Pterional keyhole approach to middle cerebral artery aneurysms through an outer canthal skin incision

OBJECT

The supraorbital keyhole approach via an eyebrow skin incision provides a method for the minimally invasive clipping of aneurysms located in the circle of Willis, but has disadvantages for aneurysms located in the lateral Sylvian fissure. The pterional keyhole minicraniotomy via an outer canthal skin incision is proposed for the clipping of unruptured aneurysms of the middle cerebral artery (MCA).

METHODS

The procedure consists of a 35-mm outer canthal skin incision, partial temporal muscle dissection restricted in the pterion, a 20-25-mm keyhole minicraniotomy, and a 15-20-mm dural incision to expose the lateral Sylvian fissure. Twenty keyhole clipping procedures were performed in 20 patients with unruptured MCA aneurysms.

RESULTS

Only one patient showed a temporary mild hemiparesis (reversible ischemic neurological deficit) due to lacunar infarction. No shaving of scalp hair, drain placement, or anticonvulsant drug administration were required. Most patients were discharged on the 2nd or 3rd postoperative day. One patient showed a weakness of the frontalis muscle, but this complication was eliminated by the definition of a safety zone to avoid damage to the frontal branch of the facial nerve.

CONCLUSIONS

The pterional keyhole approach via outer an canthal skin incision is another treatment option for relatively small, unruptured MCA aneurysms.

High-viscosity liquid meal accelerates gastric emptying

Adding pectin to an elemental formula increases its viscosity through gelatinization, thus presumably preventing gastro-oesophageal reflux and aspiration pneumonia. We investigated the influence of the viscosity of an elemental formula on gastric emptying. Eleven healthy volunteers underwent three tests at intervals of >1 week. After fasting for >8 h, each subject received a test meal (enteral nutrition solution, enteral solution plus pectin, or water). Then gastric emptying (continuous (13)C breath test), gastro-oesophageal intraluminal pressures, oesophageal pH, and blood levels of glucose, insulin and gastrin were all measured simultaneously. The gastric emptying coefficient was significantly increased by adding pectin to enteral nutrition (3.01 +/- 0.10 vs 2.78 +/- 0.10, mean +/- SE, P < 0.05). The antral motility index was also significantly higher with pectin than without at 45-60 min and 60-75 min after the test meal (526 +/- 237 vs 6.5 +/- 4.6 mmHg s(-1) and 448 +/- 173 vs 2.3 +/- 2.3 mmHg s(-1) respectively; P < 0.05). Plasma glucose was significantly higher with pectin than without it at 60 min after ingestion (141.5 +/- 6.03 vs 125.8 +/- 4.69 microM mL(-1), P < 0.05). In healthy individuals, pectin increased the viscosity of enteral nutrition and accelerated gastric emptying.

Apparent diffusion coefficients of benign and malignant salivary gland tumors. Comparison to histopathological findings

OBJECTIVE

To evaluate the apparent diffusion coefficient (ADC) of benign and malignant salivary gland tumors in comparison to histopathological findings.

MATERIALS AND METHODS

This study included 32 patients with a wide spectrum of major salivary gland tumors (17 benign, 15 malignant). Diffusion-weighted imaging (DWI) and ADC measurements were performed in all patients. The degrees of extracellular components (myxoid and chondroid matrices, microcysts and hyalinization), were histopathologically classified as mild, moderate and conspicuous. Comparisons were made of mean ADC values between benign and malignant tumors, and among tumors showing different degrees of extracellular components.

RESULTS

Mean ADC values were 1.09+/-0.34 x 10(-3) mm(2)/s in malignant salivary gland tumors and 1.40+/-0.43 x 10(-3) mm(2)/s in benign salivary gland tumors. No significant difference in mean ADC values was found between benign and malignant tumors (P>0.05). However, mean ADC values increased with the degree of extracellular components. Mean ADC values were significantly different between mild and moderate degrees (P<0.05) of extracellular components, and between mild and conspicuous degrees (P<0.05), in both benign and malignant tumor groups.

CONCLUSION

In this study, ADC values alone did not allow differentiation between benign and malignant salivary gland tumors. Comparison with histopathological findings suggests a correlation between the amount of extracellular components and mean ADC values in salivary gland tumors.

Dissecting aneurysms limited to the basilar artery: report of two cases and review of the literature

Spontaneous dissecting aneurysms limited to the basilar artery are rare. We describe two patients who presented to our institution with different clinical problems, one with brain stem infarction and the other with subarachnoid hemorrhage. We describe the clinical and imaging features in these patients, their treatment, and outcome. We also reviewed the literature concerning this entity, and we have identified 32 patients (including our two patients) with angiographically confirmed dissecting aneurysms limited to the basilar artery. Of these, 40.6% presented with brain stem infarction, 50.0% presented with subarachnoid hemorrhage, and 9.4% presented with both infarction and subarachnoid hemorrhage. Patients who presented with basilar artery dissecting aneurysms and brain stem infarction tended to be younger (mean age, 38 +/- 7 years) than those who presented with subarachnoid hemorrhage (48 +/- 12 years) and were more likely to be male. We discuss the natural history of this entity and suggest an approach to clinical management for these patients.

Apparent diffusion coefficient of pituitary macroadenoma evaluated with line-scan diffusion-weighted imaging

OBJECTIVE

The goal of this study was to evaluate the consistency of pituitary macroadenoma using apparent diffusion coefficient (ADC) with line-scan diffusion-weighted imaging (LSDWI).

METHODS

Patients with pituitary macroadenoma (n=19) were studied prospectively. The LSDWI was performed using a maximum b factor of 1000 s/mm2. The consistency of macroadenoma was rated as soft, intermediate or hard at transsphenoidal surgery. The ADC values of tumors were compared with the tumor-consistency ratings.

RESULTS

A soft consistency was found at surgery in 13 patients (mean ADC: 0.84+/-0.1x10(-3) mm2/s); an intermediate consistency was observed in six patients (mean ADC: 0.81+/-0.16x10(-3) mm2/s). No tumors of hard consistency were found. There was no significant difference in ADC values between tumors of soft consistency compared with tumors of intermediate consistency (P=0.37).

CONCLUSIONS

A relationship between tumor consistency and the ADCs of soft and intermediate macroadenomas was not shown in this study using LSDWI.

Effect of l-phenylalanine supplementation and a high-protein diet on pharmacokinetics of cefdinir in healthy volunteers: an exploratory study

BACKGROUND

Upregulation of oligopeptide transport activity by dietary protein, certain dipeptides and amino acids has been reported in the rat intestine and a human intestinal cell line.

OBJECTIVE

In this study, the pharmacokinetics of cefdinir were investigated after L-phenylalanine supplementation and a high-protein diet (HPD) in humans to explore changes in the activities of intestinal and renal oligopeptide transporters.

METHODS

A normal-protein diet (NPD, 73.2 +/- 2.6 g/day), NPD + l-phenylalanine (7.5 g/day), or HPD (141.3 +/- 3.7 g/day) was given to six male healthy volunteers for 12 days followed by a single dose of cefdinir after an overnight fast in a randomized three-way crossover study with a 22-day washout. Blood and urine were collected over a 12-h period after administration of cefdinir. Concentrations of cefdinir in plasma and/or urine were measured by high-performance liquid chromatography.

RESULTS

Plasma concentrations and urinary excretion of the drug did not change throughout the study. Physiological variables and laboratory values did not reveal any differences between the three periods except for serum and urinary nitrogen levels and serum triglyceride.

DISCUSSION

A reason for the unchanged pharmacokinetics of cefdinir may be due to lower doses of L-phenylalanine and protein in humans than in animals when converting animal effective doses to humans.

CONCLUSION

In humans, L-phenylalanine supplementation and HPD do not seem to upregulate intestinal and renal oligopeptide transport in the ranges of duration and dose examined.

Induction and selective accumulation of mutant ubiquitin in CA1 pyramidal neurons after transient global ischemia

Accumulation of mutant ubiquitin-B (UBB(+1)) in neurons is considered the hallmark of proteasomal dysfunction in neurodegenerative disorders, however no such evidence in ischemic brain has been reported. We investigated the contribution of UBB(+1) in delayed neuronal death after transient global ischemia. Transient global ischemia was achieved by occlusion of bilateral common carotid arteries for 5 min and reperfusion in male Mongolian gerbils (n=6 per each time point). In the CA1 region, UBB(+1) immunoreactivity appeared in the cytoplasm of pyramidal cells at 30 min post-ischemia, and the density of these neurons increased at day 2 (P<0.001) and further increased at day 4 post-ischemia. Terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL)-positive (apoptotic) cells appeared selectively in the CA1 region at day 3 and their density increased further at day 4 post-ischemia (P<0.001). In contrast, UBB(+1) immunoreactivity was only transiently detected from 30 min to 1 day post-ischemia in CA3, dentate gyrus, and frontal cortex, but disappeared at day 2 post-ischemia. No TUNEL-positive cells were observed in these three regions. UBB(+1) mRNA was detected by reverse transcription-polymerase chain reaction in every region of the hippocampus and frontal cortex of ischemic gerbils and even in the non-ischemic control animals, and its expression level was independent of brain region and time after ischemia. Our results indicate induction and selective accumulation of UBB(+1) protein in dying neurons of the CA1 region and suggest that UBB(+1) expression may be induced by proteasomal dysfunction after transient global ischemia.

Different effects of light food on pharmacokinetics and pharmacodynamics of three benzodiazepines, quazepam, nitrazepam and diazepam

OBJECTIVE

Quazepam, nitrazepam and diazepam are administered under fed or fasted conditions for insomnia or anxiety disorder. Light bedtime food may have clinically relevant effects on the plasma levels of those drugs and hence on psychomotor performance. This study assessed the effect of light food on the pharmacokinetics and pharmacodynamics of these drugs.

METHOD

Twenty-one eligible subjects were randomized to one of three groups of seven subjects: quazepam 20 mg, diazepam 5 mg or nitrazepam 5 mg. Each healthy subject took a single oral dose of the assigned drug after overnight fasting and after light food, on a separate occasion. Blood samples were collected until 72 h after dosing. The plasma samples were assayed using high-pressure liquid chromatography with spectrophotometric detection. Reaction time, critical flicker fusion test and visual analogue scales were conducted.

RESULTS

The peak plasma concentration (C(max)) and area under the concentration-time curve (AUC) of quazepam with light food were 1.2-fold [90% confidence interval (CI): 1.1-1.5; P < 0.05] and 1.5-fold (90% CI: 1.3-1.9; P < 0.05) higher than that without light food, respectively. For nitrazepam and diazepam, the time to peak was delayed about 1 h in fed condition (P > 0.05). However it had no effect on their C(max) and AUC. Reaction time of quazepam with light food was prolonged at 4 and 6 h after dosing and its area under the effect-time curve from 0 to 10 h was increased (P < 0.05).

CONCLUSION

Light food increased the bioavailability of quazepam and affected psychomotor performance. Light food delayed T(max) of nitrazepam and diazepam but had no effect on C(max) and AUC.

Expression of the T cell receptor Vbeta repertoire in a human T cell resistant to asbestos-induced apoptosis and peripheral blood T cells from patients with silica and asbestos-related diseases

To explore the effects of asbestos and silica on the human immune system, an experimental model of low-dose and long-term exposure was established using a human HTLV-1-immortalized polyclonal T cell line, MT-2 (MT-2Org). MT-2 cells were continuously exposed to asbestos at a concentration (10 microg/ml) which does not induce complete cell death during short-term exposure. After acquiring resistance to CB-induced apoptosis (designated MT-2Rst), an immunological comparison was made between the MT-2Org and MT-2Rst lines in terms of T cell receptor-Vbeta (TcR-Vbeta) expression. MT-2Rst cells showed excess expression of various TcR-Vbeta, although TcR-Vbeta-overpresenting cells were characterized as undergoing apoptosis due to first contact with CB. Patients with asbestos-related diseases (ARD), such as asbestosis and malignant mesothelioma, were compared with silicosis (SIL) patients as a disease control and with healthy donors (HD). SIL and ARD not only differed in their causative materials, silica and asbestos as mineral silicates, but also in terms of complications; autoimmune disorders in SIL and tumors in ARD. ARD patients showed a restricted overpresentation of TcR-Vbeta without clonal expansion, whereas SIL patients revealed significant overpresentation of TcR-Vbeta 7.2. These experimental and clinical analyses indicate the superantigenic and dysregulation of autoimmunity-inducing effects of asbestos and silica, respectively.

Endoscopic hematoma evacuation for hypertensive cerebellar hemorrhage

OBJECT

The management of spontaneous cerebral hemorrhage remains controversial, particularly the surgical indications. Endoscopic surgery was evaluated for the treatment of spontaneous cerebellar hemorrhage.

METHODS

The records of 69 patients with hypertensive cerebral hemorrhage were retrospectively reviewed. Patients treated by endoscopic surgery (n = 10) were compared with patients treated by conventional surgical hematoma evacuation (n = 10) under the same surgical indications.

RESULTS

The surgical procedure time, duration of ventricular drainage, extent of hematoma evacuation, necessity for cerebrospinal fluid (CSF) shunt, surgical complications, and outcome at discharge and at 3 months after onset were compared. The extent of hematoma evacuation was greater in the endoscopic group (95.2 %) than in the craniectomy group (90.6 %) but without significant difference. The endoscopic technique (64.5 min) took significantly less time than the craniectomy method (230.6 min, p < 0.0001). The period of ventricular drainage was significantly shorter in the endoscopic group (2.6 days) compared to the craniectomy group (12.3 days, p < 0.01). CSF shunt surgery was required in no patient in the endoscopic group compared to three in the craniectomy group.

CONCLUSION

Endoscopic hematoma evacuation is a rapid, effective, and safe technique for the removal of hypertensive cerebellar hemorrhage. Reduction of the mass effect can be accomplished with low risk of recurrent hemorrhage. Release of obstructive hydrocephalus in the early stage may improve the patient's outcome and decrease the requirement for permanent shunt emplacement.

Reversible splenial lesion with restricted diffusion in a wide spectrum of diseases and conditions

OBJECTIVE

Reversible lesion in the central area of the splenium of the corpus callosum (SCC) is a unique phenomenon occurring particularly in patients with encephalitis or encephalopathy and in patients receiving antiepileptic drugs (AED). We report MR imaging findings, clinical courses, and outcomes in eight patients with various diseases and conditions.

MATERIALS AND METHODS

Eight patients with a reversible SCC lesion with transiently restricted diffusion were reviewed retrospectively. Diseases and conditions that were associated with a reversible lesion included epilepsy receiving AED (n=1), seizure from eclampsia receiving AED (n=1), mild infectious encephalitis (n=2), hypernatremia resulting in osmotic myelinolysis (n=1), and neoplasm (n=3) such as acute lymphocytic leukemia, spinal meningeal melanocytoma, and esophageal cancer. We evaluated MR imaging findings and clinical findings.

RESULTS

Seven patients had isolated SCC lesions; one patient with osmotic myelinolysis showed additional parenchymal lesions. The reversible SCC lesion shape was oval (n=6) or extended (n=2). The mean apparent diffusion coefficient value of the splenial lesion was 0.40+/-0.16 x 10-3 mm2/s, ranging from 0.22 to 0.64 x 10-3 mm2/s. In a patient with osmotic myelinolysis, additional white matter lesions, shown as restricted diffusion, were revealed as not reversible on follow-up MR imaging. Neurological courses and outcomes were good in seven patients with isolated SCC lesions, but poor in one with osmotic myelinolysis.

CONCLUSION

Reversible SCC lesion with restricted diffusion is apparent in a wide spectrum of diseases and conditions. Neurological courses and outcomes are good, particularly in patients with isolated SCC lesions. Knowledge of MR imaging findings and the associated spectrum of diseases and conditions might prevent unnecessary invasive examinations and treatments.

Lithium inhibits stress-induced changes in tau phosphorylation in the mouse hippocampus

It has been pointed out that hyperphosphorylation of microtubule-associated protein tau caused by stress might participate in the early stages of Alzheimer's disease pathogenesis. In the present study, we investigated the effects of cold water stress (CWS) on tau phosphorylation in the mouse hippocampus and the effects of GSK-3beta inhibitor, LiCl, on CWS-induced changes in tau phosphorylation levels by immunoblot analyses. CWS exposure caused an increase in tau phosphorylation at the Tau-1 (Ser199/202), AT8 (Ser202/Thr205) and Ser396 sites. CWS-induced changes in tau phosphorylation at the Ser199/202 and Ser396, but not at Ser202/Thr205, were significantly attenuated by LiCl pretreatment. Total tau levels also showed a decided tendency to increase after CWS, which tendency was also countered by LiCl. Finally, we showed that CWS increased the active form of GSK-3beta that was phosphorylated at Tyr216. These results suggest that a CWS-induced increase in phosphorylated tau in the hippocampus is mediated, at least partly, by the activation of GSK-3beta.

Effects of calpain and Rho-kinase inhibitors on the acrosome reaction and motility of fowl spermatozoa in vitro

At the avian body temperature of 40 degrees C, intact fowl spermatozoa require Ca(2+) for the initiation of motility and a combination of both Ca(2+) and homogenized inner perivitelline layer (IPVL) together to induce the acrosome reaction. Within the range of 1-100 micromol/l, neither PD 150606 (a Ca(2+)-dependent calpain inhibitor) nor Y-27632 (an inhibitor of Ca(2+)-dependent Rho-kinase) were able to inhibit the acrosome reaction induced by the presence of Ca(2+) and IPVL. However, PD 150606, although not Y-27632, was able to inhibit sperm motility initiated by Ca(2+), as well as motility initiated by calyculin A -- a specific inhibitor of protein phosphatases, which also initiates sperm motility at 40 degrees C. The addition of PD 150606 did not reduce the ATP concentrations of intact spermatozoa, nor the motility of demembranated spermatozoa. Immunoblot analysis of sperm extract using a polyclonal antibody against calpain 12 revealed a cross-reacting protein of approximately 80 kDa. These results suggest that Rho-kinase is not involved in the regulation of the acrosome reaction or of motility in fowl spermatozoa. In contrast, calpain appears to be involved in the regulation of flagellar movement, but not izn that of the acrosome reaction. Furthermore, it seems that endogenous calpain is present in the cytoplasmic matrix and/or the plasma membrane, but not retained in the axoneme and/or accessory cytoskeletal components.

Expression of inappropriate cadherins by epithelial tumor cells promotes endocytosis and degradation of E-cadherin via competition for p120(ctn)

Cadherin cell-cell adhesion proteins play an important role in modulating the behavior of tumor cells. E-cadherin serves as a suppressor of tumor cell invasion, and when tumor cells turn on the expression of a non-epithelial cadherin, they often express less E-cadherin, enhancing the tumorigenic phenotype of the cells. Here, we show that when A431 cells are forced to express R-cadherin, they dramatically downregulate the expression of endogenous E- and P-cadherin. In addition, we show that this downregulation is owing to increased turnover of the endogenous cadherins via clathrin-dependent endocytosis. p120(ctn) binds to the juxtamembrane domain of classical cadherins and has been proposed to regulate cadherin adhesive activity. One way p120(ctn) may accomplish this is to serve as a rheostat to regulate the levels of cadherin. Here, we show that the degradation of E-cadherin in response to expression of R-cadherin is owing to competition for p120(ctn).

Widening spectrum of a reversible splenial lesion with transiently reduced diffusion

Four patients with encephalitis/encephalopathy and parenchymal lesions accompanying reversible splenial lesions were retrospectively evaluated. In 3 patients, reversible lesions with transiently reduced diffusion were seen in the splenium and symmetrically in the peripheral frontoparietal white matter, clinical signs and symptoms were mild, and recovery was complete. These and previous observations suggest a less severe course and outcome for patients with reversible lesions isolated to the splenium or to the splenium and peripheral frontoparietal white matter.

Diffusion-weighted MR imaging in carotid angioplasty and stenting with protection by the reversed carotid arterial flow

BACKGROUND AND PURPOSE

Distal embolism during carotid angioplasty with stent (CAS) can be protected by a flow-reversal device. Diffusion-weighted MR imaging was used to evaluate this protective procedure and perform a comparison with the control.

METHODS

Cases of CAS with protection procedures were included in this study. Sixty-five men (68 procedures) and 5 women (5 procedures), with an average age of 68.8 years, having severe carotid stenosis were treated in our department between 2002 and 2004. Eleven cases were treated with the Parodi Anti-Emboli System, with which the internal carotid blood flow is reversed by simultaneous occlusion of the proximal common carotid artery and external carotid artery. Diffusion-weighted MR imaging was performed within 1-3 days after CAS. As controls, data from diffusion-weighted MR imaging in 26 patients who had diagnostic angiography were included.

RESULTS

Diffusion-weighted MR imaging in diagnostic angiography showed 11.5% appearance of ischemic spots after procedures. In the Parodi Anti-Emboli System, this value was 18.2%. In the CAS group, ischemic lesions appeared only in the hemisphere ipsilateral to carotid stenosis. There were no ischemic lesions in the opposite carotid or vertebrobasilar territory. The appearance rate of new ischemic spots was not significantly different between the control group and the group of CAS with Parodi Anti-Emboli System (chi2 test, P = .6227, Fisher exact method).

CONCLUSIONS

Protection results obtained with the Parodi system were excellent and comparable with conventional angiography.

Absent left superior vena cava with persistent right superior vena cava in visceroatrial situs inversus

We report an unusual anomaly of the upper body venous drainage in a patient with visceroatrial situs inversus. The patient had a persistent right superior vena cava draining into the left-sided right atrium by way of the coronary sinus, with the absence of the left superior vena cava associated with atrioventricular discordant levocardia, pulmonary atresia, and ventricular septal defect.

Separation of single-stranded DNAs using DNA conjugates having different migration properties in capillary electrophoresis

A probe-regulated simultaneous separation (PRESS) using capillary electrophoresis (CE) was developed for separating single-stranded (ss) DNAs. We synthesized two DNA conjugate probes, -(5'-TGTGTGTGT-3')p-AAm(q)- and -(5'-GCCACCAGC-3')m-AAm(n)-, by copolymerizing 5'-methacryloyl-modified ssDNA with acrylamide (AAm), and characterized them in detail. The two probes showed lower electrophoretic mobilities than 5'-methacryloyl-modified ssDNAs. Furthermore, -(5'-TGTGTGTGT-3')p-AAm(q)- showed slightly faster electrophoretic mobility toward the anode than -(5'-GCCACCAGC-3')m-AAm(n)- due to its higher molar fraction of negatively-charged ssDNA. We successfully separated target ssDNAs having the same chain length by using two ssDNA conjugate probes that showed different electrophoretic mobilities, although the separation of these ssDNAs was difficult in conventional capillary electrophoresis systems.

CYP2A6 polymorphisms are associated with nicotine dependence and influence withdrawal symptoms in smoking cessation

CYP2A6 is the main enzyme that catalyzes nicotine into cotinine. Interindividual differences in nicotine metabolism result at least partially from polymorphic variation of CYP2A6 gene. In this study, we evaluated the influence of CYP2A6 polymorphisms on clinical phenotypes of smoking, such as smoking habit and withdrawal symptoms. Japanese smokers (n = 107) were genotyped for CYP2A6*1, *4 and *9. Consistent with the previous reports, CYP2A6 genotypes have a tendency to correlate with the number of cigarettes per day and with daily intake of nicotine. Interestingly, CYP2A6 high-activity group (CYP2A6*1/*1, *1/*9, *1/*4, *9/*9) smoked the first cigarette of the day earlier than low-activity group (CYP2A6*4/*9, *4/*4), indicating more remarkable nicotine dependence. Furthermore, nicotine withdrawal symptoms were more serious in smoking cessation in CYP2A6 high-activity group. Collectively, CYP2A6 genotypes are related with nicotine dependence, influencing smoking habits and withdrawal symptoms in quitting smoking. It is proposed that individualized smoking cessation program could be designed based on CYP2A6 genotypes.

Synovial osteochondromatosis of the Lisfranc joint: a case report

Synovial osteochondromatosis arising in the foot is a rare condition. We report a 69-year-old woman with synovial osteochondromatosis of the Lisfranc joint. The patient presented with a 10-year history of left foot pain. Imaging studies showed multiple calcified masses around the Lisfranc joint. We performed a synovectomy and removal of the loose bodies in the dorsal, lateral, and plantar aspects of the Lisfranc joint by dislocating the bases of the fourth and fifth metatarsal bones. To our knowledge, this is only the second case report of synovial osteochondromatosis involving the Lisfranc joint.

Radiation-induced gamma-H2AX in mammalian cells irradiated with a synchrotron X-ray microbeam

In order to study the radiobiological effects from low dose radiation, a cell irradiation system using synchrotron X-ray microbeam has been developed, by which cells can be recognised individually and irradiated one by one with the desired dose of monochromatic X rays. The minimum beam sizes obtained are 2 microm with the focusing optics and 5 microm square with the non-focused beam, and the beam size can be changed easily with a high-precision slit in the case of a non-focused beam. Human fibroblast cells were individually irradiated with this system, and immunostained by gamma-H2AX antibody to visualise the DNA damage. Most of the fluorescent foci were observed in a localised area in cell nuclei, the size of which was almost the same as the beam size.

Loss of interleukin-2-dependency in HTLV-I-infected T cells on gene silencing of thioredoxin-binding protein-2

The transition from interleukin-2 (IL-2)-dependent to IL-2-independent growth is considered one of the key steps in the transformation of human T-cell leukemia virus type-I (HTLV-I)-infected T cells. The expression of thioredoxin-binding protein-2 (TBP-2) is lost during the transition of HTLV-I-infected T-cell lines. Here, we analysed the mechanism of loss of TBP-2 expression and the role of TBP-2 in IL-2-dependent growth in the in vitro model to investigate multistep transformation of HTLV-I. CpGs in the TBP-2 gene are methylated in IL-2-independent but not in IL-2-dependent cells. Sequential treatment with 5-aza-2'-deoxycytidine and a histone deacetylase inhibitor augmented histone acetylation and TBP-2 expression, suggesting that loss of TBP-2 expression is due to DNA methylation and histone deacetylation. In IL-2-dependent cells, a basal level of TBP-2 expression was maintained by IL-2 associated with cellular growth, whereas TBP-2 expression was upregulated on deprivation of IL-2 associated with growth suppression. Overexpression of TBP-2 in IL-2-independent cells suppressed the growth and partially restored responsiveness to IL-2. Knockdown of TBP-2 caused the IL-2-dependent cells to show partial growth without IL-2. These results suggested that epigenetic silencing of the TBP-2 gene results in a loss of responsiveness to IL-2, contributing to uncontrolled IL-2-independent growth in HTLV-I-infected T-cell lines.

Intraneural metastasis of a synovial sarcoma to a peripheral nerve

We describe a case of intraneural metastasis of a synovial sarcoma, the first published case of a metastasis of a soft-tissue sarcoma to a peripheral nerve.

Intraneural metastasis of a synovial sarcoma to a peripheral nerve

We describe a case of intraneural metastasis of a synovial sarcoma, the first published case of a metastasis of a soft-tissue sarcoma to a peripheral nerve.

Prostaglandin E2 (PGE2) downregulates interleukin (IL)-1alpha-induced IL-6 production via EP2/EP4 subtypes of PGE2 receptors in human periodontal ligament cells

OBJECTIVES

Prostaglandin E2 (PGE2) exerts its biological actions via EP receptors, which are divided into four subtypes, EP1, EP2, EP3 and EP4. In the present study, we examined whether PGE2 regulated interleukin (IL)-1alpha-induced IL-6 production in human periodontal ligament (PDL) cells and if so, which subtypes of PGE2 receptors were involved.

METHODS

PDL cells were stimulated with vehicle or IL-1alpha in the presence or absence of indomethacin (a cylooxygenase inhibitor), PGE2 or various EP agonists. IL-6 and PGE2 levels were measured by enzyme-linked immunosorbent assay. EP receptor mRNA expression was examined by reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

Indomethacin significantly enhanced IL-1alpha-induced IL-6 production by PDL cells, although it completely inhibited IL-1alpha-induced PGE2 production. Exogenous PGE2 significantly suppressed IL-1alpha-induced IL-6 production. Butaprost, a selective EP2 agonist, and ONO-AE1-329, a selective EP4 agonist, significantly inhibited IL-1alpha-induced IL-6 production, although 17-phenyl-omega-trinor PGE2, an EP1 agonist, and ONO-AP-324, an EP3 agonist, did not affect it. RT-PCR analysis showed that EP2 and EP4 mRNA was expressed in PDL cells.

CONCLUSIONS

We suggest that PGE2 downregulates IL-1alpha-induced IL-6 production via EP2/EP4 receptors in human PDL cells.

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion

OBJECTIVE

To clarify whether patients with clinical diagnoses of encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum (SCC) share common clinical features.

METHODS

Possible encephalitis/encephalopathy patients with a reversible isolated SCC lesion on MRI were collected retrospectively. Their clinical, laboratory, and radiologic data were reviewed.

RESULTS

Fifteen encephalitis/encephalopathy patients with a reversible isolated SCC lesion were identified among 22 patients referred for this study. All 15 patients had relatively mild clinical courses. Twelve of the 15 patients had disorders of consciousness. Eight patients had seizures, and three of them received antiepileptic drugs. All 15 patients clinically recovered completely within 1 month (8 patients within a week) after the onset of neurologic symptoms. The SCC lesion was ovoid in six patients; it extended irregularly from the center to the lateral portion of SCC in the other eight patients. Homogeneously reduced diffusion was seen in all seven patients who underwent diffusion-weighted imaging. There was no enhancement in the five patients so examined. The SCC lesion had completely disappeared in all patients at follow-up MRI exams between 3 days and 2 months after the initial MRI (within 1 week in eight patients).

CONCLUSION

The clinical features among the affected patients were nearly identical, consisting of relatively mild CNS manifestations and complete recovery within 1 month.

[The tape for pulmonary artery banding]

Pulmonary artery banding remains a useful procedure for special conditions. A 3-month-old girl diagnosed as Down syndrome with atrioventricular septal defect underwent pulmonary artery banding. We used polyester tape smeared with Bone Wax for this pulmonary artery banding. After 7 months period, the tape was easily dissected from surrounding tissue and removed at radical operation. Microscopic appearance showed that the tape was intact and no evidence of inflammation or mineralization. We believe Bone Wax smeared polyester tape accomplishes well as silicone impregnated one.

A patient with untreated tongue carcinoma surviving for 15 years

A rare case of untreated tongue carcinoma survived for 15 years is presented. A 43-year-old Japanese woman was referred to our department with a 1.8 cm x 1.0 cm white and red non-indurated lesion of the left border of the tongue. The histological examination showed a diagnosis of well-differentiated squamous cell carcinoma. We informed the patient and her family that she had a Stage I tongue carcinoma and needed to receive treatment immediately. However, they refused treatment. Fifteen years later, the patient presented again, complaining of a 55 mm x 40 mm painful gradual-growth swelling of the same site as before, and the clinical stage was T3N2aM0 (Stage IV). The patient agreed to receive radical surgery following preoperative chemoradiotherapy this time. Currently the patient has been free of recurrence for 4 years. Clinical and immunohistochemical features of this rare case are presented and discussed.

Electron microscopic studies on the occurrence of activated neutrophils in peripheral blood of children with acute leukemias

Peripheral blood (PB) cells are examined to assess cellular maturity and the degree of bone marrow abnormality in children with acute leukemias. During the ultrastructural assessments of PB cells in these children, we noted a frequent occurrence of activated neutrophils. This phenomenon had not been reported previously. We here report for the first time the identification of activated neutrophils in PB of children with acute leukemias. To examine the impact of activated neutrophils, we compared two groups of children including 18 with acute lymphoblastic leukemia (ALL) and 7 with acute myelogenous leukemia (AML) by an ultrastructural leukocyte count method. Many cases (50%) showed more than 30% activated neutrophils per total neutrophil count in PB. Activated neutrophils were elongated or amoeboid-shaped cells ranging from 13-18 microns in greater diameter with a decreased number of granules in the cytoplasm. A significantly higher rate of activated neutrophils was observed in ALL as compared with AML (median: 42.97% vs. 10.64%). Non-leukemic hospitalized (n =3) and healthy (n = 3) control cases showed a median rate of 3.32% activated neutrophils in PB. These findings reveal that a significantly high rate of activated neutrophils occurs in PB of children with ALL which may be exploited in the diagnostic assessment of children with acute leukemias.

[Short-term results of the Fontan operation in patients with Down syndrome]

Despite an extensive experience with Fontan operation, there is a paucity of information to guide the indication of the procedure in patients with Down syndrome. Of 79 patients who had undergone a Fontan operation in our hospital between 1995 and 2003, 3 had Down syndrome. All 3 patients had complete atrioventricular septal defect with single ventricular physiology. Two patients survived, and 1 died of chylothorax and respiratory infection. The 2 survivors have done well in the short-term without complications. We consider that in appropriately selected patients with Down syndrome in whom biventricular repair is precluded, the Fontan operation is the choice of the procedures.

Free-prefabricated auricular composite graft: a new method for reconstruction following extended hemilaryngectomy

A free-prefabricated auricular composite graft was applied in two patients who underwent extended hemilaryngectomy. Good phonatory and respiratory functions were obtained without any significant aspiration. Although this reconstructive method is a two-staged procedure involving microsurgical techniques, we believe that it provides a good physiologic reconstruction of the larynx and trachea.

Development of the real-time control (RTC) system for Tokyo sewage system

Tokyo Metropolitan government has decided to make the maximum possible use of the existing facilities while ensuring safety against inundation and to promote measures also from a software approach by introducing a system capable of minimizing combined sewer overflow, the real-time control system (RTC). A pilot RTC system was installed in August 2002 for the Shinozaki Pumping Station. The RTC system monitors the precipitation volume and the water level in the pipe. Simulations were carried out on the basis of these data. From the results, it was found that with the use of the RTC it is possible to reduce CSO by roughly 50% for small rainfalls with a total precipitation level of 20 mm or less by strong rainwater in the pipe routes at the beginning of the rain. It has also been shown that CSO can be reduced by about 80% through the use of rainfall forecasting.

Gallbladder aspiration for acute cholecystitis in average-surgical-risk patients

We conducted a retrospective case note review to assess whether or not gallbladder aspiration can be applied as a temporary measure for the treatment of acute cholecystitis in average-surgical-risk patients. Gallbladder aspiration was performed in 79 consecutive average-surgical-risk patients with acute cholecystitis, who had no indications of emergent surgery and who complained of severe colicky pain. Elective surgery became possible in 92% of patients by gallbladder aspiration. The percentage reached 97 when percutaneous cholecystostomy was added (four patients). Emergent surgery was needed in one patient suffering bile leakage following gallbladder aspiration. Colicky pain was controlled soon after the procedure in most cases. Neither major complications nor mortalities were observed in the following surgical therapies. It is suggested that gallbladder aspiration might be applied as a temporary measure for acute cholecystitis in average-surgical-risk patients, although early surgery should remain the primary choice of therapy in such patients.

Advantages of oxygen inhalation therapy for postoperative pulmonary hypertension

Total correction was performed in a case of complete transposition of the great arteries (TGA) with severe pulmonary vascular obstructive disease (PVOD). Although severe pulmonary hypertension remained after surgery, oxygenation was continued for 15 months, which included a shift to at-home oxygen inhalation therapy (HOT). Cardiac catheterization 15 months after surgery demonstrated that pulmonary hypertension was greatly improved. For patients in whom the palliative Mustard operation is considered due to severe PVOD on the basis of lung biopsy diagnosis, total correction of TGA is possible by employing HOT after surgery.

Dissecting aneurysm of the posterior communicating artery

A 36-year-old male presented with an extremely rare dissecting aneurysm of the posterior communicating artery manifesting as severe occipital headache. Magnetic resonance (MR) imaging revealed a partially thrombosed aneurysm of the right posterior communicating artery and angiography showed the pearl and string sign. Three months later, repeat angiography showed that the aneurysm was completely thrombosed and the posterior communicating artery was occluded. Magnetic resonance (MR) imaging showed an intimal flap. These neuroradiological findings demonstrated that the aneurysm was a dissecting aneurysm of the right posterior communicating artery. He was discharged with no neurological deficit.