Different clinical features in monozygotic twins: a case of 7q--syndrome

We present male monozygotic twins who showed quite different clinical features. Blood chromosome analysis revealed 46,XY/46,XY,del(7) (q32-->qter) mosaicism in both twins. However, cultured skin fibroblasts from the twins showed different karyotypes. Twin 1, with a normal phenotype, had normal chromosomes and was 46,XY. Twin 2, on the other hand, had the characteristic manifestations of 7q- syndrome and chromosomes of 46,XY,del(7) (q32-->qter). DNA fingerprint analysis of their peripheral blood samples revealed the same pattern. However, DNA fingerprint patterns of cultured skin fibroblasts and buccal mucosal cells were different when a 7q terminal marker, probe g3, was used. These identical twins with discordant phenotypes can be explained by the occurrence of twinning and simultaneous erroneous mitosis. In addition, there might be a vascular communication which probably resulted in blood exchange and chromosomal mosaicism of the lymphocytes of the monozygotic twins.

Seroepidemiology status of Nepalese against hemolytic streptococcal infection in Katmandu

Immune status of apparently healthy Nepalese against hemolytic streptococci was studied by measuring antibodies to various streptococcal antigens such as streptolysin-O (SO), streptokinase (SK), deoxyribonuclease-B (DN-B) and streptococcal polysaccharide (SP). The normal range of anti-streptolysin-O (ASO), anti-streptokinase (ASK), anti-deoxyribonuclease-B (ADN-B) and anti-Streptococcus polysaccharide (ASP) was 60-480 (T.U.), 40-1024 (titer), 60-1280 (titer) and less than 2-128 (Unit), respectively. No difference was observed between the two sexes. ASO and ADN-B were measured by the neutralization method. Passive hemagglutination (PHA) was used to measure ASK and ASP. These values were 2-3 fold higher than those obtained on the Japanese subjects.

Similarity graphing and enzyme-reaction database: methods to detect sequence regions of importance for recognition of chemical structures

We developed a new method which searches sequence segments responsible for the recognition of a given chemical structure. These segments are detected as those locally conserved among a sequence to be analyzed (target sequence) and a set of sequences (reference sequences). Reference sequences are the sequences of functionally related proteins, ligands of which contain a common chemical substructure in their molecular structures. 'Similarity graphing' cuts target sequences into segments, aligns them with reference sequence pairwise, calculates the degree of similarity for each alignment, and shows graphically cumulative similarity values on target sequence. Any locally conserved regions, short or long in length and weak or strong in similarity, are detected at their optimal conditions by adjusting three parameters. The 'enzyme-reaction database' contains chemical structures and their related enzymes. When a chemical substructure is input into the database, sequences of the enzymes related to the input substructure are systematically searched from the NBRF sequence database and output as reference sequences. Examples of analysis using similarity graphing in combination with the enzyme-reaction database showed a great potentiality in the systematic analysis of the relationships between sequences and molecular recognitions for protein engineering.

[Fallopian tube recanalization with a catheter system--experience in the use of a balloon catheter]

Fallopian tube obstruction is one of the most difficult problems in the treatment of infertility. This report gives the results of a pilot study on the transcervical recanalization of the occlusive fallopian tube. Selective catheterization of the uterine cornu was applied through a balloon catheter, which was wedged at the internal uterine os. In 16 occlusive fallopian tubes of 11 cases, the catheterization procedure was attempted and accomplished with a 87.5% success rate. Recanalization was successful in 75.0% of the affected tubes. Subsequent pregnancy was confirmed in three cases. This convenient technique is safe and effective and it will be accepted as the first choice in the diagnosis and treatment of fallopian tube obstruction.

[Bone mineral contents of lumbar vertebrae in postmenopausal women--using a quantitative computed-tomography method]

We measured bone mineral contents of lumbar vertebrae (L1, L2, L3, L4) in 58 post-menopausal female volunteers (49-76 years old), using a quantitative computed-tomography method. We investigated age-related changes of bone mineral content, and analyzed the relation of bone mineral content to vertebral deformity and to physical characteristics. The following results were obtained: (1) There were highly significant correlations and some significant differences among bone mineral contents of L1, L2, L3 and L4. (2) Bone mineral content showed an apparently linear decline with age. (3) A significant negative correlation was observed between bone mineral content and the central deformity index of the vertebral body, but not for the anterio-posterior deformity index. (4) It was difficult to verify an association of bone mineral content with physical characteristics, such as height, weight, and body mass index.

[A female infant of mitochondrial myopathy with findings of active necrosis and regeneration of muscle fibers]

An 8 year-old female infant with the clinical and pathological characteristics of both progressive muscular dystrophy and mitochondrial myopathy was described. Her maternal cousin had clinical and pathological findings of Duchenne muscular dystrophy (DMD). Since the patient had markedly elevated serum CK and calf muscle hypertrophy, her muscle was biopsied and she was diagnosed as having female DMD at the age of 5 years. She had generalized tonic-clonic convulsions and alternate hemiconvulsions for recent 4 years which brought her our hospital. On admission, she had mild generalized muscle atrophy and weakness predominantly in the proximal limbs. The lactate and pyruvate levels in both serum and cerebrospinal fluid were elevated, but with no metabolic acidosis. Serum CK was elevated to 4464 IU/L. Brain CT and MRI showed the expanding arachnoid cyst in the left middle fossa of cranium. In the biopsied left biceps crachii muscle, in addition to numerous ragged-red fibers, there were active muscular fiber necrosis and regeneration and interstitial fibrosis similar to those seen in progressive muscular dystrophy. Biochemically, no decrease or defect in the respiratory chain enzymes was detected. On electron microscopy, a large number of fibers contained aggregates of giant mitochondria with proliferated complicated cristae. Scattered throughout were necrotic muscle fibers filled with phagocytes and regenerating fibers. This patient had the diagnostic features of mitochondrial encephalomyopathy and progressive muscular dystrophy. We supposed that the patient provided very interesting evidences to study the relationship between mitochondrial myopathy and progressive muscular dystrophy.

A prospective cohort study on the development of colorectal cancer after gastrectomy

A prospective cohort study was conducted to examine whether an association exists between gastric surgery and the subsequent development of colorectal carcinoma. One thousand nine hundred twenty-seven patients (1316 men and 611 women) who had undergone curative gastrectomy for gastroduodenal diseases in the First Department of Surgery, Tottori University Hospital, during the 18-year period from 1964 to 1981, were followed to determine the incidence of the development of large-bowel carcinoma after gastric surgery. The age-, sex-, and calendar-specific population at risk was calculated by the person-years method. The observed number of colorectal cancers after gastrectomy was 19 (15 men, 4 women) compared with 9.69 expected carcinomas. The difference between the observed and expected numbers was statistically significant. The authors believe that patients with previous gastrectomy are at high risk for colorectal carcinoma.

Does extensive dissection of lymph nodes improve the results of surgical treatment of gastric cancer?

The results of surgical treatment of patients with advanced gastric cancer were analyzed retrospectively in terms of the extent of dissection of lymph nodes. The postoperative 5-year survival rate was 50.3% for 160 patients who had undergone potentially curative surgery with dissection of group 1, 2, and 3 lymph nodes (R3), compared with 48.8% for 185 patients with dissection of group 1 and 2 lymph nodes (R2). There was no difference in terms of survival between the two groups of patients. Of 160 patients receiving R3, 19 (11.9%) were found to be positive for metastasis to group 3 lymph nodes, and only 5 survived for more than 5 years after surgery (postoperative 5-year survival rate of 26.3%). In four of these five patients, metastases in the group 3 lymph nodes were confined to nodes in the hepatoduodenal ligament. Thus, it appears that in dissection of the deepest nodes, lymph nodes in the hepatoduodenal ligament are the most important to remove in the surgical treatment of advanced gastric cancer.

Multiple malignant lymphoma within an ileal blind loop--report of a case

A 55-year-old woman presented to our hospital with abdominal fullness and edema of both legs. She had undergone a bypass operation by an ileotransversostomy for adhesive ileus following a drainage operation for acute appendicitis 35 years previously. We diagnosed the patient as having blind loop syndrome as a consequence of the side-to-side ileotransversostomy, and performed a right hemicolectomy and intestinal resection. The resected specimen of dilated ileal blind loop contained 15 crater-like lesions, proven histologically to be nodular proliferation of atypical lymphocytes. Lymph follicles had also proliferated in the mucosa of the blind loop and the histologically confirmed diagnosis of non-Hodgkins lymphoma of the diffuse medium-sized cell type was thus made. The etiology of such tumors is probably related to the alteration in intestinal environment caused by conditions such as fecal stasis, bacterial overgrowth, and bacterial toxins in the blind loop.

Blood transfusion and the prognosis of patients with gastric cancer

A retrospective analysis was undertaken of the association between blood transfusion and long-term results for 218 patients with stage III gastric cancer who were curatively treated by partial gastrectomy. One hundred and fifty-two patients received blood transfusion within the perioperative period. The postoperative 5-year survival rates were 49.3% for the transfused patients and 62.1% for the non-transfused patients (P less than 0.05). Furthermore, the postoperative survival of patients who had been transfused preoperatively was significantly lower than that of the non-transfused patients. The preoperatively transfused group of patients were found to have tumors that were larger than those of the non-transfused group. On the basis of the above data, it appears that the prognosis of patients with advanced gastric cancer is poorer when such patients receive preoperative blood transfusion than when patients do not receive transfusions, and that this adverse effect in the transfused patients is probably attributable to the larger size of their tumors, even though the stage of advancement of gastric cancer is the same in both groups of patients.

Intravenous flunitrazepam for status epilepticus

Flunitrazepam (FZP) was administered intravenously, with success, to two patients with status epilepticus. Case 1 was a patient with a tonic-clonic status epilepticus. Intravenous phenytoin had no effect. Case 2 had minor status epilepticus. With the intravenous administration of FZP, diluted 1:10 with distilled water at a dose of 0.03 mg/kg at a slow rate, both patients were relieved of the status epilepticus. Unlike diazepam, FZP neither looks cloudy when diluted with distilled water nor causes angialgia. No disturbances in circulation or respiration occurred. Considering that FZP has a strong anticonvulsant action on status epilepticus, it can be expected to be a useful therapeutic agent for status epilepticus in infants and children.

[A case of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) with progressive cytochrome c oxidase deficiency]

We report a 9 year-old boy with MELAS. High dosed oral thiamine administration and high fat diet induced remarkable neurological and biochemical improvement. His mother had episodic headaches and hemiplegia, probably MELAS. He complained muscle weakness and repeated episodes of vomiting started from 2 years of age. High levels of serum lactate and pyruvate were recognized, but with no metabolic acidosis. He developed generalized muscle weakness, growth retardation, generalized convulsions and stroke-like episodes at 5 years old. Optic nerve atrophy and mental retardation gradually appeared. A muscle biopsy at 5 years old revealed numerous ragged-red fibers with excess accumulation of lipid droplets and glycogen particles. Scattered fibers had no cytochrome c oxidase (CCO) activity representing focal CCO deficiency. An electron microscopy showed markedly increased number of giant mitochondria filled with markedly proliferated complicated cristae. Pyruvate dehydrogenase complex level in the fibroblasts was within normal ranges. Serum carnitine level was normal. With oral administration of thiamine hydrochloride (1000 mg) and high fat diet (60-70%), muscle weakness improved, and lactate and pyruvate levels in the serum reduced to normal ranges, whereas the mental deterioration, muscle atrophy, pes cavus progressed very slowly. He died from cardiac and renal failures at 9 years old. Autopsied muscles showed a marked decrease in cytochrome c oxidase activity (biochemically 12.8% of the normal level), and almost all muscle fibers had no cytochrome c oxidase activity histochemically. The progression of the MELAS was probably in parallel with the decrease in CCO activity.

[Ultrasonic Doppler assessment of hemodynamics in extra-intracranial arterial anastomosis in children with Moyamoya disease]

Recently the extra-intracranial (EC/IC) arterial bypass operation has been introduced in the treatment of Moyamoya disease and excellent postoperative outcomes have been reported. To assess the cerebral hemodynamic changes after the bypass surgery, ultrasonic Doppler flowmetry was performed in 10 children with Moyamoya disease. Their surgical treatments included superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis or encephalo-duro-arterio-synangiosis. The flow velocity and pattern of the major cerebral arteries and STAs, the donor artery of the bypass, were studied both before and after the operation. The results of Doppler flowmetry were compared with clinical symptoms and angiographical findings. Though the Doppler sonography of the major cerebral arteries showed little change, the flow velocity of the STAs revealed a pronounced and rapid increase after the bypass surgery. The flow pattern of the STAs, which was of the external carotid type preoperatively, changed to the internal carotid type postoperatively. These ultrasonic Doppler findings were thought to be due to a decrease in the peripheral vascular resistance, and suggested a good patency of the bypass arteries. These results of the Doppler flowmetry were in good agreement with clinical and EEG improvement and the findings of the postoperative cerebral angiography. It is suggested that ultrasonic Doppler flowmetry is a noninvasive and reliable method of assessing the function of the EC/IC bypass in children with Moyamoya disease.

Double exposure speckle technique for imaging system analysis and use in rod lens arrays

New double exposure speckle techniques for imaging system analysis are developed and their feasibility is experimentally examined. Using a single convex lens as the test lens, the MTF of the lens is obtained from the measured visibility of Young's fringes which have been produced by Fourier transforming a double exposure specklegram recorded through the test lens. By using conventional optical filtering techniques the spatial variations in the imaging quality are visualized for GRIN rod lens arrays.

A comparison of pelvic retroperitoneal pneumography and computed tomography in the assessment of extramural invasion of rectal carcinoma

Pelvic retroperitoneal pneumography (PRP) and pelvic computed tomography (CT) were performed on 33 patients with rectal carcinoma in order to compare the usefulness of the two diagnostic procedures in the preoperative assessment of local malignant extramural invasion. Six PRP-negative patients in whom no free air was visualized in the retroperitoneal space surrounding the mass, were all assessed as having extramural invasion by CT scan and all had histologic evidence of invasion. Of 27 PRP-positive patients in whom free air was seen surrounding the mass, 18 were diagnosed as having extramural invasion on CT, 15 of whom had histologic proof of invasion. In the remaining 9 PRP-positive patients, there was no evidence of extramural invasion on the CT scans, but 5 patients showed evidence of invasion histologically. PRP, when positive, had an unacceptably high rate of being false positive and was therefore unreliable in assessing extramural invasion, whereas CT was able to detect, to some extent, extramural invasion which PRP failed to demonstrate. Based on these findings, we conclude that CT is more useful than PRP in the preoperative assessment of extramural invasion of rectal carcinoma, but is of limited diagnostic value when negative.

[A case of type IIa early gastric cancer complicated with multiple endocrine cell micronests in pernicious anemia]

The patient, a 5-year-old male, was diagnosed as having pernicious anemia at our hospital in 1969. By means of an upper G-I series, he was found to have a gastric protruded lesion on the greater curvature of the upper corpus in 1983. After an endoscopic polypectomy, a type II a early gastric cancer was diagnosed which, histologically, showed a well-differentiated adenocarcinoma and a total gastrectomy was performed. From the histologic findings of the resected stomach, the were multiple endocrine cell micronests, that coincided with the distribution of intestinal metaplasia localized in the fundic gland area.

Structure-taste correlation of L-aspartyl dipeptides using SIMCA method

One of the pattern recognition techniques, the SIMCA method, has been applied to structure-taste studies on L-aspartyl dipeptides (L-Asp-NH-R). The sweet and bitter taste class models of the peptides were obtained by using five structural descriptors, such as molar refractivity, and four kinds of STERIMOL parameters. The classification rates were calculated to be 87% and 81% for sweet and bitter peptides, respectively. The SIMCA method has also suggested that two factors, shape and size, of the C-terminal amino acid moiety R in the dipeptides are extremely important to model their taste qualities.

[Serum levels of mitomycin C following a high-dose continuous hyperthermic peritoneal perfusion]

Valid therapeutic means have not been established for treatment of disseminated peritoneal metastasis of carcinoma. Continuous hyperthermic peritoneal perfusion (CHPP) with high-dose of mitomycin-C (MMC) was applied to 26 patients with peritoneal metastasis from gastric, rectal or ovarian cancers. Levels of MMC in the sera and in the perfusate were measured. The results obtained were: 1. Approximately a half of the dose of MMC added into the perfusion fluid was recovered. 2. When perfused with 100 mg of MMC, the maximum serum concentration of MMC was equivalent to 1/3 of the maximum serum level when injected with 10 mg of MMC intravenously. Therefore, MMC which could not be detected in CHPP seemed to be retained in the abdominal cavity. 3. Bone marrow inhibition caused by CHPP was observed in only 2 of 26 patients. 4. The total dose of 300 mg of MMC, consisting of the maximum dose of 100 mg each, is acceptable in CHPP without any severe side effect. 5. CHPP exerts antitumor effects when utilizing hyperthermia and a high-dose of MMC on the disseminated peritoneal foci of carcinoma.