A case of improved obstructive sleep apnea by distraction osteogenesis for midface hypoplasia of an infantile Crouzon's syndrome

We performed Le Fort III midfacial advancement with gradual distraction using internal devices on a 2-year 5-month-old boy with Crouzon's syndrome with associated severe obstructive sleep apnea. The device was not activated until 7 days after surgery, after which the distraction was initiated, 1 mm per day, and the midface was advanced 4 mm intraoperatively and distracted 12 mm postoperatively. A total advancement of 16 mm was obtained. The obstructive sleep apnea improved remarkably after the distraction. In infants and younger children with associated severe obstructive sleep apnea, advancement by distraction osteogenesis of the midface in Le Fort III maxillary osteotomy will be initially indicated to obviate tracheostomy improving the upper airway obstruction.

Inhibition of invasion and experimental metastasis of murine melanoma cells by human soluble thrombomodulin

Thrombomodulin (TM) is an anticoagulant molecule expressed on the endothelial cell surface and soluble TM antigen, which is present in human plasma and urine, represents the products of limited proteolytic cleavage of cell-surface TM. Recently, it was demonstrated that TM is also expressed on the surface of several tumor cells and the expression level of TM negatively correlated with malignancy in cancer. We investigated the effect of soluble TM isolated from human urine (uTM) on the invasion and metastasis of murine melanoma cells (B16F10 cells) through a reconstituted basement membrane (Matrigel) and in a murine model of experimental lung metastasis. Matrigel reconstituted with uTM inhibited the invasion of B16F10 cells in a dose-dependent manner in a range from 10 to 1000 ng/ml uTM as compared with the control Matrigel without uTM. The inhibitory action of uTM was not altered in the presence of an excess amount of hirudin, an inhibitor of thrombin proteolytic activity, but abolished in the presence of anti-human TM IgG. Matrigel reconstituted with thrombin (1 NIH unit/ml) enhanced the invasion level of cells by 1.5-fold relative to the control Matrigel without thrombin. The thrombin-enhanced invasion of B16F10 cells was repressed by addition of hirudin (10 units/ml) or uTM (100 ng/ml) into the Matrigel. Matrigel reconstituted with hirudin (10 units/ml) and uTM (100 ng/ml) additionally accelerated the inhibitory activity of hirudin or uTM on the thrombin-enhanced invasion of B16F10 cells. Moreover, metastatic colonies formed in the lungs of mice injected intravenously with B16F10 cells were significantly reduced by injection of uTM once a day up to 2 days after co-injection of uTM with the cells. These results suggested that Matrigel reconstituted with uTM inhibited the invasion of B16F10 cells in vitro through a thrombin-independent mechanism and the injection of uTM suppressed experimental lung metastasis of the cells in mice.

Electromyographic study of the striated urethral sphincter in type 3 stress incontinence: evidence of myogenic-dominant damages

OBJECTIVES

To determine the electromyographic features of the striated urethral sphincter in patients with type 3 stress incontinence (SI) due to intrinsic sphincteric deficiency (ISD).

METHODS

We performed electromyography (EMG) of the striated urethral sphincter muscle and urodynamic studies in a total of 51 women, 41 female patients with type 3 SI and 10 women with normal urinary control (NUC). The results were analyzed in both groups, and the correlation of EMG findings with the patient characteristics and urodynamic parameters was evaluated.

RESULTS

Motor unit potentials (MUP) of SI patients showed significantly shorter duration (P = 0.0014), lower amplitude (P = 0.0008), and larger number of phases (P = 0.0022) compared with those in the NUC group. Thirty (73%) of the SI patients showed an obvious low amplitude (less than 350 microV)/short duration (less than 4.5 milliseconds)/polyphasic pattern and early recruitment of interference activity with low amplitude at voluntary contraction of the striated sphincter, both indicating existence of myogenic damages. These patients showing myogenic damages had significantly lower Valsalva leak point pressure (P = 0.002) and more leakage in the pad-weigh test (P = 0.010) compared with the SI patients without myogenic damage findings.

CONCLUSIONS

These results suggested that myogenic-dominant damages of the striated urethral sphincter may contribute to the etiology of ISD in most patients with type 3 SI.

Xeroderma pigmentosum variant heterozygotes show reduced levels of recovery of replicative DNA synthesis in the presence of caffeine after ultraviolet irradiation

Patients with xeroderma pigmentosum variant show clinical photosensitivity, skin neoplasias induced by ultraviolet light, and defective postreplication repair, but normal nucleotide excision repair. We recently reported an alternative, simple method for the diagnosis of xeroderma pigmentosum variant that measures by autoradiography three cellular markers for DNA repair after ultraviolet irradiation: unscheduled DNA synthesis, recovery of RNA synthesis, and recovery of replicative DNA synthesis. Among hereditary photosensitive disorders, including other xeroderma pigmentosum groups, Cockayne syndrome, and a newly established ultraviolet-sensitive syndrome, only xeroderma pigmentosum variant cells exhibited normal unscheduled DNA synthesis, normal recovery of RNA synthesis, but reduced recovery of replicative DNA synthesis (51 +/- 6% the rate relative to normal controls). This reduction of recovery of replicative DNA synthesis was enhanced in the presence of a nontoxic level of caffeine to 36 +/- 5%. In this study we assess the cellular markers in two independent families that included two photosensitive patients that were identified as xeroderma pigmentosum variant. Cells from heterozygotic parents showed normal levels of unscheduled DNA synthesis, recovery of RNA synthesis, and recovery of replicative DNA synthesis, but reduced rates of recovery of replicative DNA synthesis in the presence of 1 mM caffeine (53 +/- 8% relative to the normal control). Furthermore, with a colony-forming assay, the cells showed normal survival by ultraviolet without caffeine, but slightly reduced survival by ultraviolet with 1 mM caffeine present. In one family, we confirmed inheritance of two heterozygous mis-sense mutations. One mutation is an A-->G transition at nucleotide 1840 that generates a K535E mis-sense mutation. Another mutation is an A-->C transversion at nucleotide 2003 that generates a K589 mis-sense mutation. Each of these mutations were absent in 52 unrelated Japanese individuals. These results suggest that xeroderma pigmentosum variant heterozygotes can be identified by their sensitivity to ultraviolet irradiation in the presence of nontoxic levels of caffeine.

[Antibacterial activity of 16 antibiotics against Helicobacter pylori]

The susceptibilities of 24 Helicobacter pylori isolates, which were originated from clinical materials, to 5 beta-lactam antibiotics [benzylpenicillin (PCG), ampicillin (ABPC), cephalothin (CET), ceftazidime (CAZ), cefotiam (CTM) and imipenem (IPM)], two macrolides [clarithromycin (CAM) and rokitamycin (RKM)], two aminoglycosides [amikacin (AMK) and gentamicin (GM)], two new quinolones [ciprofloxacin (CPFX) and levofloxacin (LVFX)], two tetracycline [tetracycline (TC) and minocycline (MINO)], rifampicin (RIF) and chloramphenicol (CP) were tested. All of the isolates showed similar susceptibilities against beta-lactam antibiotics. However, MICs of CTM and CAZ were two- to four-fold higher than those of PCG, ABPC, CET and IPM, MICs of rokitamycin for the tested strains were higher than those of clarithromycin. MICs of CPFX and LVFX showed two-modal distributions. The first peak of distributions was observed between 0.06 to 0.5 microgram/ml and second one was between 4 to 16 micrograms/ml. These distributions suggested that MIC values of 4 to 16 micrograms/ml could result from the expression of a resistance mechanism. In addition, some of H. pylori strains were observed drug resistances between CP and AMK, new quinolones and AMK respectively. From the molecular epidemiological study, cryptic plasmids were detected from the 3 isolates among 24 strains tested.

Cystic renal cell carcinoma diagnosed by cystofiberscopy

A 64-year-old man suffered from hypertensive syncope and was admitted to Branch Hospital, Faculty of Medicine, The University of Tokyo. On admission he had no symptoms; however, two renal cysts of about 5 cm in diameter were found in his left kidney. Cystofiberscopy with a thin optical fiberscope was performed in addition to puncture and cystography. Cytology revealed class I, but the wall surface of the lower cyst was uneven, fluid-filled, colloid-like and white-gray compared with that seen in the upper cyst. It was diagnosed as renal cell carcinoma (RCC) and left nephrectomy was performed (5 cm in diameter, RCC, papillary tubular, common, clear cell subtype, G2>G1, INF beta, pT2, pMx, pV0, ew(-)).

[Extratesticular germ cell tumor focusing on treatment and prognosis]

About 3% to 5% of all germ cell tumors are thought to be primary extratesticular tumors, including a small group of benign tumors. Though the testes are clinically normal, diagnosing whether the tumor is primary or metastatic is problematic. Developments in ultrasonography have enabled the detection of tiny testicular lesions, and ultrasonography is applied to determine the biopsy sites. Nevertheless, burned-out tumor and carcinoma in situ are not always easy to find. Extratesticular germ cell tumors are usually treated using methods similar to those for advanced testicular tumors; however, the results are discouraging. Only limited cases are suitable for a monotherapy of surgery, so a combined treatment of cisplatin based chemotherapy and surgery is prevalent. Against seminomas, radiotherapy is effective. In addition to the advent of such pharmaceuticals as G-CSF and serotonin receptor antagonists, recent development of peripheral blood stem cell transplantation is expected to produce improved prognoses among patients burdened with this refractory disease. A prognostic factor-based staging system developed by the International Germ Cell Cancer Collaborative Group is reasonable and useful. Non-seminomas are classified as having good or intermediate prognoses if retroperitoneal tumors having no non-pulmonary visceral metastases show good or intermediate markers. A poor prognosis is associated with extratesticular tumors with mediastinal primary or non-pulmonary visceral metastases or poor markers. Seminomas with normal AFP are classified as having good or intermediate prognoses if no non-pulmonary visceral metastases are seen or discarded. No seminomas are classified in the poor prognosis group.

Prolonged recovery of cardiac output after maximal exercise in patients with chronic heart failure

OBJECTIVES

The aim of this study was to characterize the kinetics of cardiac output during recovery from maximal exercise in patients with chronic heart failure (CHF).

BACKGROUND

Recent studies have shown that oxygen uptake kinetics during recovery from exercise are delayed in patients with CHF. However, the kinetics of cardiac output during recovery from maximal exercise in CHF has not been examined.

METHODS

Thirty patients with CHF performed maximal upright ergometer exercise with respiratory gas analysis. Kinetics of oxygen uptake (VO2) and carbon dioxide output (VCO2) during recovery were characterized by T1/2, the time to reach 50% of the peak values. Cardiac output was measured at 1-min intervals during exercise and recovery. Kinetics of cardiac output during recovery were characterized by the ratios of cardiac output during the first 4 min of recovery to cardiac output at peak exercise. Overshoot of cardiac output was defined as a further increase in cardiac output at 1 min of recovery above the cardiac output at peak exercise.

RESULTS

Both T1/2 VO2 and T1/2 VCO2 increased as CHF worsened. The ratios of cardiac output during recovery to cardiac output at peak exercise were significantly correlated with T1/2 VO2 (r = 0.47 to 0.62, p < 0.05) and T1/2 VCO2 (r = 0.40 to 0.70, p < 0.05). There was a negative correlation between cardiac index at peak exercise and both T1/2 VO2 (r = -0.65, p < 0.001) and T1/2 VCO2 (r = -0.60, p < 0.001). Overshoot of cardiac output was recognized in 11 of 30 patients. Cardiac index at peak exercise was significantly lower in patients with overshoot (4.5 +/- 0.9 L/min/m2) than in those without overshoot (6.1 +/- 2.1 L/min/m2, p < 0.05). However, because of a continued increase in cardiac output at 1 min of recovery in patients with overshoot, there were no differences in cardiac index after the first minute of recovery. Heart rate at peak exercise and recovery of heart rate did not differ between these groups. Overshoot of cardiac output was caused by a rebound increase in stroke volume which was due to a reduction in systemic vascular resistance.

CONCLUSIONS

Prolonged kinetics of VO2 or VCO2 during recovery from maximal exercise represent impairment of circulatory response to exercise and delayed recovery of cardiac output after exercise. Overshoot of cardiac output at 1 min of recovery was characteristic of severe CHF with poor cardiac output response to exercise.

Immune response to adenovirus-delivered antigens upregulates utrophin and results in mitigation of muscle pathology in mdx mice

The upregulation of endogenous utrophin in skeletal muscle may lead to a new approach to the treatment of Duchenne muscular dystrophy (DMD). We found that injection of an E1, E3-deleted adenovirus vector expressing beta-galactosidase (beta-Gal) or green fluorescent protein (GFP) into the skeletal muscle of neonatal dystrophin-deficient mdx mice alleviated dystrophic pathology. In the adenovirus-infected muscles, an evaluation of sarcolemma stability showed low permeability and immunohistochemistry revealed utrophin upregulation at the extrasynaptic sarcolemma of mature muscle fibers. This utrophin upregulation was concomitant with endomysial cellular infiltration from a host immune reaction. There was no evidence of active muscle regeneration. In normal C57BL/10 mice, utrophin was also upregulated in adenovirus-injected skeletal muscles, where upregulated utrophin often coexisted with dystrophin. FK506 and anti-CD4 antibody administration decreased utrophin expression in adenovirus-injected mdx muscles and prevented the dystrophic phenotype from being mitigated, suggesting that an immune reaction is involved in utrophin upregulation. This is the first report demonstrating the improvement of the dystrophic phenotype as a result of the acquired overexpression of endogenous utrophin. Our findings provide an important clue to understanding the mechanism of utrophin expression and the development of an effective treatment for DMD.

Aesthetic and plastic surgery for trichorhinophalangeal syndrome

Trichorhinophalangeal syndrome is an autosomal dominant disorder characterized by a number of clinical features including short stature, sparse scalp hair, a pear-shaped bulbous nose, upper lip deformity, protruding ears, mandibular hypoplasia, and cone-shaped epiphyses of the phalanges. The syndrome has three subgroups: types I, II, and III. Although a few authors have pointed out the importance of aesthetic and plastic surgery in this syndrome, it has attracted relatively little attention. This review of the literature indicates that many patients have had various surgical corrections for associated abnormalities, including otoplasty and rhinoplasty. Unlike aesthetic or plastic corrections in other well-known congenital disorders, most corrections in trichorhinophalangeal syndrome have been performed prior to a diagnosis of the syndrome. Accurate identification of this syndrome is important to provide appropriate aesthetic treatments. Careful evaluation of patients is required when they present for surgery or aesthetic counseling, because they may have a variety of occult associations such as recurrent respiratory tract infections and urogenital anomalies.

Binding of influenza type A viruses to group B Streptococcus and haemagglutination by virus-bound bacteria

We studied the bindings of human influenza A type viruses to group B Streptococcus (GBS), types Ia, II, III and IV, of sialic acid (SA)alpha2-3 linkage, using A/PR/8/34(H1N1) and A/Memphis/1/71(H3N2). The viruses were found to bind to all types of GBS, with the exception of PR/8/34 for GBSII, and to elute from GBSIa, III and IV at 37 degrees C, except GBSII. Electron microscopy confirmed these behaviours of the influenza viruses. The virus-binding capability of GBS types seemed to depend on the side chain length of the terminal SA. Treatment of GBSIa, III and IV, except enzyme-resistant type II, with bacterial neuraminidase resulted in the loss of virus-binding capability of GBS. These findings confirmed that SAalpha2-3 linkage of GBS capsules functions as receptor for human influenza viruses. When singular bacteria were prepared from mainly chain-like GBS with sonication, viruses were found to bind to them more efficiently. Untreated and sonicated GBS were both aggregated with high doses of virus. Furthermore, using A/Memphis/1/71(H3N2) and GBSII, we found that virus-bound GBS, untreated or sonicated, caused haemagglutination (HA). The morphological evidence that chicken erythrocytes were bridged with virus-bound native GBSII, supporting occurrences of HA, was obtained. Statistical analysis suggested that HA by virus-bound sonicated (singular) GBS was mediated by bacteria bound by at least two or three virus particles.

ATIII-independence of anticoagulant effect of human urinary soluble thrombomodulin

We investigated antithrombin III (ATIII)-dependency of the anticoagulant effects of human urinary soluble thrombomodulin (UTM) both in vivo and in vitro, in comparison with those of heparins. For neutralization of rat plasma ATIII activity, we used F(ab')2 fragment of anti-rat ATIII antibody and could establish an appropriate in vivo model to evaluate the ATIII-dependency of antithrombotic agents. The efficacy of UTM on thromboplastin-induced disseminated intravascular coagulation produced in ATIII-decreased rats was almost the same as that in normal rats, whereas unfractionated (UF)-heparin remarkably diminished its effect in ATIII-decreased rats. The prolongation effect of UTM on activated partial thromboplastin time or prothrombin time in plasma in vitro was unchanged in both normal and ATIII-decreased rats, but the effect of UF-heparin remarkably diminished in ATIII-decreased rat plasma. Such ATIII-independence in the anticoagulant effect of UTM was also observed in human plasma. Thus, differing from heparins, since the anticoagulant effect of UTM does not depend on plasma ATIII activity, UTM is expected to be a useful antithrombotic agent for the treatment of thromboembolic diseases, even in the case with low plasma ATIII activity.

Downregulation of the human taurine transporter by glucose in cultured retinal pigment epithelial cells

In diabetes, activation of the aldose reductase (AR) pathway and alterations of glucose-sensitive signal transduction pathways have been implicated in depletion of intracellular taurine, an endogenous antioxidant and compatible osmolyte. Cellular taurine accumulation occurs by an osmotically induced, protein kinase C (PKC)-regulated Na(+)-taurine cotransporter (hTT). The effects of ambient glucose on taurine content, hTT activity, and hTT gene expression were therefore evaluated in low and high AR-expressing human retinal pigment epithelial cell lines. In low AR-expressing cells, 20 mM glucose decreased taurine content, hTT transporter activity, and mRNA levels, and these effects were unaffected by AR inhibition (ARI). In these cells, the inhibitory effects of high glucose on hTT appeared to be posttranscriptionally mediated, because 20 mM glucose decreased hTT mRNA stability without affecting hTT transcriptional rate. Inhibition of PKC overcame the decrease in hTT activity in high glucose-exposed cells. In high AR-expressing cells, prolonged exposure to 20 mM glucose resulted in intracellular taurine depletion, which paralleled sorbitol accumulation and was prevented by ARI. In these cells exposed to 5 mM glucose, hTT mRNA abundance was decreased and declined further in 20 mM glucose but was corrected by ARI. In 5 mM glucose, hTT transcriptional rate was markedly decreased in high AR-expressing cells, did not decline further in 20 mM glucose, but was increased by ARI to levels above those observed in low AR-expressing cells. Therefore, glucose rapidly and specifically decreases taurine content, hTT activity, and mRNA abundance by AR-unrelated and AR-related posttranscriptional and transcriptional mechanisms.

Exercise-induced rise in arterial potassium in patients with chronic heart failure

OBJECTIVES

In patients with chronic heart failure (CHF), exercise is frequently associated with skeletal muscle fatigue and breathlessness due to heightened ventilatory response. The exercise-induced rise in potassium, which is released from the exercising skeletal muscle, has been implicated in ventilatory control during exercise. The aim of the present study was to determine whether the exercise-induced rise in arterial potassium is altered in patients with CHF and to examine the relationship between increased exercise ventilation and exercise-induced hyperkalemia in patients with CHF.

METHODS AND RESULTS

We evaluated 88 patients with CHF (25 patients were in class I, 35 in class II, and 28 in class III according to the New York Heart Association functional classification) and 14 normal subjects. Subjects performed symptom-limited ergometer exercise while expired gas, arterial blood gas, and arterial potassium were analyzed. The increases in ventilation (deltaV(E)), effective alveolar ventilation (deltaVA), and carbon dioxide output (deltaV(CO2)) from rest to peak exercise decreased as the severity of CHF advanced. The ratio of deltaV(E) to deltaV(CO2) was significantly elevated in class III patients, although there was no difference in the ratio of deltaVA to deltaV(CO2) among the four groups. Rest and exercise arterial P(CO2) did not differ among the four groups and was controlled within the normal range. The increase in arterial potassium (deltaK+) from rest to peak exercise was markedly reduced as the severity of CHF advanced: (mean +/- SD) 1.70+/-0.32 mmol/L in normal subjects; 1.46+/-0.27 mmol/L in class I patients; 1.15+/-0.24 mmol/L in class II patients; and 0.78+/-0.24 mmol/L in class III patients. The ratios of deltaVA or deltaV(CO2) to deltaK+ were not different among the four groups. The ratio of deltaV(E) to deltaK+, however, was significantly greater in patients in class III than in normal subjects or patients in class I or II.

CONCLUSIONS

The deltaK+ from rest to peak exercise was markedly reduced as the severity of CHF advanced. The increased exercise ventilation due to increased physiologic dead space in severe CHF was not accompanied by the corresponding augmentation of exercise-induced hyperkalemia. Exercise-induced hyperkalemia does not contribute to the increased ventilatory drive to keep normal arterial P(CO2) during exercise in the presence of increased physiologic dead space in severe CHF.

The effect of papaverine on morphologic differentiation, proliferation and invasive potential of human prostatic cancer LNCaP cells

BACKGROUND

Intracellular cyclic adenosine monophosphate (AMP) level changes are thought to play an important role in inhibiting cell proliferation and inducing differentiation in several types of cells. It has been reported that cyclic AMP analogs induce terminal differentiation in human prostate cancer cells. Consequently, phosphodiesterase inhibitors may be useful in delineating the role of cyclic AMP in the differentiation of these cells. Therefore, the effect of phosphodiesterase inhibitors on morphologic differentiation, proliferation and invasive potential of human prostate cancer cells was investigated.

METHODS

Three human prostate cancer cell lines PC-3, DU145 and LNCaP were treated with one of the phosphodiesterase inhibitors, papaverine, 3-isobutyl-1-methylxanthine (IBMX) or theophylline, for 6 days. Morphologic changes of these cells induced by phosphodiesterase inhibitors were observed by microscopy. Intracellular cyclic AMP levels in LNCaP cells were measured by radioimmunoassay using a cyclic AMP assay kit. The effect of papaverine on the proliferation and invasive potential of LNCaP cells were measured by cell counting and the Matrigel invasion chamber assay.

RESULTS

Of the three agents, examined papaverine (10(-5) mol/L) is the most effective inducer of morphologic change and also raised intracellular cyclic AMP levels in LNCaP cells. However, unlike LNCaP cells, PC-3 and DU145 cells treated with phosphodiesterase inhibitors, including papaverine, showed little change in morphology. Additionally, proliferation and invasive potential of LNCaP cells were significantly inhibited by papaverine.

CONCLUSION

The results suggest that papaverine induces terminal differentiation in LNCaP cells, which is correlated with an intracellular cyclic AMP-mediated pathway.

Alternate splicing in human Na+-MI cotransporter gene yields differentially regulated transport isoforms

myo-Inositol is a ubiquitous intracellular organic osmolyte and phosphoinositide precursor maintained at millimolar intracellular concentrations through the action of membrane-associated Na+-myo-inositol cotransporters (SMIT). Functional cloning and expression of a canine SMIT cDNA, which conferred SMIT activity in Xenopus oocytes, predicted a 718-amino acid peptide homologous to the Na+-glucose cotransporter with a potential protein kinase A phosphorylation site and multiple protein kinase C phosphorylation sites. A consistent approximately 1.0- to 13.5-kb array of transcripts hybridizing with this cDNA are osmotically induced in a variety of mammalian cells and species, yet SMIT activity appears to vary among different tissues and species. An open reading frame on human chromosome 21 (SLC5A3) homologous to that of the canine cDNA (96.5%) is thought to comprise an intronless human SMIT gene. Recently, this laboratory ascribed multiply sized, osmotically induced SMIT transcripts in human retinal pigment epithelial cells to the alternate utilization of several 3'-untranslated SMIT exons. This article describes an alternate splice donor site within the coding region that extends the open reading frame into the otherwise untranslated 3' exons, potentially generating novel SMIT isoforms. In these isoforms, the last putative transmembrane domain is replaced with intracellular carboxy termini containing a novel potential protein kinase A phosphorylation site and multiple protein kinase C phosphorylation sites, and this could explain the heterogeneity in the regulation and structure of the SMIT.

Butyrolactone I induces cyclin B1 and causes G2/M arrest and skipping of mitosis in human prostate cell lines

Several naturally occurring cyclin-dependent kinase (CDK) inhibitors have been isolated from different lower organisms. In this report, we examined the effect of one of the CDK inhibitors, butyrolactone I (BL), on the expression of cyclins D2, A and B1 in three human prostatic cancer cell lines (DU145, PC-3, LNCaP) using two colored flow cytometric analysis. The percentage of DU145 cells in the 4C phase of the cell cycle were increased significantly at both 70 microM and 100 microM BL. Furthermore, an additional 8C peak was observed which had double the DNA content of the 4C phase at these concentrations of BL. The appearance of the 8C peak increased gradually and was more evident in DU145 and PC-3 than LNCaP. Cells in the 8C peak had either two nuclei or abnormal nuclei as observed by Papanicolaou stain. BL also increased the amount of cyclin B1 positive cells in the 4C phase. This increase was apparent on day 1 and returned to normal by day 3. Since BL selectively inhibits cyclin-dependent kinase, cyclin B1 might accumulate without being degraded. Other cyclins were not significantly changed by BL. The data demonstrate that BL inhibited Cdc2 of unsynchronized cultured prostate cancer cells, and interrupted the cell cycle progression toward cell division. The BL inhibition of Cdc2 led to the accumulation of cells in the 4C phase without mitosis resulting in an accumulation of cyclin B1. The appearance of cells in the 8C phase may be due to the progression of cells in the 4C phase through the cell cycle skipping mitosis. Cyclin B1 decreased in correlation with the progression through a new cell cycle. These results suggest that BL does not cause a complete arrest of the cell cycle in G2/M but that BL occasionally allows for the skipping of mitosis and subsequent progression through the cell cycle to occur.

Correlation between proliferation, apoptosis, and angiogenesis in prostate carcinoma and their relation to androgen ablation

BACKGROUND

Proliferation, apoptosis, and angiogenesis are essential for carcinogenesis. Little is known regarding the relation between proliferation, apoptosis, and angiogenesis in untreated prostate carcinoma as well as alterations associated with androgen ablation.

METHODS

Eighty patients who underwent radical prostatectomy for clinically localized prostate carcinoma were recruited for the study. The study population included 2 groups: 35 patients receiving 3-month neoadjuvant hormonal treatment using a combination of luteinizing hormone-releasing hormone analogue and the antiandrogen flutamide (NHT group) and 45 patients without prior treatment (non-NHT group). The authors measured the Ki-67 labeling index (Ki-67 LI) by MIB-1 immunohistochemistry, the apoptotic index (AI) by the terminal deoxynucleotidyl transferase-mediated dUTP biotin nick end labeling technique, and intratumoral microvessel density (IMVD) by CD31 immunohistochemistry on serial sections of formalin fixed, paraffin embedded tissues. Correlations among these parameters were examined in both groups.

RESULTS

A significant decrease in the Ki-67 LI coupled with a significant increase in AI was found in the NHT group compared with the non-NHT group, whereas IMVDs in both groups were not significantly different. AI was related to IMVD inversely in the non-NHT group (correlation coefficient [r] = -0.327; P = 0.03); in contrast, AI was related to IMVD positively in the non-NHT group (r = 0.579; P < 0.001). The Ki-67 LI was related to AI significantly in the non-NHT group but not in the NHT group. There was no correlation between Ki-67 LI and IMVD in either group.

CONCLUSIONS

Correlations between proliferation, apoptosis, and angiogenesis in prostate carcinoma are altered significantly in association with androgen ablation. The results indicate that spontaneous apoptosis is suppressed by neovascularization, whereas hormone-induced apoptosis is enhanced in hypervascular tumors.

Langer-Giedion syndrome associated with submucous cleft palate

We report a 4-year-old girl with characteristic features of the Langer-Giedion syndrome (trichorhinophalangeal syndrome type II) who also had submucous cleft palate. When she underwent a palatoplasty, a diagnosis of Langer-Giedion syndrome was made because of the characteristic facial features, multiple exostoses, and partial deletion of the long arm of chromosome 8. This is the first case of trichorhinophalangeal syndrome associated with cleft palate. We review the clinical alterations of trichorhinophalangeal syndromes and differential diagnosis of Langer-Giedion syndrome from trichorhinophalangeal syndrome type I and hereditary multiple exostoses. We also describe the importance of trichorhinophalangeal syndrome in plastic surgery.

Experimental vascular graft using small-caliber fascia-wrapped fibrocollagenous tube: short-term evaluation

This study was undertaken to evaluate the application of autogenous fascia as a framework for a fibrocollagen tube for small-caliber vascular prostheses in Japanese white rabbits (n = 15). The fascia, measuring 10 x 40 mm, was harvested from the dorsal fascia and was carefully wrapped around a silicone rod of 1.5 mm in diameter. Then, the fascia-wrapped silicone rod was implanted into a subcutaneous pocket on the medial thigh. Four weeks later, the fascia-wrapped silicone rod was removed from the subcutaneous pocket. The rod was removed from the material, and the fascia-wrapped fibrocollagen tube was treated to make it antithrombogenic. Subsequently, the 1.5 x 10-mm fascia-wrapped tube was prepared as an arterial conduit. Using microvascular techniques, the tube was interposed into the divided femoral artery. Eleven of 15 grafts maintained patency over the follow-up period and no aneurysmal formation was found at any graft site. Microscopically, there was an ingrowth of endothelium with fibroblast proliferation from each end of the recipient vessel at 2 weeks after interposition; however, no neointima was found to line the center of the conduit. At 5 weeks after interposition, the neointimal growth rate was 70 percent. There was an ingrowth of endothelium with fibroblast proliferation from each end onto the entire internal surface of the conduit at 8 weeks after interposition. Further study is required before any long-term conclusions can be drawn.

The use of otherwise redundant skin to provide nasal lining in the reconstruction of full-thickness alar defects by nasolabial flap repair

The use of otherwise redundant nasolabial flap skin is described for lining in reconstruction of full-thickness alar defects. The techniques have been successfully used to reconstruct full-thickness alar defects in four patients. The overall procedure has the advantage of providing well-vascularised tissue of appropriate colour, texture and thickness for external skin and nasal lining in one-stage reconstruction.

Cranioplasty with neovascularized autogenous calvarial bone

We have presented two cases of cranioplasty with neovascularized autogenous calvarial bone. A surgical procedure applying the principle of flap prefabrication has been applied to the preservation of autogenous calvarial bone obtained during external cranial decompression. The rectus abdominis muscle flap was elevated. A subcutaneous pocket was prepared for preservation of calvarial bone integrated with the rectus abdominis muscle. The outer cortex of calvarial bone was removed partially by bone chiseling. The muscle flap was attached to the bone graft by means of two holes on the bone by suture. The calvarial bone, grafted onto the rectus abdominis muscle flap, was inserted into the subcutaneous pocket. Several weeks later, the neovascularized calvarial bone flap was dissected along with inferior epigastric pedicle. Cranioplasty was performed using the bone element of the flap. Revascularization was achieved by anastomosing the inferior epigastric vessels to the temporal vessels. The postoperative films demonstrated marked radiolucency at the borders of the flap, although bone scan documented that the flap was vascularized. We speculate that the transferred bony segment was not completely vascularized.

Effect of percutaneous transvenous mitral commissurotomy on postexercise breathlessness as determined by ventilation during recovery from constant workload exercise

We evaluated the effect of percutaneous transvenous mitral commissurotomy (PTMC) on ventilatory variables and dyspnea during recovery from a 6-minute submaximal constant workload exercise, and showed that the decrease in postexercise ventilation after PTMC was closely related to improvement in postexercise dyspnea after PTMC. Ventilation during recovery from submaximal constant workload exercise is related to postexercise breathlessness and can be used to assess the effectiveness of therapeutic interventions.

Prefabricated osteomusculocutaneous flaps using calvarial bone: experimental study

Prefabricated osteomusculocutaneous flaps using free calvarial bone were examined and evaluated in a rat model. The animals were divided into two groups according to prefabrication time: 14 days in Group 1 (n = 10) and 28 days in Group 2 (n = 10). Nine of 10 preparations demonstrated neovascularization in Group 1, and all flaps showed neovascularization in Group 2. One flap was lost in Group 1 as a result of infection. Each group was evaluated histopathologically before the second stage of the experiment. Muscles without atrophy and osteocytes were noted in Group 1; however, Group 2 animals had both muscle atrophy and nonviable bone. The prefabricated osteomusculocutaneous flaps were then transferred as both island and free flaps. Flap viability was assessed on postoperative day 7 by macroscopic observation. Although all flaps survived in the island-flap group, two flaps failed to survive due to technical error in the free-flap group. Neovascularization was clearly evident by 2 weeks in the osteomusculocutaneous flaps; after 4 weeks, complete atrophy of the muscle meant that the flaps could no longer be characterized as osteomusculocutaneous. Clinically, it might be possible to use the outer table alone, in which case both thin skin and bone would be desirable. This study may provide a model for this approach.

An axial-pattern skin flap in the rat

An axial-pattern rat skin flap based on the caudal femoral artery is described with orthotopic and heterotopic island flap transfers. Free-tissue transfers could also be carried out based on the common femoral artery. Since the pedicle is very small, instead of selective dye injection, a nonselective dye injection was utilized, elevating a very large island skin flap based on the caudal femoral artery. This flap model can provide an alternative opportunity to study the physiology of skin flaps and for training in the basic principles of plastic surgery, including microsurgical practice, with a more challenging model.

Morphological analysis of olfactory receptor cells using whole-mount preparations of the rat nasal mucosa

The distribution and entire shape of olfactory receptor cells were investigated by means of whole-mount preparations of the nasal mucosa. Whole mucosa isolated from the nasal septum of rats was processed, as "a free-floating section", and examined by the avidin-biotin complex (ABC) method using antisera against protein gene product 9.5 (PGP 9.5) and calbindin. Essentially all receptor cells were immunolabeled with the PGP 9.5 antiserum, but only half of PGP 9.5-immunoreactive cells were calbindin-immunoreactive. In the immunostaining of whole-mount preparations, pretreatment of tissues by freeze-thawing and dipping in ethanol and xylene greatly improved the permeability of antibodies. Overview of the nasal septum showed that the dorsal and ventral portions of the rostral olfactory area extended deeply into the respiratory area, making a "semi-lunar" shape. The boundary between the two areas was clearly demarcated, although several receptor cells were scattered in the respiratory area near the boundary. Observation at higher magnification clearly demonstrated that several axons derived from perikarya gathered to form nerve bundles showing a dendritic pattern. Proximal axons close to perikarya displayed beaded structures with intense immunoreactivity. They were electron-microscopically identified as swollen portions of axons which might be formed in association with the axonal flow. The present study showed that whole-mount preparation of the nasal mucosa for immunohistochemistry is a useful tool to analyze the morphology of olfactory receptor cells and axons.

Immunohistochemical study of p21WAF1 and p53 proteins in prostatic cancer and their prognostic significance

Mutations of p53 tumor suppressor gene occur in a subset of aggressive prostatic carcinomas and are detectable by immunohistochemistry. However, it is uncertain whether p53 overexpression really reflects p53 gene mutation or loss of p53 function. p21WAF1, an inhibitor of cyclin-dependent kinases, is activated by wild-type p53 protein, not by mutant type. Therefore, it is possible that combined analysis of p21WAF1 and p53 proteins aids in determining the functional status of p53 immunostaining. Routinely processed prostatic tissues from 60 patients with prostatic adenocarcinomas were examined by immunohistochemistry for p21WAF1 and p53 expression. As for tissue distribution, p21WAF1 protein was expressed mostly in the luminal layers, in contrast, p53 protein was restricted to the basal layers of benign prostatic glands. In prostatic adenocarcinomas, p21WAF1 protein was more likely to be expressed in well-differentiated areas; in contrast, p53 protein was more likely in poorly differentiated areas in the tumors. The percentage of positive nuclear areas for p21WAF1 and p53 proteins in prostatic adenocarcinomas, assessed by CAS200 computerized image analyzer, were 8.6+/-10% and 16+/-14% (mean+/-SE), respectively. The survival study showed that the p53+/ p21- phenotype showed poorer prognosis than p53+/p21+. Multivariate analysis showed that p21WAF1 expression, clinical stage, and Gleason score were independent prognosticators. In conclusion, p21WAF1 immunohistochemistry is a useful method for interpretation of p53 immunohistochemical results. Combined analysis by p21WAF1 and p53 immunostaining would predict the patient survival more accurately than p53 immunostaining alone.

Human Na(+)-myo-inositol cotransporter gene: alternate splicing generates diverse transcripts

Na(+)-myo-inositol cotransport activity generally maintains millimolar intracellular concentrations of myo-inositol and specifically promotes transepithelial myo-inositol transport in kidney, intestine, retina, and choroid plexus. Glucose-induced, tissue-specific myo-inositol depletion and impaired Na(+)-myo-inositol cotransport activity are implicated in the pathogenesis of diabetic complications, a process modeled in vitro in cultured human retinal pigment epithelium (RPE) cells. To explore this process at the molecular level, a human RPE cDNA library was screened with a canine Na(+)-dependent myo-inositol cotransporter (SMIT) cDNA. Overlapping cDNAs spanning 3569 nt were cloned. The resulting cDNA sequence contained a 2154-nt open reading frame, 97% identical to the canine SMIT amino acid sequence. Genomic clones containing SMIT exons suggested that the cDNA is derived from at least five exons. Hypertonic stress induced a time-dependent increase, initially in a 16-kb transcript and subsequently in 11.5-, 9.8-, 8.5-, 3.8-, and approximately 1.2-kb SMIT transcripts, that was ascribed to alternate exon splicing using exon-specific probes and direct cDNA sequencing. The human SMIT gene is a complex multiexon transcriptional unit that by alternate exon splicing generates multiple SMIT transcripts that accumulate differentially in response to hypertonic stress.

Microsurgical training with beads

To assist beginners in the microsurgical practices of handling instruments and tying knots before using an animal model, the authors suggest the use of colored beads. These beads will diminish eyestrain and secondary fatigue. Also, working with colored beads might be a little more amusing and enjoyable for beginners in learning microsurgical techniques during preliminary studies to achieve the necessary orientation for working under the operating microscope.

Species specificity of the anticoagulant activity of human urinary soluble thrombomodulin

The anticoagulant activities of human urinary soluble thrombomodulin (UTM) in blood taken from various species using several anticoagulant assay systems were compared; it was examined which coagulant assay system is appropriate for evaluation of the antithrombotic effects of UTM and how the species specificity of UTM is involved in the mechanisms of action of UTM. When anticoagulant activities were compared using activated partial thromboplastin time (APTT), thromboelastography (TEG), and thrombin generation test (TGT), the effect of UTM was found to be the strongest in humans among various species tested. Among the anticoagulant assays tested, TGT reflecting protein C (PC) activation by UTM, appeared to be more sensitive than APTT and TEG in detection of thrombomodulin activity. In the study of the mechanisms of action of UTM, UTM exhibited nearly the same antithrombin activity against human and rat thrombin; the rate of activation of human PC by thrombin/UTM complex was much higher than that of rat PC. Therefore, the species specificity of the anticoagulant activity of UTM may be attributable to thrombin/UTM-PC interaction, but not to UTM-thrombin interaction. From these results, we concluded that TGT reflecting PC activation by UTM will be a more useful assay than APTT and TEG for estimating the antithrombotic effects of UTM in humans. Furthermore, our findings suggest that UTM will exhibit more potent antithrombotic effects in humans than those in rats by strongly enhancing thrombin-catalyzed PC activation.

Thrombomodulin in human plasma contributes to inhibit fibrinolysis through acceleration of thrombin-dependent activation of plasma procarboxypeptidase B

Thrombomodulin (TM) expressed on endothelial cells binds thrombin and initiates anticoagulant pathways. Soluble functional proteolytic fragments of TM are also present in circulating plasma. Recently, it was reported that TM accelerated thrombin-dependent plasma procarboxypeptidase B (pro-pCPB) activation in a purified system and suggested that TM may inhibit fibrinolysis in crude plasma. The aim of present study was to evaluate any functional role of soluble TM fragments in plasma or purified TM added into plasma to the regulation of coagulation and fibrinolysis. Addition of rabbit TM (1-200 ng/ml) to plasma resulted in a concentration-dependent prolongation of urokinase (UK)- or tissue plasminogen activator (t-PA)-induced clot lysis time. The concentration of TM required for the inhibition of fibrinolysis was lower than that required for the inhibition of coagulation. Addition of anti-rabbit TM IgG or anti-human TM IgG into plasma reduced UK- or t-PA-induced clot lysis time without affecting clotting times, indicating that exogenous TM or soluble TM fragments in normal human plasma participated in regulation of fibrinolysis. Moreover, the TM-dependent inhibition of fibrinolysis was observed only in the presence of thrombin and blocked by addition of carboxypeptidase B inhibitors, but not mediated by protein C activation or direct inhibition of UK, t-PA or plasmin. Analysis of various substrates and inhibitors indicated that TM accelerated thrombin-dependent pro-pCPB activation in plasma. The present results indicate that TM, including soluble TM fragments in plasma, inhibit fibrinolysis via activation of pro-pCPB in plasma.

Ultrastructure of murine tumour cell lines defective in MHC class I expression before and after interferon-gamma treatment

Two tumour cell clones, 6D1 and 4C2 cells, which are defective both in the major histocompatibility gene complex (MHC) class I expression and in the endogenous antigen presentation, are recovered with interferon (IFN)-gamma treatment. The present study describes the ultrastructure of these cells by using scanning and transmission electron microscopy in relation to the effect of IFN-gamma treatment. The general morphology of these cells was found to be similar to each other and comparable to that of a tumour cell clone, 4A1 cells, of the same origin, normal in MHC class I expression; they exhibited a fibroblast-like appearance and had many blebs on all the cell surfaces, with desmosome-like junctions between cells. On IFN-gamma treatment, surface fine blebs appeared less, and mitochondria became more densely stained. Expression of MHC class I molecules on the cell surface was much higher in the IFN-gamma treated 6D1 and 4C2 cells than in untreated cells, when estimated by immunoelectron microscopy. The addition of an epitope peptide to these cells did not enhance the class I expression, which differed from other antigen presentation-defective cells such as RMA-S cells, nor change the cell surface morphology.

Binding of influenza and paramyxoviruses to Group B Streptococcus with the terminal sialyl-galactose linkage

Using the virus-binding assay and scanning electron microscopy (SEM), influenza A and B type viruses and two paramyxoviruses, parainfluenza (Sendai) and mumps viruses, were found to bind to Group B Streptococcus (GBS), type Ia and II, with the terminal sialyl-galactose linkage, although some viruses detached during the sample processing for SEM, and mumps virus did not bind to GBSIa. Binding of viruses eluted from GBS at 37 degrees C depended on combination of virus and GBS. The biological significance of these findings is discussed.

Cardiac angiosarcoma responding to multidisciplinary treatment

Early detection of cardiac angiosarcoma is usually difficult and the prognosis is very poor. We experienced a 32-year-old man with cardiac angiosarcoma who responded to multidisciplinary treatment with recombinant interleukin-2, postoperative chemotherapy (cyclophosphamide, vincristine, doxorubicin, Dacarbazine) and radiation. At 30 months after surgery, there was no evidence of recurrence or metastasis in spite of incomplete resection.

Combined analysis with Bcl-2 and P53 immunostaining predicts poorer prognosis in prostatic carcinoma

PURPOSE

The objective of the current study is to investigate the relationship between bcl-2 and p53 expression and prognosis in prostatic carcinoma.

MATERIALS AND METHODS

One hundred and forty-six needle core biopsy specimens obtained before any treatment were used for immunohistochemical detection of bcl-2 and p53 positivity. The relationship between these proteins was assessed by serial sections. Associations with Gleason score, clinical stage and patient survival were studied. Additionally, multivariate analysis by Cox proportional hazard model was used to determine the prognostic significance of these proteins.

RESULTS

Bcl-2 positivity was found in 20% and p53 in 27% of 146 prostatic carcinomas. Both bcl-2 and p53 positivity were found only in 5%. They were expressed almost reciprocally in the tumors. P53 positivity correlated with high Gleason grade tumors. Bcl-2 positivity correlated with high T stage. Both bcl-2 and p53 positivity correlated with poor survival and short progression-free period. Multivariate analysis revealed that bcl-2 positivity was an independent prognostic indicator (p = 0.001).

CONCLUSIONS

Bcl-2 and p53 were almost independently expressed in prostatic cancer. Both correlated with malignant phenotypes of prostatic cancer. The combined data from this staining further improved the ability to predict the patient prognosis.

[Antigenic epitopes of influenza virus specific CTL]

CTLs play an essential role in the protection to influenza virus infection. Virus specific CTLs recognize the complex of class I molecule and epitope peptide derived from viral proteins on surfaces of virus infected cells. In these 10 years great progress has been made in understanding of the process of epitope peptide production and the structure of the peptide. It has been clearly shown that proteasome and TAP are involved in the class I restricted antigen processing and epitope peptides have motifs depending on class I allele. In this article topics concerning CTL epitopes of influenza viruses are described; especially prediction and identification of epitopes are mainly discussed.

[Structure and function of influenza virus nucleoprotein (NP)]

Influenza virus nucleoprotein (NP) is the major structural protein which interacts with the 8 segment RNAs, to make the panhandle structure of RNPs, nucleocapsids, together with 3 polymerase protein complex (PB2, PB1, and PA). The NP proteins (498 aminoacids, MW 56,000) self-polymerize to form the panhandle structure similarly as the nucleocapsids. The nucleocapsids ensure the base pairing RNA structure in the handle region corresponding to the complementary structure in the both ends of vRNAs. This handle structure is supposed to play roles in regulation of switch for transcription and replication, and encapsidation. The NP protein is one of the type-specific antigens distinguishing among influenza A, B, and C type, and a target of cross-reactive CTL.

[Viremia in influenza: detection by polymerase chain reaction]

Gastroenteritis, arthralgia and myalgia are frequently associated with influenza virus infections in humans. One explanation for these symptoms may be that they are due to extra respiratory transmission of virus by viremia. We tried to detect genomic viral RNA of the nucleoprotein (NP) and H3 subtype hemagglutinin (HA) genes by method of RT-PCR in peripheral blood mononuclear cells (PBMC) of 18 children aged 1-14 who suffered from an influenza outbreak in the Kansai district of Japan between December 1992 and February 1993. Three of the 18 samples were RT-PCR positive. The NP gene sequence observed in one patient's PBMC was identical to that obtained from his throat swab fluid. The HA gene sequences observed in the two other PBMC differed from those of RT-PCR amplified DNA from throat swabs by an order of 3-9 nucleotides. Moreover we tried to isolate virus by co-culture with MDCK cells and RBC or WBC of the patients from an influenza outbreak between December 1993 and March 1994. No virus was isolated from 9 patients suffering from H3 subtype but virus was isolated from 5 of 17 patients suffering from type B influenza virus. We believe these results suggest that the viremia on influenza infection is not so rare.

[A case of hormone-refractory prostate cancer responsive to low-dose prednisolone therapy]

A 67-year-old man with hormone-refractory (stage D2) prostate cancer was admitted to the hospital because of general malaise and bone pain. The patient had been receiving hormonal therapy, which was discontinued after admission. Instead, 10 mg per day of prednisolone was administered orally. His symptoms improved, and the serum prostate specific antigen (PSA) level decreased markedly. After 18 weeks of treatment with prednisolone, the serum PSA level rose again, and bone pain worsened. The patient died of cancer one month later.

Human urinary soluble thrombomodulin (MR-33) improves disseminated intravascular coagulation without affecting bleeding time in rats: comparison with low molecular weight heparin

We compared the antithrombotic and hemorrhagic effects of naturally existing human urinary soluble thrombomodulin (MR-33) with those of low molecular weight heparin (LMW-heparin) in rats. In in vitro experiments, MR-33 prolonged APTT in a dose-dependent fashion; its effect in this respect was as potent as that of LMW-heparin, but it was less potent than unfractionated heparin (UF-heparin). MR-33 was effective on endotoxin- or thromboplastin-induced disseminated intravascular coagulation (DIC) in rats. In both DIC models, infusion of MR-33 improved hematological abnormalities compatible with DIC in a dose-dependent, fashion without excessive prolongation effect on APTT. Although LMW-heparin and UF-heparin also improved both DIC models, excessive prolongation of APTT was observed at high doses. It is well-known that the excessive prolongation of APTT with antithrombotic drugs like heparins is an index for hemorrhage, which is a major side effect in the treatment of DIC. We therefore further compared the antithrombotic (Benefit: dose required for 50% inhibition of fibrinogen decrease: ED50) and hemorrhagic (Risk: minimum dose required for significant prolongation of bleeding time) effects of MR-33 and LMW-heparin in the thromboplastin-induced DIC model. As a result, Benefit-Risk ratio was 1:27 for MR-33 and 1:3 for LMW-heparin. These results indicate that MR-33 may be a clinically useful antithrombotic agent with reduced risk for hemorrhage compared with LMW-heparin.

Detection of influenza virus RNA in peripheral blood mononuclear cells of influenza patients

Gastroenteritis, arthralgaia and myalgia are frequently associated with influenza virus infections in humans. One explantation for these symptoms may be extrarespiratory transmission of virus by peripheral blood mononuclear cells (PBMC). We tried to detect genomic viral RNA of the nucleoprotein (NP) and H3 subtype hemagglutinin (HA) genes by the method of RT-PCR in PBMC of 18 children aged 1-14 who suffered from an influenza outbreak in the Kansai district of Japan between December 1992 and February 1993. Three of the 18 samples were RT-PCR positive. The NP gene sequence observed in one patient's PBMC was identical to that obtained from his throat swab fluid. The HA gene sequences observed in the two other PBMC differed from those of RT-PCR-amplified DNA from throat swabs by an order of 3-9 nucleotides. We believe these results suggest the presence of a PBMC-associated virus.

Responses of peri-implant tissues to undisturbed plaque formation in dogs: clinical, radiographic, and microbiological findings

The present investigation evaluated the clinical and microbiological effects of long-term undisturbed plaque formation on peri-implant tissues. Four mongrel dogs were used in the study. The mandibular 3rd and 4th premolars were extracted. Three months later, four Brånemark implants (BR, n = 8) or Integral implants (IN, n = 8) were placed in the edentulous area of each dog. After another 3 months, an abutment connection was performed. Plaque control regiment was maintained for 30 days until the superstructure was placed (Day 0: baseline). Then the plaque control program was terminated to allow gross plaque accumulation. Clinical, radiographical and microbiological data were recorded at the baseline, and at 90 and 180 days after the termination of the plaque control. Values for the clinical indices such as probing depth, plaque index and bleeding on probing increased at day 90 on both the implant and tooth sites, and remained unchanged at day 180. Significantly more implant sites showed bleeding on probing than did tooth sites. Neither implants nor tooth sites showed clinically significant changes in mobility. No distinct bone resorption was observed over time by radiography. In microscopic morphological observations, cocci dominated at the baseline, and decreased by day 180, while the proportion of motile bacteria increased. In a culture study, black-pigmented anaerobic rods, which consisted predominantly of Porphyromonas gingivalis-like bacteria, were consistently found from the baseline to day 180. No Actinobacillus actinomycetemcomitans-like organisms were isolated. These results indicate that, although the long-term plaque accumulation did not cause marked periodontal destruction, the peri-implant tissue may be more susceptible to plaque accumulation than the periodontal tissue, and that teeth may serve as a reservoir for the bacterial colonization of the implant sulcus.

A case of congenital ectopic nails on bilateral little fingers

Congenital ectopic nails are a rare anomaly, but we observed a case of a 43-year-old woman with ectopic nails at the tips of her bilateral little fingers. On X-ray, the distal phalanx of the each little finger appeared depressed. We surgically removed the ectopic nails. One year and 6 months later, no relapse had occurred. The histopathological examination revealed undifferentiated nail tissue including nail, nail matrix, and nail epithelium.