Surgical removal of giant basal ganglia arteriovenous malformations through the extended transsylvian approach following preoperative embolization--two case reports

A 12-year-old boy and a 22-year-old male presented with sudden onset of consciousness disturbance with right-sided hemiparesis and aphasia due to massive intracerebral hemorrhage from giant striocapsular arteriovenous malformations (AVMs). Angiography revealed giant AVMs located at the left basal ganglia in both patients. Large frontotemporal craniotomies were performed following staged embolization of the feeding arteries. Through an extended transsylvian approach, the lesions were totally excised with confirmation using intraoperative digital subtraction angiography. The patients showed a transient postoperative worsening of symptoms, but recovered to their preoperative status at discharge. Motor functions of the right upper and lower extremities were graded 4/5 in both patients. These cases demonstrate that combined use of preoperative embolization and intraoperative angiography allows some giant deep AVMs to be resected with encouraging results.

[The founders of neurology. Moritz Heinrich Romberg and Hiroshi Kawahara]

Moritz Heinrich Romberg was born on November 11, 1795 in Meiningen, Thüringen, Sachsen (Germany at present). He had completed his medical studies at Berlin. He was greatly influenced by Johann Christian Reil at the University of Berlin, Johann Peter Frank in Wien, and Christoph Wilhelm Hufeland, the director of das Königliche Poliklinische Institut, Charité Krankenhaus of the University, and devoted himself to the study of nervous diseases. Romberg can be looked on as the first great neurologist in the modern sense of the word, because he began the neurological propaedeutics in Berlin, and published the first systematic book on neurology. The year 1995 is the bicentennial anniversary of his birth. Hiroshi Kawahara was born at Ohmura, Nagasaki, in 1865. His medical studies were pursued at the University of Tokyo under the guidance of Prof. Elwin von Baelz. He was the first neurologist in Japan, to give particular attention to the neurological diseases. In 1897, Kawahara described two brother cases belonging to a family suffering from muscle atrophy, and characterized it as having sex-linked recessive inheritance, adult onset, prominent fasciculation of the tongue and four limbs, and relatively benign course of illness. The Kawahara's paper on this familial disease later known as "bulbo-spinal muscle atrophy" or "Kennedy-Alter-Sung disease" is the first description in the world. The textbook written by him in 1897 is the first publication dealing with a variety of diseases of the nervous system in Japan.

Distribution of neuronal cytoplasmic inclusions in multiple system atrophy

Neuronal cytoplasmic inclusions (NCIs) were demonstrated by means of silver staining (Gallyas staining) in the central nervous systems of 18 deceased patients with multiple system atrophy (MSA) - 6 with olivopontocerebellar atrophy (OPCA), 6 with striatonigral degeneration (SND) and 6 with Shy-Drager syndrome (SDS). We observed NCIs in the cerebral cortex, putamen, pons, medulla oblongata and spinal cord, and especially in the putamen and pons of all cases with MSA. No NCIs were observed in the cerebellum and midbrain. The findings were common to all 3 subtypes of MSA. NCIs were not present in patients with other neurodegenerative disorders and non-neurological disorders. Our findings indicate that NCIs represent a special neuronal alteration characteristic of MSA and support the theory that OPCA, SND and SDS represent manifestations of a single condition i.e. MSA.

Malignant intestinal schwannoma: a case report and a review of the literature in Japan

We report the rare case of malignant intestinal schwannoma, not accompanied with von Recklinghausen's disease. The main tumor was located in the ileum with multiple small tumors observed on the peritoneum. Histologically the tumor was composed of spindle cells exhibiting a nuclear palisading formation and abnormal mitotic figures were observed. The tumor was immunohistochemically positive for S-100 protein, glial fibrillary acidic protein, vimentin and neuron-specific enolase, but negative for desmin. Electron microscopically the tumor cell exhibited morphological findings characteristic of schwann cell differentiation. On the basis of these results, the tumor was diagnosed as malignant schwannoma occurring in the ileum.

Dog liver microsomal P450 enzyme-mediated toluene biotransformation

1. We studied toluene metabolism in dog liver microsomes and the major metabolite was benzyl alcohol with o- and p-cresol as minor metabolites. 2. The enzyme kinetics of toluene biotransformation were examined by means of Lineweaver-Burk analyses. The Michaelis-Menten values differed among the three pathways, the order being; Km, o-cresol > p-cresol > benzyl alcohol; Vmax, benzyl alcohol > o-cresol > p-cresol; and Cl(int), benzyl alcohol > p-cresol > o-cresol. 3. The formation of benzyl alcohol, o- and p-cresol from toluene was substantially inhibited by the P4502E inhibitors such as DDC (diethyldithiocarbamate) and 4-methylpyrazole in all pathways, with IC50's in the range of 0.02-0.59 mM. The P4502B inhibitors, metyrapone and secobarbital also inhibited benzyl alcohol and p-cresol formation, whereas o-cresol was not inhibited by these latter compounds. 4. Anti-rat P4502E1 antibodies inhibited benzyl alcohol, o- and p-cresol formation from 26 to 30% 0.2 ml serum/mg microsomal protein. Furthermore, anti-rat P4502B1/2 antibody inhibited benzyl alcohol and p-cresol formation (47 and 44% respectively), but not that of o-cresol. Anti-rat P4502C11/6 antibody also inhibited benzyl alcohol and p-cresol formation 31 and 24% respectively in a similar manner to that by the anti-rat P4502B1/2 antibody. 5. These results suggested that the P4502B, 2C and 2E isozymes in dog liver contribute to the formation of benzyl alcohol and p-cresol from toluene, and 2E isozyme preferentially contributes to the formation of o-cresol.

PACAP stimulates catecholamine release from adrenal medulla: a novel noncholinergic secretagogue

The secretory response of the adrenal medulla to pituitary adenylate cyclase-activating polypeptide (PACAP), a novel polypeptide with 68% structural homology to vasoactive intestinal polypeptide (VIP), was investigated in anesthetized rats by in vivo microdialysis. The injection of PACAP (1.5 nmol) caused a greater amount of increase in catecholamine concentration than carbachol (30 nmol) or VIP (30 nmol) in the dialysate for a period of 60 min. The ratios of norepinephrine to epinephrine in the dialysate after stimulation with these compounds showed no change from resting conditions. The simultaneous application of both nicotinic and muscarinic antagonists (10 mM mecamylamine and 1 mM atropine) eliminated the increase in catecholamine secretion induced by carbachol. In contrast, PACAP-induced catecholamine secretion was not inhibited by these cholinergic antagonists. These data led to the following conclusions: 1) PACAP was more potent than either carbachol or VIP in enhancing the secretion of catecholamine from the adrenal medulla, and 2) PACAP-induced catecholamine secretion was due to the direct action of PACAP on the adrenal medulla rather than an indirect action mediated by acetylcholine release. These results strongly suggest that PACAP is a noncholinergic secretagogue of the adrenal medulla in rats.

Alterations of effector cell molecule expression on neutrophils in granulocyte colony-stimulating factor-producing tumour

A 68-year-old man was diagnosed as having a granulocyte colony-stimulating factor (G-CSF)-producing mediastinal tumour. Mediastinotomy was performed, and thereafter the elevated leucocyte count and serum G-CSF concentration returned to the normal range. The surface expression of effector cell molecules on neutrophils was serially examined. Before operation, the expression of FcRI and CR1 was increased but the expression of FcRIII and L-selectin was reduced in the patient. The altered expression of these molecules returned to the normal levels after operation. These findings suggest that G-CSF produced by the tumour modulated neutrophil effector cell molecule expression in the patient.

Clinical and angiographic follow-up of childhood-onset moyamoya disease

To clarify the differences between childhood-onset moyamoya disease and that with onset in adulthood, we studied the clinical course and angiographic findings of adult patients (over 20 years of age) with moyamoya disease of childhood onset (up to 15 years of age). The clinical course in 25 patients could be assessed. The follow-up period was 5-27 years. Neurological deficits were noted in 11/23 and mental disorders in 9/21. In all except one, the illness had started before the age of 7 years. Neither neurological nor mental condition changed during or after adolescence (15-20 years of age). Two patients died of intracranial hemorrhage. The disease progressed in angiographic stage until adolescence, but had stabilized or almost stabilized by the age of 20 years. This study indicates that moyamoya disease with onset in childhood carries high morbidity and mortality. The disease advances in angiographic stage between childhood and adolescence, but stabilizes or almost stabilizes between adolescence and adulthood.

[Undifferentiated connective tissue syndromes (UCTS) accompanied by laryngeal involvement and autoimmune hepatitis]

Here we report a patient with undifferentiated connective tissue syndromes (UCTS) who developed hoarseness during exacerbation of autoimmune hepatitis. A 51-year-old woman was hospitalized in November 1993 because of hoarseness and liver dysfunction. She had demonstrated Raynaud's phenomenon, polyarthralgia and hoarseness since 1992. In August 1993, liver dysfunction was noted. On admission, laboratory data showed mild leukopenia, thrombocytopenia (WBC 3,900/mm3, platelet 12.4 x 10(4)/mm3), and elevations of transaminase (GOT 96 IU/l, GPT 79 IU/l) and IgG (4,556 mg/dl). Anti-nuclear antibody (ANA) and anti-smooth muscle antibody were positive. Other autoantibodies including anti-DNA antibody, anti-Scl 70 antibody were all negative. LE test and LE cells were also negative. On laryngoscopic examination, lesions that appeared similar to a bamboo-joint were noted at the middle of the bilateral vocal cords. Pathological findings of liver biopsy specimen were compatible with autoimmune hepatitis. She was treated with 30 mg of prednisolone. Polyarthralgia, hoarseness and the abnormalities of the transaminase levels improved rapidly. Laryngoscopic findings were also normalized. We considered this laryngeal involvement to be acute laryngitis accompanied by some UCTS, including a typical systemic lupus erythematosus (SLE) because of arthritis, cytopenia and ANA positivity. Involvement of the larynx in collagen disease is rarely mentioned in published reports.

Delayed gastric emptying in a neonate, associated with a partial defect in the gastric smooth muscle

A girl born after 36 weeks' gestation had emesis 15 hours after birth. She required total parenteral nutrition (TPN) because of persistent gastric retention. When milk was given, the volume of gastric aspirate 3 hours after feeding often was greater than the volume given. Domperidon and erythromycin were ineffective. Upper gastrointestinal series showed slow gastric emptying but no abnormalities in the stomach. No stenosis or obstruction below pylorus was found. Endoscopy showed normal gastric mucosa. Manometry showed normal antroduodenal motility patterns. Transpyloric feeding, which started at age 73 days, was successful and enabled cessation of the TPN. Laparotomy at 119 days of age showed partial absence of the muscle and serosal layer in the anterior wall of the gastric body (1 x 4 cm). The mucosal layer was intact and partly adhered to the peritoneum and the left lobe of the liver. The defect was surgically corrected by plicating the place. The postoperative course was excellent, and oral feeding was fully established within 2 weeks. Although the cause of the partial muscle defect in the case is unclear, this case suggests that this rare condition can cause severe chronic gastric retention.

[Acquired amylase production induced by radiotherapy in a myeloma patient]

A 55-year-old patient with multiple myeloma (IgG-lambda) diagnosed in November 1988 was admitted because of bone pain throughout the body. After plasmapheresis and several courses of chemotherapy, a massive tumor of the left thoracic wall involving the rib appeared. Radiotherapy was performed to ameliorate the severe chest pain, after which myelomatous pleural effusion appeared on the left side. The serum, urine and pleural effusion revealed increased activity of amylase of the salivary type. Amylase activity was also detected in the supernatant of myeloma cells cultured from pleural effusion. We reviewed 12 cases of ectopic amylase-producing multiple myeloma. All the cases except one have been reported from Japan, and hyperamylasemia in these cases was detected at diagnosis or during course of the illness. Moreover, cytogenetic analysis of myeloma cells of previous reports revealed structural abnormalities including chromosome 1, near the amylase gene locus. This case also showed t (1; 10) (q 21?; q 26) by examination of 8 metaphase derived from bone marrow. These observations suggested that ectopic amylase production was induced by irradiation to the plasmacytoma of thoracic wall.

Studies of the lamin proteinase reveal multiple parallel biochemical pathways during apoptotic execution

Although specific proteinases play a critical role in the active phase of apoptosis, their substrates are largely unknown. We previously identified poly(ADP-ribose) polymerase (PARP) as an apoptosis-associated substrate for proteinase(s) related to interleukin 1 beta-converting enzyme (ICE). Now we have used a cell-free system to characterize proteinase(s) that cleave the nuclear lamins during apoptosis. Lamin cleavage during apoptosis requires the action of a second ICE-like enyzme, which exhibits kinetics of cleavage and a profile of sensitivity to specific inhibitors that is distinct from the PARP proteinase. Thus, multiple ICE-like enzymes are required for apoptotic events in these cell-free extracts. Inhibition of the lamin proteinase with tosyllysine "chloromethyl ketone" blocks nuclear apoptosis prior to the packaging of condensed chromatin into apoptotic bodies. Under these conditions, the nuclear DNA is fully cleaved to a nucleosomal ladder. Our studies reveal that the lamin proteinase and the fragmentation nuclease function in independent parallel pathways during the final stages of apoptotic execution. Neither pathway alone is sufficient for completion of nuclear apoptosis. Instead, the various activities cooperate to drive the disassembly of the nucleus.

Rapid isolation of cell-type-specific protein tyrosine kinases by degenerate polymerase chain reaction combined with differential hybridization technique

To identify protein tyrosine kinase (PTK) genes preferentially expressed in renal cell carcinoma cell line, we screened a PTK-cDNA-enriched library constructed from RNA of an renal cell carcinoma cell line with a PTK probe, each produced from renal cell carcinoma, gastric cancer or esophageal cancer cell lines by degenerate polymerase chain reaction. Two cDNA fragments of PTK genes, FRK and FLT-3, were isolated from the PTK-cDNA-enriched library of the renal cell carcinoma cell line by differential hybridization technique. The FRK cDNA clone represented 15.8% of the PTK-cDNA-enriched library from the renal cell carcinoma cell line, while the FLT-3 cDNA clone was 2.8% of the same library. Both of the two PTK genes were expressed preferentially in renal cell carcinoma cell lines. This method, described here, is useful for the rapid isolation of PTK cDNA fragments, including a low abundant cDNA, preferentially expressed in a specific cell line.

[Renal autotransplantation for dissecting aneurysm]

Out of twenty-five patients operated on for dissecting aneurysm in our institution since January 1991, four patients had autotransplantation of the kidney. The renal autotransplantation and the segmental replacement of the descending aorta with the prosthesis were done at the same time in three of them, and segmental replacement of the distal aortic arch was followed by autotransplantation because of the postoperative acute renal failure in the other one. Postoperative renal function of simultaneously operated patients was good whereas the patient who had been treated by two-staged operation needed hemodialysis for two weeks after the autotransplantation. Postoperative scintigraphy showed fully recovered function of the autotransplanted kidneys with enlargement. CT scan showed that the false lumen of the dissecting aorta was reduced in size with increased intraluminal clot formation. Renal autotransplantation with entry closure is easy and safe technique and assures successful operative results for the dissecting aneurysm, restoring impaired renal blood flow.

Evaluation of large intracranial aneurysm with three-dimensional MRI

OBJECTIVE

The purpose of this study was to evaluate large intracranial aneurysms by contrast-enhanced 3D MRI.

MATERIALS AND METHODS

Eleven patients, nine women and two men, were examined. The aneurysms involved the internal carotid artery in seven patients, the middle cerebral artery in one, the basilar artery in two, and the posterior cerebral artery in one. Contrast-enhanced 3D MR images were obtained using FLASH (fast low angle shot) on a 1.5 T system. We obtained axial images first, then sagittal and coronal images by multiplanar reconstruction. Those images were reviewed for comparison with conventional and MR angiography.

RESULTS

We could easily evaluate the true aneurysmal size, the intraaneurysmal constitution (patent lumen and intraluminal thrombus), and the detailed relationship of the aneurysm to the surrounding vascular and neural structures. Except for the cavernous internal carotid artery, we could identify the aneurysmal neck by carefully observing axial, sagittal, and coronal images. In addition, the progression of intraaneurysmal thrombosis and the patency of the parent arterial lumen after the endovascular treatment were well appreciated.

CONCLUSION

We consider that 3D MRI appears to be useful for evaluation of the large intracranial aneurysm.

Accumulation of mutant p53 and hsp72 by heat treatment, and their association in a human glioblastoma cell line

The cellular content of mutant p53 and hsp72 proteins following gamma-ray irradiation, UV irradiation, and heat treatment was studied in A-7 cells, a human glioblastoma cell line. A-7 was found to contain a mutant p53 gene in which the arginine codon at position 175 was substituted by a histidine codon. Although the p53 gene was mutant, the phenotype of the p53 protein appeared wild-type since the cellular content of the p53 protein was limited under normal culturing conditions. The quantity of mutant p53 and hsp72 proteins in A-7 was increased by heat treatment as well as gamma-ray and UV irradiation. Furthermore, the mutant p53 protein was coimmunoprecipitated with anti-hsp72/hsc73 antibody. Additionally, hsp72 and hsc73 were coimmunoprecipitated with anti-p53 antibody. These results suggest that in A-7, p53 protein accumulation may be caused as a result of response to stressors, such as gamma-ray, UV and heat and that mutant p53 protein and hsp72/hsc73 may manage biological functions cooperatively after gamma-ray, UV and also heat treatments.

Compensation of multi-dimensional selective excitation pulses using measured k-space trajectories

Multidimensional spatially selective excitation pulses rely on the accuracy of gradient waveforms to achieve desired excitation volumes. Unfortunately, the high gradient slew-rates and magnitudes required by these pulses often lead to distortion of the waveforms produced by imaging systems resulting in poor selection profiles. In this paper, a k-space calibration procedure, used to determine the actual trajectory produced by the scanner's field gradients, is extended to two spatial dimensions. This measured information is then incorporated in a selective excitation design technique for correcting the RF pulse envelopes to compensate for gradient waveform induced distortion of the excitation volumes.

Isolation and characterization of melanotropins from lamprey pituitary glands

Three peptides containing the melanotropin-core amino-acid sequence, YXMXHFRWG, were isolated from the pituitary glands of a modern representative of the most primitive vertebrates, the sea lamprey, Petromyzon marinus. MSH-A, a nonadecapeptide (NPELYQMNHFRWGQPPTHF), is free at both ends. MSH-B, an eicosapeptide (VQESADGYRMQHFRWGQPLP), is free at the N-terminus and amidated at the C-terminus. They differ strikingly from gnathostome MSHs in structure. The third peptide, with an apparent molecular weight of 15 kDa, was tentatively designated lamprey ACTH, based on a structural feature: the N-terminal 22-residue-MSH (SVSSPKYAMGHFRWGSPDKATI) is followed by four consecutive basic amino acids (RKRR) and a ACTH-like sequence (PVRPNTSDSPEIPDYAF--). MSH-B is 10 and 100 times more potent than alpha-MSH and MSH-A, respectively, in a frog skin assay in vitro, whereas the lamprey ACTH showed no melanotropic activity. Lamprey ACTH did, however, show corticotropic activity on the lamprey pronephric and mesonephric tissue.

Activation induces dephosphorylation of cofilin and its translocation to plasma membranes in neutrophil-like differentiated HL-60 cells

We suggested that a cytosolic 21-kDa phosphoprotein played an important role in opsonized zymosan-trigered activation of superoxide-generating enzyme in neutrophil-like HL-60 cells through dephosphorylation (Suzuki, K., Yamaguchi, T., Oshizawa, T., Yamamoto, Y., Nishimaki-Mogami, T., Hayakawa, T., and Takahashi, A (1995) Biochim. Biophys. Acta 1266, 261-267). In the present study, we characterized the phosphoprotein and studied changes in it localization upon activation of phagocytes. The 21-kDa phosphoprotein was rapidly dephosphorylated upon activation not only wit opsonized zymosan but also with formyl-Met-Leu-Phe and arachidonic acid. The peptide fragments derived from the 21-kDa phosphoprotein were found to have the same amino acid sequences as those of cofilin, an actin-binding protein. The phosphoprotein reacted exclusively with anti-cofilin antibody on two dimensional immunoblots. Accordingly, together with its apparent molecular weight, isoelectric point, and detection of phosphoserine as a phosphoamino acid, we concluded that the 21-kDa phosphoprotein was a phosphorylated form of cofilin. The amount of cofilin in membranous fractions was increased upon activation. Furthermore, confocal laser scanning microscopy showed that cofilin existed diffusely in the cytosol and nuclear region of the resting cells, while in the activated cells, it was accumulated at the plasma membrane area, forming ruffles or endocytic vesicles on which O2.- should be produced. These results suggested that in resting cells cofilin exists as a soluble phosphoprotein in the cytosol and nuclei, while upon stimulation a large portion of cofilin is dephosphorylated and translocated to the plasma membrane regions.

Melanotropin and corticotropin are encoded on two distinct genes in the lamprey, the earliest evolved extant vertebrate

In the lamprey, which is a member of the oldest extant class of vertebrates, the agnathans, melanotropins (MSH) and corticotropin (ACTH) were found to be encoded on two distinct genes. In all other vertebrates, a single precursor gene, proopiomelanocortin (POMC), encodes MSH and ACTH, as well as beta-endorphin (END). Two different cDNAs were cloned from a lamprey pituitary lambda gt11 cDNA library using antisera against lamprey MSH-B and ACTH(1-16). One cDNA encoded MSH-B, MSH-A and beta-END, while the other cDNA encoded nasohypophysial factor (NHF), ACTH and a different beta-END, but not MSH-A and MSH-B. Northern blot analysis demonstrated that in the adult lamprey pituitary, genes for MSH and ACTH are expressed in the pars intermedia (PI) and pars distalis (PD), respectively.

Compressive and bone-bonding strength of hydroxyapatite thermal decomposition product implanted in the femur of rabbit as a bioactive ceramic bone cement

Hydroxyapatite thermal decomposition product (HATDP) after mixing with water was injected into the femur of rabbits, and its biocompatibility, compressive strength and bone-bonding strength were investigated. The compressive strength of a block of HATDP was 56.0 MPa 4 weeks after injection, which was about 60% of that of poly(methyl methacrylate) (PMMA) cement. The bone-bonding strength was 8.2 MPa 4 weeks after injection, which was significantly higher than that of PMMA cement. HATDP seems to be useful as a cement material because of its good bone-bonding property and relatively high mechanical strength.