Giant epiphrenic diverticulum with achalasia occurring 20 years after Heller's operation

We report a case of giant epiphrenic diverticulum in a 43-year-old woman who underwent Heller's myotomy because of achalasia 20 years earlier. She complained of heartburn and dysphagia from March of 1991 and was hospitalized in our institution. An upper gastrointestinal X-ray examination with contrast medium revealed a large hemispheric lesion (7.8 x 4.8 cm) occupying the right posterior wall of the lower thoracic and abdominal esophagus. Manometry revealed a motility disorder and high pressure of the lower esophageal sphincter due to achalasia. Therefore she was diagnosed as having a giant diverticulum with achalasia after Heller's operation. She underwent transhiatal esophagectomy and reconstruction with placement of a gastric tube on June 4, 1992. Pathology results on the resected specimen revealed a false diverticulum. She has been doing well for 4 years since the operation. It has been said that a complication of incomplete long myotomy causes pulsion diverticulum, but we could not find a case of epiphrenic diverticulum after myotomy for achalasia reported in the literature in the last 10 years.

[Tuberculous mediastinal lymphadenitis presenting as hoarseness]

A 70 year-old woman was admitted to our hospital complaining of hoarseness. Bronchoscopic examination revealed that the left vocal cord was fixed in the paramedian position, and therefore left recurrent nerve paralysis was suspected. Although a chest X-ray film showed no abnormal findings, a chest computed tomogram showed that pretracheal (#3) and subaortic (#5) lymph nodes were swollen (1 to 2 cm in diameter). An open biopsy was done. Histological examination of the resected mediastinal lymph nodes revealed an accumulation of Langhans giant cells and epithelioid cells in caseous necrosis. An acid-fast bacillus was seen after Ziehl-Neelsen staining. This was a rare case of mediastinal tuberculous lymphadenitis in which hoarseness was useful for early diagnosis. Fifty-three cases of tuberculous mediastinal lymphadenitis have been reported in Japan.

Upregulation of the APC gene product during neuronal differentiation of rat pheochromocytoma PC12 cells

The adenomatous polyposis coli (APC) gene, the mutation of which is responsible for familial adenomatous polyposis and sporadic colorectal tumors, is highly expressed in the central nervous system. To elucidate the contribution of the APC protein to neuronal differentiation, changes in APC expression were examined during nerve growth factor (NGF)-induced differentiation of rat pheochromocytoma PC12 cells. The expression of APC gradually increased throughout the time course, in particular it increased markedly after 7 days of exposure to NGF. However, forced expression of APC did not induce neuronal differentiation of PC12 cells. These results suggest that the APC protein itself does not have the potential to induce neuronal differentiation, but rather is upregulated secondary to the differentiation of PC12 cells.

Hassab operation with intraoperative endoscopic injection sclerotherapy ("Hassab-EIS") for esophagogastric varices: with an autopsied case after excessive gastric vascular damage

BACKGROUND/AIMS

Endoscopic injection sclerotherapy (EIS) does not always treat advanced esophagogastric varices completely. Moreover, it may cause deterioration of gastric varices and may result in gastric hemorrhages. We would like to emphasize a combination treatment of the obliteration therapy of intramural varices by EIS and the transabdominal devascularization with splenectomy by Hassab's operation for such advanced esophagogastric varices. The purpose of this study is to develop an effective, less-painful procedure, having the fewest operational risks and a minimum number of treatment days.

MATERIALS AND METHODS

We tried both therapies simultaneously (Hassab+EIS) on four patients with esophagogastric varices.

RESULTS

Excessive vessel damage occurred in one patient which resulted in postoperative bleeding. He subsequently fell into sepsis/DIC and eventually died on the 9th POD. The three other patients are doing well and required less hospitalization time and a fewer number of additional EIS treatments than the esophageal transection group or the Hassab's operation group.

CONCLUSION

From the reconsideration of the autopsied case, it is important to limit the distribution of the sclerosant only in the varicose veins of the lower esophagus and the upper stomach.

Persistent activation of CDK4 during neuronal differentiation of rat pheochromocytoma PC12 cells

It has been shown that suppression of cyclin-dependent kinase 4 (CDK4) expression or its kinase activity is a critical event for the differentiation of hematopoietic and myoblastic cells. To investigate the role of CDK4 during NGF-mediated neuronal differentiation of PC12 cells, we examined the changes in the expression and kinase activity of CDK4. Unexpectedly, both the expression of CDK4 and its kinase activity remained high throughout 10 days of exposure to NGF. Furthermore, constitutive overexpression of the human CDK4 did not inhibit the differentiation. These results suggest that suppression of CDK4 is not required for the NGF-induced neuronal differentiation of PC12 cells.

DNA polymerase beta gene mutations in human bladder cancer

We examined 24 human bladder cancer tissues for possible mutations in the entire coding region of the human DNA polymerase beta gene using polymerase chain reaction analysis, single-strand conformational polymorphism analysis of RNA, and sequence analysis. DNA polymerase beta gene mutations were observed in four of the 24 cases (16.7%) and included three missense point mutations and a single base insertion. The single base insertion was also observed in our previous study of human prostate cancer, suggesting that this region may be a hot spot for mutation of the DNA polymerase beta gene. No clinical or pathological association was found among the four cases that contained the mutation. Three of the four cases with DNA polymerase beta gene mutation had mutations of the p16 or RB genes or loss of heterozygosity of the p53 and APC gene loci. The results of the study presented here suggest that DNA polymerase beta gene mutations, in combination with mutations of tumor suppressor genes, may be involved in certain cases of human bladder cancer.

DNA polymerase beta gene mutations in human bladder cancer

We examined 24 human bladder cancer tissues for possible mutations in the entire coding region of the human DNA polymerase beta gene using polymerase chain reaction analysis, single-strand conformational polymorphism analysis of RNA, and sequence analysis. DNA polymerase beta gene mutations were observed in four of the 24 cases (16.7%) and included three missense point mutations and a single base insertion. The single base insertion was also observed in our previous study of human prostate cancer, suggesting that this region may be a hot spot for mutation of the DNA polymerase beta gene. No clinical or pathological association was found among the four cases that contained the mutation. Three of the four cases with DNA polymerase beta gene mutation had mutations of the p16 or RB genes or loss of heterozygosity of the p53 and APC gene loci. The results of the study presented here suggest that DNA polymerase beta gene mutations, in combination with mutations of tumor suppressor genes, may be involved in certain cases of human bladder cancer.

Retinoblastoma gene mutations in primary human prostate cancer

Structural alterations in the entire coding regions (exons 1 to 27) of the retinoblastoma (RB) gene in primary human prostate cancers were investigated, using polymerase chain reaction and single strand conformational polymorphism analysis of RNA. Of 25 samples obtained from patients, four (16.4%) were found to have RB alterations. DNA sequencing of the PCR products revealed point mutations resulting in single amino-acid substitutions of exons 6 and 19 in two cases, and base deletions of exons 8 and 17 in two cases. Two of four cases with RB mutations were moderately differentiated localized tumors and other two with RB mutations were poorly differentiated tumors with metastases. Our results suggest that RB gene mutation is involved in progression steps of prostate carcinogenesis.

Constitutive overexpression of CDK2 inhibits neuronal differentiation of rat pheochromocytoma PC12 cells

Changes in the levels of cyclins A, D, and E, p21, and cyclin-dependent kinase 2 (CDK2) were examined in rat pheochromocytoma PC12 cells during neuronal differentiation induced by nerve growth factor (NGF). Expression of cyclin A decreased to an undetectable level after 5 days of exposure to NGF, while expression of CDK2 decreased gradually after day 3. In contrast, the levels of cyclins D1 and E increased gradually through day 10, yet the amount of cyclin E associated with CDK2 decreased concomitant with a decrease in the CDK2 protein level. p21 expression increased gradually after day 7, while the level of CDK2-associated p21 remained unchanged. When human cDNAs encoding cyclins and CDK2 were introduced into PC12 cells, only CDK2 overexpression inhibited NGF-induced differentiation. The cell lines overexpressing CDK2 showed stable and high levels of CDK2 kinase activity during differentiation, whereas parental and vector-transfected cell lines displayed a marked decline in CDK2 kinase activity 1 day after NGF treatment. In cell lines overexpressing cyclins A, D, and E, this reduction of the kinase activity was not apparent until day 3. These results suggest that down-regulation of CDK2 activity is a crucial event for the neuronal differentiation of PC12 cells.

Tumor suppressor gene p53 mutations in human prostate cancer

The genetic background underlying the growth and development of human prostatic cancer is not yet clear. Here we searched for possible mutations in the entire coding region of tumor suppressor gene p53 in primary human prostatic carcinomas, using polymerase chain reaction and single-strand conformational polymorphism analysis of RNA. We found p53 gene mutations in 4 of 21 cases (19%). DNA sequencing of the polymerase chain reaction products revealed missense point mutations that resulted in amino acid changes in exon 5 or 3 in three cases and single base deletions in exon 7 in two cases. One case contained both a missense point mutation and a single base deletion. Three of these four cases were pathologically diagnosed as poorly differentiated adenocarcinomas, and three of the four cases were clinically localized to stage C or D. None of seven noncancerous prostate tissues nor three well-differentiated adenocarcinoma tissues showed any mutations. The present results suggest that p53 gene mutation is involved in the late progression steps of human prostate carcinogenesis.

Portal hypertension: influence on management

In treating cases of portal hypertension, it is important to know the intramural, extramural, and communicating vascular structures of the esophagus and stomach using EUS. From these structures, suitable treatment for the esophagogastric varices can be selected and the efficacy of treatment can be evaluated.

Expression of transforming growth factor-beta 1 in human bladder cancer

BACKGROUND

Elevated expression of transforming growth factor-beta 1 (TGF-beta 1) has been reported in several types of human cancer. However, the significance of TGF-beta 1 expression in clinical bladder cancer is not well known.

METHODS

The levels of TGF-beta 1 expression were quantitated using a polymerase chain reaction-based method in tissue specimens obtained from 51 patients with bladder cancer.

RESULTS

Transforming growth factor-beta 1 expression in bladder cancer was higher than that found in normal bladder epithelium (P < 0.01). Significantly higher levels of TGF-beta 1 transcripts were observed in low and intermediate grade (Grade 1 and 2) tumors than in high grade (Grade 3) tumors (P < 0.02). Superficial (pTa and pT1) tumors had higher levels of TGF-beta 1 than invasive (pT2 or higher) tumors (P < 0.05).

CONCLUSIONS

These results suggest that enhanced expression of TGF-beta 1 is specific to low grade and stage bladder cancer. Transforming growth factor-beta 1 may play an important role in the early stages of human bladder cancer development, and TGF-beta 1 expression could provide a new relevant tumor marker for determining tumor progression in patients with bladder cancer.

Polymorphisms in the human DNA polymerase beta gene

Recently, evidence has accumulated that mutations in DNA repair genes might be associated with certain steps in carcinogenesis. The DNA polymerase beta gene is one of the DNA repair genes, and mutations in it have been detected in 83% of human colorectal cancers. To assess the involvement of polymerase beta gene mutations in the development of human prostate cancers, we performed sequence analyses of human DNA samples. Unexpectedly, we found six regions that were polymorphic. This information should be taken into consideration at the time of sequence analysis of the DNA polymerase beta gene.

Hepatic resection under the intermittent selective portal branch occlusion by balloon catheter

BACKGROUND

In hepatic resection, it is important to control intrahepatic blood flow to minimize blood loss. Intermittent and selective vascular occlusion, if possible, are advisable.

STUDY DESIGN

For this purpose, we created the double balloon catheter, which when introduced into a lobar or a smaller branch of the intrahepatic portal vein through a branch of the ileocolic vein, made it possible to occlude these branches temporarily during hepatic resection. The small balloon located at the tip of the catheter made it easy to introduce the catheter to the portal branch selectively, under the guidance of ultrasonography. Another balloon was inflated intermittently to occlude selective portal blood flow. Using this technique, hepatic resection was achieved in 18 consecutive patients: 13 with hepatocellular carcinomas (11 with cirrhosis, two with chronic hepatitis), one with cholangiocellular carcinoma, three with metastatic carcinomas, and one with intrahepatic calculi.

RESULTS

In these cases, 19 hepatic resections were performed; two left hepatectomies, one extended right hepatectomy, one right hepatectomy, six segmentectomies, eight subsegmentectomies, and one partial hepatectomy. In each case, well demarcated hepatic tissue delineated by ischemic change was removed with minimal bleeding and little impairment to the residual hepatic tissue, resulting in a good postoperative course.

CONCLUSIONS

This double balloon catheter can replace the dissection of the hepatoduodenal ligament for hepatic resection, which causes bleeding, especially in patients with cirrhosis, and results in less cell injury of the residual hepatic parenchyma.

An approach to the hepatic hilus with marked fibrosis: a surgical technique for reconstruction of the bile duct with a benign stricture

It is very difficult to approach the hepatic hilus safely in patients with common and/or hepatic bile duct strictures in which normal tissue has been replaced by scarred tissue with firm fibrous adhesions. In this report, we describe how eight patients with benign strictures of the bile duct underwent an operation which involved dividing the superior mesenteric and portal veins from the lower margin of the pancreas in a dorsal direction using a finger in a tunneling technique. The common bile duct, which was buried in scar tissue, was then explored, while the common and/or proper hepatic arteries in the hepatoduodenal ligament were confirmed, after transsection at the superior margin of the pancreas. Biliary reconstruction was successfully performed after resection of the constricted bile duct in all the patients, none of whom have experienced recurrence from 6 months to 5 years after the operation.

DNA polymerase beta gene mutation in human prostate cancer

DNA polymerase beta is a nuclear protein essential to DNA repair in mammalian cells. A high frequency of mutations in this gene has been reported in colorectal cancers. To clarify the tumorigenesis steps of human prostate cancers in the molecular basis, we examined the entire coding region of the human DNA polymerase beta gene in human prostate cancer tissues using polymerase chain reaction, single-strand conformational polymorphism analysis of RNA, and sequencing analysis. Consequently, we detected DNA polymerase beta gene mutations in 2 of 12 cases (17%). The first case is an A to G transition at nucleotide 893, resulting in a substitution of the amino acid from tyrosine to cysteine. In the second case, we found an A to G transition at nucleotide 305, a T deletion at nucleotide 569, and an A insertion into the 6 repeats of A from nucleotide 612 to 617. This T deletion shifted the subsequent reading frame and resulted in the premature termination at codon 163 instead of 336. The two cases were advanced grade and stage. Present results suggest that polymerase beta gene mutations, although they occurred at relatively low frequency, are involved in certain cases of human prostate carcinogenesis.

Alteration of immunoreactivity by hydrated autoclaving, microwave treatment, and simple heating of paraffin-embedded tissue sections

The effects of treatment in a hydrated autoclave (121 degrees C, 2 atm for 20 min), microwave oven (in water), and simple heating (60 degrees C overnight in distilled water or 90 degrees C for 10 min in ZnSO4) on the stainability of 56 antigens by commercially available antibodies in formalin-fixed paraffin-embedded tissue sections were evaluated. The detectability of nuclear antigens, glycoprotein, lymphocytic surface markers, and chromogranin A was significantly and reproducibly improved by these treatments, whereas the detectability of viral antigens and peptide hormones was attenuated or unchanged. This enhancement includes not only the distinctiveness of the positive staining, but also the number of positive cells, as revealed by comparing serial sections. Among these four heating procedures, microwave heating and autoclaving were more effective than the others on p53, c-erbB-2, and CA125, whereas simple heating was best for smooth-muscle actin (HHF35 and CGA7). Generally the effects of the heating procedures for these antigens were consistent among the cases, but the effects on GFAP varied with the case. The alterations we observed could significantly influence the interpretation of immunohistochemical staining of currently popular tumor markers such as p53 in terms of their prevalence (28% vs 64% in gastric cancer; 36% vs 82% in metastatic liver cancer) and other diagnostically important markers.

Stepwise participation of p53 gene mutation during dedifferentiation of human thyroid carcinomas

The spectrum of p53 gene mutations was investigated in thyroid carcinomas with respect to histopathological classification. In all histological subtypes of thyroid carcinoma that had previously revealed positivity in immunohistochemical staining for p53 protein, single-stranded conformation polymorphism analysis and direct sequencing were performed to detect point mutations between exons 5 and 8. In well differentiated papillary and follicular carcinomas, in which we had already known that 11.1 and 14.3% of the cases, respectively, revealed p53 overexpression as determined by immunohistochemistry, genetic aberrations were undetectable. In poorly differentiated carcinoma, in which 40.9% had revealed overexpression, two of six cases revealed point mutations at codon 244 in exon 7 and at codon 278 in exon 8. In undifferentiated carcinoma, in which 63.6% had revealed overexpression, four of six cases examined showed point mutations at codon 157 in exon 5, at codon 248 in exon 7, and at codon 273 and a two-base insertion between codons 266 and 267 in exon 8. These results strongly suggest the crucial role of p53 gene aberration and protein overexpression in a biologically aggressive subtype, possibly as a stepwise participation in the process of tumor dedifferentiation in human thyroid carcinomas.

[A clinical study of fulminant Legionnaires' disease]

Seven cases of fulminant Legionnaires' disease treated at Kitasato University Hospital between 1985 and 1992 were reviewed. These patients were male with a mean age of 55.9 years (range, 37-67 yrs), and five were heavy alcohol drinkers. All seven patients required mechanical ventilation. Four patients recovered (group 1) and three expired due to respiratory failure (group 2). The mean interval from initial symptoms to the development of respiratory failure was 8.8 days in group 1 and 6.0 days in group 2, except in the one patient with lung cancer (case 6). The progression of pneumonia was more rapid in group 2. The mean intervals from admission to administration of erythromycin were 1.5 days and 3.5 days, respectively, in groups 1 and 2. In group 1, pulmonary infiltrates and respiratory insufficiency worsened for the first few days after erythromycin administration but improved thereafter. The average duration of ventilatory care in group 1 was 13.3 days. The administration of rifampicin combined with erythromycin may be useful for the treatment of fulminant Legionnaires' disease. When fulminant pneumonia is encountered in a middle-aged or elderly male alcoholic, Legionnaires' disease should be suspected and erythromycin administration with rifampicin should be initiated as early as possible.

Possible association of p53 overexpression and mutation with high-grade chondrosarcoma

Overexpression and point mutation of the p53 protein/gene was investigated in a series of chondrosarcoma by an immunohistochemical approach, and direct sequencing of the genomic DNA, respectively. In 2 of the 16 cases studied, both of which were high grade chondrosarcomas (grade III), immunodetectable p53 was identified. Histologically, one was ordinary type and the other a clear cell variant. However, no positivity was observed in the other cases including nine of low grade, ordinary type, three of low grade, clear cell type, and two of extraskeletal myxoid chondrosarcoma. Direct sequencing, following polymerase chain reaction amplification of exons 5-9 of the p53 gene in 14 cases, in which fresh materials were available, successfully demonstrated base substitution mutations in only two cases with detectable p53 overexpression on immunohistochemistry. Their details were GTC (valine) to TTC (phenylalanine) at codon 157 in exon 5, and CGT (arginine) to CAT (histidine) at codon 273 in exon 8. No mutation was detected in the other 12 cases which were negative for p53 immunostaining. These findings strongly suggest that p53 mutation plays a crucial role in the biologically aggressive subtype, and possibly in the process of tumor progression in human chondrosarcoma.

Overexpression of p53 as a possible prognostic factor in human thyroid carcinoma

A total of 110 cases of thyroid carcinomas were examined immunohistochemically to evaluate the overexpression of mutant forms of p53 protein in the light of their relationship with their histological subtypes. A polyclonal antibody, CM-1, was applied to the routine formalin-fixed, paraffin-embedded tissues for this survey. Overall, immunohistochemically detected p53 expression confined to the nucleus was identified in 22.7% of the thyroid carcinomas. A significant difference in the positivity of p53 among histological subtypes was noted; the positivity was 11.1% of the cases in well-differentiated papillary carcinoma, 14.3% in well-differentiated follicular carcinoma, 40.9% in poorly differentiated carcinoma, and 63.6% in undifferentiated carcinoma. No immunohistochemical positivity was found in adjacent non-neoplastic tissues or in benign lesions, including follicular adenoma, adenomatous goiter, and chronic thyroiditis. These results suggest that overexpression of p53 is not a responsible factor for the oncogenesis itself, but rather that it plays a crucial role in aggressive subtypes of thyroid carcinomas. Additionally, the distinct entity of poorly differentiated carcinoma, previously categorized in the well-differentiated carcinoma under the name of papillary or follicular carcinoma, was statistically confirmed.

Polymorphism of coagulation factor XIII B subunit: further occurrence of FXIIIB*15 in Japanese and phenotyping in bloodstains

The polymorphism of FXIIIB was investigated in 555 unrelated Japanese individuals using isoelectric focusing and immunoblotting. Five common phenotypes and a rare variant type FXIIIB 15-3 were observed. The allele frequencies were FXIIIB*1 = 0.3063, FXIIIB*2 = 0.0162, FXIIIB*3 = 0.6766 and FXIIIB*15 = 0.0009. Phenotyping was also possible from bloodstains stored at 37 degrees C for up to 4 months and from bloodstains stored at room temperature and at 4 degrees C for over 6 months. The FXIIIB system can provide a new powerful genetic marker for the medicolegal grouping of bloodstains.

[Plasma catecholamine levels during air-oxygen-enflurane anesthesia compared with those during nitrous oxide-oxygen-enflurane anesthesia]

This study was designed to investigate the differences in plasma levels of epinephrine, norepinephrine and dopamine during air-oxygen-enflurane anesthesia (AOE) and those during nitrous oxide-oxygen-enflurane anesthesia (GOE). These catecholamine levels were measured at 8 carefully defined points before and during hysterectomy or ovariectomy in two groups of each ten patients. Plasma levels of epinephrine decreased significantly immediately after intubation in both groups. In the AOE group, epinephrine levels increased significantly 30 and 60 minutes after the beginning of the operation. In the GOE group, however, epinephrine levels decreased significantly 15 and 30 minutes after the beginning of the operation. The difference between the two groups was statistically significant. Plasma levels of norepinephrine increased significantly after the beginning of the operation in the GOE group but no significant differences were found in the AOE group except the levels 60 minutes after the operation. The difference between the two groups was statistically significant 15 minutes after the operation. Plasma levels of dopamine remained unchanged in the two groups. Mean arterial pressure changed with intubation and surgical stress in the two groups. The arterial pressure was significantly higher 30 minutes after the operation in the GOE group compared with AOE group. Pulse rate increased significantly during anesthesia and surgery in the GOE group. It is concluded that AOE induces more increase of plasma epinephrine and less release of plasma norepinephrine compared with GOE.

[The effect of stationary time of punch in the process of compression on dividing properties of scored tablets]

The significance of the stationary time of punch in the process of compression on the dividing properties of scored tablets was investigated in several tablets prepared from lactose, corn starch, hydroxypropyl starch, synthetic aluminum silicate, microcrystalline cellulose or Perfiller. The dividing strength of scored tablets was not affected by the stationary time of punch. The effect of the stationary time of punch on the coefficient of variation of divided tablet weight differed in the compacting characteristics and compaction profiles of powders. In case of tablets prepared from microcrystalline cellulose, the effect of stationary time of punch was not observed. However, in the other excipients, there existed a specific stationary time of punch to minimize the coefficient of variation of divided tablet weight. The time was different due to the change of compression pressure. The coefficient of variation of divided tablet weight showed minimum at the longer stationary time of punch when tablets were compressed at the low compression pressure, and the time showed a tendency to become short with the increase of compression pressure. These results suggested that the effect of the stationary time of punch on the coefficient of variation of divided tablet weight was concerned with the compaction structure of powders produced by the movement of punch in the process of compression.

[Therapeutic modality for esophago-gastric varices analyzed by endoscopic ultrasonography]

For 64 cases with portal hypertensive disease, we investigated the intramural and extramural structure of the stomach and esophagus by endoscopic ultrasonography (EUS). Variously developed intra- or extra-mural vascular structures had a relationship to the endoscopic variceal form, and the communicating (inflow) vessels to varices were found in 35 of 50 primary treated cases (70%). We classified the esophago-gastric varices into three types according to the vascular structure, such as the esophageal type, the esophago-gastric type and the solitary gastric type. From the analyses of these collateral structures, we should select a treatment as follows. In the esophageal type which has a few inflow vessels, it is easy to eliminate the varices by obturating the inflow vessels by endoscopic injection sclerotherapy (EIS). In the esophago-gastric type, which has many enlarged inflow vessels, the Hassab operation is effective to devascularize extramural inflow vessels, and the combination of EIS is necessary to sclerous the intramural varices. In the solitary gastric type which is a part of the downward porto-systemic shunt, Hassab operation is recommended to prevent the rupture of varices for the subtype with intramural running vessels, but conservative therapy is enough for the subtype without intramural running vessel.

Polypoid cystic adenomyosis of the uterus: report of a case

A case of focal adenomyosis of the uterus with unusual gross features is presented. The patient, a 43-year-old woman, had experienced abnormal vaginal bleeding for 8 years. Hysteroscopy revealed a polypoid mass compatible with a submucosal leiomyoma, and a hysterectomy was performed. The uterus showed a 7 x 5 x 3-cm firm polypoid mass attached to the anterior wall that occupied most of the uterine cavity and protruded through the cervical os. It contained a large, central, cystic cavity filled with bloody fluid that communicated with the endometrial cavity through a fistula-like tract. Both the surface of the mass and the inside of the cystic cavity were covered by endometrial mucosa, and there were endometrial islands in the intervening wall. The differential diagnosis of this unique form of adenomyosis included polypoid submucosal leiomyoma with invagination of endometrium, endometrial polyp, submucosal leiomyoma with invagination of endometrium, endometrial polyp, and uterine diverticulum.

Polymorphism of complement factor I: population study in Japanese and phenotyping in bloodstains

Polymorphism of the complement component factor I (IF) was investigated in 645 unrelated Japanese individuals using isoelectric focusing and immunoblotting. The allele frequencies were IF*A = 0.1031 and IF*B = 0.8969. The population data fitted the Hardy-Weinberg law. Phenotyping was also possible from bloodstains stored at 37 degrees C for up to 1 week, at room temperature for up to 2 weeks and at 4 degrees C for up to 5 weeks. The IF system can be a useful supplement for the medicolegal identification of bloodstains, but seems useless in Caucasoids.

Membrane-anchored forms of EGF stimulate focus formation and intercellular communication

Epidermal growth factor (EGF) is the prototype for a small family of soluble proteins that bind to and activate the EGF receptor. These proteins are derived from larger propeptides that are anchored to the plasma membrane. Although the signalling properties of soluble EGF are well-characterized, the signalling potential of the membrane-anchored form had not been determined. We therefore investigated whether membrane-anchored EGF can stimulate the EGF receptor. An EGF mini-gene expression system that we had previously constructed for expression of soluble EGF was modified to encode anchored forms of EGF. In the encoded proteins EGF was fused to the spacer in the EGF propeptide that separates EGF from the transmembrane domain. The spacer was followed by vesicular stomatitis virus G protein transmembrane and cytoplasmic domain sequences. Three forms of EGF/G fusion protein were expressed in rat fibroblasts. The plasmids for expression of anchored EGF induced focus formation in rat fibroblasts, indicating that anchored EGF can cause autocrine transformation. When mixed with indicator HeLa cells, cell lines expressing EGF/G fusion proteins activated the HeLa EGF receptor. This activation was mediated by cell-associated, rather than soluble EGF. The finding that membrane-anchored EGF is capable of activating the EGF receptor on neighboring cells has broad implications for the functions of EGF in the organism.

Chemical change involved in the oxidative reductive depolymerization of hyaluronic acid

The oxidative reductive depolymerization (ORD) of hyaluronate has been investigated. A solution of hyaluronate (Mr 4.07 x 10(5] in phosphate buffer (pH 7.2) was incubated in the presence of Fe2+ for 24 h at 37 degrees C under an oxygen atmosphere to yield depolymerized hyaluronate (ORD fragments; an average Mr of 2,600). The ORD fragments contain 21 and 24% less hexosamine and uronic acid, respectively, but no olefinic linkage. They were exhaustively digested with chondroitinase AC-II. The resulting oligosaccharides and monosaccharides were separated by gel filtration and ion-exchange chromatography, and their structures were determined by proton and carbon-13 NMR, fast atom bombardment mass spectrometry, and chromatographic techniques combined with chemical modifications. The following structures derived from the reducing ends of the ORD fragments were identified: 4,5-unsaturated GlcA(beta 1----3)-N-acetyl-D-glucosaminic acid (where GlcA- represents glucuronosyl-) (21%), 4,5-unsaturated GlcA(beta 1----3)GlcNAc(beta 1----3)-D-arabo-pentauronic acid (24%), and N-acetyl-D-glucosamine (51%). The following structures derived from the nonreducing ends were identified: L-threo-tetro-dialdosyl-(1----3)GlcNAc (a tentative structure, 8%), N-acetylhyalobiuronic acid (20%), and N-acetyl-D-glucosamine (45%). The results indicate that the ORD reaction of hyaluronate proceeds essentially by random destruction of unit monosaccharides due to oxygen-derived free radicals, followed by secondary hydrolytic cleavage of the resulting unstable glycosidic substituents.

Enantiomer resolution of D- and L-alpha-amino acid derivatives by supercritical fluid chromatography on novel chiral diamide phases with carbon dioxide

The rapid resolution of racemic N-4-nitrobenzoylamino acid isopropyl esters was accomplished without the loss of enantioselectivity by supercritical fluid chromatography (SFC) on novel chiral valine-diamide phases with carbon dioxide and a polar methanol modifier. In each stationary phase, a chiral moiety was anchored to the silica gel surface by a long decamethylene spacer. The enantioselectivity in SFC was comparable to that in liquid chromatography using 2-propanol-n-hexane. The time required for analysis was less than 5 min, and the range of enantiomer resolution (Rs) was 10.8-1.25. On using 2-propanol in place of methanol the separation was improved, but was accompanied by a decrease in column efficiency. The end-capping effect of the remaining surface silanols on enantiomer resolution is discussed.

[Chromosome changes induced by industrial chemicals (author's transl)]

Radiation-induced chromosome damage has been widely recognized and intensively studied. Recently, attention is placed on chromosome changes induced by various industrial chemicals. In case of occupational exposure to ionizing radiation, chromosome breaks are characterized as one of the most sensitive biological effects. Chromosome breaks among industrial workers who dealt with benzene, vinyl chloride monomer or styrene have also been reported. Moreover, relationship between chromosome changes and exposure to environmental lead, cadmium and mercury compounds have been studied. Ionizing radiation, benzene and vinyl chloride monomer are known also as industrial carcinogens and attention is now placed on carcinogenicity of clastogens or chromosome breaking agents. In the present paper, our studies on in vitro chromosome breakage induced by benzene and its metabolites as well as cadmium, lead, and chromium compounds are reviewed. Also, inhibition of repair of radiation-induced chromosome breaks by clastogens is reported. Significance of cytogenetic studies in industrial medicine is also discussed.