Vestibular findings and brainstem pathology in two siblings with Cockayne's syndrome

Two siblings with Cockayne's syndrome (CS) are described. Both showed cachectic dwarfism, photosensitivity and progressive neurological dysfunction. The damped-rotation test revealed no vestibular nystagmus in one of them, and reduced per-rotatory nystagmus in the other. Neuropathological examination in the former subject disclosed neuronal loss with fibrillary gliosis in the vestibular nuclei, whereas neuronal degeneration was not apparent in the abducens nuclei, the oculomotor nuclei and the paramedian pontine reticular formation. Our findings suggest that CS might cause vestibular dysfunction as well as hearing loss and that the lesions in the vestibular nuclei might be related to the vestibular dysfunction.

Kinetic analysis of cell proliferation using bromodeoxyuridine labeling and in situ detection of dying cells in the tympanic membrane and middle ear cholesteatoma

Using specimens from the posterior-superior quadrant of the human tympanic membrane, meatal skin, retroauricular skin and middle ear cholesteatoma, epidermal cell proliferation was studied by cultures in FC43 emulsion containing bromodeoxyuridine (BrdU), and cell death was detected by in situ labeling of nuclear DNA fragmentation (TUNEL staining). The culture of specimens with BrdU revealed labeling in the basal cell layer and/or the layer immediately above it. The counts of BrdU-labeled cells both at and beside the malleus handle and at the annulus were significantly higher than those in the tympanic membrane, meatal skin, retroauricular skin and cholesteatoma, indicating the existence of epidermal proliferation centers in the annulus and malleus handle. TUNEL-positive cells were observed in the uppermost layer of the epidermis, and counts of dying cells did not show any significant differences among specimens from the different areas. From these observations, we conclude that addition of newly proliferated cells at the proliferation center and uniform cell death cause epidermal cell migration over the tympanic membrane and ear canal. In addition, no proliferation center was seen in the epidermis of cholesteatoma, suggesting a disturbance of epidermal cell migration. Furthermore, BrdU-labeling at the margin of persistently perforated tympanic membranes from patients with chronic otitis media revealed that, at the perforation margin, the counts of BrdU-labeled cells were not higher than those of the normal tympanic membrane. In addition, a few BrdU-labeled cells were observed in the lamina propria and mucosal cell layer, indicating that persistent perforation of the tympanic membrane results from the failure of proliferating cells to increase at the margin of the perforation.

Intestinal motility after massive small bowel resection in conscious canines: comparison of acute and chronic phases

To evaluate intestinal function after 80% massive distal small bowel resection (MSBR), we continuously monitored interdigestive and postprandial bowel motility using bipolar electrodes and/or contractile strain gauge force transducers in conscious beagle dogs before and at 2-4 weeks (acute postoperative phase; acute phase) and 8-13 months (chronic postoperative phase; chronic phase) after the surgery. Fasting duodenal migrating myoelectric (or motor) complexes (MMC) occurred at longer intervals in the acute phase after 80% MSBR than in control beagles. Intervals between duodenal MMC in the chronic phase were similar to those found in control beagles. MMC arising from the duodenum were often interrupted before the jejunum above the anastomosis in the acute phase, and a slight recovery of propagation frequency to the jejunum above the anastomosis was observed in the chronic phase. However, duodenal MMC did not migrate smoothly to the terminal ileum in both groups. In the acute phase, the velocity of duodenal MMC propagation was slowed in every intestinal segment, including the duodenum and the jejunum above the anastomosis, and had not recovered even long after the operation. The duration of the postprandial period without duodenal MMC was prolonged significantly in the acute phase postoperatively. Although it shortened in the chronic phase, it still remained significantly longer than in controls. These findings suggest that changes in gut motility after MSBR tend to compensate for the shorter intestine and maintain small bowel absorption early postoperatively. However, these compensatory changes decrease over the long term, and their adaptive contributions to increased intestinal absorption may decrease as well.

Isolation of methicillin-resistant coagulase-negative staphylococci from chickens

Methicillin-resistant coagulase-negative staphylococci were isolated from the nares and skin of 1- to 8-week-old healthy chickens in three flocks from a farm. Isolation of methicillin-resistant coagulase-negative staphylococci was positive for 72 (25.7%) of the 280 chickens tested, with the frequency varying from 2.2 to 100% according to flock. A total of 45 appropriate isolates were selected and subjected to identification. Of the 45 methicillin-resistant coagulase-negative staphylococcal isolates selected, 37 were identified as Staphylococcus sciuri, 5 were identified as Staphylococcus epidermidis, and 3 were identified as Staphylococcus saprophyticus. The distribution of the species was different among the flocks. Comparative analysis of the SmaI-digested chromosomal DNA by pulsed-field gel electrophoresis revealed that the isolates could have originated from a single clone of each of S. sciuri and S. saprophyticus and three clones of S. epidermidis. By two methods based on the PCR technique, the mecA gene was detected in all five representative isolates of each methicillin-resistant coagulase-negative staphylococcal clone. The nucleotide sequence of a PCR fragment obtained from an isolate of S. sciuri was completely identical to the corresponding region of mecA genes reported in human methicillin-resistant Staphylococcus aureus isolates and Staphylococcus epidermidis isolates. The representative methicillin-resistant coagulase-negative staphylococcal isolates were resistant to many beta-lactam antibiotics, and some isolates were also resistant to macrolide and aminoglycoside antibiotics. This is the first evidence of the existence of methicillin-resistant coagulase-negative staphylococci from animals possessing the mecA gene.

Mediastinal yolk sac tumor in a young girl: case report and review of the literature

The authors report a rare case of a female infant who underwent successful treatment of a mediastinal yolk sac tumor. Therapy included four cycles of preoperative PVB (cisplatinum, vinblastine, bleomycin), complete surgical resection of the tumor, and one postoperative cycle of PVB and four cycles of VAC (vincristine, actinomycine, cyclophosphamide) chemotherapy. The successful treatment of this tumor depends on preoperative chemotherapy to reduce the size, followed by complete surgical excision with subsequent postoperative chemotherapy. Recent improvements in the treatment of mediastinal yolk sac tumors are discussed.

Analysis of the megakaryocyte glycoprotein IX promoter identifies positive and negative regulatory domains and functional GATA and Ets sites

The glycoprotein (GP) Ib-V-IX multisubunit complex binds to von Willebrand factor and mediates the adhesion of platelets to the subendothelium of damaged blood vessels. Expression of the GPIX subunit is required for stability of the complex, and its absence in platelets is associated with the rare bleeding disorder Bernard-Soulier syndrome. Comparative analyses indicate that the four GPIb-V-IX subunits are members of the leucine-rich repeat family and suggest that GPIX resembles a possible primitive progenitor of this group. To characterize GPIX transcriptional regulation, a series of 5' deletion constructs was made linking the GPIX upstream flanking sequence to the luciferase marker gene, and promoter activity was measured in transiently transfected human erythroleukemia cells. This analysis identified two negative regulatory domains between -686 to -423 and -311 to -203 and two positive regulatory domains at -323 to -311 and -151 to -100 relative to the GPIX transcription start site. In addition, site-directed mutagenesis experiments and in vitro gel retardation assays identified Ets and GATA elements at -42 and -65, which positively regulate GPIX promoter activity and specifically bind nuclear factors derived from human erythroleukemia cells. DNase I protection experiments identified a protein-dependent "footprint" and hypersensitive site within the GPIX Ets sequence. These results provide a framework for comparison of the GPIX promoter with others of the GPIb-V-IX system, other megakaryocyte-specific genes, and other members of the leucine-rich repeat family.

[Hearing acuity in the elderly in Japan]

In Japan, the elderly population has progressively increased. It is therefore expected that various social services for the elderly will be demanded. As most of the elderly have hearing impairment due to presbycusis, it is difficult to communicate smoothly with them. To provide the various social services, it is necessary to investigate hearing acuity in the elderly. Accordingly, the Hearing Research Group, which belongs to the Research Project on Aging and Health in the Ministry of Health and Welfare of Japan, investigated the hearing acuity of people 65 years old, or more. One thousand one hundred ninety two subjects were divided into five groups, Group A consisted of 170 males and 216 females between 65 and 69 years old, Group B, 186 males and 158 females between 70 and 74; Group C, 147 males and 140 females between 75 and 79; Group D, 63 males and 61 females between 80 and 84; and Group E, 29 males and 22 females 85 years old or more. We examined the 175 subjects 80 years old or more. Therefore, it is considered that this study could indicate the present condition of hearing acuity of the elderly of Japan. The average hearing levels measured at seven frequencies (125, 250 and 500Hz, and 1, 2, 4, and 8KHz) were 35.0dB in group A, 42.1 in group B, 46.1 in group C, 52.1 in group D, and 55.6 in group E. There were no differences in the average hearing level between males and females in any group. The audiogram pattern indicated a gradually descending curve in most subjects in all groups. The average speech discrimination rate was 75.4% in group A, 70% in group B, 63.8% in group C, 59.7% in group D, and 52.1% in group E. The percentage of subjects showing a short increment sensitivity index of more than 70% was 45.2% in group A, 49.3% in group B, 47.9% in group C, 51.6% in group D, and 59.7% in group D. In conclusion, hearing loss due to aging tended to be more progressive at higher frequencies while hearing acuity of frequencies covering normal speech was preserved. However, the speech discrimination rate decreased relative to changes in the pure tone hearing level. It was considered that the pathology of hearing loss due to aging begins with retrocochlear changes and cochlear factors are added to retrocochlear changes with aging.

Anti-interferon activity of adenovirus-2-encoded VAI and VAII RNAs in translation in cultured human cells

The mode of anti-interferon action of VAI and VAII RNAs of adenovirus type 2 (Ad2) was studied by transfecting interferon-alpha (IFN-alpha)-treated KB cells in culture with a plasmid construct containing the VAI or VAII RNA gene and an SV40 promoter-chloramphenicol acetyltransferase (CAT) gene construct as reporter (pSV2-CAT). The longer the treatment of KB cells with IFN-alpha (2,000 IU/ml) lasted, the higher was the inhibition of CAT expression. A maximum of 76% inhibition was attained without pronounced cytotoxicity during 48 h of treatment. The earlier the VAI RNA gene was transfected, the higher was the enhancement of CAT expression. CAT activity increased from 113 to 157% in normal cells and 200-400% in IFN-alpha treated cells, as compared with the corresponding controls without VAI RNA transfection. The level of CAT mRNA was neither appreciably decreased by IFN-alpha treatment, nor detectably increased by VAI or VAII RNA. The effect of VA RNA thus appeared to be on translation rather than on transcription. The relative constancy of the level of CAT mRNA indicated that IFN-alpha inhibition of CAT expression was not due to the activation of RNase L, but due mainly to translational repression. The level of VAII RNA expressed was only 9-13% of that of VAI RNA. Nevertheless, VAII RNA gene transfection stimulated CAT activity to 112% of the control in non-IFN-alpha-treated cells, and 126-182% in IFN-alpha-inhibited cells. When IFN-alpha treatment was started late after VAI RNA cotransfection, CAT expression increased to 169% which was higher than the expression in cotransfected control cells without IFN-alpha treatment. The enhanced level of CAT activity was in remarkable contrast to the IFN-alpha inhibited level of 25% without VA RNA co-transfection when IFN-alpha was added upon seeding. The enhanced CAT activity in cells treated late with IFN-alpha could be ascribed to higher levels of VA RNAs.

Immunosuppressant FK506 induces interleukin-6 production through the activation of transcription factor nuclear factor (NF)-kappa(B). Implications for FK506 nephropathy

FK506 is a powerful immunosuppressive drug currently in use that inhibits the activation of several transcription factors (nuclear factor (NF)-AT and NF-kappaB) critical for T cell activation. We show here that, contrary to the situation in T cells, FK506 activates transcription factor NF-kappaB in nonlymphoid cells such as fibroblasts and renal mesangial cells. We further show that FK506 induces NF-kappaB-regulated IL-6 production in vitro and in vivo, in particular in kidney. IL-6 has been shown previously to produce renal abnormalities in vivo, such as mesangioproliferative glomerulonephritis. Similar renal abnormalities were also observed in FK506-treated animals. These results thus suggest a causal relationship between FK506-induced NF-kappaB activation/IL-6 production and some of FK506-induced renal abnormalities.

Liver transplantation for hepatocellular carcinoma: consideration from the findings on autopsy

Extrahepatic spread of hepatocellular carcinoma was investigated in twenty autopsy cases with unresected hepatocellular carcinoma to define the appropriate patient selection criteria for liver transplantation. Diagnosis of extrahepatic spread of cancer by diagnostic imaging was not easy, and unsatisfactory prognosis after liver transplantation in patients with hepatocellular carcinoma might have been attributed to the high incidence of extrahepatic occult foci of cancer. All patients with multiple nodular, massive and diffuse tumor had extrahepatic spread of cancer. Only patients with a single nodular type tumor, no larger than 30 mm in diameter, had no extrahepatic metastasis, and these patients are the preferred candidates for liver transplantation.

[Analysis of the p16INK4, p15INK4B genes abnormality and the amplification of cyclin D1 gene in esophageal cancer]

To evaluate the prognostic significance of gene amplification and overexpression of cyclin D1 in the patients of esophageal squamous cancer, slot blot hybridization and immunohistochemical staining were performed. The patients with gene amplification or overexpression of cyclin D1 were significantly poorly prognosis than patients these were negative. And to investigate abnormality of p16 and p15 genes in 12 squamous cell carcinoma of esophagus, PCR and SSCP analysis were performed. In only one of 12 tumors, complete deletion of p16 and p15 genes was detected. But in other 11 tumors, no abnormality could be detected. Besides to evaluate the prognostic significance of expression of p16 in patients of esophageal squamous cancer, immunohistochemical staining for p16 was performed. The patients with overexpression of p16 were significantly better prognosis than patients that was negative, and this result was opposite contrast with the result of cyclin D1.

[Changes in intestinal motility after massive small bowel resection with a reversed jejunal segment]

To evaluate the functioning and effectiveness of a 20-cm reversed jejunal segment after 75-80% massive small bowel resection (MSBR), and whether migrating polarity changes or not, we continuously measured the postoperative bowel motility (using bipolar electrodes and/or contractile strain gage force transducers) in interdigestive and postprandial conscious dogs in short- (2-5 weeks) and long-term (6-10 months) after surgery. The fasting migrating myoelectric (or motor) complex (MMC) arising from the duodenum was often interrupted at the jejunum above the proximal anastomosis and did not migrate smoothly to the reversed segment or terminal ileum. In addition, brief small discordant contractions were frequent in the jejunum above the proximal anastomosis and the proximal part of the reversed segment. The duodenal MMCs predominantly propagated to the ileum through the inherent anatomic continuity of the bowel. These findings of the MMC propagation pattern are very similar in short- and in long-term after surgery. The duration of the postprandial period without duodenal MMC activity was markedly longer in short-term, but shorter in long-term (both were significantly longer than in controls). Marked dilatation of the jejunum and reversed jejunal segment was noted across the proximal anastomosis. These results suggest that the transit time and passage of intestinal contents can be delayed and stagnated for at least 10 months after MSBR with a 20-cm reversed jejunal segment. Although, reports on the polarity of peristalsis in the reversed segment in long-term followup have been contradictory in both experimental and clinical studies, this results support the conclusion that the reversed jejunal segment maintains its inherent propagative polarity and pattern over a long postoperative period.

Four cases of selenium deficiency in postoperative long-term enteral nutrition

Because selenium is seldom added to formulations for enteral nutrition (EN), postoperative patients who are supported with EN are at risk for selenium deficiency. This report describes four cases of suspected selenium deficiency in long-term EN. Two patients underwent pancreaticoduodenectomy, one underwent total gastro-pancreatectomy, and one underwent esophageal resection and reconstruction with jejunal autotransplantation. They all developed malabsorption syndrome within 2 yr after operation. Enteral nutritional support with an elemental diet was provided continuously for 7-11 yr. Over the past 1-2 yr they experienced increasing bilateral muscular pain and weakness in the legs, gait disturbance, palpitation, and shortness of breath. Investigation for possible trace element deficiency revealed very low levels of selenium in the blood. After 10-20 d of supplementation with daily intravenous administration of selenious acid 0.16 mg/d (100 micrograms/d of selenium), their blood levels of selenium rose and their symptoms resolved. They were then continued on a maintenance regimen of oral sodium selenite 0.13 mg/d (60 micrograms/d of selenium).

Human platelet glycoproteins V and IX: mapping of two leucine-rich glycoprotein genes to chromosome 3 and analysis of structures

Human platelet glycoproteins Ib alpha, Ib beta, V, and IX comprise an interrelated set of molecules (the Ib-V-IX system) that together form a surface adhesion receptor for the ligand, von Willebrand factor. To complete the primary structural characterization of the genes involved in this system, we have analyzed cosmid clones for both the glycoprotein V and IX genes and used these clones to localize the two genes by fluorescence in situ hybridization. Both genes were found on the long arm of chromosome 3, but at distinct sites, the GPV gene on 3 band q29 and the GP IX gene on 3 band q21. The transcriptional start site of the GPV gene was defined by "anchored" PCR and primer extension. The GPV gene contains two exons, the first consisting of approximately 37 bases and the second of approximately 3500 bases, interrupted by a single 958 base intron. The GPV transcript has multiple start sites spread over a twenty base region. The 5' flanking region of the GPV gene has a series of potential consensus regulatory elements including GATA, ets, and Sp-1 sites, similar to those found in other described megakaryocyte/platelet genes, including those of the Ib-V-IX system. In assessing the four Ib-V-IX genes as a group, all four have a simple, "intron-depleted" structure with the entire open reading frame of the mature polypeptide located within a single exon.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal responses to atrial natriuretic peptide (ANP) in rats with non-oliguric acute renal failure induced by cisplatin

This study was designed to compare the renal effects of atrial (A-type) natriuretic peptide (ANP) on control (saline-injected) rats and rats with non-oliguric acute renal failure induced by cisplatin. The results obtained here are summarized as follows: (1) In the metabolic cage study, cisplatin-treated rats showed increases in blood urea nitrogen and serum creatinine while creatinine clearance decreased to the lowest levels on day 4. A transient increase in urinary protein was observed at day 4. (2) ANP infusion significantly increased urine flow rate (UFR), creatinine clearance (CCr), fractional excretion rates of sodium (FENa) and chloride (FECl), and urinary phosphorus and magnesium (Mg) excretions in a dose-dependent manner without affecting renal plasma flow and fractional excretion rates of potassium and urea in cisplatin-treated rats. (3) Renal effects of ANP on UFR, CCr, FENa, FECl and excretion of Mg were more pronounced in cisplatin-treated rats compared to control rats although markedly blunted responses to ANP have been reported in nephrotic patients and nephrotic animals induced by adriamycin and aminonucleoside. (4) Histological examination showed extensive necrosis of the S3 segment of the proximal tubule located in the outer stripe of the outer medulla with minimal glomerular abnormalities in the kidney of cisplatin-treated rats. In conclusion, the main mechanism of the increased renal responses to ANP is considered to be due to an increased delivery of sodium, fluid and ANP itself to the inner medullary collecting duct which is the major renal site of action of ANP under the condition of acute proximal tubular necrosis by cisplatin.

Human platelet glycoprotein V: its role in enhancing expression of the glycoprotein Ib receptor

Platelet adhesion to an injured blood vessel wall is a critical initiating step in hemostasis mediated by a four member receptor complex (glycoprotein Ib/V/IX) interacting with plasma von Willebrand factor (vWF). The function of the GPV subunit within this complex is presently undefined. To study the role of glycoprotein (GP) V within the GPIb receptor complex, we transfected the GPV subunit gene into a hematopoietic cell line that constitutively expresses the other three subunits (human erythroleukemia [HEL] cells). Using flow cytometry, we found transfected GPV was surface expressed in HEL cells; this, in turn, led to increased surface expression of the ligand-binding GPIb alpha and GPIX subunits. Radioligand binding assays showed that GPV-transfected HEL cells bound more vWF than their non- or mock-transfected counterparts. We employed confocal microscopy of GPV-transfected HEL cells to show that GPV colocalizes with GPIb alpha on the cell surface. These findings suggest that the GPV subunit plays a role within the GPIb receptor complex by enhancing Ib alpha surface expression.

A huge immature cervical teratoma in a newborn: report of a case

A neonate with a large cervical mass was transferred to our hospital at 4 days of age. A computed tomography scan showed a contrast-enhanced solid mass with multiple cystic elements and fine calcification. Ultrasonography also revealed a predominantly solid mass with calcification, containing multiple cysts. These studies suggested a teratoma, but could not rule out a hemangioma. The tumor was removed on the 12th day of life. A pathological study revealed an immature teratoma that demonstrated fetal type cartilage and an immature neural tube. The operative complete removal of a cervical teratoma in neonates is recommended as soon as possible. The management of a pediatric cervical teratoma should also be similar to that of a sacrococcygeal teratoma. The incidence of cervical teratoma in all pediatric teratomas ranges from 2.3%-9.3% in the West, and from 1.6%-8.3% in Japan.

[Intestinal motility after massive small bowel resection]

To evaluate intestinal motility after 80% massive distal small bowel resection (MSBR), we continuously monitored interdigestive and postprandial bowel motility using bipolar electrodes and/or contractile strain gage force transducers in conscious beagle dogs before, and at 0-4 weeks and 8-13 months after the surgery. Fasting duodenal migrating myoelectric (or motor) complexes (MMCs) occurred at longer intervals in the short-term after 80% MSBR than in controls, and were simulated in long-term that in controls. MMCs arising from the duodenum were often migrated to the proximal jejunum, the jejunum above the anastomosis, and to the terminal ileum beyond the anastomosis. The velocity of duodenal MMC propagation was slowed in every intestinal segment in the short-term, and had not recovered even long after the operation. The duration of the postprandial period without duodenal MMCs was prolonged significantly in the short-term, and still remained longer in the long-term than in controls. These findings suggest that changes in gut motility after MSBR tend to compensate for the shorter intestine and maintain small bowel absorption early postoperatively, and adaptations of motility would occur over the long-term to increased intestinal absorption.

Transient expression of type I collagen in glomeruli with anti-Thy-1 antibody-induced mesangial proliferative lesions

Glomerular expression of extracellular matrices at the protein and mRNA levels was examined in rats with mesangial proliferative glomerulonephritis induced by the intravenous administration of a monoclonal anti-rat Thy-1 antibody. In close association with the mesangial proliferative lesion, type I collagen was immunostained at day 8 but not demonstrated at day 28 in the glomeruli of the kidneys. Type I collagen mRNA expression prominently increased in the nephritic glomeruli at day 4, prior to the appearance of type I collagen protein. In addition, fibronectin expression was also elevated in the diseased glomeruli at both the protein and mRNA levels. These results indicated that glomerular, probably mesangial cells, change their phenotypes during this disease, to synthesize abnormal extracellular matrices that lead to the progression of glomerular sclerosis.

Analgesic and hypnotic effects of subanaesthetic concentrations of xenon in human volunteers: comparison with nitrous oxide

The purpose of this study was to examine the effects of xenon and nitrous oxide in equipotent doses of 0.3 MAC on pain threshold and auditory response time in six healthy male volunteers. Compared with 100% oxygen inhalation, xenon and nitrous oxide significantly increased the pain threshold as measured by a radiant heat algometer. There was no significant difference in analgesic effects between xenon and nitrous oxide. Xenon significantly prolonged the response time to auditory stimuli compared with 100% oxygen, but nitrous oxide did not. The inhibitory effect of xenon on the auditory response time was significantly greater than that of nitrous oxide. The same six volunteers were studied to test if naloxone antagonized analgesia induced by xenon or nitrous oxide. The analgesic effects of xenon and nitrous oxide did not differ with or without naloxone.

Morphological and biochemical changes in a hematopoietic cell line induced by jacalin, a lectin derived from Artocarpus integrifolia

Treatment of the human erythroleukemia cell line K562 with the galactose-binding lectin, jacalin, results in rapid and profound alterations in the morphology and biochemistry of the cells. Within minutes of lectin addition, the cells adhere to the plastic tissue culture surface, and within hours, the cells spread on the surface, acquiring a monocyte-like appearance. Jacalin treatment results in elevated expression of CD61 (integrin beta 3) and CD14, a monocyte-associated cell surface antigen. These results suggest that jacalin treatment of K562 cells triggers intracellular events that result in differentiation along the monocyte lineage.

Electrogastrography prior to and following total gastrectomy, subtotal gastrectomy, and gastric tube formation

On electrogastrography (EGG) spectral analysis, an activity of 3 cycles per minute (cpm) is supposed to be specific for the stomach. After total or subtotal gastrectomy, the original site of the stomach is occupied mainly by the intestine. We attempted to determine if intestinal activity could be recorded in this region with EGG. Epigastric recordings were performed in patients prior and following gastrointestinal or control surgeries. Spectral analysis, using the maximal entropy method and ensemble means was applied to data analysis from these recordings. Preoperatively, the majority of the power peaks were found around 3, 6, and 11 cpm. The postprandial-to-fasting power ratio of all of these power peaks increased significantly postprandially (P < 0.05-0.01). Following total gastrectomy, the power peak around 3 cpm disappeared or was significantly diminished in amplitude (P < 0.05). The postoperative-to-preoperative power ratio ranged from 0.03 to 0.10 (P < 0.001-0.01). However, the power peak around 11 cpm did not significantly change prior to or following total gastrectomy, and the 11 cpm peak appeared relatively dominant. Simultaneous manometric studies in the Roux limb demonstrated a correlation between the power spectral frequency of EGG and manometry at 11 cpm. Therefore, the 11 cpm peak appeared to reflect jejunal or Roux limb electrical activity. The postoperative to preoperative power ratio for the 3 cpm also was significantly reduced following subtotal gastrectomy and gastric tube formation in patients in the postprandial state (P < 0.05-0.001).

Columbin isolated from calumbae radix affects the sleeping time of anesthetized mice

In a screening series of bioactive components in edible and medicinal plants, we found that Calumbae Radix (Colombo root, 1% powdered feed, for 5 d) and its component, columbin (20-40 mg/kg/d, for 5 d, orally), shortened the sleeping time induced by a urethane and alpha-chloralose mixture and prolonged the sleeping time induced by hexobarbital in mice.

Evaluation of long-term survivors after pancreatoduodenectomy for pancreatoduodenal carcinoma

Long-term survivors (> or = 5 years) of pancreatoduodenal carcinoma were evaluated. The absence of retropancreatic invasion seemed to be an important factor for long-term survival in carcinoma of the pancreatic head, carcinoma of the intrapancretic bile duct confined within the bile duct wall, and stage II papilla of Vater carcinoma. The mode of infiltration was INF alpha or INF beta, with a low infiltration tendency. Lymph node metastasis, when present, was confined to the pancreatic head. It is noteworthy that two of the patients with intrapancreatic bile duct cancer had perineural infiltration to the pancreatic head plexus. In patients treated by extended resection, postoperative malnutrition and diarrhea was severe, indicating the importance of long-term nutritional management.

Prognostic significance of nucleolar organizer regions in hepatocellular carcinoma

It has been suggested that the number of argyrophilic nucleolar organizer regions (AgNORs) correlates with cellular activity and the aggressiveness of malignancy. The mean number of AgNORs per nucleus may, therefore, be a prognostic factor for hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the prognostic significance of the number of AgNORs in HCC. The silver-staining technique was applied to surgically resected specimens to indicate AgNORs. Eighty-nine of the specimens were of HCC, 23 were of normal liver adjacent to HCC, and 32 were of cirrhotic liver adjacent to HCC. The number of AgNORs of HCC (mean +/- SD, 3.26 +/- 1.23) was significantly higher than those of normal liver (1.37 +/- 0.13) and cirrhotic liver (1.49 +/- 0.14). The number of AgNORs was significantly correlated with serum alpha-fetoprotein level, tumor size, portal vein invasion, and Edmondson-Steiner histological grade. In patients undergoing curative resection, the survival rate of those with a high number (> 3.04) of AgNORs was significantly worse than that of those with a low number (< or = 3.04) of AgNORs. Multivariate analysis showed that the number of AgNORs was a significant prognostic indicator in patients without portal vein invasion, and portal vein invasion was the only significant variable when all patients undergoing curative resection were assessed together. The results of this study suggest that the number of AgNORs is useful as an indicator of the grade of malignancy and as a predictor of the prognosis of patients with HCC who do not have portal vein involvement.

Familial nesidioblastosis in two sisters

We herein present two female siblings with persistent hyperinsulinemic hypoglycemia in the neonatal period who were diagnosed as having familial nesidioblastosis. Despite both the administration of diazoxide and the intravenous infusion of glucose, one of the affected infants died of severe metabolic acidosis at about 1 month of age, before pancreatectomy could be performed. The other, in whom the disorder was diagnosed early, also failed to respond to conservative medical treatment and ultimately required a 99% pancreatectomy for control of hypoglycemia. A third female sibling was normal. The possibility of familial nesidioblastosis should thus be considered in the case of neonatal intractable hypoglycemia to ensure a prompt diagnosis and allow for early surgical intervention when indicated. The relevant literature on this life-threatening disorder is also reviewed.

Immunohistochemical quantitation for extracellular matrix proteins in rats with glomerulonephritis induced by monoclonal anti-Thy-1.1 antibody

Extracellular matrix proteins (type I collagen and fibronectin) in frozen histologic sections of kidney cortex from rats with glomerulonephritis induced by a single intravenous administration of anti-Thy 1.1 antibody were quantified using an immunohistochemical micromethod. Type I collagen and fibronectin contents in renal cortex of rats with experimental glomerulonephritis (4.33 +/- 0.79 and 10.41 +/- 2.01 microgram/mg of total protein, respectively) were 262% and 151%, respectively, higher than in control rats given normal mouse IgG (1.65 +/- 0.16 and 6.88 +/- 0.95 microgram/mg, respectively; p < 0.01 in each case). In the glomerulonephritic rats, the increase in the contents of extracellular matrix proteins, especially type I collagen, correlated with increasing glomeruli with expansion of mesangial areas. The increase in type I collagen content correlated well with increasing urinary protein excretion and blood urea nitrogen and serum total cholesterol levels (r = 0.851, 0.812, and 0.837, respectively; p < 0.05 in each case). The decrease in creatinine clearance correlated with increasing content of type I collagen (r = 0.781; p < 0.05). The immunohistochemical micromethod may make it possible to evaluate the histopathological diagnosis of mesangial proliferative glomerulonephritis quantitatively.

Long-term results after nonshunt operations for esophageal varices in children

The clinical results of nonshunt operations for esophageal varices in 15 children were evaluated. The varices were caused by congenital extrahepatic portal obstruction (EHPO) in 10, liver cirrhosis or fibrosis (C/F) in 3, and idiopathic portal hypertension (IPH) in 2. The operative procedures were transthoracic esophageal transection with paraesophageal devascularization (TR) for 2 EHPO patients under 5 years of age, TR combined with splenectomy and paragastric devascularization (Sugiura procedure) for 11 (8 EHPO, 3 C/F), and splenectomy with devascularization (SP) or splenectomy for the 2 IPH patients. In the EHPO patient under 5 years of age, TR is associated with a likelihood of gastric or esophageal hemorrhage resulting from hypersplenism, gastric congestion, or persistent distal esophageal varices, which can be treated with partial splenic arterial embolization (PSE), endosclerotherapy, or an additional abdominal procedure. The Sugiura procedure has provided satisfactory long-term results, without rebleeding from esophageal varices, in patients with EHPO and C/F for 1 to 20 years. But EHPO patients who undergo the Sugiura procedure before age 6 can have gastric hemorrhage, because of mucosal congestion, for more than 10 years after the procedure, and selective gastric arterial embolization (GAE) might be necessary. In some EHPO patients, especially young ones who have variceal bleeding, a significant increase in hepatopetal portal flow may not develop, but hepatofugal natural shunts may progress. Therefore we recommend direct operative procedures, ie, TR for patients < or = 6 years of age and a one- or two-stage Sugiura procedure for those over 7 years old.(ABSTRACT TRUNCATED AT 250 WORDS)

Resulting long-term intestinal motility in dogs following construction of a reversed jejunal segment after extensive small bowel resection

To evaluate the long-term function and effective motility of a reversed jejunal segment after extensive small bowel resection, the authors continuously measured postoperative bowel motility during interdigestive and postprandial periods in conscious dogs 6 to 10 months after surgery. The long-term findings were compared with previously reported short-term results measured 2 to 4 weeks after the operation. In the long-term follow-up dogs with a 20-cm reversed jejunal segment constructed after extensive (75% to 80%) small bowel resection, the fasting duodenal migrating myoelectric (or motor) complex (MMC) was often interrupted in the jejunum above the reversed segment, and did not migrate smoothly to the reversed segment or terminal ileum. The MMCs arising from the duodenum predominantly propagated to the ileum through the inherent anatomic continuity of the bowel. In addition, brief small discordant contractions were frequent in the reversed segment and the jejunum, above the proximal anastomosis. These findings are similar to those of the MMC propagation pattern noted 2 to 4 weeks after surgery. However, the postprandial duration without duodenal MMC activity was significantly shorter in the dogs with long-term follow-up than in those with short-term follow-up (both were longer than in control dogs). Marked dilatation of the jejunum and reversed jejunal segment was noted across the proximal anastomosis. These results suggest that the transit time and passage of intestinal contents can be delayed and stagnated for at least 10 months after extensive small bowel resection with a 20-cm reversed jejunal segment.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary tuberculosis of the nasopharynx with erythema induratum of Bazin

A 44-year-old Japanese woman with primary tuberculosis of the nasopharynx associated with erythema induratum of Bazin (EI) is reported. The patient presented with erythematous nodules of the lower legs diagnosed as EI. Since EI is a tuberculosis-related skin disease, the presence of latent tuberculous lesions was investigated, and a tuberculous lesion was found in the nasopharynx. Primary tuberculosis of the nasopharynx is very rare. Furthermore, our review of the literature revealed no case in which nasopharyngeal tuberculosis acted as the latent focus of EI.

A solid and cystic tumor of the pancreas in a 10-year-old girl: report of a case and review of the literature

We report herein the unusual case of a 10-year-old girl in whom a neoplasm developed in the head of the pancreas. Complete extirpation of the tumor was performed, which was histologically classified as a "solid and cystic tumor of the pancreas." Postoperative DNA analysis revealed a diploid pattern. The patient remains well with no sign of tumor recurrence 2 years after her operation. Thus, complete tumor extirpation without pancreatectomy is recommended for pediatric patients when there is no direct invasion to the adjacent organs or distant tumor metastasis.

Induction of oesophageal and forestomach carcinomas in rats by reflux of duodenal contents

A study was designed to determine whether oesophageal carcinomas can be induced through reflux of duodenal contents. Male Wistar rats weighing 230-250 g were divided into three groups according to the surgical procedure performed: (1) the duodenal contents were directed into the forestomach through a stoma (duodeno-forestomach reflux); (2) the duodenal contents were regurgitated into the forestomach through the glandular stomach (duodeno-glandular-forestomach reflux); and (3) a sham operation was performed as a control. Animals were fed standard CRF-1 solid food and tap water that was not exposed to carcinogens and were sacrificed 50 weeks post-operatively. While no neoplasia was observed in any of the 32 control rats, 4/11 (36%) with duodeno-forestomach reflux and 3/18 (17%) animals with duodeno-glandular-forestomach reflux developed carcinomas in the lower oesophagus and forestomach. The incidence in each group was significantly higher than in the controls (P < 0.01 and P < 0.05 respectively). Six of the seven lesions consisted of squamous cell carcinomas, and one was a mucinous adenocarcinoma. Oesophageal columnar epithelial metaplasia was observed in two (18%) of the animals with duodeno-forestomach reflux. Carcinomas were always surrounded by chronic inflammatory changes, including regenerative thickening, basal cell hyperplasia and dysplasia. Additional well-differentiated adenocarcinomas were observed in the prepyloric antrum of 6/18 (33%) animals with duodeno-glandular-forestomach reflux. These findings indicate that chronic reflux of duodenal contents may cause oesophageal carcinoma.

Postoperative adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs in patients with hepatocellular carcinoma

Vascular invasion and intrahepatic metastasis by hepatocellular carcinoma are important factors predisposing to tumor recurrence. Recurrences of this malignancy occur frequently in residual liver, and its prevention is one of the most important factors in obtaining better surgical survival. Fifty patients who underwent hepatectomy for invasive hepatocellular carcinoma with vascular invasion and/or intrahepatic metastases were studied to evaluate the effect of adjuvant bolus hepatic arterial infusion of iodized poppyseed oil (Lipiodol) containing anticancer drugs in preventing recurrence and in prolonging survival. Patients were assigned to two treatment groups. Twenty-three of the fifty patients received adjuvant bolus infusion of Lipiodol containing doxorubicin and mitomycin C, whereas 27 patients received no therapy. The disease-free survival rate for the patients who received adjuvant therapy was significantly better (p < 0.05) than that for those who did not when measured at 172, 516, 688 and 860 days after hepatectomy, and the disease-free survival curve for patients with adjuvant therapy was significantly (p = 0.0237) better than that without adjuvant therapy. The cumulative survival rates and curves were not significantly different between the two groups. While adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs was effective in improving disease-free survival, the effect was not satisfactory. Further trials of adjuvant chemotherapy are required to improve the surgical survival of hepatocellular carcinoma patients.

Structural characterization and chromosomal location of the gene encoding human platelet glycoprotein Ib beta

Human platelet glycoprotein Ib beta (GPIb beta) (M(r) 22,000) is part of the GPIb-V-IX system that constitutes the receptor for von Willebrand factor and mediates platelet adhesion in the arterial circulation. The four members of the receptor (GPs Ib alpha, Ib beta, V, and IX) share structural and functional features. Individually, GPIb beta contributes to surface expression of the receptor and participates in transmembrane signaling through phosphorylation of its intracellular domain. To define the structure of the GPIb beta gene, a cosmid clone from a human genomic library was analyzed. The transcriptional start site was located by both primer extension and the "anchored" polymerase chain reaction. Similar to the genes for Ib alpha, V, and IX, the Ib beta gene is compact with a single 274-base intron inserted into the 5' end of the open reading frame. The 5'-flanking region of the gene contains both GATA and ets sites that are also found in the 5' promoter regions of other described megakaryocyte/platelet genes. The GPIb beta gene was localized to chromosome 22q11.2 by fluorescence in situ hybridization. The GPIb beta gene has a simple structure, similar to that of other described megakaryocyte/platelet genes, including those of the GPIb-V-IX system.

DNA strand-breaking activities of quinolone antimicrobial agents under visible light irradiation

The DNA strand-breaking activities of 9 quinolones, widely used as antimicrobial agents and suspected to induce photo-dermatological disorders in humans, were examined under irradiation using standard domestic fluorescent lamps. Two quinolones, tosufloxacin and enoxacin, converted the supercoiled covalently closed circular plasmid DNA to the open circular form under visible light irradiation. The maximum of photodynamic single strand-breaking activity for tosufloxacin was found to be 12% at 50 microM and that of enoxacin was 33% at a concentration of 2 mM. The DNA strand-breaking activities of photoirradiated tosufloxacin and enoxacin were markedly inhibited by NaN3 but only partially by D-mannitol, superoxide dismutase (SOD) and catalase did not inhibit these activities. These results suggest that some quinolone antimicrobial agents can be activated by visible light and induce phototoxic DNA damage in various organisms. We should carefully investigate such phototoxic activities during the development of new quinolones to avoid producing phototoxic disorders in man.