[Characterization of prostate cancer, benign prostatic hyperplasia and normal prostates using endorectal 1H magnetic resonance spectroscopy]

BACKGROUND

We evaluate the usefulness of 1H endorectal resonance spectroscopy to characterize prostate pathology.

METHODS

With an endorectal surface coil we have studied 20 individuals with normal (1), benign hyperplastic (9) and malignant (10) prostates.

RESULTS

The major findings of our studies were that the patients with cancer have a significantly lower citrate-to-choline ratio (cit/cho) and creatin-to-choline ratio (cre/cho) than the patients with BPH (p < 0.05). There is well correlation between cit/cho and gland-to-stroma ratio of the BPH tissue as well as histological grade of the cancer tissue. 1H spectroscopy offers the advantages of differential diagnosis between benign and malignant prostates. We, however, failed to demonstrate cancer in 2 cases; the lesion was too small in one case, and out of the region of interest in the other. It is necessary that the foci in the prostate is at least 1.5 X 1.5 X 1.5 cm3 of the volume in order to obtain genuine spectrogram of carcinoma.

CONCLUSION

Endorectal 1H magnetic resonance spectroscopy can characterize metabolic differences between the normal and malignant prostate.

Fluid attenuated inversion recovery (FLAIR) imaging in acute Wernicke encephalopathy

We report a case of Wernicke encephalopathy in which the FLAIR sequence could reveal involvement of the mammillary bodies. FLAIR imaging was useful in monitoring the lesions as well as in diagnosing Wernicke encephalopathy.

[Phase 3 multicenter clinical study of 111In-DTPA-D-octreotide (MP-1727) in patients with gastrointestinal hormone producing tumors]

A phase 3 multicenter clinical study was performed to investigate the efficacy, safety and usefulness of MP-1727, a novel tumor imaging agent which binds to somatostatin receptors, in 23 patients with gastrointestinal hormone producing tumor. The efficacy was graded effective or very effective in 16 cases (76.2%) out of 21 cases who could be evaluated. Positive predictive accuracy was 77.8% (7/9) for carcinoids, 100% (5/5) for gastrinomas and 40.0% (2/5) for insulinomas. In three cases, tumor lesions which had been unknown were detected by MP-1727 scintigraphy. The consistent ratio between scintigraphically positive sites and preinjection localizations was 82.0% (41/50 sites) in total. Although adverse drug reactions were observed in two cases, the safety was graded 'not problematic at all' in all of 23 cases. These results show that MP-1727 is a very useful radiopharmaceutical for detection and localization of gastrointestinal hormone producing tumors.

Neuronal localization of CD38 antigen in the human brain

CD38 is a lymphocyte differentiation antigen which is involved in the cyclic ADP-ribose-mediated second messenger system. We provide immunochemical and immunohistochemical evidence for the expression of CD38 in the adult human brain. We used six polyclonal antibodies against synthetic CD38 polypeptides, in addition to four monoclonal antibodies already available. Brain CD38 was detectable by Western blotting after immunoaffinity purification of the brain extracts. Immunoperoxidase staining localized CD38 immunoreactivity to the perikarya and dendrites of many neurons, such as the cerebellar Purkinje cells, implying that CD38 is involved in the signal transduction within the central nervous system neurons.

Preparation of soluble recombinant T cell receptor alpha chain by using a calmodulin fusion expression system

We have isolated a full length T cell receptor alpha chain (TCR alpha) cDNA derived from a bee venom phospholipase A2-specific mouse suppressor T cell hybridoma. A bacterial fusion expression system was constructed using rat calmodulin as a fusion partner for production of soluble TCR alpha. In this system, calmodulin-TCR alpha fusion protein was expressed at a high level in the soluble fraction of bacterial cell lysate, and could be purified by binding of calmodulin portion of the protein to phenyl-Sepharose. Using this system, fusion proteins containing a TCR alpha peptide corresponding to the complete extracellular region, V alpha-J alpha region or C alpha extracellular region were isolated. TCR alpha peptides were then released from the fusion proteins by digestion with thrombin which recognizes a linker sequence between calmodulin portion and TCR alpha segment. Polyclonal antibodies against constant region of TCR alpha chain (C alpha) were obtained by immunization of rabbits with the recombinant C alpha peptide. ELISA for TCR protein was established by using the polyclonal antibodies and the monoclonal antibody specific for C alpha region.

Toxicity of dioxins: role of an absolute hardness-absolute electronegativity diagram (eta-chi diagram) as a new measure in risk assessment

The differences in biological activities among polychlorinated dibenzo-p-dioxins (dioxins) are strongly dependent on the substitution pattern of chlorine at various positions on the parent dibenzo-p-dioxin molecule. The absolute hardness, eta, of dioxins shows a good correlation with the potency of biological activity and the chlorine substitution pattern. The result means that the soft dioxins have a small HOMO-LUMO gap, and are more toxic than the hard dioxins. Therefore, the values of absolute hardness, eta, of dioxins can be used to predict their toxic potency (dioxin hardness). Moreover, we show that the absolute hardness-absolute electronegativity (eta-chi) diagrams, as an activity coordinate, play an important role as a new measure in the assessment of the toxicity and potency of the biological activity of dioxins.

[Bone mineral density of the lumbar spine and its relation to biological and lifestyle factors in middle-aged and aged Japanese women (Part 3). Relationships of physical fitness and lifestyle factors to bone mineral density in premenopausal and postmenopausal women]

We recruited community-dwelling women for participation in a study to investigate the effects of risk factors in lifestyle on bone mineral density (BMD). The subjects were 177 women aged 35 years and over living in a rural area in Fukui Prefecture. Their BMD of the lumbar spine (L2-L4) was determined by dual energy X-ray absorptiometry (DXA). In addition to measurements of height, body weight and grip strength, the lifestyles of the women, including physical load in work, sporting activities, smoking habits, calcium intake, and history of bone fracture were interviewed in detail. Adjusted for age, the BMD significantly correlated to body weight (r = 0.337, p < 0.05 for premenopausal women and r = 0.289, p < 0.01 for postmenopausal women) and body mass index (kg/m2) (r = 0.291, p < 0.05 for premenopausal women and r = 0.190, p < 0.05 for postmenopausal women). These results indicated the lower body weight to be a risk factor for the osteoporotic process in middle-aged and aged women. With respect to the grip strength as a physical fitness indicator, a significant correlation coefficient (r = 0.267, p < 0.01) with BMD was obtained for postmenopausal women independent of age and body weight. In univariate analysis, BMD showed no significant correlations with sporting activities, smoking habits, lower back pain and history of bone fracture for either premenopausal women or postmenopausal women.(ABSTRACT TRUNCATED AT 250 WORDS)

Cloning and sequence of the gene encoding a cefotaxime-hydrolyzing class A beta-lactamase isolated from Escherichia coli

Escherichia coli TUH12191, which is resistant to piperacillin, cefazolin, cefotiam, ceftizoxime, cefuzonam, and aztreonam but is susceptible to cefoxitin, latamoxef, flomoxef, and imipenem, was isolated from the urine of a patient treated with beta-lactam antibiotics. The beta-lactamase (Toho-1) purified from the bacteria had a pI of 7.8, had a molecular weight of about 29,000, and hydrolyzed beta-lactam antibiotics such as penicillin G, ampicillin, oxacillin, carbenicillin, piperacillin, cephalothin, cefoxitin, cefotaxime, ceftazidime, and aztreonam. Toho-1 was markedly inhibited by beta-lactamase inhibitors such as clavulanic acid and tazobactam. Resistance to beta-lactams, streptomycin, spectinomycin, sulfamethoxazole, and trimethoprim was transferred by conjugational transfer from E. coli TUH12191 to E. coli ML4903, and the transferred plasmid was about 58 kbp, belonging to incompatibility group M. The cefotaxime resistance gene for Toho-1 was subcloned from the 58-kbp plasmid by transformation of E. coli MV1184. The sequence of the gene for Toho-1 was determined, and the open reading frame of the gene consisted of 873 or 876 bases (initial sequence, ATGATG). The nucleotide sequence of the gene (DDBJ accession number D37830) was found to be about 73% homologous to the sequence of the gene encoding a class A beta-lactamase produced by Klebsiella oxytoca E23004. According to the amino acid sequence deduced from the DNA sequence, the precursor consisted of 290 or 291 amino acid residues, which contained amino acid motifs common to class A beta-lactamases (70SXXK, 130SDN, and 234KTG). Toho-1 was about 83% homologous to the beta-lactamase mediated by the chromosome of K. oxytoca D488 and the beta-lactamase mediated by the plasmid of E. coli MEN-1. Therefore, the newly isolated beta-lactamase Toho-1 produced by E. coli TUH12191 is similar to beta-lactamases produced by K. oxytoca D488, K. oxytoca E23004, and E. coli MEN-1 rather than to mutants of TEM or SHV enzymes. Toho-1 has shown the highest degree of similarity to K. oxytoca class A beta-lactamase. Detailed comparison of Toho-1 with other beta-lactamases implied that replacement of Asn-276 by Arg with the concomitant substitution of Thr for Arg-244 is an important mutation in the extension of the substrate specificity.

Dermal histology of hairless rat derived from Wistar strain

The dermal histology of 9-week-old hairless rats derived from Wistar rats was investigated and compared with that of age-matched Wistar rats. Skin samples were taken from 4 portions: the head, dorsal and ventral skin, and foot pad. The epidermis of the 3 portions other than the foot pad was thicker in hairless rats than in Wistar rats. The hair canals of hairless rats contained lamellar cornified tissues instead of hair, and some of the hair follicles deep in the dermis exhibited cyst formation. S-100-immunoreactive cells were detected in the basal layer of epidermis and their number in hairless rats was greater than that in Wistar rats. Ultrastructurally, electron-lucent cells, i.e. Langerhans cells, which contained Birbeck granules and/or cored tubules, were observed more frequently in the epidermis of hairless rats than in that of Wistar rats. Some cells in one hairless rat, which had similar characteristics to Langerhans cells without Birbeck granules, contained confronting cisternae.

Ultrastructure of the dorsal skins of hairless descendants derived from Mexican hairless dogs

Ultrastructural characteristics of the dorsal skin of hairless descendants derived from Mexican hairless dogs (3-month-, 1-year- and 5-year-old) were investigated and compared with those of age-matched beagles. Except that beagles had no melanocytes in epidermis, there was no essential difference in ultrastructural characteristics of epidermis between hairless dogs and beagles. In the Stratum basale of epidermis of hairless dogs, a small number of melanocytes and a few Langerhans cell (LC)-like cells were observed among keratinocytes. Melanocytes contained many melanosomes and a few premelanosomes. LC-like cells were characterized by electron-lucent cytoplasm and lobulated nucleus and lacked melanin granules, tonofilaments and desmosomal attachments. Unlike LC in humans and rodents, these LC-like cells did not contain Birbeck granules. Although age-related ultrastructural changes of dorsal skin were generally not clear both in hairless dogs and in beagles, cells containing melanin granules were not infrequently observed among dermal collagen bundles in 5-year-old hairless dogs.

Phase-extraction algorithm in laser-diode phase-shifting interferometry

A phase-shifting interferometer with a laser diode has been studied that is insensitive to the changes in laser power associated with variation in current. The tested phase is measured by six interferograms by a newly developed phase-extraction algorithm. The phase is calculated from a least-squares fit to an interferogram. The systematic phase error that is due to the variation in laser output has been numerically investigated to have a periodicity of 2pi rad compared with the experimental result for the conventional phase-extraction algorithm. Good agreement between them is shown.

[Computed tomography of pneumoconiosis]

This review describes the usefulness of computed tomography (CT) and high-resolution computed tomography (HRCT) in image evaluation in pneumoconiosis. For pneumoconiosis, in the same way as for other diffuse lung diseases, conventional CT includes 10 mm collimation scans at 1 cm intervals from the apex to the base of the lung, whereas HRCT uses five to six 1.2 to 3 mm collimation scans at predetermined representative locations including the aortic arch, the tracheal carina, and 2 cm above the dome of the right hemidiaphragm. The CT scans are performed in the supine position in silicosis and coal workers' pneumoconiosis, and both in the supine and prone position in asbestosis. In silicosis, CT is superior to chest radiography in detecting coalescence of nodules and early stage formation of large opacities. There are good correlations between HRCT findings and histological changes, especially in secondary pulmonary lobules. With HRCT, small nodules are found to be located in the center of the secondary pulmonary lobule in silicotic lungs. The mild emphysematous change associated with silicosis can also be found with HRCT. In coal workers' pneumoconiosis, the HRCT is useful in detecting nodules located in the subpleural and fissural subpleural areas. In asbestosis, the conventional CT can detect pleural plaques more sensitively than chest radiography. HRCT is also especially useful in detecting earlier fibrotic change in asbestosis in lung parenchyma, apparent as subpleural lines, parenchymal bands, subpleural curvilinear line shadows and so on.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of nephrotic syndrome associated with severe interstitial pneumonitis due to cyclophosphamide whose life was saved by steroid pulse therapy]

A 53-year-old man was admitted for treatment of nephrotic syndrome due to membranous nephropathy. Since he did not improve with prednisolone alone, cyclophosphamide was administered concomitantly. However, this induced severe interstitial pneumonitis, which was not cured by discontinuation of the drug, but disappeared completely with six episodes of methylprednisolone pulse therapy. The incidence of cyclophosphamide-induced interstitial pneumonitis is low, but the mortality is high. Since cyclophosphamide is often used for the treatment of nephrotic syndrome, attention should be focused on the incidence of interstitial pneumonitis. Discontinuation of cyclophosphamide and intensive therapy are required when it occurs.

Extramedullary versus intramedullary alignment guides in total knee arthroplasty

Use of extramedullary and intramedullary guides to prepare the tibia was studied comparatively in 100 consecutive primary total knee arthroplasties done by a single surgeon. Each type of guide was used in 50 consecutive cases, for a total of 100 cases. In all cases, an intramedullary guide was used to prepare the distal femur. Long (hip to ankle) anteroposterior radiographs were taken postoperatively to measure the mechanical angle, tibial component angle, femoral component angle, physiologic valgus angle, and tibiofemoral angle. No significant differences between the extramedullary and intramedullary groups were found; each system allowed satisfactory alignment. It is important for the surgeon to appreciate the benefits and deficiencies of each guide and to use whichever is suited most properly in each particular case.

[Hypersensitivity pneumonitis caused by a home humidifier]

A 33-year-old man was admitted complaining of a fever, dyspnea, and a dry cough almost every night since December of 1992. He had been using an ultrasonic humidifier at home. The chest CT scan and roentgenogram showed bilateral reticulonodular shadows. After admission, the symptoms resolved spontaneously. These findings were suggestive of hypersensitivity pneumonitis. After analysis of fluid obtained by bronchoalveolar lavage and of a specimen obtained by transbronchial biopsy, "humidifier lung" was diagnosed. Ten species of microorganisms were isolated from the water left in the patient's humidifier. On precipitation and complement fixation tests of the patients serum, the results were positive for three of those microorganisms: Flavobacterium multivorum, Yersinia pseudotuberculosis, and Aureobacterium liquefaciens. The titer on the complement fixation test increased immediately after a provocation test. The laboratory results suggest that at least one of these three microorganisms was the causative antigen in this case.

Two-wavelength laser-diode interferometer with fractional fringe techniques

A two-wavelength interferometer with a fractional fringe technique (the method of coincidence) has been constructed by using dual frequency-ramped laser diodes. The respective wavelengths of two optical phases were measured by the heterodyne technique. The detected two phases are employed with real-time electronic processing to produce two signals that correspond to the integer and the fractional fringe numbers at a single wavelength. These summed signals can yield a synthetic phase having a single-wavelength resolution. The upper limits for the measurement accuracy are theoretically analyzed.

Effect of mannitol on focal cerebral ischemia evaluated by somatosensory-evoked potentials and magnetic resonance imaging

BACKGROUND

Mannitol has been used in routine neurosurgical practice for the control of increased intracranial pressure. The effect of mannitol on focal cerebral ischemia was evaluated by somatosensory-evoked potentials (SEP) and magnetic resonance imaging (MRI).

METHODS

The left middle cerebral artery (MCA) was exposed via the superomedial transorbital approach and occluded proximal to the origin of the perforating arteries. Ten cats received mannitol (0.5 g/kg IV) immediately, 6, 12, and 18 hours after MCA occlusion. The other 10 cats received saline solution and served as control. The animals were initially prepared to measure SEP before and 15, 30, and 60 minutes after MCA occlusion. Following SEP measurement, all cats were prepared for MRI. Sequential MRI of both intravoxel incoherent motion (IVIM) and T2-weighted spin echo techniques were obtained at 2, 4, 6, and 24 hours after MCA occlusion. The animals were sacrificed after the last MRIs for histologic study.

RESULTS

The SEP amplitude decreased to about 10% at 15 minutes after MCA occlusion and then gradually recovered to 38% at 60 minutes in the mannitol group, and 21% in the control group. In MRI study, IVIM imaging demonstrated ischemic cerebral injury as a sharply demarcated area at 2 hours after MCA occlusion, while T-2 weighted imaging failed to show clear evidence of injury until 2-6 hours. High-signal intensity areas on both IVIM and T2-weighted images were smaller in the mannitol group than those in the control group. Histologic study demonstrated that infarction size was 36.9% +/- 7.7% of the left hemisphere in the mannitol group and 57.3% +/- 5.3% in the control group (p < 0.05).

CONCLUSIONS

Mannitol is effective for acute cerebral ischemia, and SEP and MRI are useful for monitoring it.

Determination of free fatty acids in blood, tagged with 4-(2-carbazoylpyrrolidin-1-yl)-7-(N,N-dimethylaminosulfonyl )- 2,1,3-benzoxadiazole, by high-performance liquid chromatography with fluorescence detection

The free fatty acids in blood were determined by high performance liquid chromatography (HPLC) after pre-column tagging with 4-(2-carbazoylpyrrolidin-1-yl)- 7-(N,N-dimethylaminosulphonyl)-2,1,3-benzoxadiazole [sequence: see text] (DBD-ProCZ). The tagging conditions were optimized with palmitic acid (C16:0) and linoleic acid (C18:2) as representative free fatty acids, saturated and unsaturated, respectively. Under the mild reaction conditions of room temperature for 90 min in dimethylformamide (DMF) containing 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide hydrochloride (EDC, 0.2 M)/pyridine (2%), all the fatty acids tested were tagged with the DBD-ProCZ to produce highly fluorescent derivatives which emit light at 550 nm (excitation at 450 nm). The fluorescence wavelengths were essentially the same for all fatty acids, whereas the intensities were different for individual fatty acids. The derivatives obtained from ten free fatty acids were completely separated by reversed-phase chromatography with two isocratic elution conditions. The on-column detection limit (signal-to-noise ratio of 3) with proposed HPLC separation and fluorescence detection is in the range of 19 (palmitic acid)--176 fmol (palmitoleic acid). The free fatty acids in rat serum and human plasma were successfully determined using the present methods.

Serial cerebral MRI with FLAIR sequences in acute carbon monoxide poisoning

In a patient with acute carbon monoxide (CO) poisoning in whom no delayed sequelae have been observed, MRI was performed serially from the time of exposure. When few clear findings were noted on conventional T2-weighted spin echo (SE) imaging, distinct hyperintense areas in the deep cerebral white matter were already evident on fluid attenuated inversion recovery (FLAIR) pulse imaging. These abnormal findings appeared to reflect a disease process differing from the acute phase disturbance of consciousness, namely the course of a gradually progressive demyelination. Neither serial intelligence tests nor single photon emission CT (SPECT) studies of regional cerebral blood flow conducted in the same period revealed any abnormalities. These results suggest that, in the subclinical phase in which there are few significant findings on T2-weighted SE imaging or SPECT, insidious demyelinating changes are already apparent on FLAIR imaging and that FLAIR imaging may thus be useful in the early diagnosis of the interval form of CO poisoning.

Elevated levels of soluble ICAM-1 in serum and BAL fluid in patients with active sarcoidosis

Intercellular adhesion molecule-1 (ICAM-1), a member of the immunoglobulin superfamily of adhesion molecules, plays an important role in inflammatory and immune diseases. The soluble form of ICAM-1 (sICAM-1) shed from the cell surface may be a marker of inflammatory response and may reflect the disease activity. We measured the levels of sICAM-1 in serum and bronchoalveolar lavage fluid (BALF) in patients with sarcoidosis. Healthy volunteers were examined as controls. sICAM-1 concentrations were measured using an enzyme-linked immunosorbent assay kit with two different monoclonal antibodies. Serum and BALF sICAM-1 levels in sarcoidosis were significantly higher than those in control. Serum sICAM-1 levels correlated with serum soluble interleukin-2 receptor levels (a marker of T-lymphocyte activation) but not with serum angiotensin-converting enzyme levels. sICAM-1 levels in BALF correlated significantly with the percentage of lymphocytes in BALF. Some patients were examined twice during follow-up periods. In patients in whom the chest radiograph improved, serum and BALF sICAM-1 levels decreased. However, in patients in whom the radiograph worsened, sICAM-1 levels increased. These results suggest that measurement of sICAM-1 may be useful to investigate not only the pathogenic mechanisms, but also the clinical status and disease activity in patients with sarcoidosis.

Effects of sematilide, a novel class III antiarrhythmic agent, on action potential in guinea pig atrium

Electrophysiological effects of sematilide, a novel class III antiarrhythmic agent, were examined and compared with those of (+/-)sotalol in guinea pig left atrium by a conventional microelectrode technique. Application of 0.1-1000 microM sematilide or 1-1000 microM (+/-)sotalol concentration-dependently prolonged the duration of action potentials (APD) that were elicited by electrical stimulation at 1 Hz. Other parameters of action potentials such as the maximum upstroke velocity of phase 0 depolarization, action potential amplitude and resting membrane potential were not affected significantly by these drugs in the concentration ranges employed. The prolongation of APD by sematilide or (+/-)sotalol was accompanied by a corresponding increase in the effective refractory period (ERP). Approximately a 30% increase in ERP was obtained by the treatment with 5 microM sematilide or 100 microM (+/-)sotalol, suggesting that sematilide as a class III antiarrhythmic agent is approximately 20 times more potent than (+/-)sotalol on a molecular basis. When the stimulation rate was increased stepwise from 0.2 to 2 Hz, the relative increase in APD at 90% repolarization by the treatment with sematilide and (+/-)sotalol was slightly larger at 2 Hz than at 0.2 Hz, indicating that "reverse rate-dependence" was not observed under these conditions. These results may suggest a possibility that sematilide effectively blocks atrial arrhythmia.

[A case of pulmonary tuberculosis associated with tuberculous fistula of anus]

A 39-year old male visited the hospital complaining of perianal pain, swelling and redness. Under the diagnosis of an anal abscess, drainage was performed repeatedly. As the wound failed to heal and fistulae were detected, excision of entire tract was performed. On histopathological examination of the resected fistulae, caseous necrosis, Langhans giant cells, and epithelioid cell infiltration were found and diagnosed as anal tuberculosis. Chest X-ray showed cavitary lesion with infiltrative shadow in right upper lobe. Acid-fast bacilli were positive in sputum, and the diagnosis of pulmonary tuberculosis was confirmed. Anti-tuberculosis therapy was immediately started with good response to treatment. As tuberculosis of anal region is so rare recently and there is no characteristic clinical picture, it is very difficult to diagnose it pre-operatively. In some cases such as ours, pulmonary or other tuberculosis is accompanied with anal tuberculosis. Therefore, accurate diagnosis of anal tuberculosis is needed to find other tuberculosis early. As anal tuberculosis is rarely diagnosed correctly before operation on the basis of the clinical picture, the histopathological examination of the excised fistula is mandatory for the correct diagnosis of anal tuberculosis.