[Assessment of enlarged left atrium with 99mTc-tetrofosmin SPECT and echocardiography]

This study was performed to clarify the possibility of visualization and quantification with 99mTc-tetrofosmin (Tf) myocardial scintigraphy in cases with a large atrium demonstrated by trans-thoracic echocardiography (TTE). Myocardial SPECT was evaluated in 4 patients with mitral stenosis and 15 patients with mitral regurgitation. Left atrium was identified in 12 out of 19 cases from an antero-posterior projection. The Tf uptake ratio of the left atrium, which was defined as the ratio of ROI count of the left atrium divided by the ROI count of the left ventricle, showed a good correlation with the left atrial area obtained by both trans-thoracic and trans-esophageal echocardiography (r = 0.88 and 0.91, respectively), These data suggest that Tf myocardial SPECT is a useful method of evaluating left atrial enlargement.

Follow-up of children after fetal treatment for obstructive uropathy

BACKGROUND

Improvement in the ability to evaluate fetuses with obstructive uropathy, combined with technologic advances, has allowed successful fetal treatment of these conditions in Japan. We analyzed the prenatal and postnatal clinical courses of patients who underwent shunt placement in utero.

METHODS

We treated 6 patients who underwent fetal intervention and were transferred to us for urologic management. Gestational age at detection of abnormalities ranged from 11 weeks to 31 weeks, and fetal intervention was done between 16 weeks and 32 weeks. Excluding 1 infant who was delivered 6 days after the intervention, the mean period between shunt placement and delivery was 17 weeks.

RESULTS

Urologic pathology included prune belly syndrome with urethral hypoplasia in 3 patients, cloacal anomaly in 1, posterior urethral valves in 1, and pelviureteric junction stenosis of a solitary kidney in 1. Four patients required ventilation support in the neonatal period, and 2 of them suffered frequent infections during follow-up. Five patients who underwent vesico-amniotic shunt placement continue to require clean intermittent catheterizations via vesicostomy because of hypoactive detrusors and hypoplastic urethras. After urologic treatment, serum creatinine in 5 patients reached a minimum of less than 0.4 mg/dL at some time during the first year of life. Another patient with a minimum creatinine level of 1.0 mg/dL has moderate renal insufficiency.

CONCLUSION

From our series, it appears that early (before 20 weeks of gestation) shunt placement in severe lower urinary tract obstruction may benefit renal and pulmonary function. However, its efficacy in regard to bladder function remains questionable: shunt placement does not permit regular storage and evacuation, which may be essential for functional bladder development.

[Perinatal management of posterior urethral valves detected by prenatal ultrasonography]

PURPOSES

Posterior urethral valves (PUV) are the most common cause of mechanical infravesical obstruction in children. It is emphasized that this disorder has broad spectrum of severity, and patients presenting signs and symptoms in neonates or early infancy are at high risks for renal failure. The clinical pictures changed dramatically with the introduction of prenatal diagnosis by ultrasonography (USG). We report on perinatal management of PUV detected by prenatal USG, especially stressing on the significance of early delivery in risky fetuses.

PATIENTS AND METHOD

From 1987 to 1996, we treated 6 patients with PUVs who had been detected by prenatal USG. Fetal hydronephrosis was noticed between 26 to 29 weeks of gestation. Oligohydramnios was apparent at the same weeks of the detection or 2 to 7 weeks later. Fetal conference including obstetrician, neonatologist, anesthesist and urologist was taken place to discuss the date and mode of delivery. Among the patients, 5 were induced early delivery around 30 weeks of gestation. After birth, serum Cr was monitored, and small feeding tube was placed in the urethra. Primary valve ablation was indicated in 4 patients whose Cr returned to near normal after the urethral drainage. One required upper tract diversion because of the continuous elevation of Cr levels.

RESULTS

Of the patients, one died of respiratory failure from lung hypoplasia. Ventilation support was needed in 3 patients. The patient who required upper tract division went into ESRF when he was 6 months old. Except for this patient, renal function improved in 4 patients with nadir Cr levels between 0.4 mg/dl to 0.6 mg/dl. Transurethral valve ablation was done on 5 patient between 16th to 40th days after birth with the lowest body weight at operation of 1450 g. Cystometric studies in neonatal periods showed small capacity, and hypertonic bladder in all patients. Valve ablation and administration of anticholinergics improved bladder function.

CONCLUSION

Prenatal ultrasonography clearly demonstrate the pathological features of the fetus with PUVs. Because oligohydramnios started in the early 3rd trimester indicates acute renal failure of the fetus, early delivery followed by emergency treatment may salvage the most severe type of this entity.

[Bladder hemangioma in a child: a case report]

We report a case of bladder hemangioma in a child. An 8-year-old girl was referred to our hospital for the evaluation of painless hematuria. Neither pyuria nor bacteriuria was detected. She had no dysuria. Intravenous pyelography showed deformity of the bladder without dilation of the upper urinary tract. Voiding cystourethrography revealed a filling defect of the bladder. Reddish blue masses were seen cystoscopically at the right wall and the dome of the bladder. Partial cystectomy was performed. From the histological findings, the diagnosis was cavernous hemangioma of the urinary bladder. Her postoperative course was uneventful and no recurrence was seen at the cystoscopical examination 3 months postoperatively. This is the 15th case of bladder hemangioma in children reported in Japan.

[A clinical study of intermittent hydronephrosis]

A clinical study was conducted on the intermittent hydronephrosis in children. Of 78 children with hydronephrosis due to ureteropelvic junction obstruction operated between 1991 and 1995, 5 had intermittent hydronephrosis. All 5 patients were boys between 6 months and 6 years of age. Presenting symptoms were intermittent flank pain and vomiting. Ultrasonography performed during pain attack demonstrated dilation of the renal pelvis in all patients. Diuretic renography demonstrated obstruction in 4 of the 5 children and deterioration of renal function on the affected side in 2. The cause of ureteropelvic junction obstruction was aberrant vessels in 2 cases, fibrous band in 1, ureteral kinking within adventitia in 1 and a ureteral polyp in 1. Postoperatively, all patients have been relieved from the pain. In summary, ultrasonography at the time of symptom attack as well as diuretic renography are useful for the diagnosis and observation of intermittent hydronephrosis.

Selective deficiency of debrisoquine 4-hydroxylase activity in mouse liver microsomes

Cytochrome P450 enzymes belonging to the CYP2D subfamily have been shown to be one of determinants of the polymorphic drug oxidations in the human and the rat. Debrisoquine 4-hydroxylation is a typical reaction catalyzed by these enzymes. However, various strains of mice were observed to have much lower debrisoquine 4-hydroxylase activity than Wistar rats, whereas other monooxygenase activities in mice toward bunitrolol, propranolol, imipramine and amitriptyline, which are mediated by the CYP2D enzymes in the rat, were comparable to those of the rats. Immunoblot analysis of mouse liver microsomes with an antibody raised against a rat CYP2D enzyme indicated that the mouse liver contained a P450 enzyme(s) immunochemically related to the rat CYP2D enzyme. The antibody inhibited propranolol ring-hydroxylase and imipramine 2-hydroxylase activities, as well as testosterone 16alpha-hydroxylase activity, a typical reaction of mouse CYP2D9, but not debrisoquine 4-hydroxylase activity in mouse liver microsomes. We partially purified a P450 enzyme (designated P450 ML2d) from livers of male ddY mice by monitoring the cross-reactivity with the antibody. The partially purified enzyme was indicated to belong to the CYP2D subfamily from its N-terminal amino acid sequence, but the homology of the sequence to other CYP2D enzymes of the mouse (CYP2D9-11) was 62%, suggesting that P450 ML2d is a novel P450 enzyme. P450 ML2d had the oxidation activities for the rat CYP2D-substrates, such as propranolol 4-hydroxylation and imipramine 2-hydroxylation, in higher rates than those of the microsomes, but did not exhibit debrisoquine 4-hydroxylase activity. Our result is the first finding that a mouse CYP2D enzyme also metabolizes substrates for the rat CYP2D enzyme, in addition to steroids, but the enzyme had a limited specificity for the substrates of the CYP2D enzymes of the rat and the human.

["Ghost Hanako's syndrome": report of 2 cases--initial stage of nonneurogenic neurogenic bladder (Hinman syndrome)?]

Two girls aged 6 and 7 years old with established urination habit complained of daytime incontinence and deterioration of nocturia after they started school life. They were quite afraid of the lavatory and sometimes skipped urination during school time completely. Voiding cystography revealed bladder trabeculation and vesicoureteral reflux. On cystometry, bladder compliance was preserved with no uninhibited contraction. Ghost tales about labatories, such as "the tale of Ghost Hanako," prevail in almost every elementary school in Japan. In some children, especially schoolgirls, lavatory phobia results in dysfunctional voiding. Such "Ghost Hanako's syndrome" may be an early phase of non-neurogenic neurogenic bladder (the Hinman syndrome). Detailed information regarding school life and urination habit is important for the treatment of this entity.

[Influence of low high-density lipoprotein cholesterolemia induced by probucol on the progression of coronary atherosclerosis]

The influence of probucol-induced low high-density lipoprotein (HDL) cholesterolemia on the progression of coronary atherosclerosis was studied in 320 patients with angina pectoris or myocardial infarction, 32 patients with probucol 500 mg/day, 288 patients without probucol, who underwent follow-up angiography at intervals of at least 2 years. The 288 patients were divided into two groups depending on the serum HDL-cholesterol (HDL-C) level at the follow-up angiography: the low HDL-C group had a serum HDL-C level below 40 mg/dl (152 patients) and the control group had 40 mg/dl or above (136 patients). Coronary sclerosis index was defined as the total products of coronary scores (0-6) by segments according to the American Heart Association reporting system in the branches without angioplasty and was compared between the three groups. In the probucol group, serum HDL-C level was significantly reduced from 43.9 +/- 10.6 (at baseline) to 31.1 +/- 7.6 mg/dl (at follow-up, p < 0.01) and was lower than that in the other two groups (low HDL-C group 33.1 +/- 5.0 mg/dl, p < 0.07; control group 52.6 +/- 9.8 mg/dl, p < 0.01). Coronary sclerosis index was most increased in the low HDL-C group (8.3 +/- 5.4-->11.9 +/- 6.1, p < 0.01), whereas there was no significant change in the probucol group (7.2 +/- 5.9-->9.1 +/- 6.8, p = 0.24). Our results showed that treatment with probucol inhibits the progression of coronary atherosclerosis despite the decrease in HDL-C level. One possible reason may be remarkable improvement in the other lipid factors, especially the low-density lipoprotein cholesterol level (165.7 +/- 33.9-->123.7 +/- 29.0 mg/dl, p < 0.01).

Differentiating between multiple system atrophy and Parkinson's disease by positron emission tomography with 18F-dopa and 18F-FDG

Both the striatal 18F-dopa uptake and brain glucose metabolism were studied by PET with 6-L-[18F]fluorodopa (FD) and [18F]fluorodeoxyglucose (FDG) in 9 patients with multiple system atrophy (MSA) and 15 patients with idiopathic Parkinson's disease (PD). Five of the 9 MSA patients were diagnosed as having olivopontocerebellar atrophy, whereas 2 had striatonigral degeneration and 2 demonstrated Shy-Drager syndrome. The FD uptake ratios to the occipital cortex in the MSA patients at 120 min after the administration of FD were 2.07 +/- 0.31 (mean +/- SD) and 1.96 +/- 0.29 in the caudate and the putamen, respectively, and decreased compared to those in the controls (2.72 +/- 0.11, 2.71 +/- 0.10). The same ratios in the PD patients were 2.07 +/- 0.36 and 1.74 +/- 0.24, respectively, which also decreased, but the decreased uptake in the putamen was more prominent. The caudate-putamen index (CPI)(%), which was calculated by a formula based on the difference in the uptakes in the caudate and putamen divided by the caudate uptake, indicated 5.6 +/- 4.6 in the MSA patients and 14.8 +/- 5.4 in the PD patients. The CPI for all PD patients was more than 7.0, which was the mean + 2SD for the controls, but the CPI for 3 MSA patients was more than 7.0 (accuracy: 88%). The glucose metabolic rates for each region in the PD patients showed no difference from the normal controls. The frontal and the temporal cortical glucose metabolism and the caudate, the putaminal, the cerebellar and the brainstem glucose metabolism in the MSA patients decreased significantly in comparison to those in the controls. But, as the glucose metabolic rates in such regions of each patient overlapped in the two groups, the accuracy of the FDG study for differentiation was lower than that of the FD study. The putaminal glucose metabolic rates, for example, in 3 PD patients were less than 6.8 (mg/min/100 ml), which was the mean-2SD for the controls, while those in 3 MSA patients were more than 6.8 (accuracy: 75%). In addition, the combination of these two methods slightly improved the accuracy. The glucose metabolism is useful for evaluating the regional metabolic activity of the brain, and the FD study, which is specific to the dopamine system, seems to be more useful for differentiating between MSA and PD.

[Pathological study of the kidney and the lung in patients with Potter sequence]

PURPOSES

The condition in infants showing the characteristic facial abnormalities, limb deformities, and pulmonary hypoplasia induced by oligohydramnios is termed Potter sequence (PS). In addition to bilateral renal agenesis, Potter sequence could be caused by other urological abnormalities such as cystic dysplasia and obstructive uropathy. Although lethal in most of the patients with PS, some exceptional infants were reported to survive in spite of the antenatal demonstration of oligohydramnios from renal abnormalities. These surviving patients put new questions to us regarding the management of both respiratory and renal failure starting from the newborn periods. The diversity of clinical courses in patients with antenatally detected PS may imply that this entity has a spectrum of severity. Our study of infants autopsied on the diagnosis of PS was undertaken to determine various histological grade of the kidneys and the lungs.

MATERIALS AND METHODS

Thirty-two autopsy cases of PS (19 males and 13 females) diagnosed by the presence of the characteristic stigmata, oligohydramnios, and renal or urological abnormalities were studied retrospectively. Patients were divided according to the urological abnormalities into 3 groups; renal hypodysplasia, urinary obstruction, and polycystic kidney disease (PCKD). Renal histology was evaluated by two parameters; renal glomerular count (RGC), and dysplastic grade. Developmental aspects of the lung were judged by lung/body-weight ratio (L/ B ratio) and radial alveolar count (RAC) proposed by Emery.

RESULTS

The underlying urological disorders included renal hypodysplasia in 22 patients, obstruction in 7, and polycystic kidney disease in 3. Dysplastic grade of 29 patients with hypodysplasia and obstruction consisted of grade 4 in 12 patient, grade 3 in 9, and grade 2 in 8. In 10 kidneys from 8 patients with grade 2-dysplasia, RGC was significantly fewer than that of normal fetuses for the gestational age. The term patient with PS showed the glomerular count equivalent to normal fetus of around 25 weeks of gestation. L/B ratio indicated definite pulmonary hypoplasia in 25 of 29 patients. The ratio was much smaller than normal in another 4 patients. RAC was calculated in 24 patients; of these only 2 had normal count for gestational age. In another 22, the number of air space stopped to increase at about 20 to 25 weeks of gestation. There was a tendency for L/B ratio to decrease according to dysplastic grade (1.3% for grade 2 vs. 0.9% for grade 3 and 4).

CONCLUSION

The primary urological abnormalities leading to PS included bilateral renal hypodysplasia, obstructive uropathy, and PCKD. Histological study of the kidneys indicates that PS is the spectrum disease with various degree of nephron formation. The development of the lung depends, in part, on the grade of renal dysplasia.

[Study of trough type audiogram of sudden hearing loss]

We investigated 974 patients with sudden sensorineural hearing loss who consulted the otolaryngological service of Hamamatsu University Hospital and four affiliated hospitals from 1984 to 1992. Among them, we selected 569 new cases showing a pure tone average of 31 dB or more at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz on the affected side in the initial audiometry performed within 14 days after the onset of sudden sensorineural hearing loss. The 569 patients consisted of 13 with acoustic neuromas (SHLANs), 493 with idiopathic sudden sensorineural hearing loss (ISHLs) and 63 others. Ten of the 13 SHLANs and 40 of the 493 ISHLs showed the trough type audiogram on the initial examination. We defined the 10 cases as the Trough AN group and the 40 as the Trough ISHL group. Statistical analysis of the difference in pure tone averages at 5 frequencies between the 2 groups demonstrated that the mean hearing losses at 125, 250 and 500 Hz of Trough AN were significantly less than those of Trough ISHL. This study demonstrates that the trough type audiogram, especially a slight low tone loss, shown in patients with sudden sensorineural hearing loss was a significant finding suggesting the presence of acoustic neuroma.

[Continent urinary reservoir using dilated renal pelvis of non-functioning pelvic kidney in a girl with cloacal exstrophy]

We performed construction of continent urinary reservoir in an 8-year-old girl with cloacal exstrophy who had double stoma of ileostomy and colon conduit. Preoperative evaluation revealed non-functioning right kidney with severely dilated renal pelvis and calyxes in her pelvis. Urinary reservoir was constructed using detubularized colon segment which had been used as the urinary conduit and dilated renal pelvis of non-functioning pelvic kidney. Using Mitrofanoff's principle, continent catheterizable channel was also made of the anterior wall of the renal pelvis. Postoperative course was uneventful. Reservoir capacity increased to 350 ml one and half year postoperatively and she is almost dry with clean intermittent catheterization 5 times a day. Dilated upper urinary tract is one of the ideal material for bladder enlargement that avoids the complication associated with the use of gastrointestinal tract.

Electrocardiographic nature of restored sinus rhythm after Cox maze procedure in patients with chronic atrial fibrillation who also had other cardiac surgery

OBJECTIVE

To characterise heart rate variability and high frequency components of restored sinus rhythm after the maze procedure. The maze procedure for chronic atrial fibrillation may prevent thrombotic events and improve the quality of life. However, the electrocardiographic nature of restored sinus rhythm after the maze procedure has not been fully elucidated.

PATIENTS AND METHODS

Between March 1993 and August 1995, 104 consecutive patients undergoing the maze procedure in combination with other cardiac surgery were studied. There were 100 long-term survivors (78 with mitral valve disease, 9 with aortic valve disease, 8 with congenital heart disease, and 5 others). Twenty age-matched patients with mitral valve disease who were in normal sinus rhythm preoperatively were enrolled as a control group. 30 days after surgery, the presence of arrhythmias and the circadian changes of heart rate variability were estimated by ambulatory electrocardiographic monitoring and the filtered P duration was evaluated by signal-averaged electrocardiogram.

RESULTS

Restoration of sinus rhythm was observed in 73 of 100 cases. Subjects were classified into three groups according to their postoperative ambulatory electro-cardiographic monitoring findings: patients in group 1 (n = 73) (1a: 58 regular sinus rhythm; 1b: 15 sinus rhythm with frequent premature atrial contractions (> 1000/day); patients in group 2 (n = 21) still had persistent atrial fibrillation; and patients in group 3 (n = 6) required permanent pacemaker implantation because of sick sinus syndrome. The success rate of restoration of sinus rhythm was 88.3% if left atrial diameter was small (< 65 mm). Circadian changes in the low frequency to high frequency power ratio in group 1a were significantly diminished compared with control group (P < 0.01). Furthermore, the filtered P duration in group 1a (150 (20) ms) and group 1b (158 (23) ms) were longer than in the control group (122 (11) ms) (P < 0.01).

CONCLUSIONS

The maze procedure may result in a decreased sinus response and non-uniform transmission of impulses in the atrium.

A multiple gastric ulcer case caused by cytomegalovirus infection

The patient was a 31 year old male complaining discomfort in the epigastrium. Endoscopy of the upper gastrointestinal tract indicated multiple gastric ulcers. Biopsy specimen taken from the ulcerous region indicated giant cells accompanying intranuclear inclusion bodies in the gastric mucosa. Since the patient tested positive to cytomegalovirus (CMV)-IgM antibody, he was assumed to have gastric ulcers caused by CMV infection. However, the patient was cured without the administration of antiviral agent because no definite immunodeficiency status was observed. The result of present study indicated that endoscopic biopsy is useful for diagnosing gastrointestinal lesion attributable to CMW infection.

[A case of postrenal acute renal failure in a neonate with bilateral ectopic ureters]

A male neonate was referred to our institute after the placement of right nephrostomy because he presented syndrome of acute renal failure and bilateral hydronephrosis. Voiding cystourethrography revealed bilateral vesicoureteral reflux (right.; grade I, left.; grade V), and renal scintigraphy revealed left hypodysplastic kidney. Endoscopy revealed bilateral ectopic ureters; posterior urethra on the right and bladder neck on the left. We performed bilateral ureterocystoneostomy with bilateral ureteral folding. Postoperative course was uneventful, and the serum creatinine improved to the level of 0.5 mg/dl 6 months after the intervention.

Glucose metabolism in the cortical and subcortical brain structures in multiple system atrophy and Parkinson's disease: a positron emission tomographic study

The brain glucose metabolism was studied by PET with 18F-FDG in 11 patients with multiple system atrophy (MSA) and 12 patients with idiopathic Parkinson's disease (PD). Seven of the 11 MSA patients were diagnosed as having olivopontocerebellar atrophy, two had striatonigral degeneration, while two demonstrated Shy-Drager syndrome. The glucose metabolic rates for each region in the PD patients showed no difference from the normal controls. The frontal, temporal and parietal cortical glucose metabolic rates and the caudate, the putaminal, the cerebellar and the brainstem glucose metabolic rates in the MSA patients decreased significantly from the controls. The atrophy of the cerebellum and the brainstem in the MSA patients were scored by MRI. The cerebellar and brainstem glucose metabolism in the MSA patients decreased as the atrophy score in such regions advanced in each group; however, some patients with no atrophy showed a decreased glucose metabolism. Although the cerebellar and the brainstem glucose metabolism decreased in all MSA patients, such a decrease was not observed in the SND patients. The decrease in the glucose metabolism for the non-cortical regions in the MSA patients seems to be due to a diffuse depletion of the neurons not restricted to the nigrostriatal neurons. Deafferentation to the cerebral cortices seems to result in a decreased cortical metabolism. The differences in the glucose metabolism between MSA and PD as assessed by PET may be caused by the pathophysiological differences between MSA and PD, and such differences therefore appear to be useful when making a differential diagnosis between MSA and PD. The relative sparing of the brainstem and cerebellar glucose metabolism is considered to be a feature of patients with SND.

[Ectopic ureter opening in the vestibulum without urinary incontinence: a case report]

A case of ectopic ureter without urinary incontinence despite its ureteral orifice in the vestibulum is reported. A 2-year-and-9-month-old female was referred to our hospital with the pain of external genitalia, pollakisuria and macroscopic hematuria. Examination revealed a complete double system of the left upper tract with vestibular opening from the upper moiety. She did not show any signs of ureteric incontinence after the establishment of voiding habits. Because radioisotope (RI) scintigram showed apparent uptake in the upper half of the left kidney we performed left ureterocystoneostomy with psoas hitch procedure. We postulate that the incontinence mechanism is maintained when the running course of the ectopic ureter is through some portion of the urethral sphincter musculature. This is the 10th case reported in Japan.

[A case of bilateral testicular torsion in a neonate]

A case of testicular torsion in the newborn is presented. A 8-day-old infant with bilateral intrascrotal swelling since birth was referred to us. Bilateral testicular torsion was suspected and operation was carried out at the same day. We operatively found extravaginal torsion of the bilateral spermatic cord. The bilateral testis appeared extensively necrotic, but we repaired the torsion and performed bilateral orchiopexy because of bilateral torsion. We could not palpate well the bilateral testis in one year, probably due to an atrophy. Sixty-nine cases of testicular torsion in the newborn including our case from Japanese literatures were reviewed and discussed. Especially forty-seven cases were presented at birth.

[Results of antireflux surgery in infants with vesicoureteral reflux]

BACKGROUND

Due to the advancement of prenatal and postnatal ultrasound screening in addition to better understanding by pediatricians, more infants have been detected to have vesicoureteal reflux. There are still debates, however, about their management whether to take conservative or surgical treatment.

METHODS

We analysed clinical courses of 51 children with primary reflux undergoing antireflux surgery when they were under 1 year.

RESULTS

A total of 41 infants (80%) presented with febrile urinary tract infections. The first UTI was seen as early as 7th day after birth, with the average age of 2 months. Seven infants had hydronephrosis detected by prenatal ultrasound, and 2 were identified by neonatal screening ultrasonography. Sixty-eight of 86 reflux ureters (79%) showed high grade reflux (grade IV approximately V). All the other 18 ureters with mild to moderate grade of reflux except one accompanied with contralateral high grade reflux. One ureter with grade II reflux was associated with contralateral obstructed meganreter. Renal parenchymal abnormalities, either with scarring and/or small kidney, were identified in 64 kidneys (74%) at or before the reimplantation. The operation was done as early as 1 month-old with the average age of 5.6 months. Among the children, 24 (47%) underwent anti-reflux surgery before 6 month-old. Smallest infant weighted 2500 gr at the time of operation. Reimplantation was done by the Cohen transverse advancement technique in 75 ureters (87%). The modified Politano-Leadbetter method in 6 with Hutche's diverticulum, and the Glenn-anderson advancement method in 5 with moderate to mild reflux. Two dilated ureters were treated with folding of the intravesical segment. Follow-up voiding cystourethrogram of 49 children at 6 months revealed no evidences of persistent reflux. There were no patients with obstruction of reimplantation except one with slight upper-tract dilatation. One infant revealed new low grade contralateral reflux, and he is being observed. Two children presented pyelonephritis after the operation.

CONCLUSION

Our success rate of 100% in antireflux surgery enables us to continue our policy to perform early operative interventions in infants with high grade reflux. In addition to the meticulous and careful technique, the conditions for successful results include; 1) A through checkup of the lower tracts by VCG and endoscopy. 2) Find the better operative instruments for the small bladder. 3) Do not hesitate to perform the ureteral tapering. 4) Make good use of operative loupe.

Differential expression of platelet-derived endothelial cell growth factor (thymidine phosphorylase) in nonpolypoid and polypoid lesions of the colon

To clarify the relationship between angiogenesis and the early development of colon cancer, expression of platelet-derived endothelial cell growth factor (PD-ECGF), a known angiogenic and endothelial cell chemotactic factor, was examined in 119 human colon premalignant adenomas and colon carcinomas. Localization of PD-ECGF was assessed by immunocytochemistry in 70 nonpolypoid growth (NPG) lesions that represented 29 carcinomas (NPG carcinomas) and 41 adenomas (NPG adenomas) and 49 polypoid growth (PC) lesions that included 15 carcinomas (PG carcinomas) and 34 adenomas (PC adenomas). Simultaneously, the expression of tranforming growth factor alpha (TGF alpha) and epidermal growth factor receptor (EGFR) were examined in serial sections from these lesions. Twenty (68.9%) of 29 NPC carcinomas and 20 (48.7%) of 41 NPC adenomas exhibited positive staining for PD-ECGF, whereas 15 (100%) of 15 PG carcinomas and 27 (79.4%) of 34 PG adenomas expressed PD-ECGF. There was a statistically significant difference in the frequency of PD-ECGF expression between NPG adenomas and PG adenomas (p<0.01). In addition, the incidence of PD-ECGF expression was higher in PG carcinomas than in NPG carcinomas (p<0.05). Positive staining for TGF alpha and EGFR was detected in 14 (48.2%) and 10 (34.5%) of 29 NPG carcinomas, respectively, whereas, 17 (41.5%) and 13 (31.7%) of 41 NPG adenomas expressed TGF alpha and EGFR, respectively. A significant trend for coexpression of PD-ECGF and TGF alpha was detected in either NPG adenomas (p<0.05) or PG adenomas (p<0.01). These data demonstrate that PD-ECGF may be involved in the early stages of colon cancer development during the adenoma-carcinoma transition and additionally that angiogenesis which may be induced by PD-ECGF and/or TGF alpha could play an important role of colon cancer development.

Ipsilateral hemiplegia caused by right internal capsule and thalamic hemorrhage: demonstration of predominant ipsilateral innervation of motor and sensory systems by MRI, MEP, and SEP

A patient with a right internal capsule and thalamic hemorrhage showed ipsilateral hemiplegia. MRI at 10 months after the cerebral hemorrhage demonstrated Wallerian degeneration, which could be traced to the ipsilateral anterior funiculus at the cervical level. The findings of motor evoked potentials and somatosensory evoked potentials indicate a predominantly ipsilateral innervation of motor and sensory systems in this particular patient.

Differences in the reduced 18F-Dopa uptakes of the caudate and the putamen in Parkinson's disease: correlations with the three main symptoms

It has been reported that the F-Dopa (FD) uptake in patients with idiopathic Parkinson's disease (PD) decreased significantly in the caudate and putamen when compared to controls. The FD uptake severely decreased in the putamen, while it was relatively spared in the caudate nucleus. We also previously reported that atypical parkinsonism with no or little tremor showed a homogeneously reduced FD uptake in both the caudate and the putamen. In this study we evaluated the caudate and the putaminal FD uptakes in relation to the three main symptoms in PD. The FD uptake was measured by PET with 6-L-[18F]fluorodopa in 17 patients with PD. The caudate and the putaminal FD uptake ratios to the cerebellum at 120 min were evaluated. The caudate and the putaminal FD uptake ratios in the patients with PD decreased as their clinical stages advanced. These decreases also correlated with the degree of rigidity and bradykinesia. However, such decreases did not correlate with the degree of tremor. The caudate-putamen index (CPI)(%), which was calculated by a formula based on the difference in the uptakes of the caudate and putamen divided by the caudate uptake, indicated 11.6 +/- 3.6, 16.5 +/- 5.5 and 18.3 +/- 4.1 in the group of no, mild and moderate tremor, respectively, and increased as the degree of tremor advanced. The CPI in the group of moderate tremor significantly increased from that in the group of no tremor (P < 0.04). However, the CPI did not correlate with the clinical stage, the degree of rigidity or the degree of bradykinesia. The FD/PET study therefore effectively demonstrated the severity of the clinical symptoms of rigidity and bradykinesia in patients with PD in correlation with a decrease in the FD uptakes in the caudate and the putamen, and it also demonstrated that the severity of tremor might have a different mechanism from that of such other symptoms as rigidity and bradykinesia.

[Femoral testis: report of three cases]

Three patients were referred to our clinic with the chief complaint of emptiness of the right scrotal contents. Every physical examination in these patients revealed a little-finger-tip sized mass corresponding to the normal testis at the right side of the femoral region. Right orchiopexy by the dartos-pouch technique was successfully performed. On every surgical exploration of these patients, the gubernaculum was fixed to the femoral skin and the testis was found to be normal in size. Our cases are the 2nd, 3rd and 4th cases of femoral testis, reported in the Japanese literature.

[Accessory scrotum with lipoma: a case report]

A newborn male infant was referred to our clinic because of anomalies of external genitalia. The infant was born at term after a normal pregnancy and delivery, and was appropriate for gestational age. A tumor mass covered with scrotum-like skin on its tip was noticed in the right side of perineum between the scrotum and anus. The raphe, which ran along the midline at the penis and the normal scrotum, circumscribed the right side of this structure. Both testes had descended into the scrotum. The condition was associated with incomplete penoscrotal transposition. There was no other urological anomaly including lower urinary tract. Histological findings of the tumor indicated perineal lipoma, and the scrotum-like portion was diagnosed as an accessory scrotum. Thirty-one report cases of the accessory scrotum including our own were reviewed and discussed.

Transient cortical blindness following bypass graft angiography. A case report

Transient cortical blindness, an uncommonly recognized complication of cerebral angiography, is an exceedingly rare event after cardiac catheterization and angiography. This report describes a sixty-two-year-old patient who had transient cortical blindness following bypass graft angiography. In this case, the authors showed that cortical blindness was associated with the breakage of the blood-brain barrier (BBB) and an increase in vascular permeability rather than with primary cerebral circulatory insufficiency. When the possibility exists that an excess volume of contrast medium may enter the cerebral circulation as in this case, that is, following a coronary artery bypass graft (CABG) using the internal mammary artery (IMA), precautionary measures may be necessary such as changing the type of contrast medium to be used or decreasing the volume injected. When cortical blindness occurs, it is a serious clinical problem whether transient or permanent. Therefore, the circumstances leading to this complication should be understood to determine suitable treatment and management.

A possible mechanism for the increase in serum luteinizing hormone levels in male rats by oxolinic acid

Oxolinic acid (1-ethyl-1,4-dihydro-6,7-methylenedioxy-4-oxo-3- quinolinecarboxylic acid), an antimicrobial agent, raises the serum levels of luteinizing hormone (LH) and increases the incidence of testicular Leydig cell tumors in male rats. In the present study the mechanism by which serum LH levels are raised in male rats receiving oxolinic acid was investigated. Aged Wistar rats were fed a diet containing oxolinic acid at 0 or 3000 ppm for more than 4 weeks. There was no effect of oxolinic acid on either the maximal levels of serum LH after castration nor on the serum levels of LH stimulated with 1 microgram/rat of luteinizing hormone-releasing hormone (LHRH). The concentrations of testosterone in serum and testis were not changed by the treatment of oxolinic acid. In the in vitro organ culture, the testes of rats receiving oxolinic acid released testosterone in the same manner as the controls, in the presence or the absence of human chorionic gonadotropin (100 mIU/ml). The oxolinic acid-stimulated serum LH was not increased further by the daily administration of L-dopa (500 mg/kg/day, po, 7 days) and was blocked by the injection of a dopamine antagonist, haloperidol (2 mg/kg, ip). In a microdialysis study, oxolinic acid increased the extracellular concentration of dopamine in the preoptic area of hypothalamus. These findings suggest that a high dietary level of oxolinic acid elevates LH release from the anterior pituitary with an increase in LHRH, in part, by the excitatory input of a dopaminergic system in the preoptic area of rat hypothalamus.

[Urinary tract abnormalities associated with anorectal malformations]

Anorectal malformation (ARM) is often associated with urological problems such as congenital urogenital anomalies, recto-urinary fistula, neurogenic bladder due to vertebral anomalies and operative complications. We analyzed 57 cases of ARM and discussed about the management of associated urogenital anomalies during neonatal and infantile period. The incidence of urogenital anomalies was 85.7% in high type, 65.5% in intermediate type and 38.1% in low type. Among these urinary tract anomalies, VUR was most common and was documented in 38.6% of ARM patients. Renal dysplasia, PUJ stenosis, megaureter and urethral stenosis was also common in these patients. Renal dysfunction was documented in 5 cases (2 in high type, 2 in intermediate and 1 in low type), mainly due to VUR and renal aplasia. These results show the need for evaluation of urinary tract during the neonatal and early infantile period even in low type ARM. The management of urinary tract anomalies associated with ARM is firmly related with the management of ARM itself, and we must be closely in co-operation with pediatric surgeons.

Effects of repeated doses of compound E for 4 and 9 weeks on the male reproductive organs

Results of two toxicity studies of Compound E, which is an anticancer drug, on male reproductive organs and fertility by oral repeated dosing at dose levels of 12.5, 25 and 50 mg/kg/day for 4 and 9 weeks in rats were compared. After repeated dosing, the male fertility was studied by mating with untreated female animals. At the dose of 50 mg/kg/day in the 4-week study, Compound E significantly decreased testes weight and number of epididymal sperm, caused histopathological changes in the testis and epididymis characterized by decreased germ cells, but did not affect fertility. The dose of 25 mg/kg/day in the 9-week study caused reduction in epididymal weight and number of epididymal sperm and histopathological changes in the testis. The dose of 50 mg/kg/day in the 9-week study was lethal and caused more prominent toxic effects in the reproductive organs and loss of fertility. The present studies suggest that the order of sensitivity of parameters on male reproductive organs is as follows; histopathological examination = organ weight > number of sperm in epididymis > pregnancy index> copulation index. Further, 4-weeks repeated dosing is of sufficient duration to predict adverse effects of test compounds.

A new mutant rat with hyperbilirubinuria (hyb)

We have discovered mutant rats with hyperbilirubinuria at the laboratories of Eisai Co., Ltd., Gifu, Japan, and established a new inbred mutant strain, which was designated Eisai Hyperbilirubinuria Rat (EHBR/Eis). They show jaundice immediately after birth, and direct or conjugated hyperbilirubinemia throughout their life. The phenotypes are controlled by a single autosomal recessive gene, hyb with full penetrance. Affected homozygous males seem to have full reproductive capacity. On the other hand, the litter size of hyb/hyb females is significantly reduced at second parturition compared with that at first one. In order to maintain the strain efficiently and to produce both affected (hyb/hyb) and normal control (hyb/+) offspring at the same time, we have mainly been mating hyb/hyb males with hyb/+ females in establishing the inbred strain. We also report here the allele distribution of the EHBR/Eis strain.

A new mutant rat with turning behavior (Tur)

A new rat mutant with abnormal behavior has been found in a closed colony of Slc: SD. The affected rats turned around after their own tails beginning 4-5 weeks after birth, in response to extroceptive stimuli, such as sound or vibration. The behavior was more pronounced in younger animals. On gross observation, no alteration was found in the cerebrum, cerebellum, or anterior, posterior, or lateral semicircular canals. Light microscopic examination revealed no abnormality in the cerebrum or cerebellum. The trait was controlled by an autosomal dominant gene with incomplete penetrance (78.0%) when transferred to the WKY genetic strain background. It was named "turning" with the gene symbol Tur. A congenic strain was established, which was designated WKY/Eis-Tur.

A patient with Schinzel-Giedion syndrome and a review of 20 patients

The Schinzel-Giedion syndrome is characterized by severe midface retraction, multiple skull anomalies, clubfeet, and cardiac and renal malformations. So far, 20 patients have been reported. This is the first report of the syndrome demonstrated in Oriental patients. In surviving patients, severe growth and developmental deficiency is a common finding.

Differentiation of Langerhans cells from interdigitating cells using CD1a and S-100 protein antibodies

The present study shows that Langerhans cells can be differentiated from interdigitating cells at the light microscopic level. Superficial lymph nodes and skin taken from necropsies and the lymph nodes of dermatopathic lymphadenopathy (DPL) were used for this experiment. Sections of lymph node and skin were embedded using the acetone, methyl benzoate and xylene (AMeX) method and dendritic cells were immunostained with anti S-100 protein antibody (S-100, and OKT-6 (CD1a) using the restaining method. Langerhans cells in the skin were positive for both CD1a and S-100. Dendritic cells positive for both CD1a and S-100, and dendritic cells positive for S-100, but not for CD1a were observed in superficial lymph nodes. In normal superficial lymph nodes, there were more interdigitating cells than Langerhans cells. The majority of the dendritic cells in the DPL were Langerhans cells. We conclude that the S-100 and CD1a positive cells are Langerhans cells, and the S-100 positive-CD1a negative cells are interdigitating cells.

Species-specific mechanism in rat Leydig cell tumorigenesis by procymidone

To clarify the mechanism of species difference in the induction of testicular interstitial cell tumor (ICT, Leydig cell tumor) between rats and mice, male Sprague-Dawley rats and ICR mice were fed procymidone at dietary concentrations of 700, 2000 or 6000 ppm and 1000, 5000, or 10,000 ppm, respectively, for 3 months. The Leydig cell functions were evaluated by serum testosterone and luteinizing hormone (LH) levels, testosterone levels in the testis, LH levels in the pituitary, the capacity of the testis to respond to gonadotropin stimulation, i.e., the production of testosterone in vitro, and by the testicular binding of labeled human chorionic gonadotropin (hCG). Measurement of testosterone and LH levels in rat serum, the testis, or the pituitary showed that both hormones were enhanced throughout the 3-month treatment period. The hypergonadotropism was associated with the increase of interstitial cell response to hCG in vitro for up to 3 months. As with rats, both serum and pituitary LH were increased in mice at 4 weeks but not at 13 weeks. However, in contrast to rats, no significant increase in testosterone was observed in mice either in vivo or ex vivo during the course of the study. This suggests a difference between the rat and mouse in the response of the Leydig cell to the LH stimulation associated with procymidone administration. These differences in the response of interstitial cells to procymidone may be the basis for the distinct species responses to procymidone-induced Leydig cell tumorigenesis. The sustained response of the Leydig cells to stimulation in the rat results in chronic hyperplasia and subsequent benign tumor formation, while the attenuated response of Leydig cells in the mouse is associated with neither hyperplasia nor neoplasia.

Effect of chronic L-dopa administration on serum luteinizing hormone levels in male rats

We examined whether the repeated oral administration with a high dose of L-3-(3,4-dihydroxyphenyl)-alanine (L-DOPA) in 0.5% carboxymethyl cellulose increases serum luteinizing hormone (LH) levels in male rats. Serum LH levels were increased 4 h after a single administration of 1000 mg/kg L-DOPA to male rats, and returned to control levels within 8 h after administration. Four hours after a single administration, serum LH levels were significantly increased by L-DOPA at 1000 mg/kg, but not at 20, 100 or 200 mg/kg. Decreases in body weight and relative weight of the prostate were observed after 7 and 14 days of administration of 1000 mg/kg per day L-DOPA, but no changes were observed in weight of the testis, epididymis or seminal vesicle. The administration of L-DOPA at 500 or 1000 mg/kg per day for 7 or 14 days resulted in increased basal serum LH levels and decreased basal serum prolactin levels 24 h after the last administration. Serum testosterone levels tended to be higher in treated than in control rats. The levels of two metabolites of dopamine (DA), 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), in rats treated with 500 mg/kg per day tended to be slightly higher than those in control rats after 7 days of administration. Levels of DA, DOPAC and HVA were significantly increased after 7 and 14 days of administration of 1000 mg/kg per day and after 14 days of administration of 5000 mg/kg per day. The level of norepinephrine, but not its metabolite 3-methoxy-4-hydroxyphenylglycol, was significantly increased after only 7 days of administration of 1000 mg/kg per day. No significant changes were observed in levels of 5-hydroxytryptamine or its metabolite 5-hydroxyindole-3-acetic acid with administration of 500 or 1000 mg/kg per day. These findings suggest that a prolonged treatment with a high dose of L-DOPA in male rats induces release of LH from the pituitary, resulting in sustained elevation of LH levels in peripheral circulation.

Effect of recombinant human erythropoietin (rHuEPO) on protein, zinc (Zn), nickel (Ni) and manganese (Mn) in patients undergoing chronic haemodialysis

Serum protein, albumin, Zn, Ni and Mn concentrations were examined in thirty patients undergoing chronic haemodialysis and whose haematocrit levels had been maintained at 30% for two years with rHuEPO. Serum total protein, albumin, Zn, Ni and Mn concentrations significantly increased with time for two years with rHuEPO therapy. All patients showed improvement of appetite and a normal protein balance. Serum Zn, Ni and Mn levels increased with serum total protein. In conclusion, rHuEPO therapy is very effective for the increase of serum protein, albumin, Zn, Ni and Mn levels in patients undergoing chronic haemodialysis.

Silicon level in rats with chronic renal failure produced by 5/6 nephrectomy

Serum, erythrocyte and renal tissue silicon levels in normal Wister rats and in rats with chronic renal failure were examined. The relationship between serum, erythrocyte and renal tissue Si levels, and markers of renal function (BUN, serum creatinine), markers of anemia (RBC, Hb, Hct) and markers of bone formation (serum calcium, phosphate) were studied. Serum and erythrocyte Si levels were directly correlated with the markers of renal function and with serum Pi and serum Ca x P, and inversely with the markers of anemia. Renal tissue silicon levels, on the other hand, correlated only with the markers of anemia.

Role of the CYP2D subfamily in metabolism-dependent covalent binding of propranolol to liver microsomal protein in rats

In vitro covalent binding of a chemically reactive metabolite of propranolol to microsomal macromolecules, which is presumed to cause inhibition of its own metabolism in rats, was diminished in liver microsomes from rats pretreated with propranolol. Covalent binding was suppressed by the addition of an antibody against P450BTL, which is a cytochrome P450 (P450) isozyme belonging to the CYP2D subfamily. SDS-PAGE of microsomal proteins after incubation with [3H]propranolol and NADPH indicated that the binding was non-selective but prominent at the molecular mass of approx. 50 kDa, corresponding to those of the P450 protein. The radioactivity peak was markedly but not completely diminished by the addition of reduced glutathione. In a reconstituted system containing P450BTL, NADPH-cytochrome P450 reductase (fp2) and dilauroylphosphatidylcholine, propranolol 4-, 5- and 7-hydroxylase activities decreased time dependently following preincubation with propranolol in the presence of NADPH, indicating time-dependent inactivation of P450BTL. The covalent binding of a reactive metabolite of [3H]propranolol to the proteins was also observed in this system. SDS-PAGE showed that among the three proteins in the reconstituted system, fp2 and P450BTL consisting of two polypeptides with molecular masses of 49 and 32 kDa, the binding was specific for a polypeptide corresponding to the P450 isozyme with a molecular mass of 49 kDa. In addition, the ratio of the amount of covalently bound radiolabelled materials to that of P450BTL which was estimated from each impaired propranolol hydroxylase activity under the same reconstitutional conditions was calculated to be approx. 1.0. These findings indicate that propranolol is a mechanism-based inactivator of a cytochrome P450 isozyme(s) belonging to the CYP2D subfamily.

Cytochrome P450 isozymes involved in propranolol metabolism in human liver microsomes. The role of CYP2D6 as ring-hydroxylase and CYP1A2 as N-desisopropylase

Oxidative metabolic pathways of propranolol consist of naphthalene ring-hydroxylations (at the 4-, 5-, and 7-positions) and side-chain N-desisopropylation in mammals. We characterized cytochrome P450 isozymes responsible for propranolol metabolism, especially N-desisopropylation and 5-hydroxylation, in human liver microsomes. 4-Hydroxy, 5-hydroxy-, and N-desisopropylpropranolol were detected as primary metabolites, whereas 7-hydroxypropranolol was in trace amounts. Good correlations were obtained for activities of propranolol 4- and 5-hydroxylases with immunochemically determined CYP2D6 content, whereas correlations of these activities with CYP1A2, CYP2C, or CYP3A4 content were relatively low. The activities also correlated highly with debrisoquine 4-hydroxylase, compared with other metabolic activities such as phenacetin O-deethylase, hexobarbital 3'-hydroxylase, and testosterone 6 beta-hydroxylase, which are typical reactions for CYP1A2, CYP2C, and CYP3A4, respectively. Propranolol N-desisopropylase activity in the samples highly correlated with CYP1A2 content and phenacetin O-deethylase activity, but not with the other P450 isozyme contents or metabolic activities. Quinidine, a specific inhibitor of CYP2D6, inhibited propranolol 4- and 5-hydroxylase activities selectively and in a concentration-dependent manner. alpha-Naphthoflavone, a potent inhibitor of CYP1A2, inhibited all of the propranolol oxidation activities, and the IC50 value for N-desisopropylase activity was much smaller than the values for ring-hydroxylase activities. Antibody directed to CYP2D inhibited propranolol 4- and 5-hydroxylase activities by 70% at an antibody/microsomal protein ratio of 1.0. Anti-CYP2C9 antibody did not inhibit any activity determined. These results indicate that propranolol 5-hydroxylation, as well as 4-hydroxylation, is mainly catalyzed by CYP2D6 in human liver microsomes.(ABSTRACT TRUNCATED AT 250 WORDS)

The correlation of serum luteinizing hormone levels with the induction of Leydig cell tumors in rats by oxolinic acid

Studies were performed to examine the mechanism by which testicular Leydig cell tumors are induced in rats by administration of the antimicrobial agent oxolinic acid (1-ethyl-1,4-dihydro-6,7-methylenedioxy-4-oxo-3-quinolinecarboxylic acid). In these studies, the effects of oxolinic acid on serum levels of luteinizing hormone (LH), testosterone, and prolactin and the binding of testosterone to prostatic androgen receptors were examined. In a long-term hormonal study, male Wistar rats were fed a diet containing oxolinic acid at 0, 100, 1000, or 3000 ppm for 104 weeks. A statistically significant increase in serum LH levels was observed at 1000 and 3000 ppm, but no dose of oxolinic acid had a significant effect on serum testosterone levels. Serum LH levels were no longer elevated above control levels within 2 weeks of cessation of the administration of oxolinic acid. Oxolinic acid was found to have no effect on the rate of clearance of exogenous LH from the circulation. Serum prolactin levels were decreased by the administration of oxolinic acid. The increase in serum LH induced by oxolinic acid was completely blocked by the intraperitoneal injection of the dopamine antagonist haloperidol (2 mg/kg). In addition, no significant affinity of oxolinic acid for androgen receptors was found in an in vitro study. These findings suggest that: (1) oxolinic acid induces Leydig cell tumors in rats by chronically stimulating the release of LH from the pituitary, (2) the mechanism of stimulating the release of LH involves facilitation of the dopaminergic systems in the hypothalamus-pituitary axis, and (3) oxolinic acid has no effect on androgen-mediated feedback inhibition.

Effect of erythropoietin (rHuEPO) on trace elements and quality of life (Qol) in chronic hemodialysis patients

In 30 patients undergoing chronic hemodialysis and whose hematocrit levels had been maintained at 30-50% for 2 years with recombinant human erythropoietin (rHuEPO) administration, changes of serum proteins, serum albumin levels, improvement of trace elements such as zinc (Zn), nickel (Ni) and manganese (Mn), and quality of life (Qol) were examined for 2 years. rHuEPO therapy significantly improved the protein nutritional status, as well as serum Zn, Ni and Mn levels; the concentrations of Zn ion (Zn++), Ni ion (Ni++) and Mn ion (Mn++) in serum were significantly elevated. Objective and subjective Qol of 30 patients showed significant improvement with rHuEPO therapy for 2 years.

Striatal 18F-dopa uptake and brain glucose metabolism by PET in patients with syndrome of progressive ataxia

Striatal 18F-Dopa uptake and brain glucose metabolism were studied by PET with 6-L-[18F]flurodopa and [18F]fluorodeoxyglucose in 11 patients with syndrome of progressive ataxia. Five of the 11 patients were diagnosed as having cerebellar cortical degeneration (CCD), including 3 with late cerebellar cortical atrophy and 2 with Holmes type hereditary ataxia while 6 demonstrated olivopontocerebellar atrophy (OPCA). The caudate and putaminal 18F-Dopa uptake ratios to the occipital cortex in CCD showed no significant difference from those in the controls. On the other hand, those with OPCA decreased as compared to the controls. In addition, the cerebellar glucose metabolism in CCD decreased as compared to the controls, while that in the brainstem showed no significant decrease from the controls. The glucose metabolic rates both in the cerebellar hemisphere and in the brainstem in the OPCA patients decreased compared to the controls. The cerebral cortical, striatal and thalamic glucose metabolisms were normal in both the CCD and OPCA in groups. The appearance of a decreased glucose metabolism in the cerebellum is considered to be relevant in the genesis of cerebellar ataxia, even though their underlying diseases were different from each other. The differences in the glucose metabolism of the brainstem and in the nigrostriatal presynaptic dopaminergic function between CCD and OPCA as assessed by PET may be caused by differences in the pathophysiological mechanism between CCD and OPCA, and those differences appear to be useful when making a differential diagnosis of CCD and OPCA.

Clinical studies on molybdenum in patients requiring long-term hemodialysis

Molybdenum is an essential trace element in humans. However, the serum molybdenum level or its role in patients with chronic renal failure or those requiring long-term hemodialysis remains unknown. The authors examined the serum molybdenum levels and studied the role of hemodialysis in 60 patients requiring long-term hemodialysis. The serum molybdenum levels of the 60 patients with chronic renal failure were examined before and after hemodialysis. The authors also studied the relationships between serum molybdenum levels and beta 2-microglobulin (beta 2-MG) levels, c-parathyroid hormone (C-PTH) levels, and dialysis related arthritis in the 60 patients. Molybdenum was measured with a flameless atomic absorption spectrophotometer equipped with an autobackground corrector. The level of molybdenum in serum significantly (P < 0.01) decreased from 2.7 +/- 1.9 micrograms/dl (normal value, 0.02-0.13 micrograms/dl) before hemodialysis to 1.4 +/- 0.7 micrograms/dl after hemodialysis. The correlation between serum molybdenum value and serum beta 2-MG level was significant (P < 0.01). The authors also found significant correlations between serum molybdenum level and C-PTH value, serum calcium ion (C++) level in serum, and duration of hemodialysis. Serum molybdenum levels were high (12.8 +/- 0.96 micrograms/dl) in nine patients with dialysis related arthritis. In conclusion, serum molybdenum levels are high in patients undergoing long-term hemodialysis, and abnormal molybdenum accumulation may contribute to dialysis related arthritis.

[Fetal genitourinary abnormalities associated with oligohydramnios]

After 16 weeks of gestation, amniotic fluid mainly consisted of fetal urine. Therefore, the association of oligohydramnios with fetal urinary tract abnormalities implies severe deterioration of renal function. The relationship of the kidney and amniotic fluid in pulmonary development has been investigated, and fetuses with oligohydramnios starting in the second trimester are considered to have uniformly fatal outcomes. We analysed underlying urological disorders, gestational age at presentation, and ultimate outcomes in 45 fetuses with severe oligohydramnios, and especially focused on clinical courses and prognosis of 7 surviving patients. Clinical and/or autopsy diagnosis included bilateral renal hypodysplasia in 20 patients, urethral atresia with/without prune belly deformity in 9, posterior urethral valve in 6, polycystic kidney disease in 4, hydrometrocolpos in 2, hereditary renal dysplasia in 2, and the others. The average gestational age at detection of severe oligohydramnios was about 30 weeks, ranging from 16 weeks in patient with urethral atresia. Urological disorders of 7 surviving patients consisted of 4 posterior urethral valves, one hydrometrocolpos, one hydronephrosis of the solitary kidney, and one bilateral megaureter. In these 7 patients severe oligohydramnios striated in the third trimester. Four patients required ventilator supports together with the administration of surfactant, but they were weaned in one to 4 days. There was no evidence of pulmonary hypoplasia on chest X-ray films. Urological emergency drainage was necessary in all patients on the day of delivery to 2 days postnatally. One patient with posterior urethral valve developed ESRF 6 months after birth. Two patients have a normal serum creatinine, but another 4 have slight elevation of SCr for their age.(ABSTRACT TRUNCATED AT 250 WORDS)

Involvement of a cytochrome P4502D subfamily in human liver microsomal bunitrolol 4-hydroxylation

The oxidative metabolism of bunitrolol, an adrenergic beta-receptor antagonist was examined in human liver microsomes fortified with an NADPH-generating system. The microsomal fractions (n = 11) showed bunitrolol 4-hydroxylase activities, which correlated well with CYP2D6 contents (correlation coefficient, r = 0.854), debrisoquine 4-hydroxylase (r = 0.953) and imipramine 2-hydroxylase (r = 0.976) activities. On the other hand, the bunitrolol 4-hydroxylase activity showed relatively poor correlations with CYP3A4 content (r = 0.552) and testosterone 6 beta-hydroxylase activity (r = 0.668). The bunitrolol 4-hydroxylase activity was significantly inhibited by quinidine, a selective inhibitor for CYP2D6. Polyclonal antibodies raised against rat liver microsomal cytochrome P450BTL, which is thought to belong to the CYP2D subfamily, effectively inhibited bunitrolol 4-hydroxylation. In contrast, polyclonal antibodies raised against human liver microsomal CYP3A4 did not show any inhibitory effect on the activity. These results suggest that CYP2D6 is involved in the bunitrolol 4-hydroxylase activity in human liver microsomes.

Carcinogenicity studies of oxolinic acid in rats and mice

A chronic feeding study was conducted to determine the carcinogenic potential of oxolinic acid, an antimicrobial agent, in rats and mice. Oxolinic acid was administered in the diet to Wistar rats (0, 30, 100, 300 or 1000 ppm; 50 rats/dose/sex) for 104 wk and to ICR mice (0, 50, 150 or 500 ppm; 50 mice/dose/sex) for 78 wk. Clinical signs, body weight, food consumption, autopsy findings and histopathological data were noted. Mortality was unaffected by oxolinic acid administration in neither species. In rats, body weight gain was suppressed in both sexes at 1000 ppm. Histopathological examinations conducted after autopsy at 104 wk revealed a slight increase in benign Leydig cell tumours of the testis at 1000 ppm, which did not appear until late in the lifetime of rats. No other treatment-related neoplastic lesions were observed in rats. Non-neoplastic lesions in males at 1000 ppm included Leydig cell hyperplasia and tubular atrophy of the testes. In mice, decreased body weight gain was observed in both sexes at 500 ppm, but no non-neoplastic or neoplastic lesions attributable to the treatment with oxolinic acid occurred in either sex. In conclusion, oxolinic acid induced benign Leydig cell tumours of the testis in rats at the highest dose level tested (1000 ppm). The no-effect level for tumour induction was confirmed to be 300 ppm (10.9 mg/kg/day) in rats. None was induced in mice.