Hepatic embolization through extrahepatic collateral pathways after hepatic arterial embolization for the hepatocellular carcinoma

Extrahepatic collateral pathways developing after repeated transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) make therapeutic arterial embolization for recurrent lesions extremely difficult. TAE was performed through the collateral pathways using a sophisticated micro-catheter with good trackability and pushability and a coaxial system. Twenty-three TAEs were undertaken through the collateral pathways in 13 patients with recurrent HCC who had extrahepatic collateral pathways after the previous hepatic arterial TAE. There were 69 extrahepatic collateral pathways, with partially obstructed hepatic arteries. On the average, three feeding arteries were seen in the liver. The main extrahepatic collateral pathways were the inferior phrenic artery and epicholedocal artery, 18 vessels and 29 vessels, respectively, accounting for about 80% of the total collateral pathways. TAEs were successful in all cases and the number of embolized vessels was 2.1 on average. The average time of the first collateral TAE after the initial conventional hepatic arterial TAE was 2.3 years. Excellent prognosis was observed with a one-year survival rate of 77% and 3-year survival rate of 38% after the collateral TAE. We consider that collateral TAE for recurrent HCC with obstruction of the hepatic artery is the procedure of choice, is technically feasible, and provides better prognosis for the patients.

Cloning and characterization of a 92 kDa soluble phosphatidylinositol 4-kinase

A phosphatidylinositol (PtdIns) 4-kinase cDNA cloned from a rat brain cDNA library encoded a protein of 816 amino acids with a calculated molecular mass of 91654 Da. This molecule contained a lipid-kinase-unique domain and a presumed lipid/ protein kinase homology domain that are found in other PtdIns 4-kinases and PtdIns 3-kinases. Furthermore, this kinase molecule had 43.3% shared identity with the presumed catalytic domain of yeast PtdIns 4-kinase, PtdInsK1, and the two molecules had a region of similarity that is not conserved in other lipid kinases. By examining PtdIns kinase activity in transfected COS-7 cells using epitope tag immunoprecipitation as well as conventional methods, the product PtdIns phosphate was identified as phosphatidylinositol 4-phosphate (PtdIns4P), but not phosphatidylinositol 3-phosphate (PtdIns3P). The PtdIns 4-kinase activity was recovered predominantly from the soluble fraction and the activity was markedly enhanced in the presence of Triton X-100 and was relatively insensitive to inhibition by adenosine. In addition, the PtdIns 4-kinase activity was completely inhibited in the presence of 10 microM wortmannin. When examined by epitope tag immunocytochemistry, the immunoreactivity for the PtdIns 4-kinase molecule was dominantly aggregated in a cytoplasmic region juxtaposed to the nuclei and was faintly but widely dispersed in the cytoplasm. By in situ hybridization analysis, the mRNA for PtdIns 4-kinase was expressed ubiquitously and was detected in most neurons throughout the grey matter of the brain, with higher expression intensity found in fetal than in adult brain.

A case of pregnancy with adult T-cell leukemia

The incidence of adult T-cell leukemia (ATL) arising in women of childbearing age is documented infrequently. This report is the second in the world's literature of a case of ATL that occurred during pregnancy. A 43-year-old woman developed ATL during pregnancy and died of widespread disease 4 weeks after cesarean delivery.

Decreased very-low-density lipoprotein and low-density lipoprotein receptor messenger ribonucleic acid expression in placentas from preeclamptic pregnancies

OBJECTIVE

Our purpose was to investigate the levels of very-low-density lipoprotein and low-density lipoprotein receptor messenger ribonucleic acid expression in placentas obtained from normal pregnant women at various gestational stages and from patients with preeclampsia.

STUDY DESIGN

The relative level of expression of very-low-density lipoprotein and low-density lipoprotein receptor messenger ribonucleic acid in each sample was determined by Northern blot analysis as a ratio of the intensity to that of glyceraldehyde-3-phosphate dehydrogenase messenger ribonucleic acid.

RESULTS

The expression of very-low-density lipoprotein receptor messenger ribonucleic acid increased significantly (p < 0.05) from both the first (n = 9) and second (n = 8) trimesters to the third (n = 11) trimester. Similarly, the expression of low-density lipoprotein receptor messenger ribonucleic acid increased significantly (p < 0.05) from the first to the third trimester. The expression of both very-low-density lipoprotein and low-density lipoprotein receptor messenger ribonucleic acids in third-trimester placentas from preeclamptic pregnancies (n = 13) was significantly lower than that in normal pregnancies in the third trimester.

CONCLUSION

These results demonstrate the expression of very-low-density lipoprotein and low-density lipoprotein receptor messenger ribonucleic acids in the human placenta, both of which increase at late gestational stages, and the decreased expression in cases of preeclampsia. Abnormal fetomaternal lipid metabolism resulting from low expression of these receptors in the placenta may be involved in the pathogenesis of preeclampsia.

Molecular pharmacology and pathophysiological significance of endothelin

Since the discovery of the most potent vasoconstrictor peptide, endothelin, in 1988, explosive investigations have rapidly clarified much of the basic pharmacological, biochemical and molecular biological features of endothelin, including the presence and structure of isopeptides and their genes (endothelin-1, -2 and -3), regulation of gene expression, intracellular processing, specific endothelin converting enzyme (ECE), receptor subtypes (ETA and ETB), intracellular signal transduction following receptor activation, etc. ECE was recently cloned, and its structure was shown to be a single transmembrane protein with a short intracellular N-terminal and a long extracellular C-terminal that contains the catalytic domain and numerous N-glycosylation sites. In addition to acute contractile or secretory actions, endothelin has been shown to exert long-term proliferative actions on many cell types. In this case, intracellular signal transduction appears to converge to activation of mitogen-activated protein kinase. As a recent dramatic advance, a number of non-peptide and orally active receptor antagonists have been developed. They, as well as current peptide antagonists, markedly accelerated the pace of investigations into the true pathophysiological roles of endogenous endothelin-1 in mature animals; e.g., hypertension, pulmonary hypertension, acute renal failure, cerebral vasospasm, vascular thickening, cardiac hypertrophy, chronic heart failure, etc. Thus, the interference with the endothelin pathway by either ECE-inhibition or receptor blockade may provide an exciting prospect for the development of novel therapeutic drugs.

Inhibition of myocardial endothelin pathway improves long-term survival in heart failure

Occlusion of the diseased coronary artery in humans causes acute myocardial infarction, survivors of which have a high risk for the development of chronic heart failure. Cardiac myocytes and vascular endothelial cells produce endothelin-1 (refs 2-4), which increases the contractility of cardiac muscle and of vascular smooth muscle cells. Endothelin-1 also exerts long-term effects such as myocardial hypertrophy, and causes cellular injury in cardiac myocytes. Production of endothelin-1 is markedly increased in the myocardium of rats with heart failure, and acute application of an endothelin-receptor antagonist decreases myocardial contractility in such rats, indicating that myocardial endothelin-1 may help to support contractility of the failing heart. But we report here that the upregulated myocardial endothelin system may contribute to the progression of chronic heart failure, because long-term treatment with an endothelin-receptor antagonist greatly improved the survival of rats with chronic heart failure. This beneficial effect was accompanied by significant amelioration of left ventricular dysfunction and prevention of ventricular remodelling, in which there is usually an increase in the ventricular mass and cavity enlargement of the ventricle.

Pulmonary hypertension caused by congestive heart failure is ameliorated by long-term application of an endothelin receptor antagonist. Increased expression of endothelin-1 messenger ribonucleic acid and endothelin-1-like immunoreactivity in the lung in congestive heart failure in rats

OBJECTIVES

The purpose of this study was to investigate whether 1) endothelin-1, a potent vasoconstrictor peptide, is involved in progression of pulmonary hypertension caused by congestive heart failure (CHF); and 2) whether long-term treatment with BQ-123, an endothelin receptor antagonist, ameliorates pulmonary hypertension caused by CHF.

BACKGROUND

Congestive heart failure accompanies pulmonary hypertension, and the severity of pulmonary hypertension is an important determinant of prognosis. Although we reported that production of endothelin-1 is increased in the failing heart in rats with CHF, it is not known whether production of endothelin-1 in the lung is altered by CHF.

METHODS

Congestive heart failure was induced by coronary artery ligation in rats. Expression of preproendothelin-1 messenger ribonucleic acid (mRNA) in the lung and kidney was determined. Endothelin-1 staining (immunoreactivity) in the lung was studied by immunohistochemical analysis. Effects of long-term BQ-123 treatment on the rats were studied.

RESULTS

Two weeks postoperatively, CHF accompanied by pulmonary hypertension developed in the rats (CHF rats). Expression of preproendothelin-1 mRNA in the lung was markedly higher in the CHF rats than in the sham-operated rats, whereas that in the kidney did not differ between the two groups. Endothelin-1 staining on the pulmonary vascular endothelial cells was more intense in the CHF rats. BQ-123 treatment over a 2-week period in the CHF rats greatly reduced right ventricular systolic pressure and central venous pressure, but it did not affect blood pressure or left ventricular contractility (peak positive first derivative of left ventricular pressure) in these rats.

CONCLUSIONS

Long-term BQ-123 treatment greatly ameliorated pulmonary hypertension in the CHF rats. The present study suggests that endothelin-1 plays an important role in the progression of pulmonary hypertension caused by CHF and that an endothelin receptor antagonist may be a new therapeutic agent for CHF-induced pulmonary hypertension.

[A 46-year-old man with right-side dominant parkinsonism, who suffered a sudden death]

We report a 46-year-old man with right side dominant parkinsonism who died suddenly two years after the onset. The patient was well until the age of 42 years in January of 1993, when he noted an onset of difficulty in using his right hand and then the right leg. Soon after he noted nocturnal urinary incontinence. In January of 1994, a local doctor prescribed 200 mg of levodopa with benserazide and 5 mg of bromocriptine. The patient noted some improvement. Cystometry revealed 300 ml of residual urine. He visited our clinic on 24th of December, 1996. He was alert and oriented. BP was 106/60. He showed masked face and small voice. He walked in stopped posture dragging his feet; retropulsion was noted. He showed moderate bradykinesia and rigidity more on the right side. No resting tremor or cerebellar ataxia was noted. Ankle jerks were somewhat exaggerated but no Babinski sign was noted. He continued to show residual urine, but orthostatic hypotension was absent. Routine laboratory examination was unremarkable, however, his cranial MRI showed atrophy of the left putamen and a T2-linear high signal intensity lesion along the lateral border of the left putamen. On January 15, 1997, he ate certain amount of rice cake and drank alcohol. After coming back home and while changing his clothes, he suddenly complained of chest discomfort and lost consciousness. He was pronounced dead in the afternoon. The patient was discussed in a neurological CPC. Opinions were divided between Parkinson's disease and striatonigral degeneration. The chief discussed arrived at a conclusion that the patient had Parkinson's disease, because he responded to levodopa to some extent and except for nocturnal incontinence he did not have wide spread autonomic failure. Postmortem examination revealed marked loss of neurons and extensive gliosis in the left putamen. The right putamen did not show such changes. The substantia nigra showed gliosis in the lateral part on both side, however, neuronal loss was not apparent. The locus coeruleus was well retained. No Lewy bodies were found. The pontine nucleus and the cerebellum were intact. However, glial cytoplasmic inclusions were seen in oligodendrocytes of the cerebral white matter and the pontine base. The heart and lungs were intact and the cause of the sudden death could not be determined. The pathologic diagnosis is striatonigral degeneration. Such a marked asymmetry of the pathologic change is quite unusual. Probably, the death in the early stage of the disease is the reason for this asymmetry.

Synthesis and structure-activity relationships of novel phenylcyanoguanidine derivatives as potassium channel openers

3,5-Di-substituted phenylcyanoguanidine derivatives with halogen, cyano and/or nitro groups at the 3- and 5-positions of the benzene ring exhibited very strong smooth muscle relaxation activity in vitro, as compared to pinacidil. Among them, N-(3-chloro-5-cyanophenyl)-N'-cyano-N" -tert-pentylguanidine (5s) showed 27-fold more potent activity than pinacidil, and exhibited a stronger and more lasting antihypertensive effect than pinacidil by oral administration to spontaneously hypertensive rats. We propose a new pharmacophore model in which the essential factors for binding to the potassium channel are an NH and a bulky alkyl group.

Outcome of arthrocentesis for temporomandibular joint with closed lock at 3 years follow-up

OBJECTIVE

The aim of this study was to evaluate the intermediate term results of arthrocentesis for the management of temporomandibular joint closed lock.

STUDY DESIGN

Twenty consecutive patients with closed locking of their temporomandibular joint were treated by arthrocentesis. All patients rated their pain level on a visual analogue scale, and completed pain, jaw dysfunction, and daily activity questionnaires before, 6 months, and 3 years after the procedure. The patients' jaw opening was also scaled. Preoperative and postoperative differences of the data were analyzed statistically. The success rate was also calculated according to our success criteria.

RESULTS

The success rate was 70% at 6 months follow-up; it increased to 78.9% over the 3 years of follow-up. All posttreatment scores showed significant improvements in efficacy.

CONCLUSION

Arthrocentesis was considered as an effective minimally invasive surgical treatment for temporomandibular joint closed lock based when evaluated 3 years after the procedure.

Monoamine neurotransmitter function and spontaneous recurrence of methamphetamine psychosis

The process that triggered spontaneous recurrence of methamphetamine (MAP)-induced paranoid-hallucinatory psychosis, a phenomenon known as flashbacks, was studied in 41 subjects with flashbacks, along with 84 subjects with a history of previous MAP psychosis but no flashbacks. Plasma levels of norepinephrine (NE), dopamine, and 5-hydroxytryptamine, and their respective metabolites were assayed in 28 of the 41 flashbackers, 16 of the 84 non-flashbackers, 9 subjects with persistent MAP psychosis, and 28 healthy controls comprised of 20 MAP users and 8 non-users. None of the 28 controls had become psychotic. The 41 flashbackers had experienced significantly greater frequencies of threatening events and frightening paranoid-hallucinatory states during previous MAP use than the 84 non-flashbackers. The dominant factor that triggered flashbacks was a mild fear of other persons. The 41 flashbackers may have encoded threatening experiences as frightening images. Repeated MAP use with threatening experiences may induce sensitization to frightening images. Plasma NE levels during flashbacks were significantly higher than the levels during periods of normalcy, and the NE levels in the 20 user and 8 non-user controls. The 9 subjects with persistent MAP psychosis had significant higher levels of NE than the user and non-user controls. The 16 non-flashbackers had significantly higher MHPG levels than the user controls. The findings suggest that MAP use may induce changes at pharmacological levels in the process underlying sensitization to frightening images. We suggested that when the flashbackers experienced a mild fear of other persons, MAP-induced sensitization to frightening images may have been actualized. Thus, the flashbacks may have been caused through increased noradrenergic hyperactivity.

[Pathogenesis and treatments of glucose intolerance with liver cirrhosis in men--lessons from the clinical cases of Fukuoka City Hospital, Department of Internal Medicine, Fukuoka, Japan]

More than 30% of the end stage liver cirrhosis was complicated by the impared glucose tolerance, in some of which insulin supplements may be required to control the blood glucose level. However, there are many unsolved issues on the cause and cares of hyperglycemia in cirrhotic men. Here, we presented a case of liver cirrhosis and hepatocellular caricnoma complicated by the severe glucose intolerance, and summarized our recent insulin therapy on the glucose intolerance of the decompensated liver cirrhosis in Fukuoka City Hospital, Department of Internal Medicine.

A 104-kDa diacylglycerol kinase containing ankyrin-like repeats localizes in the cell nucleus

The cDNA corresponding to a fourth species of diacylglycerol (DG) kinase (EC 2.7.1.107) was isolated from cDNA libraries of rat retina and brain. This cDNA encoded a 929-aa, 104-kDa polypeptide termed DGK-IV. DGK-IV was different from previously identified mammalian DG kinase species, DGK-I, DGK-II, and DGK-III, in that it contained no EF-hand motifs but did contain four ankyrin-like repeats at the carboxyl terminus. These structural features of DGK-IV closely resemble the recently cloned, eye-specific DG kinase of Drosophila that is encoded by the retinal degeneration A (rdgA) gene. However, DGK-IV was expressed primarily in the thymus and brain with relatively low expression in the eye and intestine. Furthermore, the primary structure of the DGK-IV included a nuclear targeting motif, and immunocytochemical analysis revealed DGK-IV to localize in the nucleus of COS-7 cells transfected with the epitope-tagged cDNA, suggesting an involvement of DGK-IV in intranuclear processes.

Detection of Clostridium piliforme by enzymatic assay of amplified cDNA segment in microtitration plates

We developed a simple enzymatic assay system using reverse transcription-polymerase chain reaction products in a microtitration plate to detect Clostridium piliforme in tissue specimens. The reverse transcription-polymerase chain reaction was performed with a biotin-labeled primer directed in a highly conserved area of the C. piliforme 16S rRNA gene. The amplified cDNA was hybridized to an alkaline phosphatase-labeled DNA probe in a microtube, and the mixture was applied to a microtitration well precoated with streptavidin. Then hybridization signals in the microtitration plate were visualized by reaction with substrate for the alkaline phosphatase. When an optical density > 0.200 at 405 nm was considered a positive result, we found that the system could detect the RNA from as few as 10 organisms. The system was also capable of detecting organisms from the liver, mesenteric lymph nodes, and ileum of experimentally infected mice. In the ileum the C. piliforme gene was detected from 1 to 21 days after infection. This result suggests that the intestinal epithelium is one of the sites of persistent infection. We conclude that this enzymatic assay system of reverse transcription-polymerase chain reaction products is simple, rapid, and convenient for the detection of C. piliforme.

Cephalometric comparison of craniofacial morphology between primary bone grafted and nongrafted complete unilateral cleft lip and palate adults

The effect of primary bone grafts on craniofacial growth was evaluated in adult patients with complete unilateral cleft lip and palate (UCLP). The subjects were 18 UCLP patients with primary bone grafts and a control group of 36 UCLP patients without bone grafts. The former received primary transplantation of autogenous rib bone simultaneously with primary cheiloplasty by the same surgeon between 1963 and 1969. Frontal and lateral cephalograms taken after 16 years of age were traced. Skeletal landmarks were identified on them, and their x,y-coordinates were digitized. The effects of gender and/or primary bone graft on the craniofacial morphology were tested by ANOVA using 21 angles, 8 breadths, 13 distances, and 2 ratios. Nasal cavity breadth was wider in the primary bone grafted group. However, the anterior maxilla in that group was more upward and retruded than that in the nongrafted group. The primary bone grafted group was divided into two subgroups based on the overjet of the incisors: group N = normal overjet; group C = anterior cross-bite. There was no difference in the maxilla between groups N and C. However, the mandible in group C was more anterior and superior than in group N. In conclusion, primary bone graft may impede maxillary horizontal and vertical growth to a certain degree, and severe anterior cross-bite in primary bone grafted subjects may be brought about by mandibular closure.

Heterogeneity of diacylglycerol kinase in terms of molecular structure, biochemical characteristics and gene expression localization in the brain

Three different cDNA clones for diacylglycerol (DG) kinase were isolated from a rat brain cDNA library and designated DGK-I, DGK-II and DGK-III. These three encode distinct polypeptides with 58% identity to each other and contain EF-hand motifs, cysteine-rich zinc finger-like sequences and putative ATP-binding sites. A high kinase activity is shown in COS cells transfected with either one of the three cDNAs without substrate specificity among DG species, and the kinase activity is Ca-dependent. The activity for DGK-I is recovered dominantly in the soluble fraction of the cell, that for DGK-II in the particulate fraction; and that for DGK-III equally in both of the fractions. The difference in their expression localization is most noticeable: DGK-I is expressed in oligodendrocytes of the brain as well as T-lymphocytes in the thymus and spleen; DGK-II is expressed in neurons of the caudate-putamen, accumbens nucleus and olfactory tubercle; and DGK-III in the cerebellar Purkinje cells and granule cells. The functional significance of the discovery of three DG kinase isozymes is briefly discussed.

Identification of an osteoblastic silencer element in the first intron of the rat osteocalcin gene

The osteocalcin gene has been used as a model for studying the regulation of gene expression by 1,25-dihydroxyvitamin D3, as well as for examining factors which contribute to osteoblast-specific regulation of gene expression. Most of these studies have focused on transactivation. We report the identification of a sequence in the first intron of the rat osteocalcin gene which suppresses the expression of osteocalcin-CAT fusion genes approximately 10-fold in ROS 17/2.8 and UMR 106 osteosarcoma cells. Mutation of a TTTCTTT motif in the first intron abolishes this suppression. The silencing effect of this motif is also observed after bone morphogenic protein-2 (BMP-2)-induced expression of the osteoblastic phenotype in the MLB13MYC clone 17 cell line. Mutation of the splice donor site does not affect suppression by these sequences in ROS 17/2.8 cells. When multimerized and placed upstream of the native osteocalcin promoter, these sequences retain their ability to mediate transcriptional repression. Electrophoresis mobility shift analysis demonstrates a specific protein-DNA interaction with the TTTCTTT motif in nuclear extracts from ROS 17/2.8, UMR 106, and MLB13MYC clone 17 cells but not those from COS-7 kidney cells. The mutation of this motif, which abolishes suppressing activity in the native context, also abolishes binding. The presence and activity of this suppressor in cells of the osteoblast lineage suggest that it is expressed with other cell-specific transcriptional regulators of the osteocalcin gene, coordinately regulating expression of this gene in bone cells.

Anticoagulant factor protein S inhibits the proliferation of rat astrocytes after injury

The actions of protein S (PS) on the scratch injury-induced proliferation of rat astrocytes (AC) were studied. PS (10-300 nM) markedly inhibited [3H]thymidine incorporation into injured AC. The effect of 100 nM PS was comparable with that of transforming growth factor-beta 1 (TGF-beta 1; 20 ng/ml). The incorporation of bromodeoxyuridine, which is usually detectable in AC along the border of the wound, was undetectable in the presence of 300 nM PS. The level of PS mRNA in the injured AC was slightly increased 15 h after the injury, although the level of its receptor, Tyro 3 mRNA was not changed significantly. The results of the present study suggest that PS plays an important role in tissue repair processes in the central nervous system (CNS) by suppressing the proliferation of AC as in the case of TGF-beta 1.

Metabolism of diethyl 4-[(4-bromo-2-cyanophenyl)-carbamoyl]benzylphosphonate in the rat

1. The metabolism of diethyl 4-[(4-bromo-2-cyanophenyl)carbamoyl]benzylphosphonate (NO-1886), an antilipidaemic agent, was evaluated in the rat. 2. 14C-NO-1886 was dosed orally to rats (3 mg/kg) and within 24 h after dosing, 27.9 +/- 2.1 and 63.5 +/- 4.2% of the administered radioactivity was recovered from urine and faeces respectively. 3. The metabolite M-2 was isolated from the urine and faeces, and two other metabolites, M-3 and M-5, were isolated from the urine. Two of them were identified as ethyl 4-[(4-bromo-2-cyanophenyl)carbamoyl]benzylphosphonate (M-2) and 4-[(diethoxy-phosphoryl)methyl)]benzoic acid (M-3), and the other one was considered to be 2-amino-5-bromo-3-cyanobenzene sulphate (M-5) by ms and nmr spectrometry. 4. The major metabolic pathway of NO-1886 was found to be mono-hydrolysis of the diethyl phosphonate. It was also considered that M-5 may have been formed in vivo via 2-amino-5-bromo-benzonitrile (M-1) and 2-amino-5-bromo-3-hydroxybenzonitrile (M-4).

[Early recovery from locked-in syndrome due to brain infarction in a young patient with hypoplasia of bilateral vertebral arteries and a persistence of primitive trigeminal artery]

A 36-year-old man was admitted to Kanto Chuo Hospital because of hearing loss and dysphagia. On admission physical and neurological findings revealed obesity, hypertension, nystagmus, right hearing loss, dysarthria, and dysphagia. Routine laboratory findings disclosed leukocytosis, liver dysfunction, hypercholesterolemia, proteinuria, and glucosuria. Immunological, coagulopathic, and endocrinological findings, electrocardiogram, echocardiogram, and brain CT scan were unremarkable. He was diagnosed as brainstem infarction, and then conservative therapies were begun. Seven hours after admission, he suddenly fell into coma and apneutic state, requiring artificial ventilation. The next day he was fully conscious, but could'nt make any voluntary movements except for vertical eye movements, suggesting locked-in syndrome (LIS). Brain MRI showed infarction of pons, medulla oblongata, and right cerebellum. Cerebral angiography revealed hypoplasia of bilateral vertebral arteries, a persistence of right primitive trigeminal artery (PTA), and retrograde blood flow of basilar artery from the PTA. Then he made a rapid recovery, and on 80th day he was discharged only with right hearing disturbance and mild left cerebellar sign. We speculated that hypoplasia of the bilateral vertebral arteries caused the brain infarction, and that back flow of the basilar artery from the PTA, in part, contributed to the early recovery from the LIS.

The prevalence of Toxoplasma antibody in patients with various ocular diseases in central Japan

BACKGROUND

Ocular toxoplasmosis has been considered to be a largely asymptomatic infection because of the high seroprevalence of Toxoplasma antibodies and the low rate of clinical diagnosis. On the other hand, Toxoplasma infection has been reported to be associated with the other ocular disease. To investigate the association of Toxoplasma infection with the development of various ocular diseases, we studied Toxoplasma seroprevalence in patients with various ocular diseases.

METHODS

We investigated Toxoplasma seroprevalence in 982 patients with various ocular diseases in central Japan. Then we compared the seroprevalence of anti-Toxoplasma antibodies.

RESULTS

Of 982 patients with various ocular diseases, 122 (12.4%) had serological evidence of previous exposure to Toxoplasma gondii. There were no statistically significant differences among the patients with various ocular diseases. However, the seroprevalence in patients aged 40 to 99 years with macular degenerative lesions was significantly higher than that in patients without these lesions (P < 0.05, Yates' correction).

CONCLUSION

This result suggests that Toxoplasma infection could play some role in the development of a type of macular degenerative lesion.

Inferior vena caval thrombus associated with double neoplasms of the retroperitoneum and kidney: report of a case

We report herein the case of a patient we recently encountered who was found to have a giant retroperitoneal tumor coincident with tumor thrombus in the inferior vena cava (IVC). On the assumption that the origin was retroperitoneal, the two lesions were resected using an intracaval filter. However, histopathological examination of the specimens revealed neurilemoma for the retroperitoneal tumor and adenocarcinoma for the tumor thrombus. A right renal tumor was subsequently detected, which led to right nephrectomy being performed en bloc with part of the IVC using a venoarterial bypass. Microscopy revealed carcinoma of the Bellini duct, or collecting duct, which is an extremely rare tumor. Retrospectively, a lesion with soft tissue density was noted in the renal vein. Surgical management focused on the prevention of pulmonary embolism. We describe this case because of its extreme rarity and its significance from the viewpoint of diagnosis and therapeutic strategies.

Plasma monoamine metabolites and spontaneous recurrence of methamphetamine-induced paranoid-hallucinatory psychosis: relation of noradrenergic activity to the occurrence of flashbacks

The relationship between monoamine neurotransmitter function and spontaneous recurrence of methamphetamine (MAP) psychosis, a phenomenon known as flashbacks, was studied in a group of incarcerated women. Plasma levels of norepinephrine (NE), dopamine, 5-hydroxytryptamine, and their respective metabolites were assayed in 28 flashbackers, 19 non-flashbackers with a history of previous MAP psychosis, and 9 subjects with persistent MAP psychosis. Control data were available from 61 physically healthy prisoners (41 MAP users and 20 non-users, none of whom became psychotic). The plasma NE levels of the 28 flashbackers during flashbacks were significantly higher than levels during periods of normality, and were significantly higher than those in the MAP user and non-user controls. Plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) levels during flashbacks were significantly higher than those in the user controls. The nine subjects with persistent MAP psychosis had significantly higher NE levels than the user and non-user controls. The 19 non-flashbackers had significantly higher MHPG levels than the user controls. Plasma levels of 3-methoxytyramine and dihydroxyphenylacetic acid contributed to the NE levels in the flashbackers, in contrast to the findings in the control group. Noradrenergic systems may be compromised in the flashbackers, suggesting increased vulnerability to psychotic decompensation. These findings suggest that aggravation in peripheral noradrenergic hyperactivity may be an important factor in the occurrence of flashbacks.

Endogenous endothelin-1 initiates astrocytic growth after spinal cord injury

We developed a rat spinal cord injury model and investigated whether endogenous endothelin (ET)-1 plays a role in astrocytic growth after injury. Immunohistochemical study showed that the number of immature astrocytes (ACs) exhibiting strong reactivity to the monoclonal antibody, RC1, markedly increased 24 h after the injury. Injection of a potent nonselective ET receptor antagonist, SB209670, into the lesion sites significantly inhibited the appearance of RC1-positive cells 24 h after the injury. In conjunction with this result, the increase in immunostaining density of 5-bromo-2'-deoxyuridine in the spinal cord 24 h after the injury was inhibited by the injection of SB209670. The tissue content of ET-1-LI was significantly increased 12 and 24 h after the injury. These results suggest that endogenous ET-1 is involved in astrocytic growth after spinal cord injury.