Gene expression of hypothalamic growth hormone (GH)-releasing hormone and somatostatin does not correlate with pulsatile secretion of GH in the adult mouse

The secretion of growth hormone (GH) shows a pulsatile pattern in many mammalian species, and depends on the interaction of two hypothalamic hormones, GH-releasing hormone (GHRH) and somatostatin (SRIH). A surge of GHRH secretion into the hypophysial portal blood induces peak secretion of GH from the anterior pituitary. To study whether the rhythmic and reciprocal oscillation in secretion of GHRH and SRIH are associated with changes in synthesis of these peptides, we examined the expression of hypothalamic GHRH and SRIH mRNA by Northern blotting during trough and peak phases of GH secretion in male mice. Hypothalamic GHRH and SRIH mRNA levels did not differ between trough and peak phases of GH secretion. This result suggests that changes in GHRH and SRIH secretion have little association with changes in the synthesis of these peptides at the hypothalamus in the male mouse.

Immunohistochemical detection of progesterone receptors and the correlation with Ki-67 labeling indices in paraffin-embedded sections of meningiomas

Female sex steroids may play a role in the proliferation of meningiomas. We investigated the progesterone receptor (PgR) immunoreactivities and the Ki-67 labeling indices in the formalin-fixed, paraffin-embedded sections of meningiomas from 39 patients. After autoclave pretreatment of the sections (which were immersed in a citrate buffer), the sections were incubated with the monoclonal antibody for the PgR and the MIB-1 monoclonal antibody for the Ki-67 antigen. In the meningiomas studied, the immunoreactivity for the PgR was moderately to strongly positive in 51%, weakly positive in 21%, and negative in 28%. The nuclear staining for the PgR was clear, and no tumors were positive for the estrogen receptor. The Ki-67 labeling indices of the PgR-positive meningiomas (mean +/- standard deviation, 2.35 +/- 2.12%) were significantly lower than those of the PgR-negative meningiomas (6.53 +/- 4.83%) (P < 0.05). Two meningiomas that had recurred more than once showed high Ki-67 labeling indices and negative immunostaining for the PgR. These findings indicate that the PgR status may be closely related to the growth potentials of the meningiomas. Our results confirm that the immunodetection of the PgR and the Ki-67 antigen on the paraffin sections of meningiomas provides a practical tool for estimating the biological behavior of the meningiomas.

Resistance of growth hormone secretion to hypoglycemia in the mouse

Although previous studies have demonstrated that acute hypoglycemia inhibits growth hormone (GH) secretion due to stimulation of hypothalamic somatostatin (SS) neurones in the rat, the effect of hypoglycemia on GH secretion has not yet been elucidated in the mouse. In this study, the effects of insulin-induced hypoglycemia on mouse GH secretion, hypothalamic c-fos expression, GH-releasing hormone (GRH) and SS mRNA levels were investigated in conscious male mice. Seven days after implantation of chronic atrial catheters, blood samples were taken every 20 min from 1200-1600 h under unrestrained conditions. Insulin was administered iv every 20 min from 1200-1240 h to induce moderate hypoglycemia (MH) and severe hypoglycemia (SH), respectively. Expression of hypothalamic c-fos protein was examined 30 min and 60 min after induction of hypoglycemia by immunohistochemistry. Hypothalamic GRH and SS mRNA levels were examined 1 h and 3 h after induction of hypoglycemia by Northern blot analysis. The lowest mean plasma glucose levels after insulin injections were 49.1 +/- 4.1 mg/dl and 34.2 +/- 5.6 mg/dl in conscious mice, respectively. However, pulsatile GH secretion was not significantly altered in either group. Although both MH and SH markedly stimulated c-fos expression in specific hypothalamic nuclei including the paraventricular nucleus, they did not induce c-fos protein in the periventricular nucleus. Neither MH nor SH altered hypothalamic GRH or SS mRNA levels. These results suggest that hypoglycemia does not activate SS neurons which inhibit GH secretion in the mouse.

Persistent pure verbal amnesia and transient aphasia after left thalamic infarction

A 57-year-old right-handed man suffered persistent pure verbal amnesia (PPVA) and transient aphasia after left thalamic infarction. A neuroanatomical study with magnetic resonance imaging to identify the site of the lesion showed destruction of the internal medullary lamina (IML), mammillothalamic tract (MTT), the ventrolateral nucleus (VL) and the lower one-third of the medial nucleus. As regions critical for PPVA are unknown, we reviewed the cases of PPVA after left thalamic infarction reported in the literature. These suggest that confined destruction of the IML, MTT and VL in the left thalamus can produce PPVA.

[Two cases of cavity formation in prostatic urethra after transurethral microwave thermotherapy (TUMT) with Prostatron]

The Prostatron device, developed by Dr. Devonec, provides microwave heating of the prostate and simultaneous conductive cooling of the urethra. Treatment with Prostatron (transurethral microwave thermotherapy: TUMT) of BPH can be performed in a single session, and the urethra, the rectum and the surrounding tissue are protected with the temperature monitoring system. TUMT with Prostatron may be more suitable for a small adenoma with mild symptoms than a large adenoma with severe symptoms, because objective improvement is rarely observed compared with subjective improvement. We have treated 40 cases of BPH with Prostatron (Prostasoft 2, max. energy: 50 watt, max. urethral temperature: 44.5 degrees C, max. rectal temperature: 42.5 degrees C) since March 1993. Among them, there were 2 cases of large cavity formation involving the prostatic urethra. With cavity formation, TUMT may have its place in the treatment of a large adenoma with severe urinary symptoms, but loses its advantage in the prevention of persistent urinary infection and retrograde ejaculation, especially in the treatment of a small adenoma in a younger patient with mild urinary symptoms. It is unknown why such cavity formation occurred only in 2 patients among 40 equally treated cases, but the causes of cavity formation and safety of TUMT should be evaluated again, even though no injury to the rectum and the external urethral sphincter were detected. We report these 2 cases, and causes of cavity formation and discuss the prospects of TUMT.

Molecular evolution of a class C beta-lactamase extending its substrate specificity

Enterobacter cloacae GC1, a clinical strain isolated in 1992 in Japan, was found to produce a chromosomal class C beta-lactamase with extended substrate specificity to oxyimino beta-lactam antibiotics, significantly differing from the known E. cloacae beta-lactamases such as the P99 beta-lactamase. The 1560 nucleotides including the GC1 beta-lactamase gene were sequenced, and the amino acid sequence of the mature enzyme comprising 364 amino acids was deduced. A comparison of the amino acid sequence with those of known E. cloacae beta-lactamases revealed the duplication of three amino acids at positions 208-213, i.e. Ala-Val-Arg-Ala-Val-Arg. This duplication was attributed to a tandem duplication of a 9-nucleotide sequence. The chimeric beta-lactamases produced by the chimeric genes from the GC1 and P99 beta-lactamase genes indicated that the extended substrate specificity is entirely attributed to the 3-amino acid insertion. Two mutant beta-lactamases were prepared from P99 beta-lactamase by site-directed mutagenesis, i.e. an Ala-Ala-Ala sequence was inserted before or after the native Ala-Val-Arg at positions 208-210. These mutant enzymes revealed that the Ala-Val-Arg located from positions 211 to 213 in the GC1 beta-lactamase are the newly inserted residues, and this phenomenon is independent of the characteristics of the amino acids inserted.

[A case of lung metastasis from renal cell carcinoma showing complete response by a combination chemotherapy with methotrexate, vinblastine and pepleomycin (MVP)]

A 69-year-old woman visited our hospital with complaints of low grade fever and general fatigue in October 1990. Computed tomography (CT), ultrasonogram, and renal arteriography showed left renal tumor and she was diagnosed with renal cell carcinoma (T2M0N0). Left radical nephrectomy was performed in December 12, 1990. After operation, 3 x 10(6) unit per day of IFN-alpha were administered three times per week. She complained of low grade fever and general fatigue in June, 1991. CT showed left lung metastasis (phi 3 cm). She was given combined chemotherapy (MVP: methotrexate, vinblastine, pepleomycin). After 2 courses, lung metastasis decreased and after 4 courses, lung metastasis was not shown by CT in December, 1992. No evidence of relapse was shown by CT in June, 1994.

Role of ring size on the secondary structure and antibiotic activity of gramicidin S

In order to investigate the contribution of ring size to the secondary structure and antibiotic activity of gramicidin S, many analogs consisting of 6, 7, 8, 9, 11, 12, 13, and 14 amino acid residues were synthesized. In the analogs with smaller ring sizes than that of gramicidin S, only des-Val1-, des-Leu3- and des-Pro5-gramicidin S showed weak activity against the gram-positive micro-organisms tested. On the other hand, all analogs having larger rings, in which L- or D-Leu residues were inserted, were active. The activity of the analogs consisting of 10, 11 and 12 amino acid residues was stronger than those of the analogs with other ring sizes, and the activity of endo-Leu2a-gramicidin S against S. epidermidis SP-al-1 and B. subtilis ATCC 6633 was twice of that of gramicidin S.

Unusual recurrence pattern in peritorcular meningioma--case report

A 45-year-old female presented with a recurrent peritorcular meningioma. The recurrence was very unusual as the tumor arose from the confluens sinuum and extended to the left jugular bulb completely within the sinuses, obstructing the venous outflow. However, there were no clinical symptoms or neurological abnormalities, due to the development of collateral circulation. The possibility of intrasinus recurrence should always be considered in patients with tumor invasion to sinus walls, even if the patient has no clinical symptoms or neurological abnormalities.

[Chronic inflammatory demyelinating polyneuropathy associated with chronic liver disease due to type B and type C hepatitis virus]

A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) associated with type B and type C hepatitis virus infection is reported. A 54-year-old female who had a blood transfusion at the age of 31 years was diagnosed as a carrier of hepatitis B virus at the age of 43. Liver dysfunction was first noted in 1987 and gradually grew worse year by year. Beginning in early June 1992, the patients general fatigue became worse, her serum GOT and GPT levels became elevated, and she complained of a tingling sensation in her arms and legs. Neurological examination revealed moderate sensory disturbance of the glove-and-stocking type in all of her extremities. Deep tendon reflexes were all diminished. Hepatitis C antibody was detected in the serum at this time. On June 12, 1993, progression of her sensory disturbance was found to be associated with generalized muscle weakness. Cerebrospinal fluid studies showed increased protein without pleocytosis. Motor nerve conduction studies revealed marked prolongation of terminal latencies, reduction of conduction velocities, and abnormal temporal dispersion of the motor potentials. No sensory potentials could be evoked at any of the sites stimulated. Sural nerve biopsy showed segmental demyelination and severe loss of large myelinated fibers as well as some onion bulb formation. A diagnosis of CIDP was made. Treatment with corticosteroids was started, but there was little improvement in neurological function. The liver dysfunction progressed further and ultimately the patient died of hepatic failure. An autopsy demonstrated liver cirrhosis, but no malignant tumors were evident.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell adhesion molecules acting between C6 glioma and endothelial cells

The interactions between tumor cells and endothelium play a key role in the process of tumor growth, local invasion, and distant metastasis. In the present study, we examined the adhesion of C6 glioma cells to bovine endothelial cell (EC) monolayers and defined the cell adhesion molecules acting between these cells. Pretreatment of the EC monolayer with cytokines, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, and interferon (INF)-gamma, significantly increased the adhesion of C6 glioma cells to the EC monolayer. The effect lasted more than 24 hours and was protein-synthesis dependent. The adhesion of C6 glioma cells to TNF-activated ECs was blocked by the monoclonal antibody to the intercellular adhesion molecule-1 (ICAM-1) or beta 2 integrin, whereas that of melanoma cells was not. These findings provide evidence that ICAM-1 and beta 2 integrin function as inducible cell surface molecules that can support the adhesion of C6 glioma cells to ECs, and may contribute to the characteristic growth of glial tumors in vivo.

Immunofluorescence study of immune complexes in polymyalgia rheumatica

Two elderly patients with polymyalgia rheumatica (PMR), one with and the other without temporal arteritis (TA), are presented. Immunofluorescence study of muscle biopsy specimens showed IgG, IgA, and fibrinogen deposits in the perifascicular area in the perimysium. This finding suggests that immune complexes play a role in the pathogenesis of this condition and that the pathophysiology of PMR involves an interstitial inflammatory process.

Simple quantitative reverse transcribed-polymerase chain reaction (RT-PCR) method involving recombinant RNA generated by a false-priming PCR product

A simple and efficient method for preparing rcRNA through competitive RT-PCR has been developed. The basis of this method is the use of a false-priming PCR product including the same primers as a specific product. A 290 bp fragment obtained by two-step PCR was subcloned into a plasmid vector and then the cloned DNA was transcribed into rcRNA. After competitive RT-PCR using sample RNA and rcRNA had been carried out, Southern blot hybridization was performed. The method was applied to determine the amounts of PIMT mRNAs in the rat pituitary. The quantitative analysis indicated that an at least 2-fold difference in PIMT mRNA level can be accurately determined with our method.

Studies of gramicidin S analogues having various ring sizes by reversed-phase high-performance liquid chromatography

Many gramicidin S analogues containing six to fourteen amino acid residues were synthesized and their chromatographic behaviour was investigated using reversed-phase high-performance liquid chromatography. Cyclo(-Val-Leu-Orn-Leu-D-Phe-Pro-Val-Orn-Leu-D-Phe-Pro-) gave double peaks in the chromatogram, whereas the other peptides gave a single peak. The influences of the concentration of this peptide, column temperature and flow-rate on the chromatographic separation were examined. The isomeric conformers were separated from each of the double peaks and were in equilibrium with each other at low temperatures. These results suggested that the presence of the additional L-Leu residue preceding the Orn residue gives rise to moderate stabilization of their conformers.

Pharmacological evidence of distinct alpha 1-adrenoceptor subtypes mediating the contraction of human prostatic urethra and peripheral artery

1. The alpha 1-adrenoceptor subtypes mediating contractions of the smooth muscle in human prostatic urethra and branches of internal iliac artery were characterized in isometric contraction experiments. 2. Phenylephrine produced concentration-dependent contractions in both the urethra and artery. These responses were competitively inhibited by prazosin, WB4101 and 5-methyl-urapidil, and the slopes of Schild plots for all these antagonists were close to unity. 3. The pA2 values for prazosin were not significantly different between the urethra (9.42 +/- 0.11; mean +/- s.d.) and artery (9.50 +/- 0.27), while the pA2 values for WB4101 and 5-methyl-urapidil in the human prostatic urethra (8.94 +/- 0.19 and 8.42 +/- 0.14, respectively) were significantly greater than in the branches of human internal iliac artery (7.94 +/- 0.21 and 7.43 +/- 0.22, respectively; P < 0.01). 4. Pretreatment with chlorethylclonidine (CEC) at concentrations ranging from 0.1 microM to 100 microM attenuated the maximum contraction to phenylephrine in a concentration-dependent manner in both the urethra and artery. However, the urethra was significantly less affected by CEC than the artery. The pD'2 values (negative logarithm of the molar concentration of antagonist which reduced the maximum contraction to one half) in the urethra and artery were 4.35 +/- 0.27 and 5.20 +/- 0.37, respectively (P < 0.01). 5. The present results indicate that there are distinct populations of alpha 1-adrenoceptor subtypes in the human prostatic urethra and branches of the internal iliac artery. The alpha 1-adrenoceptors responsible for the contraction of the human internal iliac artery branches are predominantly alpha 1 B-subtype, whereas those in the human prostatic urethra are considered to be not alpha 1 B, but alpha 1 c or possibly alpha 1 A or alpha 1A/D-subtype.

Relationship between thyroid functions and urinary growth hormone secretion in patients with hyper- and hypothyroidism

Thyroid hormone plays an important role in growth hormone (GH) synthesis and secretion. To study the relationship between thyroid function and urinary GH secretion in the hyperthyroid and hypothyroid states, we measured thyroid hormones, simultaneously with serum and urinary GH levels, in 54 patients with thyroid diseases. GH-releasing hormone (GRH) test was performed in 18 patients in order to evaluate serum and urinary GH responses to GRH in hyper- and hypothyroid states. Serum thyroid hormone levels were strongly correlated with the urinary GH levels in the patients, and the correlation was greater than that between serum thyroid hormone and serum GH levels. Urinary GH levels were significantly higher in the hyperthyroid patients than in the euthyroid and hypothyroid patients, although serum GH levels were not significantly different among these three groups. Serum GH response to GRH was significantly decreased in hyperthyroid patients as compared to euthyroid patients. However, urinary GH levels after GRH administration were not decreased in the hyperthyroid patients. These results suggest that hyperthyroid states increase GH in urine and may accelerate the urinary clearance of GH.

[A study on predicting factors of the effect of intra-arterial infusion chemotherapy in patients with bladder cancers: the usefulness of in-vitro chemisensitivity test measuring intracellular ATP contents (ATP assay)]

We studied a relationship between in vitro sensitivity of the tumors to anti-cancerous drugs and histopathological effectiveness of an intra-arterial infusion chemotherapy in 15 patients with bladder cancers. The in vitro sensitivity test was performed by measuring intra-cellular ATP contents (ATP assay). The intra-arterial chemotherapy were performed by injecting methotrexate (MTX), adriamycin (ADM) and eisplatin (CDDP) from the internal iliac artery. When the intra-cellular ATP contents of the tumor cells treated with an anti-cancerous drug decreased to less than 50% of the untreated tumor cells, the tumor was evaluated as sensitive to the drug. The effectiveness of the chemotherapy were histopathologically evaluated by a pathologist according to the response criteria for bladder cancer treatment. When the histopathological responses of higher than grade 2 were observed in the tumor, the chemotherapy was evaluated as effective. In 8 of 9 tumors sensitive to ADM, chemotherapy were effective histopathologically and in all 6 tumors resistant to ADM, histopathological response of the chemotherapies were poor. The overall coincidence ratio between sensitivity to ADM and the histopathological effectiveness of the chemotherapy was 93%, showing statistically significant correlation. In 7 of 12 tumors sensitive to CDDP, the chemotherapies were effective and in 2 of 3 tumors resistant to CDDP, the chemotherapies were ineffective. Although the overall coincidence ratio between the sensitivities to CDDP and chemotherapeutic effectiveness was 60%, there was no significant correlation between them. In 7 of 8 tumors sensitive to both of ADM and CDDP, the chemotherapies were effective and in 6 of 7 tumors resistant to at least one of them, the chemotherapies were ineffective. (ABSTRACT TRUNCATED AT 250 WORDS)

[Osteoarthritis of the knee joint: a field study]

To clarify the natural history of osteoarthritis of the knee joint, a field study of the knee joint was performed on the inhabitants of Matsudai Town, Niigata Prefecture in 1979 and 1986. The study included the same 979 individuals, involving 820 women and 159 men, aged between 40 and 65 years in 1986 as in 1979. Narrowing of the femoro-tibial joint space was found in 17.7% and 26.1% of the women, and in 5.3% and 12.0% of the men, in 1979 and 1986, respectively. The individuals without osteoarthritic change and those with subchondral sclerosis or osteophytes in the femoro-tibial joint space exhibited less progressive changes in symptoms and radiographic findings. On the other hand, many of those in whom the joint space was more than 50% narrowed compared with the contralateral joint space had persistent pain, suggesting that they were candidates for active treatment. There were about twice as many women as men with symptomatic osteoarthritis of the knee. A comparative study of a group of women with, and a group of women without, radiographic progression in arthritic changes, indicated that the factors correlated with worsening osteoarthritis of the knee included aging, obesity, varus deformity of the knee, severity of inflammation, and flexion contracture of the knee.

Replacement of serine 237 in class A beta-lactamase of Proteus vulgaris modifies its unique substrate specificity

The chromosomal beta-lactamase gene of Proteus vulgaris K1 was cloned and sequenced. The gene comprises 813 nucleotides and codes for the mature enzyme of 29,655 Da, comprising 271 amino acids. The K1 beta-lactamase showed 30-70% similarity, in the overall amino acid sequence, to class A beta-lactamases of Gram-negative bacteria. However, the K1 beta-lactamase differs from most class A enzymes in having a unique substrate specificity as a cephalosporinase, its spectrum extending to even oxyiminocephalosporins. To clarify the relationship between its unique substrate specificity and specific amino acid residues, alignment of the amino acid sequence of the K1 beta-lactamase with those of class A beta-lactamases was performed, and Ala104 and Ser237 were found to be candidates. Ala104 and Ser237 were replaced with glutamic acid and alanine, respectively, which are commonly found in other class A beta-lactamases. The substitution at position 104 had no effect on the enzyme activity or the substrate specificity. The amino acid replacement at position 237, however, reduced the kcat/Km value for an oxyiminocephalosporin (cefuroxime) to 17% of that in the case of the wild-type enzyme, whereas the mutant enzyme showed a higher kcat/Km value for benzylpenicillin, 3 times, than that of the wild-type enzyme. These results indicated that Ser237 is one of the residues responsible for the unique substrate specificity of the P. vulgaris beta-lactamase.

[A case of adenoid cystic carcinoma manifesting Garcin's syndrome--effectiveness of cerebrospinal fluid ferritin as a tumor marker in malignant CNS involvement]

We reported a 69-year-old man exhibiting Garcin's syndrome caused by adenoid cystic carcinoma of the right submandibular gland. The patient first experienced abnormal sensations in his right cheek, and the cranial nerves on his right side gradually became affected. He was admitted for hoarseness and dysphagia. Physical examination revealed a right submandibular mass, and neurological examination revealed that the first cranial nerve and the fifth to twelfth cranial nerves on the right side were affected. Laboratory examination showed a rise of both serum and cerebrospinal fluid (CSF) ferritin, suggesting an intracranial invasion of the submandibular tumor. But other tumor markers, CSF protein and cell counts, CSF pathologic study and radiological studies for the central nervous system (CNS) were all negative. A submandibular tumor biopsy revealed adenoid cystic carcinoma. The radiation therapy, including the skull base, provided relief of the patient's symptoms, the tumor was reduced and serum and CSF ferritin level decreased. It is possible that CSF ferritin is a sensitive marker for CNS involvement of malignant tumor because of its permeability of the blood brain barrier and the absence of correlation between serum and CSF.

[A case of prostatic cyst]

A 45-year-old man visited our hospital for further examinations because an abnormal echogram of the bladder had been noted at a medical checkup. Transrectal echography and magnetic resonance imaging (MRI) showed a cystic mass in the bladder neck. Endoscopically it was situated in the anterior aspect of the vesical neck at about the position of 12 o'clock on the dial of a clock. Transurethral resection of the cyst wall was performed under the diagnosis of prostatic cyst. Histopathologically the cyst wall was lined by flattened epithelium and this case was supposed to be classified as retention cysts. This was thought to be the 23rd case of prostatic cysts in the Japanese literature. The characteristics, diagnostic problems and treatments of prostatic cysts are discussed.

Immunohistochemical analysis of perforin and granzyme A in inflammatory myopathies

Perforin (PF) and granzyme A (GA) are candidates suspected of being cytolytic proteins of the granules of cytotoxic T lymphocytes (CTLs) and natural killer (NK) cells. We analysed PF and GA in muscles from patients with inflammatory myopathies. Five cases of polymyositis (PM), two cases of inclusion body myositis (IBM), and five cases of dermatomyositis (DM) were studied immunohistochemically using anti-PF and GA antibodies raised against each synthetic peptide of human PF and mouse GA, together with a panel of monoclonal antibodies reactive for lymphocyte subsets. In PM and IBM, PF positive cells were colocalized with GA positive cells and occasionally invaded into the non-necrotic muscle fibres. The percentage of PF positive cells among the endomysial CD8 positive cell population was 9.9% (PM) and 12.5% (IBM), and the majority of the endomysial CD8 positive cells were alpha/beta T cells. In contrast, in DM, both PF and GA positive cells were very few in all cases. Only few inflammatory cells were CD16+ or CD57+ NK cells among these diseases. Our results suggest that PF and GA are secreted mainly from alpha/beta T cells, and may play a key role in muscle fibre damage in at least some PM and IBM, but not in DM.

[A case of incidental renal leiomyosarcoma]

A 68-year-old man visited his home doctor with the chief complaint of left flank pain. Abdominal ultrasonography revealed left hydronephrosis and space occupying lesion in the right kidney. He was referred to our hospital because of suspected left ureteral stone and for further examination. Drip infusion pyelography revealed a left ureteral stone and retrograde pyelography showed extrinsic compression and deformation of the right pyelogram. A computed tomography showed a heterogeneous solid mass, 7 x 4 cm in size, compressing the pelvicocalyceal system and growing out of the kidney. Right radical nephrectomy was performed under the diagnosis of renal cell carcinoma. The pathological diagnosis was leiomyosarcoma. Seventy-five cases of renal leiomyosarcoma have been reported in the Japanese literature and this is the third case as an incidental tumor. Because of the absence of the characteristic diagnostic signs, this malignant tumor can present diagnostic difficulty. The diagnostic problems and clinical features of renal leiomyosarcoma are discussed.

The virR gene, a member of a class of two-component response regulators, regulates the production of perfringolysin O, collagenase, and hemagglutinin in Clostridium perfringens

The perfringolysin O (theta-toxin) gene (pfoA) of Clostridium perfringens was cloned into an Escherichia coli-C. perfringens shuttle vector, and the pfoA gene was expressed in mutants of C. perfringens 13 which lacked the production of perfringolysin O. One group (SI117) could express the pfoA gene, and the other (SI112) could not. A mutation in the regulatory system for pfoA gene expression was suspected in SI112. A chromosomal DNA library constructed from strain 13 was transformed into strain SI112 to identify the regulatory gene(s) for the pfoA gene. Five strains of 10,000 transformants restored perfringolysin O production. All contained a 2.5-kb DNA fragment. This fragment activated the transcription of the pfoA gene and also restored the production of collagenase (kappa-toxin) and hemagglutinin in strain SI112. Deletion analysis showed that a 1.25-kb region was sufficient for the trans activity, and sequence analysis disclosed that open reading frame 2 (ORF2) was located in this region. A homology search for the deduced amino acid sequence revealed that ORF2 was homologous to a response regulator in a two-component signal transduction system. ORF2 was designated virR, and it is suggested that the virR gene plays an important role in the pathogenicity of C. perfringens.

Analysis of growth hormone release from rat anterior pituitary cells by reverse hemolytic plaque assay: influence of interleukin-1

Interleukin-1 (IL-1) has been suggested to directly affect pituitary growth hormone (GH) release, although other investigators have failed to observe this effect. We examined the effects of IL-1 beta on GH secretion from single somatotrophs by means of reverse hemolytic plaque assay (RHPA). Anterior pituitary cells of adult male rats were enzymatically dispersed and subjected to RHPA. IL-1 beta at 100 pM and 1 nM, increased both the mean plaque area and the fraction of somatotrophs forming large plaques. IL-1 beta did not increase the mean plaque area in the presence of the IL-1 receptor antagonist (IL-1ra). IL-1 beta (1 nM) added together with GH-releasing hormone (GHRH; 10 nM), showed no additive effect on GHRH-induced GH release. The stimulatory action of IL-1 beta on the release of GH was suppressed by somatostatin. In conclusion, our data show that IL-1 beta stimulates GH-secretion through direct action on the pituitary.

Changes in urinary excretion of endothelin-1-like immunoreactivity before and after unilateral nephrectomy in humans. Comparison with other urinary parameters and unilateral adrenalectomy

To assess the value of endothelin-1 (ET-1) as a parameter of renal functional overload and the process of hyperfiltration, urinary excretion of ET-1-like immunoreactivity (U-ET-1) and urinary excretion of other parameters [beta 2-microglobulin (beta 2-MG), N-acetyl-beta-D-glucosaminidase (NAG), albumin (Alb) and 24-hour creatinine clearance (Ccr24)] were measured before, 1, 2 and 7 days after unilateral nephrectomy in 15 patients with unilateral renal lesions (renal cell cancer, renal pelvic cancer, ureteral cancer and renal tuberculosis) and after unilateral adrenalectomy in 5 patients with adrenal lesions. In the nephrectomy group (NX), Ccr24 significantly decreased at 1 and 2 days after the operation, but the other 4 parameters significantly increased after the operation as compared to preoperative values. In the adrenalectomy group (ADX), neither Ccr24 nor ET-1/Cr showed any change after the operation, but the other 3 parameters (beta 2-MG/Cr, NAG/Cr and Alb/Cr) significantly increased. Comparing the NX and ADX groups, both ET-1/Cr and beta 2-MG/Cr in NX were significantly higher than in ADX after the operation. On the other hand, neither NAG/Cr nor Alb/Cr in NX differed from values in ADX. Comparing ET-1/Cr and other parameters, only beta 2-MG showed a positive significant correlation. These results suggest that U-ET-1 may be an indicator of functional overload of the kidney.

Effects of long-term infusion of growth hormone (GH)-releasing factor on pulsatile GH secretion in the male rat

The effects of long-term infusion of GRF on pulsatile GH secretion were investigated in conscious, freely-moving male rats. GH-releasing factor (GRF) was intravenously administered for 14 days using an osmotic minipump. Six-hour iv infusion of 0.5 microgram/h GRF significantly increased mean GH concentration in the conscious rats. In contrast, 14-day iv infusion of 0.5 microgram/h GRF significantly inhibited pulsatile GH secretion. The pituitary GH content was significantly increased by the 14-day treatment. The GH response to bolus injection of 1 microgram GRF under urethane anesthesia was enhanced by the 14-day infusion of GRF. Pretreatment with somatostatin (SS) antiserum did not restore the inhibited GH secretion in rats treated with 14-day infusion of GRF. These results suggest that neither pituitary GH depletion nor high somatostatin tone is involved in the GRF-induced GH inhibition.

Dissociation of selective renal venous plasma endothelin-1 activity and corresponding plasma renin activity in a patient with hypertension, severe stenosis of unilateral renal artery and ipsilaterally decreased renal function

Plasma endothelin-1 (ET-1)-like immunoreactivity in selective renal venous blood and peripheral venous blood was measured and compared with plasma renin activity and aldosterone level in a 26-year-old woman with suspected renovascular hypertension due to stenosis of the left renal artery. Although there was no significant step-up in plasma renin activity between the right and the left renal vein, left/right ratio of plasma ET-1 in the renal vein was 2.18. This case suggests that ET-1 may be one of the hypertensive mechanisms of suspected renovascular hypertension in addition to the renin-angiotensin system.

Cryptic arteriovenous malformation of the choroid plexus of the fourth ventricle--case report

A 54-year-old female presented with a cryptic arteriovenous malformation (AVM) of the choroid plexus of the fourth ventricle causing intraventricular hemorrhage. Computed tomography and magnetic resonance imaging disclosed the lesion near the fourth ventricle, but bilateral vertebral angiograms showed no abnormalities. The preoperative diagnosis was cavernous angioma. The mass was removed completely, and histological examination demonstrated an AVM of the choroid plexus. Vascular malformations of the choroid plexus of the fourth ventricle are extremely rare. The possibility of this lesion being the cause of primary intraventricular hemorrhage of unknown origin should always be considered.

Correlation of upper and lower urinary tract function in patients with neurogenic bladder: evaluation using simultaneous measurement of cystometry and diuresis renography with full and empty bladder

Diuresis renography and water filling cystometry were simultaneously performed with the bladder full and with the bladder empty. The findings of diuresis renography with a full bladder were compared with those of diuresis renography with an empty bladder, in 9 patients (4 male and 5 female, mean 24.4 years old) with neurogenic bladder dysfunction. According to O'Reilly's classification, the findings of diuresis renography with a full bladder were significantly worse than those of diuresis renography with an empty bladder, regardless of cystometry patterns and bladder compliance. These results suggest that in patients with neurogenic bladder dysfunction, a full bladder in itself can cause deterioration of the upper urinary tracts, regardless of bladder pressure and bladder compliance.

Simultaneous measurement of cystometry and diuresis renography during full and empty bladder in neurogenic bladder patients: a preliminary report

In 9 patients (4 male and 5 female; mean 24.7 years old) with neurogenic bladder dysfunction, diuresis renography and water filling cystometry were simultaneously monitored with a full and empty bladder, and findings of diuresis renography with a full bladder were compared with those of diuresis renography with an empty bladder. According to O'Reilly's classification, findings of diuresis renography with a full bladder were significantly worse than those of diuresis renography with an empty bladder, regardless of cystometry patterns and bladder compliances. Although every kidney without hydronephrosis on intravenous pyelogram showed normal diuresis renography with an empty bladder, some kidneys with hydronephrosis showed an obstructive pattern even with an empty bladder. These results suggest that in some patients with neurogenic bladder dysfunction, deterioration of the upper urinary tract occurs more easily with a full than with an empty bladder, regardless of bladder pressure and bladder compliance.

Differential diagnosis of solid renal tumors by MRI. Comparison of in situ relaxation times measured with a 0.1 T imager and histological findings

The T1 and T2 of kidneys in 5 normal volunteers and 27 patients with renal tumors were evaluated preoperatively using a magnetic resonance imager with a 0.1 T resistive electromagnet, and the T1 and T2 of the renal tumors were compared with the pathological findings: (i) the T1 and T2 of the normal renal medulla were longer than those of the normal renal cortex and psoas muscle; (ii) both T1 and T2 of renal pelvic cancer (RPC) were shorter than those of renal cell cancer (RCC, p < 0.05); (iii) the T2 values of RPC were significantly shorter than those of renal medulla (p < 0.01); (iv) the T1 and T2 of the normal renal cortex of subjects < 50 years old were shorter than those of subjects > or = 50 years old (p < 0.05 and p < 0.01, respectively). These findings suggest that preoperative evaluation of the pathological findings of renal tumors may be possible by calculating the relaxation time using MRI under low magnetic field.

[Application of intraurethral catheter for geriatric male patients complaining of urethral obstruction due to malignancy--comparison with benign prostatic hypertrophy]

Intraurethral catheters (IUC) were used for elderly male patients with prostatic urethral obstruction (PUO) due to malignancy (MA) and benign prostatic hypertrophy (BPH). Thirty-three men complaining of urinary retention in spite of medical therapy at the risk for prostatic surgery underwent insertion of IUC (16Fr Puroflex, Angiomed Co., Ltd., Germany). Six of 33 were patients with PUO due to MA (5 prostatic cancer, and 1 urethral invasion of rectal cancer, mean 82.7 years old), and the other 27 were patients with BPH (average 80.1 years old). Follow-up period of the former ranged from 2 to 9 (mean 6.5) months, and that of the latter ranged from 6 to 23 months. Water filling cystometry (CMG) before the insertion of IUC and fluoroscopic voiding cystourethrography (VCU) just after insertion of IUC were performed. We defined normal CMG and normal VCU as normal bladder, overactive CMG and normal VCU as overactive bladder, and normal or poor sensitive CMG and underactive VCU as underactive bladder. Five of 27 BPH patients had previous prostatic operations (TUR-P, and/or balloon dilation), but 6 MA did not. All of MA (3 normal bladder, 2 overactive bladder, and 1 underactive bladder) voided satisfactorily, and average duration of IUC in place was 6.5 months without exchange of IUC. Although sixteen of 27 (59.3%) BPH patients voided satisfactorily, and average duration of IUC in place was 12.1 months without exchange of IUC, in the other 11 of these 27 BPH patients were removed IUC, and average duration of IUC in place was 4.7 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Mononeuropathy multiplex with ulcerative colitis

We describe acute mononeuropathy multiplex in a patient with chronic ulcerative colitis. The symptoms of neuropathy were well correlated with the disease activity of colitis. Both electrophysiological study and sural nerve biopsy revealed axonal degeneration. Mononeuropathy multiplex may be an extraintestinal manifestation of ulcerative colitis.

Capillary permeability in experimental rat glioma and effects of intracarotid CDDP administration on tumor drug delivery

We have examined the capillary permeability within and adjacent to experimental rat gliomas, and the effect of intracarotid administration of cisplatin in this model. Permeability to 14C-sucrose was 25-fold and six-fold higher within the brain tumor and in the tumor periphery and adjacent tissue respectively than in the normal cortex. Intracarotid administration of cisplatin resulted in ten-fold increase in experimental gliomas and also a significant increase in the tumor periphery and adjacent tissue, when compared to the intravenous route. Intracarotid administration of cisplatin to rat did not cause acute vascular damage in either the brain or brain tumor at the dosage used.

Purification, characterization and molecular cloning of an acidic amino acid-specific proteinase from Streptomyces fradiae ATCC 14544

We have isolated a novel acidic amino-acid-specific proteinase from Streptomyces fradiae ATCC 14544, using benzyloxycarbonyl-L-Phe-L-Leu-L-Glu-p-nitroanilide (Z-Phe-Leu-Glu-pNA) as a substrate. A proteinase, which we propose to call SFase, was purified from the culture filtrate by salting out, repeated S-Sepharose chromatography, and affinity chromatography (CH-Sepharose-Phe-Leu-D-Glu-OMe). The purified enzyme showed a single band having an apparent molecular weight of 19,000 on sodium dodecyl sulfate polyacrylamide gel electrophoresis. When synthetic peptides were used as substrates, SFase showed high specificity for Z-Phe-Leu-Glu-pNA. Comparison with nitroanilides of glutamic acid and aspartic acid as substrates revealed that the reactivity was about 10-fold higher for a glutamyl bond than an aspartyl bond. SFase selectively hydrolyzed the -Glu-Ala-bond of two glutamyl bonds in the oxidized insulin B-chain within the initial reaction time until the starting material was completely digested. Diisopropylfluorophosphate and benzyloxycarbonyl-Phe-Leu-Glu chloromethylketone completely inhibited SFase, while metalloproteinase inhibitors, such as EDTA and o-phenanthrolin, did not inhibit the enzyme. The findings indicate that SFase can be classified as a serine proteinase, and is highly specific for a glutamyl bond in comparison with an aspartyl bond. To elucidate the complete primary structure and precursor of SFase, its gene was cloned from genomic DNA of the producing strain, and the nucleotide sequence was determined. Consideration of the N- and C-terminal amino-acid sequences of the mature protein of SFase indicates that it consists of 187 amino acids, which follows a prepropeptide of 170 residues. In comparison with the acidic amino-acid-specific proteinase from Streptomyces griseus (Svendsen, I., Jensen, M.R. and Breddam, K. (1991) FEBS Lett. 292, 165-167), SFase had 82% homology in the amino acid sequence. The processing site for maturation of SFase was a unique sequence (-Glu-Val-), so that the propeptide could be released by cleavage of the peptide bond between Glu and Val.

[Transurethral endoureteropyelotomy]

Transurethral endoureteropyelotomy was performed in a total of 37 patients with primary ureteropelvic junction obstruction or various ureteral strictures. Thirty-one (84%) of the 37 evaluable patients showed a radiographical improvement of hydronephrosis with a mean follow-up period of 15.8 +/- 10.5 months (range: 3-40). The clinical success rates were as follows: primary ureteropelvic junction obstruction, 11/12 92%); upper ureteral stricture, 6/7 (86%); lower ureteral stricture, 14/18 (78%). This endourological procedure required a mean operation time of 38.0 +/- 27.7 minutes and hospital stay of 7.3 +/- 4.9 days. No major complication has been identified. This retrograde procedure has a straight access to the strictured segment of ureteropelvic junction. It is safe and less invasive to the renal parenchym as it does not require percutaneous nephrostomy. Therefore, it might be clinically useful for the treatment of primary ureteropelvic junction obstruction and other ureteral strictures.

[A case of Hallervorden-Spatz syndrome with marked atrophy of the brainstem and cerebellum]

We report a 20-year-old female with Hallervorden-Spatz syndrome (HSS). This patient is the product of consanguineous parents. She developed genu valgum, tendency to fall and mental deterioration at the age of 6, decrease of the number of spoken words at the age of 14, dysarthria, unsteady gait, postural tremor of the upper extremities, dystonic posture of hands and double incontinence at the age of 16. Her disease progressed slowly. Neurological examination on admission revealed severe mental retardation, optic atrophy, forced grasping, hyperactive tendon reflexes in the upper extremities and bilateral Babinski sign. An extensive laboratory investigation including the leukocyte lysosomal enzymes, serum amino acid analyses, copper studies and ceruloplasmin were almost within normal limits. MRI, T2 weighted images, showed markedly decreased signal intensity in the globus pallidus but substantia nigra and increased signal intensity in diffuse cerebral white matter. T1 weighted images showed marked atrophy of the brainstem and cerebellum. She met the diagnostic criteria for HSS by Swaiman; we diagnosed her as HSS group II. HSS is characterized by the presence of many spheroids in the central nervous system which is similar to neuroaxonal dystrophy (ND). However, clinical and pathological differences exist between HSS and ND, the precise classification of the two conditions has remained controversial. Although there are many reported cases in which both conditions overlap, this is the first reported case that simultaneously demonstrates increased iron deposition in the globus pallidus, marked atrophy of the brainstem and cerebellum and typical clinical course compatible with HSS.

Peculiar facial erythematosquamous lesions in two siblings with cyclical summer improvement and winter relapse: a variant of keratosis lichenoides chronica?

A 7-year-old girl had erythematous hyperkeratotic papules and plaques that improved in summer and recurred in winter since the age of 4 months. She had had irregular, ridge-like erythematosquamous lesions on the arms with the same seasonal variation. The lesions on the arms improved with age. Light and electron microscopic examination showed marked degeneration of keratinocytes and prominent apoptosis. Her older brother had a similar but milder dermatosis. We believe these cases may represent a variant of keratosis lichenoides chronica.

Detection of Renal Injury in Patients with Vesicoureteral Reflux Using Dimercaptosuccinic-Acid (Dmsa) - Single Photon Emission Computed Tomography and Magnetic Resonance Imaging - Comparison with Dmsa-Planar Scintigraphy and Intravenous Pyelography

The value of “Technetium (Tc)-dimercaptosuccinic acid (DMSA) planar renal scintigraphy, DMSA single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) for the assessment of renal injury related to vesico-ureterai reflux (VUR) were examined in 60 kidneys of 32 patients (28 bilateral, 4 unilateral) with primary VUR. The results were as follows: 1. Spatial resolution was best in MRI, then DMSA-planar and DMSA-SPECT; 2. For detecting renal injury, DMSA-SPECT (85%) and MRI (83.3%) were better than intravenous pyelography (55%) and DMSA-planar scintigraphy (65%). In conclusion, DMSA-SPECT or MRI should be performed in addition to DMSA-planar and IVP, to detect renal injury due to VUR.

[A case of chronic thinner intoxication developing hyperkinésie volitionnelle three years after stopping thinner abuse]

We reported a 25-year-old male with chronic thinner intoxication. He had been sniffing thinner from the age of 15 to 20. Since the age of 20, he developed gait disturbance, weakness of lower extremities, and scanning speech. At the age of 23, three years after he stopped sniffing thinner, he had hyperkinésie volitionnelle (HV) of bilateral upper extremities. MRI study revealed diffuse high intensity areas in the cerebral white matter, thinning of the corpus callosum, and cerebellar and brainstem atrophy on T1 weighted images. On T2 weighted images, low intensity areas in the thalamus, the striatum, the anterior limb of the internal capsule, the tegmentum of midbrain, high intensity areas in middle cerebellar peduncle, the posterior limb of the internal capsule, the lateral part of the cerebral peduncle, and the cerebral white matter were noted. HV almost disappeared with 2.5 mg of clonazepam daily administered. The disappearance of HV by ischemic compression of his arm suggested that input from the periphery might be relevant to the etiology of HV. The time interval between exposure to thinner and the recognition of HV in our case was in agreement with that between the occurrence of cerebrovascular disease and the recognition of HV in the previous reports. We postulated that HV in this case was the manifestation of the denervation hypersensitivity in the dentatorubroolivary system.

Non-Invasive Measurement of Intra-Abdominal Pressure through Abdominal Wall during Urodynamic Study

We found that the intra-abdominal pressure could be measured non-invasively, simply and directly through the abdominal wall using a pressure transducer that we used for routine urodynamic studies. We designed a simple device, “transducer attacher”, for attaching the transducer to the abdominal wall. To evaluate the utility of pressure this measured, we compared it with the empty intravesical pressure which is equal to the intraabdominal pressure. Pressure through the abdominal wall did not differ significantly from that of the empty urinary bladder measured on 33 strainings performed by 15 patients complaining of urinary disturbance. The relationship between the rise in empty intravesical pressure (X) and the abdominal wall pressure (Y) was shown by the equation Y = 1.13X-2.89 (r = 0.971, p<0.01). These findings indicate that the pressure measured through the abdominal wall represents the intra-abdominal pressure. This new technique presents an alternative to monitoring the rectal pressure in urodynamic studies.

Peritumoral cerebral edema in meningiomas: the role of the tumor-brain interface

We investigated the role of the tumor-brain interface in the production of peritumoral cerebral edema in meningiomas by analysing the size, shape, histological type and location of the tumor, and radiological and operative findings. Our results suggest that changes of the boundary zone between the tumor and the brain such as the disappearance of the subarachnoid space, cortical thinning or loss, and possibly partial loss of the arachnoid membrane are the most important factors in edema production, and that multiple other factors determine the morphological changes which occur at the tumor-brain interface.

[Study on chemosensitivity test of urogenital tumors by ATP assay]

In order to improve the efficacy of chemotherapy against urogenital cancers, we developed a chemosensitivity test by measuring intracellular ATP in cancer cells. In the fundamental experiments using HeLa cells, a significant correlation was observed between intracellular ATP levels and numbers of viable cells. We employed 8 drugs, ADM, VCR, VLB, MTX, 5-FU, PEP, MMC, and CDDP for the assay Thirty-four renal tumors, 68 urothelial tumors and 19 testicular tumors were tested, and evaluable results were obtained in 25 specimens of renal tumors (76%) 55 specimens of urothelial tumors (80%) and 17 specimens of testicular tumors (98%). According to the ATP assay, renal tumors were sensitive to ADM and MMC, urothelial tumors to ADM, MMC and CDDP and testicular tumors to ADM and MMC. The ATP assay to determine the chemosensitivity to clinical specimens was sensitive and efficient. Thus the ATP assay could be applied for selection of anticancer drugs in the chemotherapy of urogenital cancers.