[A case of a lumbar spinal synovial cyst located on the midline]

We report a case of lumbar spinal synovial cyst located on the midline. A 72-year-old man was admitted to our hospital with the chief complaint of low back pain radiating to the left buttock and posterior thigh. An MR image revealed an extradural cystic lesion adjacent to the dorsal side of the dural sac at the L4-5 level. The cyst was remote from the facet joints and existed on the midline just in front of the L4 lamina. A CT scan showed a concave deformity of the ventral aspect of the L4 lamina because of compression by the cyst. The patient underwent L4 laminectomy and total removal of the cyst. The cyst was in contact with the anterior surface of the ligamentum flavum and it had no connection with the facet joint. In the histological examination, the cyst was multilobular and lined with synovial epithelium. Therefore the cyst was diagnosed as a synovial cyst. After the operation, the pain radiating to the buttock and thigh completely disappeared. Intraspinal synovial cysts are usually located in the lower lumbar spine and most of them are adjacent to the facet joint. The cysts that are located on the midline are very rare. We review previous reports and discuss clinical and pathological features of spinal synovial cysts.

Suppressive effect of globin digest on postprandial hyperlipidemia in male volunteers

We have reported previously that various edible protein digests inhibit dietary hyperlipidemia in mice, rats, pigs and dogs. Of the various digests tested, globin digest had the most potent inhibitory activity, and a tetrapeptide extracted from globin digest, Val-Val-Tyr-Pro, had activity 7000-fold greater than that of the parent digest. In this clinical study, we investigated the influence of globin digest on serum chylomicron triglyceride concentrations as an indicator of the effect of globin digest on fat absorption and catabolism in humans. Parallel and crossover trials were conducted in which men consumed a control high fat diet (25 g fat, 7.6 g carbohydrate, 1.9 g protein and 0.7 g sodium chloride) or the same diet supplemented with globin digest. The supplemented dosages were 1 and 4 g globin digest. In the parallel trial, 22 men were divided into three groups: control, globin digest 1 g and globin digest 4 g. The increases in chylomicron triglyceride concentrations at 1 h after ingestion of 1 or 4 g globin digest were significantly lower (P < 0.05) compared with the control group. The crossover trial involved six subjects who consumed the control high fat diet and the same diet supplemented with 4 g globin digest. Serum chylomicron triglyceride levels increased in both groups at 1 and 2 h after ingestion, but when subjects consumed 4 g globin digest the increases were suppressed to 75 (P < 0.05) and 42% (P < 0.05) of the increases in controls at the corresponding times, respectively. The areas under the curves of chylomicron and serum total triglyceride concentrations during the 4 h after ingestion of 4 g globin digest were 46 (P < 0.05) and 34% (P < 0.05) lower, respectively, than when the men consumed the high fat control diet. In these trials, globin digest reduced the increase in serum chylomicron triglyceride concentrations as a result of the ingestion of a high fat diet. This hypotriglyceridemic effect of globin digest may be valuable for preventing obesity and in lowering the incidence of cardiovascular diseases.

Astrocyte-conditioned medium induces blood-brain barrier properties in endothelial cells

1. We evaluated the induction of endothelial barrier functions by the type 1 astrocyte-derived supernatant in culture using horseradish peroxidase (HRP) as a parameter. 2. A gel filtration fraction (molecular weight 16-20 kDa) of type 1 astrocyte-derived supernatant reduced plasmalemmal vesicles and induced tight junctions in endothelial cells. 3. In addition, this fraction promoted the uptake of [3H]-glucosamine by endothelial cells. This cell activity disappeared after heating at 95 degrees C for 10 min and was sensitive to trypsin. 4. These results suggest that a type 1 astrocyte-derived protein factor(s) promotes proteoglycan synthesis with a resultant increase in charge selectivity in endothelial cells and plays an important role in the induction of blood-brain barrier functions.

Faulty induction of blood-brain barrier functions by astrocytes isolated from stroke-prone spontaneously hypertensive rats

1. It has been suggested that astrocytes prompt the induction of blood-brain barrier (BBB) functions in cerebrovascular endothelial cells. 2. In the present study we have tried to elucidate the genetic differences between astrocytes isolated from Wistar-Kyoto (WKY) control rats and astrocytes isolated from stroke-prone spontaneously hypertensive rats (SHRSP). 3. We show that endothelial cells develop tight junction-like structures, a reduction in vesicular transport and high electrical resistance when they are co-cultured with astrocytes isolated from WKY rats. In contrast, SHRSP astrocytes have less of an ability to induce BBB functions than do WKY astrocytes. 4. In addition, we demonstrate that SHRSP astrocytes produce enormous quantities of lactic acid when cerebral ischaemia develops. The decrease in pH causes astrocyte swelling and damages BBB functions. 5. Consequently, we reason that genetically weak functions in astrocytes cause disruptions of BBB function and result in widespread cerebral lesions in SHRSP.

[A case of breast cancer metastasis to the skin and bone 13 years after, and to the brain 17 years after mastectomy]

A case of breast cancer metastasis to the skin and bone 13 years after, and to the brain 17 years after mastectomy in a 54-year-old woman, is reported. In 1978, the patient, who was then 37 years old, underwent standard radical mastectomy for left breast cancer. In 1991, because of skin and bone metastasis, systemic chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil (CAF) was performed, and she partially responded to CAF therapy. In April 1995, the patient was admitted for pain of left hip joint and left knee joint. Computed tomography of the head revealed a bleeding tumor with marked peritumoral edema. Serum levels of carcinoembryonic antigen (250 ng/ml) and CA 15-3 (810 U/ml) were increased. Bone metastases were found elsewhere in the body. Again, systemic chemotherapy with CAF was performed. CAF chemotherapy stopped the brain metastasis bleeding.

Stimulatory roles of muscarinic acetylcholine receptors on T cell antigen receptor/CD3 complex-mediated interleukin-2 production in human peripheral blood lymphocytes

It is known that there are some bidirectional interactions between the nervous and the immune systems via neurotransmitters and cytokines. To clarify whether any neurotransmitters modulate lymphocyte functions, we examined the effects of oxotremorine-M (Oxo-M) on interleukin-2 (IL-2) production in human peripheral blood lymphocytes by using enzyme-linked immunosorbent assays, Northern blot analyses, reverse transcriptase-polymerase chain reaction, and fluorescence-activated cell sorter. Pretreatment of cells with Oxo-M (10 nM to 10 microM) for 4-24 hr enhanced phytohemagglutinin (PHA)-induced IL-2 mRNA expression and markedly increased IL-2 production compared with those induced by PHA alone. Oxo-M alone did not affect IL-2 mRNA expression and IL-2 production. In CD3-positive T cells, pretreatment with Oxo-M for 24 hr enhanced PHA-induced IL-2 production. Furthermore, pretreatment with Oxo-M enhanced PHA-induced mRNA expression of the alpha and beta subunits of IL-2 receptors and DNA synthesis. Cytometric analysis showed Oxo-M treatment did not up-regulate expression of cell surface molecules such as CD3, CD2, CD4, CD8, and IL-2 receptors. These results suggest that activation of muscarinic receptors enhances T cell antigen receptor/CD3-induced IL-2 production.

Determination of the functional domain of a mouse autonomous replicating sequence

We previously isolated from mouse cells an autonomous replicating sequence (ARS) ARS65 (Ariga, Itani and Iguchi-Ariga, Mol. Cell. Biol. 7, 1-6, 1987). Here we report the nucleotide sequence of ARS65. The sequence from BgIII to EcoRI sites cloned as ARS was 2658 bp long. There exist three interesting domains: a TA repeat, a myc like box (essential sequence for c-myc ARS), and a T rich region. Cloned DNAs containing various segments of pARS65 were transfected to rat 3Y1 cells together with the hygromycinB resistance expression vector, and hygromycinB resistant clones were isolated. Established cell lines transfected with plasmids carrying either a myc-like box or a T rich region harbored the replicated plasmids, indicating that these two elements are necessary for the ARS function of pARS65.

Insulin-like growth factor-1 attenuates apoptosis in hippocampal neurons caused by cerebral ischemia and reperfusion in stroke-prone spontaneously hypertensive rats

Cerebral ischemia followed by reperfusion induced apoptosis in stroke-prone spontaneously hypertensive rats (SHRSP) but not in Wistar Kyoto rats (WKY). Our in vitro studies revealed that IGF-1 prevented apoptosis caused by nitric oxide- and N-methyl-D-aspartate-mediated toxic agents in cortical neurons isolated from SHRSP. In addition, it was reported that IGF-1 given 1 hour before ischemia significantly attenuated the incidence of myocyte apoptosis after myocardial ischemia and reperfusion. IGF-1 (20 micrograms/rat) was administered ip 1 hour before the clipping of both common carotid arteries in WKY and SHRSP. Rats underwent cerebral ischemia for 20 minutes and reperfusion for 6 days before they were killed. We cut the brain coronally, removed sections from the hippocampal CA1 region, and examined the neurons in these samples using an electron microscope. We tried to clarify whether pretreatment using IGF-1 decreases the number of apoptotic neurons in SHRSP with cerebral ischemia followed by reperfusion. SHRSP with normal cerebral circulation had 30.4 +/- 8.0 apoptotic neurons per 1000 neurons. Cerebral ischemia followed by reperfusion significantly (p < 0.01) increased the number of apoptotic neurons (235.2 +/- 25.2/1000 neurons) in SHRSP. In contrast, pretreatment with IGF-1 reduced the number of apoptotic neurons in SHRSP (82.8 +/- 11.2/1000 neurons; p < 0.01) under otherwise identical conditions. We concluded that the genetic vulnerability to apoptosis in SHRSP neurons was involved in the pathogenesis of stroke lesions and that this vulnerability was attenuated by the IGF-1 pretreatment.

Insulin-like growth factors prevent apoptosis in cortical neurons isolated from stroke-prone spontaneously hypertensive rats

Cerebral ischemia induces a massive efflux of glutamate causing delayed neuronal death in stroke-prone spontaneously hypertensive rats (SHRSP) but not in Wistar Kyoto rats (WKY). It is obvious that L-N-nitroarginine (L-NNA; NO synthase (NOS) inhibitor), benzamide (poly(ADP-ribose) synthetase inhibitor), and growth factors are involved in reducing neuronal cell death due to toxic conditions, especially phosphatidylinositol 3 (PI3)-kinase activity; however, no studies have clarified whether genetic vulnerability to neurotoxic states is present in cortical neurons isolated from SHRSP. For this purpose, we prepared cortical neurons from WKY and SHRSP (15 weeks of gestation) to test the genetic vulnerability involved in the pathogenesis of stroke as well as apoptosis of cortical neurons isolated from SHRSP. We also examined the mechanisms necessary to reduce apoptosis under neurotoxic states using ultrastructural and biochemical techniques. Cortical neurons from SHRSP were in fact found to be more vulnerable than neurons from WKY and resulted in apoptosis when treated with nitric oxide (NO)- and N-methyl-D-aspartate (NMDA)-mediated neurotoxic agents. Growth factors, especially insulin-like growth factor (IGF), rescued neurons from NO- and NMDA-mediated neurotoxicity, particularly those from SHRSP. Conversely, benzamide and L-NNA reduced NMDA-mediated neurotoxicity but not NO-mediated toxicity. The ability to protect neurons from neurotoxicity was as follows: IGF-->nerve growth factor epidermal growth factor-->L-NNA-->benzamide. In addition, it was demonstrated that wortmannin, a PI3-kinase inhibitor, lessened the protective effects of these growth factors against NO-mediated toxicity. The data thus indicate that genetic factors related to neuronal vulnerability to apoptosis are involved in the pathogenesis of stroke lesions in SHRSP. PI3-kinase activity, which is stimulated by growth factors, is closely related to protective effects against NO- and NMDA-mediated toxicity in cortical neurons, especially those isolated from SHRSP. Moreover, the genetic vulnerability observed in SHRSP neurons is possibly linked to the inadequate activation of signaling pathways in the downstream of protein tyrosine kinases.

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

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

Ultrastructural analysis of survival in cultured smooth muscle cells isolated from stroke-prone spontaneously hypertensive rats: effect of growth factors

Our previous study in vivo suggested that vascular smooth muscle cells (VSMCs) in stroke-prone spontaneously hypertensive rats (SHRSP) were vulnerable when plasma components were deficient. Therefore, we cultured VSMCs isolated from normotensive and hypertensive rats to clarify the weakness of VSMCs isolated from hypertensive rats and maintained in plasma-deficient conditions by employing ultrastructural and biochemical analyses. VSMCs, obtained from normotensive rats and cultured without fetal bovine serum (FBS) for 1 week, were intact and well differentiated; without FBS for 2 weeks retained their original structures except for several degenerative changes. VSMCs, obtained from hypertensive rats and cultured without FBS for 2 weeks, were extensively damaged and lost their cell organelles. Apoptotic bodies were frequently observed. We also cultured VSMCs in medium containing a variety of growth factors. VSMCs obtained from normotensive rats and cultured with epidermal growth factor or insulin-like growth factor-1 for 2 weeks were almost intact, as were VSMCs from hypertensive rats, although some degenerative changes of cell organelles were observed. VSMCs from hypertensive rats, maintained with platelet-derived growth factor-BB or basic fibroblast growth factor, were generally in poor condition. Thus VSMCs from hypertensive rats have hereditary weaknesses in cell survival including apoptosis and require specific growth factors for their maintenance.

Globin digest, acidic protease hydrolysate, inhibits dietary hypertriglyceridemia and Val-Val-Tyr-Pro, one of its constituents, possesses most superior effect

Globin digest (GD), prepared from globin by acidic protease treatment, suppressed the elevation of serum triglyceride level in not only total but also chylomicron fraction after oral administration of olive oil. By screening with this lowering activity, we concluded that Val-Val-Tyr-Pro (VVYP) would be most effective constituent having hypotriglyceridemic action in GD. The mode of their action was dose dependent and did not show species specificity. Neither the repression of peristaltic movement of intestine nor the delaying of gastric emptying was caused by intake of GD or VVYP, however, the excretion of administered lipid was much more than that of control. Furthermore, administration of GD caused more prominent activation of hepatic triglyceride lipase (HTGL) and the increase of hepatic free fatty acid (FFA) concentration in early phase after administration of fat. From these results, it could be elucidated that GD, and also VVYP, inhibited fat absorption from digestive tract and enhanced activity of HTGL, so that more rapid clearance of dietary hypertriglyceridemia was caused.

T-cell lymphoma presenting with pericardial and pleural effusion as the initial and primary lesion: cytogenetic and molecular evidence

A 90-year-old woman was admitted with progressive dyspnea. Chest roentgenogram and computed tomography revealed a massive pericardial effusion and bilateral pleural effusion, but no lymphomatous lesion was seen. A diagnosis of malignant lymphoma was made by cytological and immunological studies of the cells obtained from the pericardial effusion. Chromosome analysis showed a clonal abnormality and T-lineage clonality was determined by the rearrangement of the T-cell receptor gamma gene. The patient achieved remission with chemotherapy, but she later relapsed, with right pleural effusion, and died. She exhibited no lymphomatous features throughout the clinical course, indicating the possibility of malignant lymphoma originating from the pericardium and/or pleura.

Dose distribution and shrinkage of acoustic neurinomas 2 years after Gamma Knife treatment

To examine the relationship between dose distribution and tumor shrinkage of acoustic neurinomas, correlation coefficients between distribution probabilities of some dose areas and residual tumor ratios of 21 cases were studied at 2 years. Approximating a dose-volume histogram to beta-distribution, two essential dose areas for tumor control were extracted: a dose area from 14.2 to 24.7 Gy contributed to tumor shrinkage, whereas a dose area from 27.3 to 29.4 Gy was contraindicated. Given that there are at least two different dose areas with reverse characters, a formula with two opposing logistic components is proposed to predict tumor control. With this formula, Gamma Knife treatment of acoustic neurinomas may be optimized.

Onset of diabetes with high titer anti-GAD antibody after IFN therapy for chronic hepatitis

A case of hyperglycemia induced by the injection of interferon-alpha was experienced in our hospital. This patient showed a sustained high titer of anti-GAD antibody after the onset of diabetes, suggesting that the involvement of immunological disturbance by IFN induces the onset of the disease. However, the susceptibility and the response of the immune system differs from patient to patient, and only limited destruction of beta-cells in the islet of Langerhans and normalization of glucose tolerance by CSII was induced in this patient.

[Glioblastoma multiforme with liver metastasis--case report]

Extracranial metastasis of glioblastoma is rare. This is an autopsy case report of a patient with glioblastoma multiforme found to have metastasized to the liver. A 42-year-old woman was admitted with a chief complaint of headache. Physical and neurological examinations on admission showed no abnormalities. CT and MRI demonstrated a tumor in the left parietooccipital region with invasion into the subependymal area of the left lateral ventricular trig-one. A cerebral angiogram showed tumor staining in the same area. Subtotal tumor resection was performed uneventfully. The microscopic diagnosis was glioblastoma multiforme. Postoperatively, the patient underwent whole brain and local irradiation, and intra-arterial ACNU infusion therapy. One month later, she developed low back pain, probably due to spinal dissemination. Postmortem examination showed local recurrence of the tumor and subarachnoidal dissemination not only in the base of the skull but in the lower spinal cord. Tumor was also observed in the liver, but no lung or lymph node metastasis was detected. Metastasis to the liver in this patient is believed to have occurred via the anastomosis between the vertebral and portal venous system.

Long-term results after surgical repair of total anomalous pulmonary venous connection--hemodynamic evaluation of pulmonary venous obstruction with isoproterenol infusion

To evaluate late pulmonary venous obstruction following surgical repair in patients with total anomalous pulmonary venous connection, which may be disclosed at high cardiac output but not at rest, a hemodynamic study was performed using isoproterenol infusion. The study included 7 patients in NYHA class I, aged from 5 to 12 years (mean 6 years), who had undergone surgical correction in their early infancy (mean 79 days). After a routine catheterization protocol, isoproterenol was infused at a rate of 0.01 microgram/kg per min. On average, cardiac index increased from 4.8 to 8.1 L/min per m2. The pulmonary arterial and wedge pressures following isoproterenol infusion remained normal in all patients, including 1 case with mild pulmonary hypertension. These results suggest that most, if not all, patients with total anomalous pulmonary venous connection repaired in early infancy do not have any hemodynamic impairment if they show no pulmonary venous obstruction within the first 12 months following surgical correction.

Detailed examination of vascular lesions triggered by an inhibitor of endothelium-derived relaxing factor

BACKGROUND

Inhibition of an endothelium-derived relaxing factor (EDRF) may contribute to the pathogenesis of thrombotic arterial occlusions.

EXPERIMENTAL DESIGN

We measured the blood pressure and urinary excretion of protein, sodium, and potassium and histologically examined the brains, hearts, and kidneys in normotensive Wistar Kyoto rats (WKY) and stroke-prone spontaneously hypertensive rats (SHRSP) fed on a diet containing: (a) EDRF inhibitor (L-N-nitroarginine:L-NNA); (b) L-arginine, which reverses the effect of L-NNA; or (c) both L-NNA and L-arginine for 1 to 8 weeks. In addition, we examined L-NNA-treated SHRSP, the blood pressures of which were lowered using hydralazine. Furthermore, we produced and examined Goldblatt's renal hypertensive rats, which are of a different type from those resulting from the L-NNA treatment.

RESULTS

Both WKY and SHRSP rats fed on a diet containing L-NNA suffered from hypertension and cerebral infarctions in a dose-dependent manner. Cerebral infarctions occurred whether or not SHRSP rats were treated with an antihypertensive agent when they were fed a high dosage of L-NNA. In contrast, SHRSP rats, treated simultaneously with both L-NNA and L-arginine, suffered few cerebral infarctions, although they were severely hypertensive. In addition, there were no cerebral infarctions in Goldblatt's renal hypertensive rats, although they suffered from advanced hypertension.

CONCLUSIONS

The data indicate that the inhibition of EDRF injures the vessel walls and encourages platelet adhesion to the damaged areas. The adhering platelets narrow the lumen with resultant thrombotic arterial occlusions. Pathophysiologic conditions that decrease EDRF synthesis appear to play an important role in cerebral, renal, and myocardial infarctions.

[Stereotactic radiosurgery with the gamma knife for brain metastases in patients with lung cancer]

Between February 1992 and April 1993, six patients with lung cancer were treated with gamma knife radiosurgery for brain metastases. Five patients had adenocarcinoma, and one patient had small cell carcinoma. Two patients had solitary metastases, and four patients had multiple metastases. Twelve metastases were treated with the gamma knife (peripheral dose between 12 Gy and 25 Gy). After radiosurgery, three complete and eight partial responses were achieved, which resulted in an overall response rate of 92%. In two patients, histological studies showed that few viable cells were surrounded by necrosis. Neurological status improved in all patients, and none died of complications. However, four of six patients later developed new intracranial metastases outside the treatment field. These data suggest that radiosurgery with the gamma knife is effective against brain metastases in patients with lung cancer, especially when the lesions are deep in the brain.

[Synthesis of ethyl 1-(Difluoro-1,3,5,-triazinyl)-2-methylindolizine-3-carboxylate as a fluorescent derivatization reagent and its reactivity]

Ethyl 1-(difluoro-1,3,5-triazinyl)-2-methylindolizine-3-carboxylate was found to be a selective fluorescence derivatization reagent for primary and secondary amines. The reagent reacted with amines in aqueous acetonitrile in the presence of sodium hydroxide to give the corresponding fluorescent products, which could be separated on a TSK gel ODS-80TM reversed-phase column with aqueous methanol as eluent. 2-Phenethylamine and spermidine were used to investigate the derivatization conditions. The detection limits (signal-to-noise ratio = 3) of each compound were 3 and 2 pmol per 10 microliters injection volume, respectively. Alcohols, thiols and aromatic amines did not give any fluorescent products under these derivatization conditions.