[Changes in human evoked spinal potentials (ESP) by epidural lidocaine]

Controversies exist on the sites of action of epidural anesthesia. Leading opinion says that it works on spinal nerve root. We examined ESP and tactile sensations in 4 patients during epidural anesthesia with lidocaine to determine the effects of the anesthesia on spinal cord. Prolongation of latency and decrease in amplitude of ESP appeared 10 min after injection of 1.5% lidocaine 4 ml, each parameter reaching maximum value of 115% and 60% of the control value 30 min afterwards, respectively. Then they started to recover slowly, reaching normal values 150 min later. Changes in ESP and tactile sensation were closely related. Decreases in amplitude to 90%, 80%, 60% of the control values were observed for hypesthesia, analgesia, and anesthesia, respectively. We conclude that the spinal cord also is an important site of action of epidural anesthesia.

[A case of sarcoidosis presenting as pulmonary nodules associated with pleural indentation fifteen years after onset]

A 65-year-old woman was admitted to our hospital because of pulmonary nodules, about 3 cm in diameter in the right upper lobe accompanied by pleural indentation, and 5 mm in diameter in the left middle lung field, revealed by chest X-ray. She had no clinical signs or symptoms except achalasia-like discomfort swallowing. Results of physical examinations were within normal limits. A specimen obtained from the nodule in right S2 by transbronchial biopsy showed noncaseating epithelioid granuloma containing asteroid bodies, and negative staining for acid-fast bacilli. No malignant cells were found in the specimen. Bacteriological examination of a bronchial lavage specimen was negative for pyogenic bacteria, mycobacteria and fungi. A PPD skin test was negative. BALF revealed an increase of lymphocytes and elevation of CD4/CD8 ratio. Fifteen years previously, the patient had been diagnosed as having sarcoidosis by scalene node biopsy, and had been treated with steroid therapy. Pulmonary nodules associated with pleural indentation in sarcoidosis is relatively rare, and is usually due to malignancy such as lung cancer. This possibility was ruled out clinically in the present case. Therefore, it was concluded that the pulmonary nodules in this case were due to the sarcoidosis itself.

Effects of halothane on the synthesis of neurotransmitter amino acids in mouse brain

The effects of halothane on the synthesis of the three major neuroactive amino acids (gamma-aminobutyric acid, aspartate and glutamate) and glutamine, which is closely related metabolically, were investigated in mouse brain using a labelled precursor ([13C]glucose) and a gas chromatography-mass spectrometry system. The ratios of newly synthesized amino acids were increased relative to baseline values when animals were exposed to 1% halothane, and decreased when they were exposed to 2% halothane. These findings suggest that halothane affects the synthesis of neurotransmitter amino acids in a concentration-dependent manner, without discrimination between excitatory and inhibitory amino acids.

Biotinidase activity in patients with liver disease

To investigate whether biotinidase deficiency may occur in liver disease, we determined biotinidase activity, biotin levels, and organic acids in patients with liver disease. Serum biotinidase activity in patients with liver disease (2.63 +/- 1.40 nmol/min/ml) was significantly lower than in the control group (5.43 +/- 1.06 nmol/min/ml). Serum biotinidase activity in decompensated liver cirrhosis (LC) and hepatoma was significantly lower than in acute viral hepatitis (AVH), chronic viral hepatitis (CVH), and compensated LC. The mean serum level of biotin in decompensated LC (1.8 +/- 0.6 microgram/ml) and hepatoma (1.7 +/- 0.8 microgram/ml) was significantly lower than in the control group (2.5 +/- 1.0 microgram/ml), and urinary excretion of biotin was increased in patients with liver disease, particularly in decompensated LC. Biotinidase activity correlated positively with serum biotin level and correlated negatively with urinary biotin level. Moreover, in four of five patients with severe liver disease the excretion of propionate, lactate, and 3-hydroxybutyrate decreased after biotin supplementation. The data for patients with severe liver disease so resembled those for late-onset multiple carboxylase deficiency that biotinidase deficiency is likely in patients with severe liver disease.

Effect of LC9018 combined with radiation therapy on carcinoma of the uterine cervix. A phase III, multicenter, randomized, controlled study

BACKGROUND

The failure rate with radiation therapy alone for Stage III cervical cancer is quite high, and therefore other modalities are being pursued as adjuvants to radiation therapy in hopes of improving the results.

METHODS

A randomized, controlled, comparative study on the efficacy and safety of radiation therapy combined with LC9018 (a biologic response modifier prepared from heat-killed Lactobacillus casei YIT9018) was conducted using 228 patients with Stage IIIB cervical cancer.

RESULTS

LC9018 enhanced tumor regression (P < 0.1) by radiation after both 30 Gy of external radiation and at the completion of radiation therapy. The combination therapy also prolonged survival and the relapse-free interval (P < 0.05) compared to radiation alone. Analysis of survival using the Cox proportional hazard model indicated that use of LC9018 was a significant factor related to survival duration. Major side effects of combined LC9018 included fever and skin lesions at the injection site, but no severe symptoms were noted. Radiation-induced leukopenia was significantly less severe (P < 0.05) in the LC9018-combined group than in the radiation-alone group, suggesting that this agent might help to prevent leukopenia during radiation therapy.

CONCLUSIONS

LC9018 was shown to be an effective agent for adjuvant immunotherapy when combined with radiation therapy.

Human mannose-binding protein gene is regulated by interleukins, dexamethasone and heat shock

Mannose-binding protein (MBP) is a plasma protein synthesized by hepatocytes. MBP, a structural analogue of the complement component C1q, can activate complement via the classical pathway and plays an important role in host defence. Expression of the human MBP gene was studied using the human hepatoma cell line HuH-7. RNA extracted from HuH-7 cells was reverse-transcribed to cDNA, amplified by the polymerase chain reaction and analysed by Southern blot hybridization. MBP mRNA expression in HuH-7 cells was increased by interleukin-6 (IL-6), dexamethasone and heat shock, decreased by interleukin 1 (IL-1), and unaffected by interferon gamma (IFN gamma), tumour necrosis factor alpha (TNF alpha) and transforming growth factor beta (TGF beta). Gel shift assays demonstrated Sp-1 binding sites in the 5' region of the gene, and formation of specific complexes between DNA and nuclear protein extracted from HuH-7 cells treated with IL-1 or IL-6. Human MBP is an acute-phase protein, and transcription of its gene is enhanced by IL-6, dexamethasone and heat shock but inhibited by IL-1. The actions of the cytokines appear to be mediated by specific transcription factors.

Gross total removal of adult brainstem glioma--two case reports

Two adult patients with brainstem glioma were successfully treated surgically. A 37-year-old male had a dorsally exophytic pontine glioma developing from the fourth ventricular fundus, and another 27-year-old male an intrinsic nodular mesencephalic glioma. Preoperative magnetic resonance imaging clearly visualized the tumor margin in both cases, and showed the relationship between the tumor and brainstem structure accurately. The tumors were radically excised using intraoperative evoked potential monitoring, ultrasonic surgical aspirator, and microsurgical techniques. Surgery is indicated when the tumor margin in the brainstem and adjacent region is clear, and the approach is possible without affecting the functional prognosis.

[Cardiovascular instability in schizophrenic patients may be caused by alpha 1-blocking activity of major tranquilizer--measurement by isometric handgrip test]

In order to prove the hypothesis that cardiovascular instability of schizophrenic patients is caused by alpha 1-blocking effect of major tranquilizer, we measured the blood pressure (BP), the heart rate (HR), and serum epinephrine and norepinephrine levels before and after isometric handgrip (IHG) test in schizophrenic patients and normal adults (control). The results were as follow: (1) In schizophrenic patients systolic BP rose significantly less than in controls after IHG test. (2) HR in patient group was constantly higher than in control group. (3) Though HR after IGH test decreased in normal group, there was no significant difference in HR before and after IHG test in patient group. (4) In patient group, norepinephrine level was higher than in control group before IHG test but it did not increase after IHG test, while it did increase in normal group. It is concluded that alpha 1-receptors are selectively blocked and the reactivity to norepinephrine is reduced in schizophrenic patients who has been taking a major tranquilizer. This results in the impairment of the ability to control immediately BP corresponding to postural change and to exercise, which probably causes instability in circulatory state in schizophrenic patients under general anesthesia.

Hepatic blood flow and energy metabolism during hypotension induced by prostaglandin E1 and nicardipine in rabbits: an in vivo magnetic resonance spectroscopic study

Hepatic blood flow (HBF) and energy metabolism during moderate hypotension induced by prostaglandin E1 (PGE1) and nicardipine were studied by in vivo magnetic resonance spectroscopy. HBF was determined by the deuterated water clearance method by using deuterium magnetic resonance spectroscopy, and energy metabolism was estimated from the changes in the levels of adenosine triphosphate and inorganic phosphate by using phosphorus (31P) magnetic resonance spectroscopy. Mean arterial blood pressure was intentionally reduced to 60% of control with PGE1 (n = 5) or nicardipine (n = 5). The HBF decreased by 38% and by 50% during the hypotension induced by PGE1 and nicardipine, respectively. The level of adenosine triphosphate decreased by 12% and that of inorganic phosphate increased by 80% during nicardipine-induced hypotension, whereas the corresponding levels showed no remarkable changes during PGE1-induced hypotension. After the cessation of drug administration, mean arterial blood pressure and HBF recovered to the control levels in the PGE1 group, but not completely in the nicardipine group. In the latter group, the level of inorganic phosphate did not recover either. These results indicate that during hypotension induced with PGE1 hepatic circulation and metabolism are conserved to a greater extent than during hypotension induced with nicardipine.

Inhibition of mitogen-induced proliferation of spleen lymphocytes is correlated with the induction of cell-mediated immunity in Salmonella infection in mice

The proliferation of murine spleen cells stimulated by a T-cell mitogen such as phytohemagglutinin (PHA) or concanavalin A (ConA) was significantly suppressed when the mice were immunized with either the viable cells or the sonicate of Salmonella typhimurium but not of Escherichia coli. The suppression of T-cell proliferation caused by the sonicate of S. typhimurium was completely restored by addition of phorbol 12-myristate-13-acetate (PMA), an activator of protein kinase C (PKC). Western blots using anti-phosphotyrosine antibodies showed that the mitogen-induced tyrosine phosphorylation of 120-, 106-, 94-, 76-, 68- and 57-kDa proteins in murine splenic T-cells was inhibited in the mice immunized with the viable cells but not the sonicate of S. typhimurium. These results suggest that the inhibition caused by the sonicate involves suppression of PKC activity, whilst that produced by viable cells involves down-regulation of tyrosine phosphorylation, and both inhibitions correlate with the induction of cell-mediated immunity in mice, as evidenced by the induction of delayed-type hypersensitivity reactions.

Alkaline phosphatase activity in the human promyelocytic leukemia cell line, HL-60, induced by retinoic acid and recombinant human granulocyte colony-stimulating factor

Recombinant human granulocyte colony-stimulating factor (rhG-CSF) not only enhanced the growth of HL-60 cells, but also significantly increased NBT-reducing ability and alkaline phosphatase (ALP) activity of the cells, which were enhanced by the treatment with retinoic acid (RA). Protein kinase C inhibitors (H-7 and staurosporine) significantly suppressed this induction of ALP. The pretreatment with RA followed by rhG-CSF treatment showed almost the same degree of ALP activity as that induced by the simultaneous treatment with RA and rhG-CSF. This study suggests that RA and rhG-CSF are the potent inducers of ALP activity of HL-60 cells and protein kinase C is supposed to have a role in this induction of ALP.

Efficacy of carbon monoxide laser in selectively intimal thermal welding--implications for laser balloon angioplasty

Excessive vascular damage causes excessive vascular repair, which results in restenosis. To limit the thickness of the coagulation layer in laser balloon angioplasty, we used a carbon monoxide (CO) laser, which has high tissue absorption, as a therapy laser source instead of a Nd: YAG laser. To investigate the benefit of short-penetration CO laser light to vascular tissue, excised human abdominal aorta was irradiated with a CO laser through a 30 microns polyethylene membrane. The temperature of the vascular tissue was continuously monitored during irradiation. CO laser irradiation of 20 W/cm2 was performed in either a continuous mode or an intermittent mode with various duty ratios (exposure/interval duration). With a total fluence of 200 J/cm2, the adventitial temperature decreased as the duty ratio was reduced. The adventitial temperature at a duty ratio of 1:2 was 43 degrees C. Microscopic examination of aorta which had been intermittently irradiated duty ratio of 1:2 showed thermal coagulation localized within the intima and a flattened intimal surface. These results suggest that intermittent laser irradiation with a CO laser can be used to limit the depth of thermal coagulation, and can selectively weld the intima without excessive thermal damage. Laser balloon angioplasty using a CO laser may help to prevent restenosis.

Respiration-driven Na+ pump of the marine Vibrio is encoded by chromosomal DNA

A plasmid-cured strain of the marine Vibrio alginolyticus 138-2 retains a respiration-driven Na+ pump. Examinations of several strains of V. alginolyticus and V. parahaemolyticus revealed that these murine Vibrio always possessed the respiration-driven Na+ pump irrespective of the presence or absence of plasmids. These results strongly suggested that the genes for the Na+ pump were encoded by chromosomal DNA.

Alteration of hepatic enzyme activities in obese KK mice treated with monosodium aspartate

Changes in body weight, concentrations of urine glucose, blood glucose, plasma insulin and FFA and hepatic enzyme activities were investigated in KK and C57BL mice treated with monosodium-L-aspartate (MSA). MSA was administered subcutaneously to neonates at a dose of 4 mg/g body weight. The MSA-treated KK and C57BL mice were remarkably obese at 10 weeks of age. The average plasma insulin concentration in the control KK mice was 73.6 microU/ml, over 4 times higher than in the control C57BL mice. In the control KK mice, hepatic glucokinase (GK) activity was quite low, and fructose-1,6-bisphosphatase (FBP) and acetyl-CoA carboxylase (CBX) activity was much higher than in the control C57BL mice. In the MSA-treated KK and C57BL mice, the plasma insulin concentration increased to 2 to 3 times higher than in the controls. The MSA-treated C57BL mice showed an increase in GK and CBX activity and acceleration of obesity. In the MSA-treated KK mice, GK activity did not change and CBX activity decreased, and only FBP activity increased significantly. Glycosuria was induced and blood glucose and plasma FFA increased remarkably in all MSA-treated KK mice.

cDNA nucleotide sequence and primary structure of mouse uterine peptidylarginine deiminase. Detection of a 3'-untranslated nucleotide sequence common to the mRNA of transiently expressed genes and rapid turnover of this enzyme's mRNA in the estrous cycle

Peptidylarginine deiminase is a protein-modulating enzyme which converts the arginine residues in proteins to citrulline residues. This study describes the complete primary structure of mouse peptidylarginine deiminase, which was deduced from nucleotide sequence analysis of cDNA clones plus proteochemical analysis of the purified enzyme. The composite cDNA sequence contained a 5' untranslated region of 7 bases, an open reading frame of 2019 bases that encoded 673 amino acids, a 3' untranslated region of 2662 bases, and part of a poly(A) tail. The N-terminal and C-terminal sequences of the enzyme matched the sequences deduced from nucleotide analysis. Furthermore, we determined that the N-terminal sequence was N alpha-acetyl-Met-Gln-, a sequence which has never previously been reported among N alpha-acetyl-Met proteins. The Arg 352 of the enzyme was converted to a citrulline residue and the potential Asn-linked glycosylation site (Asn542-Glu543-Ser544) had no carbohydrate moiety. Thus, mouse peptidylarginine deiminase consists of 673 amino acids with a molecular mass of 76,260. Mouse peptidylarginine deiminase mRNA has two AU-rich structures in the 3' untranslated region which exhibit a high degree of similarity to those in lymphokine, cytokine and proto-oncogene mRNA species. Since the rat enzyme (previously reported) does not possess these characteristic structures, we compared the levels of enzyme activity and mRNA in the mouse and rat uterus at four defined phases of the estrous cycle. The degradation of peptidylarginine deiminase and its mRNA proceeded significantly faster in the mouse than in the rat. We speculate that the unusual structure of the mouse enzyme and its mRNA be involved in this species-specific rapid degradation.

p53CM1 expression is not associated with prognosis in uterine cervical carcinoma

BACKGROUND AND METHODS

Specimens obtained from 192 patients with Stage III squamous cell carcinoma of the cervix treated by radiation therapy alone were investigated with an immunohistochemical method for the expression of p53CM1, a monoclonal antibody that recognizes wild and mutant type p53 gene products in histologic materials fixed and processed conventionally.

RESULTS

Cancer cells that had positive results for p53CM1 showed a nuclear staining pattern. Of the 192 patients, 99 had tumors that had negative findings (-) for p53CM1, 44 had tumors that were weakly reactive or ambiguous (+/-), 36 had tumors with positive results (+), and 13 had strongly reactive tumors (++). There was no significant correlation between survival of patients and p53CM1 (-) or (+/-) expression or p53CM1 (+) or (++) expression (chi-square test and Kaplan-Meier method, P = 0.466).

CONCLUSIONS

The p53CM1 expression in cancer cells is not a predictive factor for the prognosis of patients with cervical carcinoma.

Rabbit eye irritation caused by wearing toxic contact lenses and their cytotoxicities: in vivo/in vitro correlation study using standard reference materials

To clarify the relationship between eye irritancy and cytotoxic potential induced by irritant materials, we made lenses coated with standard reference materials (SRMs) prepared from various amounts of zinc diethyldithiocarbamate (ZDEC) and polyurethane (PU). Zinc diethyldithiocarbamate was classified as a mild irritant by the Draize eye irritation test. When ZDEC-SRM coated contact lenses were applied to rabbit eyes, Draize scores increased in proportion to both the ZDEC and PU concentrations used for coating. Furthermore, correlation with the cytotoxic potential (gamma = -0.93) was better than with lactate dehydrogenase (LDH) activities of tears from rabbit eyes wearing these coated lenses (gamma = 0.78). In conclusion, in vivo eye irritancy induced by wearing lenses could be estimated quantitatively with the cytotoxic potentials using a colony assay. Furthermore, we could compare different sensitivities caused by the same set of SRMs among three different sites of tissue. As a result, the order of sensitivity was eye > muscle >> skin.

A study of the arterial supply in the human rectus femoris muscle

The rectus femoris muscles have been used in reconstructive surgery, although their vascular anatomy has not been examined in detail. Thus, using cadavers, we have analyzed the extramuscular vascular pattern of 40 rectus femoris muscles and the intramuscular vascular pattern in 27 of these 40 muscles by means of an injected radiopaque substance and subsequent arteriography. The arterial patterns seen, depending on their relationship to the intramuscular tendon, then were classified as follows: type 1a (13 muscles), type 1b (3 muscles), type 2 (7 muscles), and type 3 (4 muscles). In the type 1a pattern, most of a muscle belly was supplied by one artery, but this was not seen in the other pattern types. We also observed an average of 2.6 musculocutaneous perforators. Therefore, in planning a free muscle transfer, the anatomic characteristics of the muscle should be kept in mind.

[Successful treatment of supravalvular mitral stenosis associated with ventricular septal defect]

Supravalvular mitral stenosis is a rare congenital anomaly. A case of a 2-year-old girl with supravalvular mitral stenosis and ventricular septal defect was successfully treated. The preoperated echocardiogram showed supravalvular mitral stenosis associated with congenital mitral stenosis and ventricular septal defect. However, the mitral valve was found to be normal after the excision of the ring. The ring has been attaching itself to the mitral valve, so it required a meticulous surgical technique to avoid injury to the mitral valve itself.

[Comparison of glutathione peroxidase activity in erythrocytes and certain tissues between voles and mice]

Glutathione peroxidase (GSH-Px) activities in erythrocytes and certain tissues were investigated in herbivorous voles and C57BL/6J mice. In both voles and mice, GSH-Px activities in liver, kidney and erythrocyte were higher than those of the other tissues, such as adipose tissue, pancreas and skeletal muscle. Voles showed lower GSH-Px activities in liver, kidney, erythrocyte and brain compared with mice.

[A case of suspected liver dysfunction induced by sevoflurane anesthesia]

We report a case of suspected liver dysfunction after general anesthesia with sevoflurane. A 30 day old male infant underwent inguinal herniorrhaphy under sevoflurane anesthesia (sevoflurane concentration: 1.3-1.5% with 50% oxygen and nitrous oxide). Two days after the operation, he developed frequent vomiting, anorexia and fever. GOT, GPT and LDH values were 242 Ku, 326 Ku and 901 Wu, respectively and peaked at 520 Ku, 709 Ku and 1000 Wu 12-16 days after the operation. Clinical symptoms and the laboratory data became normal within 2 months. The antibody titers of EB-virus, cytomegalo-virus and HA-virus were all within normal ranges and HBs antigen was negative. There were no blood transfusion or antibiotics administration before the onset, and no epidemic of hepatitis around him. His mother had no history of hepatitis during her pregnancy. Lymphocyte stimulation test for indication of sevoflurane allergy was also negative. From these evidences, toxic (not allergic) liver dysfunction due to exposure to sevoflurane was considered to be the most probable diagnosis.

Characterization of two distinct monoclonal antibodies to paired helical filaments: further evidence for fetal-type phosphorylation of the tau in paired helical filaments

Two monoclonal antibodies C5 and M4 raised against Sarkosyl-insoluble paired helical filaments (PHF) specifically labeled fetal tau, but hardly labeled normal adult tau. C5 immunoreactivity was eliminated by alkaline phosphatase treatment at 37 degrees C, whereas M4 reactivity could be removed only by the treatment at 67 degrees C. Epitope analysis showed that C5 and M4 recognition sites are in residues 386-406 and 198-250, respectively, according to the numbering of the longest human tau isoform. Thus, the phosphorylation sites are located in the amino- and carboxyl-terminal portions of the microtubule-binding region. These two well-characterized monoclonals should be valuable in the identification of a protein kinase(s) that converts normal tau into PHF-tau.

Reduced nm 23-H1 messenger RNA expression in metastatic lymph nodes from patients with papillary carcinoma of the thyroid

The nm 23 gene product, which possesses nucleoside diphosphate kinase activity, is a possible mediator of cancer cell invasion and metastasis. It has been divided into two distinct gene products, nm23-H1 and nm23-H2. We have developed a method for detecting nm 23-H1 and nm 23-H2 RNA using the polymerase chain reaction, based on the amplification of complementary DNA copies of nm 23-H1 and nm 23-H2 RNA. Using this method, the nm 23-H1 and nm 23-H2 messenger (m)RNA levels in 35 thyroid papillary carcinomas, 11 metastatic lymph nodes from patients with thyroid papillary carcinomas, five thyroid follicular adenomas, and three normal thyroid tissue samples were studied. Both nm 23-H1 and nm 23-H2 mRNA were expressed ubiquitously in normal and malignant thyroid tissues. However, in metastatic lymph nodes no (3 of 11) or weak expression (8 of 11) of nm 23-H1 mRNA was observed, the extent of which was inversely proportional to the degree of cancer cell occupancy, whereas nm 23-H2 mRNA was expressed and the levels were similar to those in other tissue tested. These results show that nm 23-H1 only may play a role in cancer cell invasion and metastasis although the exact mechanisms involved have yet to be elucidated.