However, considerable egg to egg variations in cPGC concentration, especially at stages 13, 14, 15, and 16 were observed. After conducting experiments to elucidate the source of egg to egg variation in cPGC concentration among embryos, it was revealed that there are hens that lay eggs which contain either constantly high (more than 80 PGCs/microliter) or constantly low (less than 30 PGCs/microliter) concentration of cPGCs. The results obtained from the present experiments showed that one of the major source of egg to egg variation in the concentration of cPGCs was due to the individual differences among females that produced the eggs.

Potent antinociceptive effects of TRK-820, a novel kappa-opioid receptor agonist

TRK-820, a new type of 4,5-epoxymorphinan derivative, was investigated in vivo for antinociceptive activities and its selectivity on various opioid receptors in mice. TRK-820 given s.c. or p.o. was found to be 351- and 796-fold more potent than U50,488H with acetic acid-induced abdominal constriction test. The duration of the antinociceptive effect produced by TRK-820 was longer than that produced by mu-opioid receptor agonist morphine or other kappa-opioid receptor agonists. In addition, with four other antinociceptive assays, low temperature hot plate (51 degrees C), thermal tail flick, mechanical tail pressure and tail pinch tests, TRK-820 was also found to be 68- to 328-fold more potent than U-50488H, and 41- to 349-fold more potent than morphine in producing antinociception, as comparing the weight of the different compound. However, TRK-820 was less active in inhibiting the high temperature (55 degrees C) hot plate response. The antinociceptive effects produced by TRK-820 were inhibited by nor-BNI, but not by naloxone or naltrindole (NTI) with the abdominal constriction test, indicating that the antinociception is selectively mediated by the stimulation of kappa-, but not mu- or delta-opioid receptors. Co-administration of TRK-820 with morphine slightly enhanced the antinociception induced by morphine in the mouse hot plate test. On the other hand, pentazocine significantly reduced the morphine-induced antinociception. TRK-820 produced sedation at doses, which are much higher than the doses for producing antinociception. These results indicate that the potent antinociception induced by TRK-820 is mediated via the stimulation of kappa-, but not mu- or delta-opiod receptors.

Sellar chondroma--case report

A 12-year-old boy presented with right visual disturbance. Skull radiography and computed tomography (CT) showed an irregular deformity of the sella turcica, hypertrophic change of the dorsum sellae, and an inhomogeneously calcified mass in the sella turcica. Magnetic resonance (MR) imaging demonstrated the mass lesion filled the hypophyseal fossa, and extended to the dorsum sellae, right cavernous sinus, and right suprasellar region. The Dolenc pterional combined epidural and subdural approach was carried out. The histological diagnosis was chondroma. Sellar chondroma requires relief of the compression to the chiasm or optic nerve as soon as possible, so partial resection can still be beneficial. However, follow-up MR imaging or CT, visual examination, and control of pituitary dysfunction are required after the operation.

Distribution of adrenomedullin (AM), proadrenomedullin N-terminal 20 peptide, and AM mRNA in the rat gastric mucosa by immunocytochemistry and in situ hybridization

Adrenomedullin (AM) is a novel vasorelaxant peptide isolated from pheochromocytoma. Proadrenomedullin N-terminal 20 peptide (PAMP) is a hypotensive peptide generated by posttranslational enzymatic processing of a 185-amino acid pro-AM molecule, the same precursor as AM. In this study, we investigated localizations of these peptides by immunocytochemistry and AM mRNA by non-radioisotopic in situ hybridization followed by the streptavidin and biotin complex (ABC) method and catalyzed signal amplification (CSA) in the rat adrenal medulla and gastric mucosa. In the gastric mucosa, both AM- and PAMP-like immunoreactivities were found in the neuroendocrine cells, but PAMP-positive cells were more abundant than AM-positive ones. By immunoelectron microscopy, AM and PAMP were localized exclusively in the secretory granules. The distribution pattern of AM mRNA-positive cells, only a limited portion of which had AM and/or PAMP, was also similar to that of the two peptides. But AM mRNA was detected also in a few epithelial cells as well as neuroendocrine cells. The two peptides might play an important role in the control of local circulation in the rat stomach.

Metastatic renal cell carcinoma mimicking pleural mesothelioma

Although it is well known that renal cell carcinoma metastasizes to the thorax, sole pleural metastasis is rare. We report a case of mesothelioma-like metastasis of renal cell carcinoma.

Surgical treatment of renal cell carcinoma associated with Budd-Chiari syndrome: report of four cases and review of the literature

AIMS

Renal cell carcinoma is sometimes associated with inferior vena caval tumour thrombus, but occlusion of hepatic veins by the tumour thrombus causing liver dysfunction, the so-called Budd Chiari syndrome, is relatively uncommon. There are only a few reports in the literature which discuss this condition.

METHODS

Four cases admitted to our hospital over a 7-year period and eight cases reported in detail in the English and the Japanese literature were included in this study. They are classified into two groups: mild/silent, without liver failure, and severe, with liver failure.

RESULTS

Five patients were classified as mild/silent and seven as severe. Clinical manifestations were mild in the former cases and acute in the latter. Surgery was performed in four of the former cases but only in one case of the latter cases.

CONCLUSIONS

In mild cases, surgical treatment seems to avoid imminent hepatic failure effectively and should be performed as soon as possible. In such cases Budd Chiari syndrome in itself does not affect the prognosis. In severe cases, however, surgical treatment is very difficult and risky due to the existing hepatic failure.

Donor primordial germ cell-derived offspring from recipient germline chimaeric chickens: absence of long-term immune rejection and effects on sex ratios

1. Germline chimaeric chickens were produced by the transfer of primordial germ cells, and the generation of donor-derived offspring was examined for a maximum of 146 weeks. 2. The frequencies of donor-derived offspring from the chimaeras were 47% to 97%, and no apparent changes in frequency were observed with increasing age during the test period. 3. Differentiation of donor primordial germ cells into functional gametes appeared to be restricted to a degree at some developmental stage in the gonads of chimaeric chickens of the opposite sex.

Production of germ-line chimeras by transfer of cryopreserved gonadal primordial germ cells (gPGCs) in chicken

Gonadal primordial germ cells (gPGCs) were collected from gonadal anlage of 5-day-old White Leghorn (WL) embryos. Collected gPGCs were suspended in freezing medium containing 10% dimethyl sulphoxide (DMSO). The cell-suspension was frozen at 1 degree C/min until the temperature reached -80 degrees C; cells were then immersed in liquid nitrogen at -196 degrees C and stored up to 3 mo. Approximately 100 frozen/thawed gPGCs were injected into the dorsal aorta of each Barred Plymouth Rock (BPR) embryo from which blood was drawn prior to germ-cell injection. The injected embryos were incubated until hatched, and hatched chicks were raised until sexually mature. Upon reaching sexual maturity, a progeny test was performed by mating recipient chicks with normal BPR of the opposite sex. Of 840 progeny produced from 4 gPGC recipients, 74 chicks (8.8%) were phenotypically white. Present results demonstrate that frozen/thawed gPGCs collected from gonadal anlage are capable of producing germ-line chimeras in chicken.

Blood volume and flow velocity through parenchymal microvessels in ischemic brain edema of rats

Focal cerebral ischemia was produced in rats with left middle cerebral artery occlusion for 24 hours. Regional CBF was measured by the 14C-iodoantipyrine technique. The distribution of red blood cells (RBC) and plasma in cerebral microvessels was determined by radioluminography using 51Cr-RBC and 125I-bovine serum albumin, respectively. The mean transit times of RBC and plasma, blood volume, and hematocrit were calculated. The water content was measured by specific gravity. The blood flow was reduced to 2% of the control value in the central core, where the brain edema was the most severe. The blood volume decreased to 25% and the mean transit times of RBC and plasma increased about tenfold. In the outer periphery, where CBF was reduced to 39% but brain edema was not induced, the blood volume was decreased to 76% while the mean transit time of RBC was increased 2.1-fold, being greater than the increase in the plasma transit time. These findings indicate that focal ischemia has variable effects on the blood volume and flow velocities of RBC and plasma in the parenchymal microvessels depending on the depth of blood flow and edema. A decrease in blood flow is probably related to a reduction in the flow velocities of RBC and plasma in the surrounding ischemic tissue rather than to decreased number of perfused capillaries in the ischemic core.

Unusual high signal intensity on MR images in a patient with multiple tendinous xanthomas

The MR features of a 57-year-old man with multiple tendinous xanthomas are reported. The lesions of the peroneus longus tendons and the Achilles tendons showed diffuse reticulated pattern, which is the typical MR finding of tendinous xanthomas. However, the lesions of the patellar tendons showed no diffuse pattern and contained focal regions of high signal intensity on T 1-weighted images suggesting the deposition of triglycerides. The regions showed high signal intensity on T 2-weighted images and moderate enhancement on contrast-enhanced T 1-weighted images suggesting the presence of associated inflammation.

Carcinosarcoma in the region of the female urethra

A 61-year-old woman with acute urinary retention was found to have a carcinosarcoma in the region of the urethra. Evaluation of the computed tomogram suggested a urethral tumor, which was resected by a transperineal approach. She received local radiotherapy after surgery, and is alive at 1-year follow-up with a tumor metastasis to the pelvis.

[Outcome from surgery of lung cancer invading the carina]

By 1995, 17 patients with lung cancer invading the carina underwent surgical resection and reconstruction of the carina. Procedures which applied to patients were two cases of wedge pneumonectomy, seven cases of sleeve pneumonectomy, four cases of carinal reconstruction with right upper lobectomy, and four cases of carinal resection and reconstruction. Overall survival for five years were 40.3% and 33.6% for ten years survival. Operative death occurred in 5 cases. Long term survival was achieved in localized diseases which showed no lymph node extension. As for N1 and N2 diseases, only one patient among 7 cases survives 12 months. Thus we conclude that selected cases which showed localized disease without lymph node extension are the candidate for carinal resection and reconstruction. Postoperative intensive care is mandated for these patients. Adjuvant therapy with surgery for these patients with lymph node progression is a future problem.

Timing and side effects of flumazenil for dental outpatients receiving intravenous sedation with midazolam

We studied the timing and side effects of flumazenil treatment for 10 healthy volunteers and 46 dental outpatients who received intravenous sedation with midazolam. For the volunteers, vital signs were monitored before and after intravenous injection of midazolam and flumazenil. In addition, grip strength, signs and symptoms, and performance on the Romberg's test and addition tests were evaluated 30 min and 60 min after midazolam injection as well as after flumazenil injection. There were no significant changes in vital signs before, immediately after, or 50 min after injection of flumazenil, the latter time corresponding to the half-life of the drug. Thus, awakening from sedation was associated with no effects on the cardiovascular or respiratory systems. Distinct effects of flumazenil were demonstrated by the Romberg's test and the assessment of sedation status. Flumazenil had no effect on the outcome of the addition test. For the outpatients, sedation status and signs and symptoms were studied in patients undergoing procedures lasting 30 min or less (group S) and those undergoing procedures lasting 31 to 60 min (group L). Three patients in group S and one in group L had signs and symptoms of resedation. After treatment with flumazenil, abnormalities such as excitability and nausea were reported by only two patients in group L. One patient in group S had drowsiness that did not resolve after injection of flumazenil and continued until the following day. Our results indicate that flumazenil should be given at least 60 min after intravenous sedation with midazolam in dental outpatients. Moreover, caution should be exercised with regard to the potential side effects of flumazenil.

Long-term culture of avian embryonic cells in vitro

The pH of the embryonic blood, one of the most important environmental factors for embryonic cells, was found to range from 8.1 to 8.5 in chick embryos until 108 h after incubation. Based on these results, the culture medium adjusted to pH 8.0 was used to culture embryonic chick and quail cells. They were easily subcultured for a long period of time at pH 8.0. This pH culture condition may have wide application for manipulating embryonic cells or tissues and establishing cell lines from avian embryos.

[Changes in red blood cell aggregation rate after aneurysmal subarachnoid hemorrhage]

Red blood cell (RBC) aggregability is one of the important factors determining blood viscosity in the microcirculation. The RBC aggregation rate was monitored in 38 patients who underwent early aneurysmal clipping surgery after subarachnoid hemorrhage (SAH). The intravascular factors (hematocrit, serum albumin, alpha 2-macroglobulin, fibrinogen, IgG) that influence RBC aggregation were also examined. The RBC aggregation rate increased on days 5-7 but decreased significantly as a result of hypervolemic hemodilution therapy (H-H therapy). The hematocrit level was also reduced by H-H therapy. The serum albumin concentration decreased and the serum alpha 2-macroglobulin concentration increased significantly on days 5-7. After H-H therapy, the serum albumin concentration increased and the serum alpha 2-macroglobulin concentration decreased significantly. Serum IgG and plasma fibrinogen concentrations did not change significantly. It is known that albumin decreases and alpha 2-macroglobulin increases RBC aggregability. It has become apparent that serum albumin and alpha 2-macroglobulin play important roles in the determination of RBC aggregability after SAH. We conclude that the improvement in RBC aggregability induced by H-H therapy is effective for reversing progressive neurological deterioration due to cerebral vasospasm.

[Urothelial carcinoma of the navicular fossa]

We report a case of transitional cell carcinoma arising in the fossa navicularis. The patient was a 74-year-old man. He had no history of sexually transmitted disease or urethral stricture. Clinically, the tumor was suspected to be a condyloma acuminatum; however, the pathological diagnosis yielded an unexpected result: transitional cell carcinoma. Radiological examinations and cystoscopy showed no other tumor besides the primary cancer in the fossa navicularis. Partial resection of the urethra was performed and the patient has been without evidence of disease for 3 years.

Rate constant of gadolinium (Gd)-DTPA transfer into chronic subdural hematomas

Gadolinium (Gd) DTPA concentrations in subdural fluid and arterial blood were measured following intravenous Gd-DTPA injection by ion coupled plasma emission spectrometry in 31 chronic subdural hematomas and 12 with subdural effusions. Dynamic biological modeling analysis was used to calculate the unidirectional transfer rate constant (K) for Gd-DTPA influx into the subdural fluid. The Gd concentrations in subdural hematomas and subdural effusions were 36.3 +/- 3.7 nmol ml(-1) and 80.0 +/- 14.0 nmol ml(-1), respectively. The transfer rate constants (K) for subdural hematomas and subdural effusions were 12.4 +/- 1.5 (x10(-4)) min(-1) and 19.7 +/- 2.2(x10(-4)) min(-1), respectively. The Gd concentration and transfer rate constant for subdural effusions were significantly (p<0.05) higher than for subdural hematoma. The Gd transfer rate constant was significantly correlated with the interval from head injury to operation. The present study shows that the immature outer membrane has a high transfer rate constant, allowing extravasation of plasma components into the subdural space and increasing the volume of the subdural effusion; the rate constant decreases with aging of the subdural hematoma.

Hypertrophic anterior falx artery associated with interhemispheric subdural empyema--Case report

A 14-year-old boy presented with interhemispheric subdural empyema. Angiography demonstrated a hypertrophic anterior falx artery. He was treated with antibiotics and craniotomy to evacuate the lesion. The postoperative course was uneventful with no signs of neurological deficit. The abnormal artery was no longer visualized angiographically after the resolution of the empyema. Reactive appearance of the anterior falx artery is a pathognomonic sign of interhemispheric subdural empyema.