[Thoracic outlet syndrome due to first rib anomaly: a case report]

Compared to cervical rib, first rib anomaly is less familiar to us as a cause of thoracic outlet syndrome. We report a case of thoracic outlet syndrome due to first rib anomaly. A 50-year-old man was admitted to our hospital because of right arm pain when his arm was raised up. Chest X-ray showed an abnormal right first rib which made a J-shaped curve and was attached to the second rib. A palpable mass was noted in the supraclavicular region. Angiography revealed complete occlusion of the right subclavian artery in the Allen test position. During conservative therapy for two months, the symptom was gradually getting worse. We performed resection of the right first rib and anterior scalenotomy by the supraclavicular approach. The patient made a good recovery after the surgery. Postoperative angiogram showed no stenotic lesion of the right subclavian artery. If a patient has complaints suggesting compression of the subclavian neurovascular bundle, we should be careful not to overlook the first rib anomaly on chest X-ray.

Effects of alcohol on lipoprotein lipase, hepatic lipase, cholesteryl ester transfer protein, and lecithin:cholesterol acyltransferase in high-density lipoprotein cholesterol elevation

The mechanism whereby alcohol increases high-density lipoprotein cholesterol (HDL-C) levels is unclear. Lipoprotein lipase (LPL), hepatic lipase (HL), cholesteryl ester transfer protein (CETP) and lecithin:cholesterol acyltransferase (LCAT) act on lipoprotein metabolism. The purpose of the present study is to determine which one or what combination of these factors is responsible for the rise in HDL-C levels following alcohol ingestion. After 3 weeks of abstinence, 12 men consumed 0.5 g/kg bw of alcohol per day for 4 weeks; 13 abstaining men served as controls. Mean plasma total cholesterol (TC) levels were unchanged in either group throughout the study. Among the alcohol consumers, plasma triglycerides (TG), HDL-C, apolipoprotein (apo) A-I and A-II levels increased significantly after 3 weeks of alcohol loading but were unchanged in the control group. High-density lipoprotein3 cholesterol (HDL3-C) levels increased significantly in the alcohol consumers after 4 weeks of alcohol loading whereas high-density lipoprotein2 cholesterol (HDL2-C) levels were unaffected. In the controls, neither HDL2-C nor HDL3-C changed significantly. Post-heparin plasma (PHP) LPL activity and mass increased significantly (P < 0.01) after the alcohol ingestion (controls remained unchanged) without changing LPL specific activity. HL, CETP and LCAT activities were unaffected in both groups. We conclude that of the factors considered, LPL contributed the most to the alcohol-induced rise in HDL-C.

Modulation of tumor immunogenicity of rat glioma cells by s-Myc expression: eradication of rat gliomas in vivo

The Myc family proteins represented by c-Myc are thought to play a crucial role in cellular proliferation, differentiation, transformation, and apoptosis. In this study, we demonstrated the novel role for a Myc family protein in elicitation of immunogenic phenotypes in tumor cells. Injection of rat 9L or C6 glioma cells, together with the s-myc gene linked to the cytomegalovirus promoter, completely prevented formation of both brain tumors and s.c. tumors derived from the parental glioma cells. However, introduction of the s-myc gene had no inhibitory effect on development of B104-derived neuroblastoma. In addition, unlike the s-myc gene, injection of the c-myc or wild type p53 (wt-p53) gene together with glioma cells did not modulate the tumor immunogenicity and resulted in formation of gliomas in the animals. These findings suggest that s-Myc expression may stimulate the presentation of a tumor antigen common to 9L and C6 cells to T lymphocytes and augment the activity of the host immune system, resulting in prevention of glioma formation in vivo. This success in tumor eradication indicates the possibility of application of the s-myc gene for gene therapy of human brain tumors.

Klinefelter's syndrome and rheumatoid arthritis. Report of a case and review of the literature

Our case report describes a patient with Klinefelter's syndrome (KFS) associated with rheumatoid arthritis (RA). He had active RA in 1985 but his arthritis almost subsided in 1993 without intensive treatments for RA as well as KFS. Recently, the lower levels of testosterone in male RA patients, especially at the active phase has been reported. However, it is still questionable whether hypogonadism is a predisposing factor or just a consequence of disease. Since our case had a mild clinical course, and since the incidence of RA associated with KFS is very rare in comparison with other rheumatic diseases, may suggest that the low levels of testosterone are not a predisposing factor to the activity of RA.

[Studies on enhancement of drug absorption through the bladder mucosa]

We examined the effects of dimethyl sulfoxide (DMSO), hyaluronidase and saponin on drug absorption through the bladder mucosa. Female Wistar rats underwent intravesical instillation of each agent prior to the administration of lanthanum solution or anticancer drug; 4'-O-tetrahydropyranyldoxorubicin (THP). The absorption of lanthanum was recognized as dense grain in bladder tissue under electron microscope. The concentration of THP in bladder tissue and plasma was measured by high performance liquid chromatography. The ultrastructural change caused by instillation of DMSO, hyaluronidase and saponin was also investigated by transmission and scanning electron microscopy. The electron microscopic study of the bladder treated with DMSO revealed the exfoliation of superficial cells, and the electron-dense grains of lanthanum were observed in submucosal layer. The concentration of THP was twice as high as that of untreated animals in both bladder tissue and plasma. The treatment with hyaluronidase caused no severe histological change of bladder mucosa, and lanthanum was observed only in the cytoplasma of superficial cells. The increased concentration of THP was slightly exhibited in plasma but not in bladder tissue. The treatment with saponin caused vacuolization and swelling of superficial cells, and many grains of lanthanum were observed between superficial cells and intermediate cells. The concentration of THP in bladder tissue was significantly higher than that of untreated animals, but in plasma no difference was revealed. These findings indicate that each three agent caused an unique effect on drug absorption of bladder mucosa and such characteristic of each agent must be considered for clinical application. Saponin is thought to be useful on intravesical chemotherapy because of increased concentration of anticancer drug (THP) in bladder tissue without that in plasma.

[Idiopathic dural arteriovenous fistula of the superior sagittal sinus associated with intracerebral hemorrhage: a case report]

A case was reported of a surgically removed idiopathic dural arteriovenous fistula of the superior sagittal sinus associated with intracerebral hemorrhage. Dural arteriovenous fistula of the superior sagittal sinus is said to be rare. Only 9 cases have been reported in detail so far. A 46-year-old male was referred to our clinic complaining of left motor weakness of sudden onset. He had no history of head injury. CT scan revealed subcortical hemorrhage in the right frontal lobe. enhanced CT scan showed string-like enhancement in the margin of the hemorrhage. Right internal carotid angiogram disclosed a dural arteriovenous fistula, of which the feeding artery was a meningeal branch of the posterior ethmoidal artery, draining the superior sagittal sinus and right frontal superficial cortical vein. The superior sagittal sinus was not obstructed. It was diagnosed as a rare idiopathic dural arteriovenous fistula in the superior sagittal sinus. Surgical obliteration of an arteriovenous fistula was performed preserving the superior sagittal sinus. Etiological aspects and surgical management of the rare lesion was discussed referring to previous reports.

Carotid arterial impedance during oscillated blood flow

Blood perfusion of systemic circulation is influenced by the physical characteristics of artery. Several investigations proposed that the physical parameters of vessels are determined by neurological factors, hormonal factors, and physical properties of arteries among others. In this study, arterial impedance was estimated because it may express the condition of vessels. To examine the change of arterial impedance according to the blood flow pattern, the typical sine wave blood flow (oscillated flow) was used during total cardiopulmonary bypass (CPB) because it is considered the most simple pulsatile flow. CPB using oscillated blood flow was performed in acute experiments on adult goats. Total systemic flow was controlled to remain at approximately 80 ml/min. Carotid arterial flow, aortic pressure, central venous pressure, and systemic flow were measured. Total peripheral resistance, carotid arterial resistance, systemic impedance, and carotid arterial impedance were calculated to evaluate blood flow distribution during CPB. This study suggested that the parameters of carotid arterial blood flow changed according to the change of flow frequency during oscillated blood flow. This change may occur because arterial impedance was influenced by flow frequency; therefore, the blood flow of the carotid artery was significantly changed according to the change of the frequency component of blood flow.

Role of eicosapentaenoic acid in lipid metabolism in the liver, with special reference to experimental fatty liver

Choline-deficient feed was given to three groups (n = 7 in each) of male Sprague-Dawley rats for 4 weeks to induce the development of fatty liver. In addition, two of the groups received eicosapentaenoic acid (EPA), 1000 mg/kg/d, administered orally either for all 4 weeks or for only the last 2 weeks of the study, respectively. The third group received the choline-deficient diet but no EPA. The untreated control group (n = 7) received only normal feed. The efficacy of EPA in preventing fatty liver was assessed based on the evaluation of pathologic and biochemical parameters and hepatic blood flow. EPA markedly improved fatty liver, probably due to both direct effects (inhibition of the synthesis of triglyceride in the liver) and indirect effects (increased hepatic blood flow). Decreased blood flow due to sinusoidal block is responsible for the progression of fatty liver. EPA has been shown to decrease thromboxane A2 production and blood viscosity and to enhance red cell deformability. These effects are thought to have contributed to the increases in hepatic blood flow.

[Vascular involvements in systemic lupus erythematosus]

It is an established fact that systemic vasculitis can occur during the course of SLE as well as other rheumatic diseases. The principal disorders of SLE are found to be associated with small arteries. However, clinical evidence of arterial disease in SLE patients varies considerably from patient to patient. Clinical manifestations of lupus vasculopathy including vasculitis and microangiopathy were described. Regarding systemic vascular lesions in SLE, the prognosis for the patients with thrombosis and vascular involvement of medium-sized arteries was the most grave. Treatments including steroids, immunosuppressants, plasmapheresis, anticoagulants, etc. are used according to causative factors which result in lupus vasculopathy.

[Postoperative delirium and abnormal behaviour related with preoperative quality of life in elderly patients]

Postoperative delirium and abnormal behavior were studied in 160 patients aged 60 and over with relation to their QOL assessed before surgical operation. QOL was assessed physically, psychologically, mentally and socially. Physical status was assessed with ability in daily life, seeing, hearing and severity of disease. Psychological condition (depression) was assessed by using GDS (Geriatric Depression Scale of Sheikh), Mentality (dementia) was assessed by using CDR (Clinical Dementia Rating) and HDS-R (Revised version of Hasegawa's dementia Scale). Sociality was assessed by social life and familial environment. Postoperatively 37.1% of males and 28.9% of females developed delirium and abnormal behaviour. Abnormal behaviour of demented patients was not defined as due to delirium or as dementia itself, so it was included in the classification "delirium and abnormal behaviour" because of the same aspect in terms of practical nursing care. The following factors were found to be statistically related to the occurrence of postoperative delirium and abnormal behaviour: disability in daily life, dementia, disturbance of hearing. Scores of HDS-R was closely related with the possibility of postoperative delirium and abnormal behaviour.

An immunohistochemical study of sebaceous carcinoma with anti-keratin monoclonal antibodies: comparison with other skin cancers

Formalin-fixed and paraffin-embedded tissue specimens of six cases of extraocular sebaceous carcinoma were studied immunohistochemically with eight anti-keratin monoclonal antibodies, 34 beta B4, 35 beta H11, Ks13.1, Ks19.1, PKK1, LP34, KL1 and AE1. The staining patterns of sebaceous carcinoma were compared with those of normal sebaceous glands and other skin cancers which should be distinguished from sebaceous carcinoma histopathologically. The other skin cancers compared were eccrine porocarcinoma, malignant clear cell hidradenoma, extramammary Paget's disease with underlying adenocarcinoma, malignant trichilemmoma, and squamous cell carcinoma. Most cases of sebaceous carcinoma were stained with 35 beta H11, Ks19.1, LP34, KL1 and AE1, while normal sebaceous glands were positive only with 35 beta H11, LP34, KL1 and AE1. By immunostaining, sebaceous carcinoma was distinguishable from extramammary Paget's disease with underlying adenocarcinoma, squamous cell carcinoma, malignant trichilemmoma, and eccrine porocarcinoma, but was not clearly distinguishable from malignant clear cell hidradenoma. These findings demonstrate that sebaceous carcinoma shows positive reactions with antibodies to simple epithelial keratin, probably as a result of neoplastic transformation, and that immunohistochemical examination using anti-keratin monoclonal antibodies is useful in distinguishing sebaceous carcinoma from several other skin cancers.

[A clinical study of total cystectomy for patients with bladder cancer]

We assessed the treatment outcome of total cystectomy for 67 patients with bladder cancer treated at Asahikawa Medical College Hospital between 1977 and 1991. The analyses of cause-specific 5-year survival rates by pathological stage (pT) and grade revealed a lower survival rate for higher stage, higher grade and non-transitional cell carcinomas. The condition of lymph node metastases (pN) was also correlated to the survival rate. Significant differences were observed between the survival rates of the patients with pT < or = 2 and pT > or = 3, and the patients with pNO and pN > or = 2. The cancer deaths were mainly caused by distant metastases. Preoperative irradiation showed prognostic advantage in the patients who had acquired down-staging by this treatment, and postoperative systemic chemotherapy also improved the prognosis in the patients with pT > or = 3.

Impaired interleukin-8-dependent chemotaxis by synovial fluid polymorphonuclear leukocytes in rheumatoid arthritis

The accumulation of polymorphonuclear leukocytes (PMN) in synovial fluid is a common feature of rheumatoid arthritis (RA). We studied the chemotactic response of PMN obtained from the synovial fluid and from the peripheral blood of patients with RA using a modified Boyden's method, in which interleukin-8 (IL-8) or N-formyl-methionyl-leucyl-phenylalanine (FMLP) was used as a chemotactic agent. The IL-8-induced response of peripheral blood PMN from 15 patients with RA did not differ from that of 15 healthy controls. A decreased chemotactic response to IL-8 was, however, observed in PMN from the synovial fluid of 12 patients with RA compared with peripheral blood cells of the same individual. This defective chemotactic ability of PMN was inversely correlated with the number of infiltrating cells in the synovial fluid. We also obtained similar results with FMLP. These results indicate that the chemotactic ability of PMN may be reduced after migrating to the synovial fluid.

[Malignant parasagittal meningioma appearing as a large subcutaneous mass]

We present a rare case of malignant meningioma appearing as an extracranial soft-tissue mass. A 34-year-old male was admitted with left parietal subcutaneous soft-tissue mass. Neurological examination on admission revealed right leg monoparesis and papilledema. Skull X rays showed hyperostosis of the left parietal bone. There was no evidence of bony destruction. CT and MRI showed a tumor with a large intracranial component, which was homogeneously enhanced. The tumor was totally removed by left ostoplastic craniotomy. The light-microscopic examination showed a meningothelial meningioma accompanied by malignant components with necrotic foci and mitotic figures. Tumor cells had invaded all the layers of the skull via the Haversian canals. We propose that hyperostosis with tumor invasion through all three layers of the skull should be considered as a malignant feature.

[Methylprednisolone pulse therapy for SLE patients with CNS disorder]

A clinical trial was conducted in 22 SLE patients with central nervous system (CNS) disorder in which the efficacy of pulse methylprednisolone suleptanate at the dose of 400 mg or 800 mg (as methylprednisolone) was assessed. The symptoms of CNS disorder disappeared within 40 days after pulse therapy in all of the 16 patients with organic brain syndrome (OBS). No improvement in the symptoms took place in any but one of the five patients who had cerebrovascular disorder. One SLE patient with depression showed improvement 55 days after pulse therapy. In the patients with OBS who had not received pulse therapy until 28 days or more after onset of CNS disorder, the symptoms disappeared in 20 days or more in both 400 mg and 800 mg dose groups. On the other hand, five of the six patients given the dose of 800 mg within 10 days of occurrence of the disease experienced a complete relief of the symptoms in 10 days after pulse therapy. However, at least 13 days were required for complete relief in all the four patients of the 400 mg group. The adverse reactions reported consisted of hyperlipemia, diabetes mellitus, and infections such as thrush or herpes zoster. The above results suggest that methylprednisolone pulse therapy is useful in the treatment of CNS disorder associated with SLE, particularly in patients with OBS who are given the dose of 800 mg early after onset of the disease.

Cerulenin-resistant mutants of Saccharomyces cerevisiae with an altered fatty acid synthase gene

Cerulenin, an antifungal antibiotic produced by Cephalosporium caerulens, is a potent inhibitor of fatty acid synthase in various organisms, including Saccharomyces cerevisiae. The antibiotic inhibits the enzyme by binding covalently to the active center cysteine of the condensing enzyme domain. We isolated 12 cerulenin-resistant mutants of S. cerevisiae following treatment with ethyl methanesulfonate. The mechanism of cerulenin resistance in one of the mutants, KNCR-1, was studied. Growth of the mutant was over 20 times more resistant to cerulenin than that of the wild-type strain. Tetrad analysis suggested that all mutants mapped at the same locus, FAS2, the gene encoding the alpha subunit of the fatty acid synthase. The isolated fatty acid synthase, purified from the mutant KNCR-1, was highly resistant to cerulenin. The cerulenin concentration causing 50% inhibition (IC50) of the enzyme activity was measured to be 400 microM, whereas the IC50 value was 15 microM for the enzyme isolated from the wild-type strain, indicating a 30-fold increase in resistance to cerulenin. The FAS2 gene was cloned from the mutant. Sequence replacement experiments suggested that an 0.8 kb EcoRV-HindIII fragment closely correlated with cerulenin resistance. Sequence analysis of this region revealed that the GGT codon encoding Gly-1257 of the FAS2 gene was altered to AGT in the mutant, resulting in the codon for Ser. Furthermore, a recombinant FAS2 gene, in which the 0.8 Kb EcoRV-HindIII fragment of the wild-type FAS2 gene was replaced with the same region from the mutant, when introduced into FAS2-defective S. cerevisiae complemented the FAS2 phenotype and showed cerulenin resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental study of the mechanism of seizure induction: changes in the concentrations of excitatory amino acids in the epileptic focus of the cat amygdaloid kindling model

L-glutamate (Glu) and L-aspartate (Asp) are two major excitatory amino acids that may be involved in seizure susceptibility and seizure induction. The concentrations of Glu and Asp were measured by microdialysis in the epileptic focus in a cat amygdaloid kindling model. Sequential changes in Glu and Asp (before, during, and after seizure) were measured in the partial seizure (S4) and generalized seizure (S6) groups. By stimulation at and 50 microA below the partial seizure-triggering threshold in the S4 group and the generalized seizure-triggering threshold in the S6 group, Glu was released from the epileptic focus in the S4 group, and both Glu and Asp were released in the S6 group after seizure and stimulation (below threshold), and the amount of Glu and/or Asp release determined seizure induction. Excitatory amino acids may be the trigger of seizure induction in the cat amygdaloid kindling model.

[A case of minocycline-induced pneumonitis with bronchial asthma]

We report a case of minocycline-induced pneumonitis. A 30-year-old woman was treated with minocycline for mycoplasma pneumonia of the right upper lobe. About 15 days after starting treatment, she developed a productive cough, stridor, and dyspnea. The chest X-ray film showed pulmonary infiltration in the left middle lung field. Based on the clinical history and the detection of eosinophilia in the bronchoalveolar fluid, drug-induced pneumonitis was suspected. Treatment with minocycline was discontinued and prednisolone (20 mg/day) was started, after which her symptoms subsided and there was marked regression of the pulmonary infiltrates on chest X-ray films. The lymphocyte stimulation test for minocycline was negative, but the diagnosis was confirmed by a positive oral provocation test.

Unique T cell differentiation markers: gangliosides with cholera toxin receptor activity on murine fetal thymocytes

Cholera toxin B subunit receptors (CTBR; gangliosides GM1a and GM1b-GalNAc-Gal) and GM1b-type gangliosides were examined during T cell development in BALB/c mice by FACS or TLC immunostaining. Sixty-two percent of CD4-8- early fetal thymocytes express CTBR [58% low affinity (GM1a+), 4% high affinity (GM1a2+)] at 13 days gestation (Day 13); GM1a2+ was expressed preferentially on Thy-1+ fetal thymocytes after Day 13. GM1a2+ Thy-1+ cells increased from 4% on Day 13 to 95% on Day 17. Surface GM1a2+ decreased beginning on Day 15 while GM1b-GalNAc-Gal (and CD4 and CD8) increased. GM1b-type+ cells increased from 8% on Day 13 to 51% on Day 17 and then decreased to 16% at 4 weeks; few asialo GM1+ cells (< 5%) are seen during gestation. Thus, synthesis of GM1a- and GM1b-type series was active until Days 15 and 17, respectively, and then was suppressed; GM1b-GalNAc-Gal was synthesized from GM1b following Gestational Day 15. GM1a- and GM1b-type identify immature T cells in mice, while GM1b-GalNAc-Gal identifies mature T cells.

[Effect of growth hormone on fetal and placental growth of spontaneous dwarf rat]

The effect of growth hormone on fetal and placental growth was studied in the spontaneous dwarf rat (SDR). The SDR is a newly established experimental model for pituitary growth hormone (GH) deficient dwarfism with an autosomal recessive mode of inheritance. The growth of heterogenic fetuses which were made by crossing female SDRs with normal male rats was similar to that of homogenic SDR fetuses on day 16 of gestation (Day 16), but on Day 20 heterogenic fetuses which had GH in their serum were significantly heavier than homogenic fetuses. There was no significant difference between the two groups in placental weight. The daily infusion of ovine-GH into pregnant SDR caused a significant increase in placental weight on Day 20, but had no effect on fetal growth. These results suggest that fetal GH plays a role in the fetal growth without affecting placental growth, and that maternal GH affects placental growth without affecting fetal growth.

Effects of imipramine and amitriptyline on intraventricular conduction, effective refractory period, incidence of ventricular arrhythmias induced by programmed stimulation, and on electrocardiogram after myocardial infarction in dog

The effects of imipramine and amitriptyline on intraventricular conduction, effective refractory period, incidence of ventricular arrhythmias induced by programmed stimulation and on electrocardiogram changes were studied after myocardial infarction in the dog. Amitriptyline, at doses of 1-3 mg/kg, significantly slowed the ventricular conduction of the infarcted zones in a dose- and frequency-dependent manner. Amitriptyline, at doses of 2 and 3 mg/kg, slowed the ventricular conduction slightly in the normal zone. The effective refractory period was prolonged by amitriptyline at a dose of 1 mg/kg. Amitriptyline increased the incidence of ventricular arrhythmias induced by programmed stimulation. Amitriptyline, at doses of 1-3 mg/kg, increased heart rate and prolonged the PQ, QRS and QT interval. Imipramine, at a dose of 3 mg/kg, slowed the conduction in infarcted zones to a lesser extent than amitriptyline. Imipramine, at doses of 1 and 2 mg/kg, did not significantly increase the incidence of ventricular arrhythmias. Imipramine, at a dose of 3 mg/kg, prolonged the QRS interval. From the present results it appears that imipramine has a lower cardiac toxicity than amitriptyline.

[Neuroleptanesthesia for a patient with mitochondrial encephalomyopathy]

This report describes a patient with mitochondrial encephalomyopathy who underwent an ophthalmic surgery under original neuroleptanesthesia. This 28-year-old female patient had been suffering from bilateral external ophthalmoplegia and blepharoptosis. Her preoperative neurological examination revealed a mitochondrial encephalomyopathy. Biopsy and blepharo-elevation for her left eyelid were scheduled. Anesthesia was induced with thiopental 5 mg.kg-1 and vecuronium 0.07 mg.kg-1, and maintained with total doses of 10 mg of droperidol, 400 micrograms of fentanyl and 4 mg of vecuronium. The patient recovered from anesthesia smoothly and her postoperative course was uneventful. Anesthetic management of patients with this disease and possible complications were discussed.