[Myogenic hyperuricemia]

Myogenic hyperuricemia is caused by over-production of uric acid, which based on the excessive degradation of purine derivatives in exercising muscle. This phenomenon is frequently observed in the patients of muscle glycogen storage disease (GSD) types III, V and VII. In these patients, impairment of muscle ATP production leads to over-production of AMP, followed by excessive release of inosine and hypoxanthine from the muscle. The molecular lesions of muscle GSDs have been well analyzed. Recent repertoire of these mutations were referred in respect of myogenic hyperuricemia.

[Endobronchial actinomycosis]

A 63-year-old man was admitted to our hospital with obstructive pneumonia. The chest X-ray film and computed tomogram showed an infiltrative shadow in the right lower lung field. Examination with a fiberoptic bronchoscope showed a mass in the right basal bronchus. These findings suggested the diagnosis of lung cancer with obstructive pneumonia. Histopathological examination of a specimen obtained by transbronchial biopsy revealed sulfur granules with infiltration of neutrophils, which led to the diagnosis of endobronchial actinomycosis. After three months of treatment with penicillin, the mass disappeared. Comparison of bronchoscopic findings before and after penicillin treatment clearly showed the efficacy of therapy.

[Therapeutic effectiveness of combined microsurgery and radiosurgery in a patient with a huge trigeminal neurinoma]

A case of right trigeminal neurinoma extending from the cavernous sinus to the cerebellopontine angle in a 48-year-old male is reported. The patient first noticed right facial numbness in June 1993. Six months later, he experienced headaches with occasional nausea, diplopia, ataxic gait, tinnitus and dysphagia and was referred to our department on January 21, 1994. Neurological examination on admission showed multiple cranial nerve palsy from the 4th to 11th nerve on the right, and the cerebellar sign on the right. Initial CT and MRI revealed a large mass lesion extending from the right cavernous sinus to the right cerebellopontine angle. On February 16, 1994, radical resection of the tumor, except the lesion invading the cavernous sinus, was performed via a combined retroauricular and preauricular transpetrosal transtentorial approach. The histological diagnosis was neurinoma. The patient's postoperative course was uneventful and there was good clinical improvement, although the right facial numbness and mild diplopia persisted. On April 6, 1994, radiosurgery was performed with a maximum dose of 28 Gy and a marginal dose to 14 Gy to the remaining cavernous sinus lesion. Two weeks after radiosurgery, the patient achieved a complete return to his daily routine. Two-year follow-up CT and MRI showed a small residual les on in the right cavernous sinus alone. There was no evidence of tumor growth. No new neurological deficits had developed, and the patient's the double vision had resolved. Thus, the patient has been able to maintain a satisfactory level of activities of daily living. We wound like to emphasize the clinical value of the strategy used to treat this patient which combined microsurgery with subsequent radiosurgery.

Overexpression of the mexC-mexD-oprJ efflux operon in nfxB-type multidrug-resistant strains of Pseudomonas aeruginosa

OprJ, overproduced in nfxB multidrug-resistant strains of Pseudomonas aeruginosa, and OprK, overproduced in the multidrug-resistant strain K385, were demonstrated to be immunologically cross-reactive using an OprJ-specific monoclonal antibody. Treatment of the purified proteins with trypsin or chymotrypsin yielded virtually indistinguishable digestion patterns, and the N-terminal sequence of two trypsin fragments was identical for both proteins, indicating that OprJ and OprK share identity. The N-terminal amino acid sequences were used to facilitate cloning of the oprJ gene on a 5kbp Kpnl fragment and a 10 kbp BamHl fragment. Nucleotide sequencing of portions of these fragments revealed that oprJ was the terminal gene in a putative three-gene operon, mexC-mexD-oprJ. The predicted mexC-mexD-oprJ gene products exhibit homology to the MexA-MexB-OprM components of the multidrug-resistance efflux pump of P. aeruginosa (43-46% identity). Consistent with an implied role for mexC-mexD-oprJ in drug efflux, the mexC-mexD-oprJ-hyperexpressing strain K385 showed reduced accumulation of a variety of antibiotics as compared with its parent strain, and this drug 'exclusion' was abrogated by energy inhibitors. The mexC and oprJ products are putative lipoproteins of a molecular mass of 40,707 and 51,742 Da, respectively, while mexD was predicted to encode a protein of 111 936 Da. Sequencing upstream of mexC revealed the presence of the nfxB gene transcribed divergently from the efflux genes. Overproduction of OprJ and the attendant multiple-antibiotic resistance of strain K385 was shown to result from a point mutation in nfxB, resulting in a H87-->R change in the predicted NfxB polypeptide. OprJ overproduction and multidrug resistance in K385 was reversed by the cloned nfxB gene, suggesting that nfxB encodes a repressor of mexC-mexD-oprJ expression. Consistent with this, the cloned nfxB gene repressed synthesis of a mexC-lacZ fusion in Escherichia coli. nfxB also repressed expression of a nfxB-lacZ fusion, indicating that NfxB negatively regulates its own expression. These data indicate that the multidrug resistance of nfxB strains is due to overexpression of an efflux operon, mexC-mexD-oprJ, encoding components of a second efflux pump in P. aeruginosa.

Natural resistance against tumors grafted into the brain in association with histocompatibility-class-I-antigen expression

The role of MHC-class-I-antigen expression in intracerebral anti-tumor natural resistance was examined using MHC-positive Lym+ and MHC-negative Lym- lymphoma cell lines. Lym+ was sensitive to MHC-class-I-restricted CTL-mediated lysis, while lym- was resistant. Both lines were susceptible to NK-cell-mediated lysis. There was no difference in in vitro growth rate of in vivo intraperitoneal tumorigenicity between them. Inoculation of Lym+ cells into the brain caused upregulation of the intracellular MHC mRNA to the same level as after treatment with interferon-gamma, resulting in an increase in cell-surface MHC expression. Although inoculated Lym- cells also underwent an increase in cytosolic MHC mRNA, the cell-surface MHC expression remained negative. Immunoprecipitation revealed that the terminal glycosylation did not occur normally in Lym-. An in vivo intracerebral tumorigenicity assay, using 2 groups of untreated and NK-cell-depleted syngeneic mice, showed that Lym+ was less tumorigenic than Lym-. In T-cell-depleted mice, however, no difference was detected between them. In addition, when Lym+ and Lym- cells were inoculated into the brain of allogeneic or syngeneic preimmunized mice (immunized with tumor cells), Lym+ was rejected, while Lym- was accepted. When allogeneic mice had received treatment for T-cell depletion before intracerebral inoculation, no rejection was observed in Lym+. On the other hand, Lym- cells, when injected i.p. into NK-depleted mice, had greater killing activity than Lym+ cells, while in T-cell-depleted mice Lym- was less tumorigenic than Lym+. These results suggest that MHC-positive tumor cells grafted into the brain may be rejected by CTL in an MHC-dependent manner, whereas MHC-negative tumor cells can escape from T-cell-mediated immunosurveillance and grow progressively in the brain, due to absence of intracerebral natural resistance mediated by NK cells.

Expression and distribution of glucose-6-phosphatase catalytic subunit messenger RNA and its changes in the diabetic state

Glucose-6-phosphatase (G6Pase) plays a major role in gluconeogenic pathway. To analyze its regulation, we have cloned a full-length cDNA for G6Pase catalytic subunit from the rat liver. In the cloned cDNA, a 492 base insertion, respective to the previously reported sequence, was found in the 3'-noncoding region. In both ends of this insertion, 5'- and 3' 2' splice site motifs were identified. However, spliced mRNA was hardly observed in the rat RNA. Abundant expression was observed in the liver and the kidney by Northern analysis. Expression was also observed in the spleen, adrenal gland and small intestines. Reverse-transcription (RT) polymerase chain reaction (PCR) analysis revealed that G6Pase mRNA was also expressed in a variety of tissues including pancreatic islets. Its expression was increased in the ketotic diabetic mice livers and was corrected by insulin treatment. However, no appreciable changes were observed in kidneys. Broad tissue distribution in expression and the tissue specificity in regulation were thus considered to be the important features of G6Pase gene.

Clinicopathologic features of early hepatocellular carcinoma

BACKGROUND/AIMS

This study attempts to clarify the clinicopathologic definition of early hepatocellular carcinomas (HCCs).

MATERIALS AND METHODS

We evaluated 57 patients, with HCCs less than 3 cm in diameter, in terms of prognosis, incidence of extrahepatic metastasis, and tumor recurrence rate following treatment.

RESULTS

Survival was related to both tumor number and histologic differentiation, but was not related to tumor size. Furthermore, prognosis appeared to depend on the functional reserve of the liver. The incidence of extrahepatic metastasis was related to histologic differentiation. There was no significant difference in the recurrence rates of patients with uninodular tumors in terms of tumor size.

CONCLUSIONS

Our findings indicate that early HCCs measure 15 mm or less in diameter, are uninodular, and are histologically well-differentiated. Finally, the functional reserve of the liver will likely be an additional parameter that will further characterize early HCCs.

Therapeutic effect of secretin in patients with jaundice; double-blind placebo-controlled multicentric trial

Secretin, a gastrointestinal hormone, has been shown to have a potent choleretic effect. Having already obtained some beneficial effects with secretin in patients with intrahepatic cholestasis, we sought to confirm its effects in a double-blind placebo-controlled study in patients with mild jaundice after acute or during chronic hepatitis, where total bilirubin level was in excess of 4.0 mg/dl for 3 days or more. Patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and familiar hyperbilirubinemia were excluded from the study. Ninety-three patients were included in this analysis, but the final evaluation covered 69 of them. No statistically significant differences were found in the reduction of serum bilirubin levels between secretin and placebo groups. As a number of patients with liver cirrhosis had been included, the subjects were subdivided into one group with cholestasis in hepatitis and one with liver cirrhosis. In the subgroup of cirrhotic patients who received secretin, serum levels of AST were significantly increased compared with the placebo group. However, since the choleretic effect of secretin is unique, further studies seem to be warranted.

Establishment of two human renal cell carcinoma cell lines with different chemosensitivity

Two cell lines, SKR1 and NKK1, were established from renal cell carcinomas (RCC) with different histopathologic characteristics: SKR1 from grade 3, solid type, pleomorphic cell type carcinoma in a 66-year-old male and NKK1 from grade 2, alveolar type, clear cell carcinoma in a 49-year-old female. Electron microscopic study showed the presence of microvilli on cell surface and desmosome-like structures between cells in both lines. Doubling time and plating efficiency of SKR1 were 28 h and 37%, respectively, whereas those of NKK1 were 45 h and 22%, respectively. The chromosome number of both cell lines was 100% aneuploid with a mode of 74 chromosomes for SKR1 and 84 for NKK1. Both SKR1 and NKK1 induced tumors at the site of subcutaneous injection of nude mice. The morphologic characteristics of the tumor were similar to those of each original tumor. NKK1 was about 20 times more resistant to doxorubicin and vinblastine as compared to SKR1. Expression of P-glycoprotein was considered to be one of the factors responsible for such multidrug resistant phenotype of NKK1 cells. These two lines with different chemosensitivity may be a useful model for developing new therapeutic strategies for RCC.

Hepatitis B virus carrier status linked to autoimmune hepatitis

We describe a hepatitis B virus carrier who satisfied the criteria of autoimmune hepatitis proposed by the International Autoimmune Hepatitis Group. A 43-year-old Japanese female showed human leukocyte antigen typing including DR4 in addition to hypergammaglobulinemia, presence of autoantibodies, and liver histology suggestive of autoimmune hepatitis. Moreover, the predominant presence of hepatitis B core antigen in nuclei rather than in cytoplasm of hepatocytes suggested less of a possibility of liver cell damage related to hepatitis B virus infection. She completely responded to immunosuppressive therapy and no clinical or biochemical relapse has been recognized to date.

The influence of azithromycin on the biofilm formation of Pseudomonas aeruginosa in vitro

The influence of azithromycin on biofilm formation by Pseudomonas aeruginosa, a cause of refractory chronic respiratory tract infection, was investigated. Alginic acid produced by a mucoid strain of P. aeruginosa was quantified by high-performance liquid chromatography from colonies growing on an agar medium. Polysaccharides in the biofilm formed on silicon chips by a nonmucoid strain were determined by a tryptophan reaction. The effect of azithromycin was examined at concentrations below the minimum inhibitory concentration (sub-MIC) for each strain. Azithromycin significantly inhibited the production of alginic acid from the mucoid strain at > or = 1/256 MIC, and the production of exopolysaccharides from the nonmucoid strain at > or = 1/16 MIC. The inhibition of biofilm formation by azithromycin was also observed by scanning electron microscopy. These findings suggest that azithromycin inhibits biofilm formation by P. aeruginosa at concentrations well below the MIC.

Establishment and characterization of two human bladder cancer cell lines

Two cell lines, SNK57 and NKB1, were established from human bladder cancer: SNK57 from a transitional cell carcinoma (TCC) in a 73-year-old female and NKB1 from a residual TCC following MEC (methotrexate, farmorubicin and cisplatin) chemotherapy in a 64-year-old female. Doubling time of SNK57 and NKB1 cells was 24 hours and 45 hours, respectively. The chromosome number of both cell lines was 100 percent anueploid with a mode of 43 chromosomes for SNK57 and 107 for NKK1. Both SNK57 and NKK1 induced tumors at the site of subcutaneous injection of nude mice. Histology of the tumors closely resembled that of the original ones from which they were derived. Although NKB1 was 4 times more resistant to doxorubicin (ADM) as compared to SNK57, overexpression of MDR1 gene product, P-glycoprotein was not evident in NKB1 as well as SNK57. These two new cell lines with different chemosensitivity to ADM may be a useful model for developing new chemotherapeutic strategies for human bladder cancer.

Vitamin A is involved in estrogen-induced cell proliferation but not in cytodifferentiation of the chicken oviduct

We examined vitamin A-deficient chicks to determine whether vitamin A affects the estrogen-induced development of the chick oviduct. When oviduct development was stimulated for 5 days with the synthetic estrogen, diethylstilbestrol, the wet weight of the oviduct in vitamin A-deficient chicks was only half that in control chicks. The DNA content in this tissue showed that the decreased oviduct weight in the vitamin A-deficient chicks was caused by the decreased proliferation of oviduct cells. However, the estrogen-induced expression of the ovalbumin gene was not affected by the vitamin A deficiency, suggesting that estrogen-induced cytodifferentiation is not affected by vitamin A. To clarify the vitamin A action on estrogen-induced development in the oviduct, transcripts of nuclear estrogen receptor (ER) and all-trans-retinoic acid (RAR alpha, beta and gamma) receptors, which exert the effects of estrogen and vitamin A, were measured. The ER, RAR alpha and RAR beta genes, but not that of RAR gamma, were expressed during oviduct development, indicating that estrogen and vitamin A may control the expression of target genes through their cognate receptors. Thus, we have shown that vitamin A is involved in estrogen-induced cell proliferation but not in cytodifferentiation of the chicken oviduct.

Role of catalase in retinal antioxidant defence system: its comparative study among rabbits, guinea pigs, and rats

The role of catalase in the retinal antioxidant defence system was examined in rabbits, guinea pigs, and rats with and without prolonged administration of a diet containing 0.4% 3-aminotriazole (3-AT), a catalase inhibitor. When weanling rabbits, guinea pigs, and rats we administered 3-AT for 8, 7, and 10 weeks, respectively, retinal catalase activity was reduced by approximately 50% in all these animals. In the retina of rabbits with 3-AT administration, a decrease in superoxide dismutase (SOD) activity and an increase in lipid peroxide (LPO) concentration occurred. while glutathione peroxidase (GSH-px) activity did not change. In the retina of guinea pigs with 3-AT administration, an increase in LPO concentration occurred, while SOD and GSH-px activities did not change. In the retina of rats with 3-AT administration, a decrease in GSH-px activity and an increase in LPO concentration occurred, while SOD activity did not change. An increase in serum LPO concentration was found in rats with 3-AT administration, while the concentration did not change in rabbits and guinea pigs. These results indicate that catalase plays an important role in the retinal antioxidant defence system, but that the way catalase contributes to the maintenance of the retinal antioxidant defence system is different among these animals. The present results suggest that under the prolonged inhibition of catalase, the retina of rats, but not of rabbits and guinea pigs, may suffer from the influence of systemic oxidative stress.

Intraoperative monitoring with pulse Doppler ultrasonography in transsphenoidal surgery: technique application

We describe an intraoperative use of pulse Doppler ultrasonography in transsphenoidal surgery to prevent mechanical vascular injury, particularly to the intracavernous portion of the internal carotid artery. This system is integrated by connection to a video processor. The use of Doppler sonography provided real-time measurement of arterial or venous flow velocity and source of flow by both real-time sonograms and sound frequencies. With the use of a microprobe, 1 mm in diameter, vessels located within 7 mm from the tip of the probe could be easily, rapidly, and noninvasively detected, without disturbing operative field. Furthermore, both the size and the distance of a vessel could be measured by turning the dial of Doppler signal gain from initially waxing to waning Doppler sounds, because the acoustic sounds were adjusted to the axial flow of each vessel in 0.1-mm increments. Our intraoperative monitoring enhanced operative safety with technical simplicity and reliability.

Explorations into development of a neurally regulated cardiac pacemaker

Although the artificial cardiac pacemaker has contributed to the management of patients with serious arrhythmias, its rate-responsive function is not sufficient to provide physiological regulation of heart rate (HR). To achieve truly physiological rate response in any given patient, we propose a framework to develop a pacemaker directly regulated by sympathetic nerve activity (SNA). In eight anesthetized rabbits, we quantified the dynamic transduction characteristics from SNA to HR as a transfer function. We then characterized the decoding rule as an impulse response, that is the transfer characteristics in the time domain. The transfer function was approximated by a first-order, low-pass filter with lag time (corner frequency: 0.024 +/- 0.013 Hz, lag time: 0.98 +/- 0.09 s). Predicted HR correlated well with measured HR (r = 0.80-0.98). The standard error of the prediction relative to mean HR was only 1.2 +/- 0.7%, indicating that the prediction was reasonably accurate. Direct decoding of SNA to predict instantaneous HR is possible through this analysis. This framework should enable development of a neurally regulated artificial pacemaker.

[Relation of life style, working posture and job category to body mass index change in young male workers]

The relationships of change in body mass index (BMI) on blood pressure, blood and serum tests, and of life style, working posture and job category on change in BMI after age twenty were investigated in a cross sectional study. A total of 771 male employees aged 21 or older (mean age 29.9 +/- 9.1 years) of a semiconductor factory were examined in December 1993. BMI change of each subject was expressed as percent increase after age twenty. BMI value at age twenty was calculated from self-reported body weight at twenty and height measured at the 1993 health examination. Prevalences of high blood pressure (systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg), high blood pressure including borderline hypertension (systolic blood pressure > or = 140 mmHg or diastolic blood pressure > or = 90 mmHg) and abnormal values of serum GOT, GPT, gamma-GPT, total cholesterol, triglyceride, HDL-cholesterol, uric acid and fasting blood glucose were greater in the high BMI change group than in the low BMI change group (Chi-square test, P < 0.1). With the exception of hypertension, these associations remained virtually unchanged after adjusting for age, alcoholic consumption, smoking habits and BMI at 20 years of age by multiple logistic regression analysis. After adjustment for age by the Mantel-Henszael method, increases in BMI after 20 years of age were positively associated with the following eight items (p < 0.05): shorter standing time, shorter walking time, lower meal skipping frequency, shorter meal time, longer sitting time during work, larger meal size, greater frequency of salad consumption, and sedentary work such as clerk and engineer. Greater rice consumption and higher frequency of instant foods consumption were weakly associated with the increase in BMI (0.05 < p < 0.1). Job categories such as clerk and engineer were significantly associated with longer sitting time and shorter meal time, resulting in greater BMI increase after 20 years of age. Multiple logistic regression analysis revealed that shorter standing time, shorter meal time, larger meal size, greater frequency of instant foods consumption and greater frequency of salad consumption were independently correlated with the increase in BMI (p < 0.05). Larger rice consumption was slightly correlated with increasing BMI (0.05 < p < 0.1). This study showed that job category, working posture and food intake patterns were strongly associated with BMI change after age 20 in young male workers. This study provides useful information for health care and health promotion programs in young male workers.

Somatostatin inhibits cholecystokinin-induced contraction of isolated gallbladder smooth muscle cells

A close relation between the hyperhormonism of somatostatin and gallstone disease suggested to us the hypothesis that somatostatin inhibits cholecystokinin (CCK)-induced gallbladder contraction on the level of target organs. To investigate this hypothesis, smooth muscle cells were isolated from human and canine gallbladders and the direct inhibitory effects of somatostatin on the CCK-induced cell contraction were examined in vitro. Somatostatin alone had no effect on the cell motility, while it significantly inhibited the cholecystokinin-octapeptide (10(-10) M)-induced cell contraction at the concentration of 10(-6) M (P < 0.01) in both human and canine gallbladders. The results demonstrate for the first time that somatostatin has a direct inhibitory action against cholecystokinin-induced gallbladder contraction. This may partly account for the high frequency of gallstone disease in patients with somatostatinoma.

[Intratumoral pharmacokinetics following intraarterial administration of MCNU in patients with malignant gliomas]

This clinical study was undertaken to examine intratumoral (i.t.) pharmacokinetics after intraarterial (i.a.) administration of MCNU (80mg/m2) in 5 patients with glioblastoma (GB) and 2 with anaplastic astrocytoma (AA). After resection or stereotactic biopsy of the cystic lesion, an Ommaya reservoir was placed into the tumor cavity in all patients. The distribution of MCNU in blood was compatible with a two-compartment model, and the half life of the alpha-phase and beta-phase was 4.1 minutes and 160.4 minutes, respectively. MCNU was detected in the i.t. fluid in 5 cases, 4 of GB and 1 of AA. The concentration of i.t. MCNU gradually increased during the 5 to 30 minutes after i.a. injection to a level about 20.0% of its blood concentration. However, no MCNU was detected in patients showing partial response (3 of GB and 1 of AA) or no change (1 of GB) after the i.a. infusion of MCNU during maintenance chemotherapy. These results suggests that MCNU may transfer into the tumor tissues. Further investigation is warranted.

[Effects of the nitric oxide donor SIN-1 on the membrane potential of mouse neuroblastoma-rat glioma hybrid cells]

The effect of the nitric oxide donor SIN-1 on the membrane potential of cultured mouse neuroblastoma-rat glioma hybrid NG108-15 cells was investigated using the whole cell patch method. It has been reported that neurite formation can be induced in NG108-15 cells by adding of dibutyryl cyclic AMP to the culture medium. Using this system we found that SIN-1 has a selective inhibitory effect on the membrane potential of the calcium current which is concentration-dependent in the 1 mu M-100 microM range. This effect was transient and reversible, the same as seen with the calcium channel blocker nilvadipine at concentrations of 10 microM to 10 microM. At higher concentrations, ranging from 500 microM to 1 mM, however, SIN-1 also caused prolonged inhibition of the membrane potential of the sodium current. However, this effect was also reversible. These findings suggest that SIN-1 has a reversible inhibitory action on the membrane potentials of neurons.

[The efficacy of granisetron as a prophylactic anti-emetic agent used in conjunction with MCNU and VP16 chemotherapeutic regimens in the management of a pediatric case of hypothalamic anaplastic astrocytoma]

The management of a 12-year-old boy with hypothalamic anaplastic astrocytoma is reported herein. The pediatric patient underwent a subtotal removal of his brain tumor, and subsequently received multimodal treatment comprising radiotherapy (30.6 Gy to the whole brain and 50.4 Gy to the local lesion) and immunochemotherapy with MCNU (80 mg/m2, day 1), VP 16 (50 mg/day, days 2 to 6), and interferon-beta (3 x 10(6) units/day, initiating on day 2 for 4 weeks). The immunochemotherapy was given as of 4 weeks after radiotherapy. The administration of anti-cancer drugs caused severe nausea and vomiting, the intra-carotid infusion of MCNU being particularly emetogenic. The multi-modal treatment was then discontinued for a few weeks. A partial response was obtained, and the patient subsequently received 3 courses of maintenance therapy at six-month intervals using the same protocol as for the initial immunochemotherapy. During maintenance therapy, granisetron (40 micrograms/kg) was given intravenously 30 minutes before and one day after the injection of MCNU. Owing to the anti-emetic management of this patient, there were no complications throughout the chemotherapy. The patient has now survived for more than 3 years with a good quality of life, showing a Karnofsky performance score of 90.

Primary malignant lymphoma of the central nervous system--report of four long-term survivors

Four of 47 patients treated between 1977 and 1993 for histologically confirmed primary malignant lymphoma of the central nervous system (non-Hodgkin's type of B-cell origin) achieved long-term survival for more than 5 years with a good quality of life. Three have remained disease-free for 9-12.5 years. The fourth achieved complete remission for more than 5 years before death from tumor recurrence. All four patients were treated with a standard therapeutic regimen, consisting of radiotherapy (50-60 Gy local and 30-40 Gy whole brain irradiation) followed by four to six courses of chemotherapy with cyclophosphamide, vincristine, adriamycin, and prednisolone at 4- to 8-week intervals. No further treatment was performed after remission had been obtained. No specific predictors for long-term survival including sex, age, tumor location, multiplicity of lesions, histology, or treatment modality was identified. All four patients showed an immediate tumor response to radiation. We recommend chemotherapy at increasing intervals as part of the post-therapeutic management of long-term, disease-free patients.

[Glial tumor cell proliferation and immune response in the brain]

The mechanism of glial tumor cell proliferation and the immune response to glioma cells in the brain were examined both in vitro and in vivo experimental systems, using mouse malignant glioma cell line, 203-glioma. A fura-2 fluorescence image showed marked rise in the intracellular calcium ion concentration in mechanically stimulated single cells. The increased calcium spread to adjacent cells, probably due to some stimulating factor released from cells. Dye microinjection revealed no gap junction between cells. Antagonists of voltage-dependent calcium channels did not act on the calcium response. These suggest that calcium signaling in the glioma cells may be mediated via a membrane receptor but not through a gap junction. Depletion of extracellular calcium ion and addition of intracellular calcium blocker demonstrated that calcium signaling in stimulated cells may be related to both an influx of extracellular calcium and a redistribution of intracellular calcium from internal stores, whereas calcium transmission to adjacent cells may involve calcium influx alone. The splenic cytotoxic T lymphocyte (CTL) activity in intracerebral tumor-bearing hosts increased with a peak 2 weeks after tumor cell inoculation, but rapidly decreased concurrently with increased intracranial pressure. The major histocompatibility complex, MHC, class I antigen expression on tumor cells grafted intracerebrally was found to enhance markedly, resulting in an increase in susceptibility to CTL. It was suggested that there may be a positive correlation between the cell surface MHC class I antigen expression and sensitivity to CTL in glioma cells.

[Detection and quantitation of cytomegalovirus DNA in plasma from patients with cytomegalovirus pneumonia]

Detection and semiquantitation of cytomegalovirus (CMV) DNA in plasma from 17 immunocompromised patients with CMV pneumonia diagnosed histopathologically, 15 CMV seropositive patients without CMV pneumonia and 24 CMV-seropositive healthy volunteers were evaluated, using the polymerase chain reaction (PCR). CMV DNA was detected in plasma from all of 17 patients with CMV pneumonia, from 1 of 15 patients without CMV disease, but from none of healthy volunteers. One patient without CMV disease exhibited positive CMV DNA by PCR 2 days before death. Plasma CMV DNA was negative at the time of admission in all patients, however, it became positive 1-28 days (mean, 14 days) before the onset of CMV pneumonia in 16 patients. The amount of viral DNA in plasma were 10(3) - 10(5) copies/ml (mean, 10 (4.0) copies/ml) when first detected by PCR. At the onset of CMV pneumonia, they were 10(4)-10(6)(mean, 10(5.3) copies/ml), and increased with disease progression and decreased with disease improvement because of treatment with antiviral agents. We succeeded in detection of CMV DNA in plasma before the development of CMV pneumonia, and showed the amount of viral DNA reflected the extent of active CMV pneumonia. Thus, PCR amplification of CMV DNA in plasma is a useful tool for early diagnosis and monitoring of immunocompromised patients.

Interleukin-2 receptor positive T and B cells in children with acute severe asthmatic attack

Subpopulations of interleukin-2 receptor (IL-2R)-positive CD4 and CD8 T cells and IL-2R+CD20 B cells in the peripheral blood lymphocytes as well as serum concentrations of soluble IL-2R (sIL2R) were measured in children aged 1-7 years who suffered acute severe asthmatic attack. Subpopulations of CD4+IL-2R+ cells, CD8+IL-2R+ cells and CD20+IL-2R+ cells in the peripheral blood lymphocytes at acute severe asthmatic attack phase were significantly higher than those at non-asthmatic attack phase (P < 0.02, P < 0.03 and P < 0.02, respectively). Subpopulations of CD20+IL-2R+ cells in the peripheral blood lymphocytes significantly decreased 5-10 days after acute severe asthmatic attack (at recovery phase, P < 0.02) and were significantly correlated with clinical severity of asthmatic attack (P < 0.05). These results indicated that activation of both T cells and B cells was important in the pathogenesis of acute asthmatic attack in young children.

[Microbiological and clinical study of fungemia between 1981 and 1992]

Fungi were isolated from 113 (14.2%) of 789 patients with positive blood cultures at Oita Medical University Hospital between 1981 and 1992. The rates of fungemia increased in recent years, 13.9% (1981-1985), 12.1% (1986-1988) and 16.9% (1989-1992). The isolated fungi were Candida parapsilosis (25.7%), C. albicans (24.8%), C. tropicalis (14.2%), Trichosporon beigelii (10.6%), C. glabrata (8.0%) and so on. The major fungi were T. beigelii and C. glabrata in patients with hematologic malignancies, whereas they were C. albicans and C. parapsilosis in patients with non-hematologic diseases and C. glabrata increased in both groups. Prophylactic or emiric administration of antifungal agents probably influenced the difference of the causative organisms in the two groups.

Measurements of thoron progeny concentration using a potential alpha-energy monitor in Japan

It is reported that thoron concentration in Japanese dwellings may be higher than in other dwellings. Therefore, in order to assess the risk for indoor thoron progeny, the portable potential alpha-energy monitor has been developed. The monitor detects alpha-particles from the 212Po collected on the filter using a piece of cellulose nitrate film. The detection efficiency of the alpha-particles has been estimated by Monte Carlo calculation. From the results of measurements, the mean indoor thoron progeny concentration in the dwellings was 1.5 Bq m-3 (ECTn), and ranged from 0.04 to 8.2 Bq m-3. The effects of three typical interior walls (soil-based plaster, concrete, and modern materials) on the thoron progeny supply were considered. The mean annual effective dose equivalent was 0.45 mSv.

[Role of nitric oxide produced by activated macrophages in their cytocidal activity against glial tumor cells]

This study investigated the role of activated macrophages (M phi) in nitric oxide (NO) production and the tumoricidal effect of NO on glioma cells. Induced peritoneal M phi were prepared 6 days following the injection of thioglycollate broth into C3H/He N (H-2 kappa) mice. M phi were activated in vitro recombinant human interferon-gamma (IFN gamma) and lipopolysaccharide (LPS) into the culture medium of the elicited M phi. Two kinds of murine malignant glioma cell lines, RSV-M glioma (H-2 kappa) and VM-glioma (H-2b) were used as targets. P815 mastocytoma cells (H-2d) were used as a control target, since they are insensitive to tumor necrosis factor-alpha, but susceptible to NO derived from M phi. L-arginine-depleted medium was used to inhibit NO-mediated cytocidal activity against tumor cells. Cytotoxicity was assayed at various effector-to-target ratios using an admixture of M phi and 1.5 x 10(4) 125I-labeled target cells 48 hours following co-culture. NO was measured in culture medium using Griess reagent, and the concentration of NO was expressed as mu mol/ml NaNO2. Peritoneal M phi induced only 10% and 15% lysis of RSV-M glioma and VM glioma cells, respective, and LPS augmented this killing activity of M phi to a maximum of 1.2 to 1.4 fold in a dose-dependent manner with dosages from 1 to 50 ng/ml. LPS demonstrated a synergistic action on M phi-mediated cytotoxicity 4 hours following pretreatment with IFN gamma. Alternatively, low doses of IFN gamma alone had no enhancing effect on M phi tumoricidal activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-CD40 monoclonal antibody induces the proliferation of murine B cells as a B-cell mitogen through a distinct pathway from receptors for antigens or lipopolysaccharide

To study the activation and differentiation of murine B cells, we prepared a hybridoma secreting monoclonal antibody, LB429, which can directly induce the proliferation of murine B cells in vitro. LB429 recognizes a B cell specific surface molecule of 45 kDa. It recognizes an epitope of murine CD40 produced as a soluble fusion protein with glutathione S-transferase. LB429 stains COS-7 transfectant with murine CD40 cDNA and mature B-cell lines but does not stain pre-B cell lines. Two color staining demonstrated that the epitope recognized with LB429 appears on the surface of B220+ cells of spleen and bone marrow. LB429 can induce a strong proliferation of murine B cells from spleen in the absence of initial triggering with anti-IgM antibody or with anti-IgM antibody + IL-4. LB429 induced the cell size enlargement and the cell cycle transition of resting B cells as well as lipopolysaccharide (LPS). LB429 and LPS stimulate B cells synergistically in vitro by accumulating 44.7% of cells in S/G2/M phases of cell cycle. However, stimulation of spleen B cells with LB429 resulted in the increase of sIgM high+ sIgD(high)+ B cells, in contrast LPS showed the proliferation of both sIgM(high)+ sIgD(high)+ B cells and sIgM(low)+ sIgD(high)+ B cells. These results suggested that LB429 and LPS cause the proliferation of B cells through different stimulatory pathways. This anti-mouse CD40 antibody (LB429) is a very useful reagent to study the activation and differentiation of B cells in vitro.

Hepatic nuclear factor 3- and hormone-regulated expression of the phosphoenolpyruvate carboxykinase and insulin-like growth factor-binding protein 1 genes

The rate of transcription of the hepatic phosphoenolpyruvate carboxykinase (PEPCK) and insulin-like growth factor-binding protein 1 (IGFBP-1) genes is stimulated by glucocorticoids and inhibited by insulin. In both cases, the effect of insulin is dominant, since it suppresses both basal and glucocorticoid-stimulated PEPCK or IGFBP-1 gene transcription. Analyses of both promoters by transfection of PEPCK or IGFBP-1-chloramphenicol acetyltransferase fusion genes into rat hepatoma cells has led to the identification of insulin response sequences (IRSs) in both genes. The core IRS, T(G/A)TTTTG, is the same in both genes, but the PEPCK promoter has a single copy of this element whereas the IGFBP-1 promoter has two copies arranged as an inverted palindrome. The IGFBP-1 IRS and PEPCK IRS both bind the alpha and beta forms of hepatic nuclear factor 3 (HNF-3), although the latter does so with a sixfold-lower relative affinity. Both the PEPCK and the IGFBP-1 IRSs also function as accessory factor binding sites required for the full induction of gene transcription by glucocorticoids. A combination of transient transfection and DNA binding studies suggests that HNF-3 is the accessory factor that supports glucocorticoid-induced gene transcription. In both genes, the HNF-3 binding site overlaps the IRS core motif(s). A model in which insulin is postulated to mediate its negative effect on glucocorticoid-induced PEPCK and IGFBP-1 gene transcription indirectly by inhibiting HNF-3 action is proposed.

Measurement of arterial tracer concentrations from cardiac PET images

OBJECTIVE

Cardiac PET imaging offers the potential capability for the noninvasive measurement of arterial input function. This capability is somewhat limited, however, because of partial volume and spillover effects. The purpose of this study was to validate arterial tracer concentration measurements using PET images by assigning a region of interest (ROI) to the left ventricle, left atrium (LA), and ascending aorta.

MATERIALS AND METHODS

We selected [11C]CO and [13N]ammonia as tracers, because the activity of [11C]CO is primarily in the blood pool and that of [13N]ammonia primarily in myocardial tissue. Six [11C]CO and 11 [13N]ammonia PET scans were obtained in 17 subjects. Arterial tracer concentrations determined by PET were compared with those measured by well counting of arterial blood sampling obtained at the midpoint of each image acquisition.

RESULTS

Arterial tracer concentrations as determined by LA-PET imaging correlated closely with those measured by blood sampling (r = 0.996, slope = 1.00 for [11C]CO; r = 0.841, slope = 0.974 for [13N]ammonia). Partial volume and spillover effects were minimized by assigning an ROI to the LA.

CONCLUSION

Arterial tracer concentrations can be measured noninvasively with cardiac PET.

[Pharmacokinetics of intratumoral interferon-gamma activity following subcutaneous administration of recombinant interferon-gamma in a patient with metastatic brain tumor derived from renal cancer]

Pharmacokinetic studies of intratumoral interferon (IFN)-gamma activity were performed 1 week and 1 month after subcutaneous (s.c.) administration of recombinant IFN-gamma (specific activity = 1 x 10(7) units/mg protein) to a patient with metastatic brain tumor in the right occipital lobe derived from primary renal cancer. The patient, a 54-year-old man, underwent total removal of the lesion on April 10, 1991, with placement of an indwelling Ommaya Reservoir in the tumor cavity. The histological diagnosis was clear-cell carcinoma. His postoperative course was uneventful. Due to detection of a new ring-like enhancing mass in the right temporal lobe on serial CT examination on May 27, radiotherapy was discontinued immediately after delivery of a total dose of 30 Gy. Recombinant IFN-gamma was then administered s.c. at a dose of 3 x 10(6) units/day for 6 weeks, and induced a partial response. During IFN-gamma therapy, IFN-gamma activity in intratumoral fluid was measured 0 min, 30 min, 90 min and 6 hours after s.c. injection of IFN-gamma. The level of IFN activity was determined by an enzyme-linked immunosorbent assay. Intra-tumoral IFN-gamma activity gradually increased, and showed the highest of measured values at 6 hours after administration, while serum IFN activity decreased rapidly with a half-life of 30 min. The patient was discharged on July 30, but died from complications of aspiration pneumonia on September 2, 1991.

Phosphofructokinase deficiency: recent advances in molecular biology

Phosphofructokinase (PFK) plays a major role in glycolysis. Deficiency of PFK-M is characterized by muscle weakness due to fuel crisis in exercising muscles. To elucidate the gene defect of PFK-deficient patients, we have cloned and determined the complete structure and transcription mechanism of human PFK-M mRNA and gene. Molecular defects were investigated in three unrelated Japanese family cases. The first case was characterized by a point mutation at the donor site of intron 15 of the PFK-M gene. Cryptic splicing resulted in a 25 amino acid truncation in the patient's PFK-M. The second case possessed a point mutation at the donor site of intron 19, resulting in the skipping of exon 19 and the truncation of 55 amino acids. In the third case, a missense mutation was identified in the coding region. The review of an updated mutation repertoire indicates the heterogeneity of the molecular mechanism of the disease.

Hepatic resection for hepatolithiasis and long-term results

BACKGROUND

Hepatic resection is an established procedure for treating patients with hepatolithiasis. The long-term results after hepatic resection for hepatolithiasis were appraised.

STUDY DESIGN

Of 127 patients with hepatolithiasis seen between 1973 and 1993, 43 patients underwent hepatic resection, and constituted the basis of this study.

RESULTS

There was one operative death (operative mortality rate of 2.3 percent) and three deaths as a result of concomitantly associated cholangiocellular carcinoma. Of the remaining 39 patients, the complete stone clearance rate was 67 percent with operation alone, but reached 87 percent when cholangioscopy was used. Operative morbidity was recorded in five patients (12 percent), but they recovered with conservative therapy. Stones recurred in 15 percent of patients after a mean follow-up period of four years (range of three to six years). Eleven (28 percent) of 39 patients died after hepatectomy as a result of related diseases after a mean follow-up of 6.2 years. These 11 patients had associated biliary drainage procedures. They experienced a higher mortality rate (p < 0.05) than patients who did not have biliary drainage.

CONCLUSIONS

We conclude that hepatic resection is adequate treatment for hepatolithiasis. The patients having additional biliary drainage procedures had a higher mortality, but one cannot reach conclusions about the negative effect of the drainage procedures because the drainage procedures were done in a selected and not a randomized manner.

Potential convergence of insulin and cAMP signal transduction systems at the phosphoenolpyruvate carboxykinase (PEPCK) gene promoter through CCAAT/enhancer binding protein (C/EBP)

Adenosine 3',5'-monophosphate (cAMP) stimulates phosphoenolpyruvate carboxykinase (PEPCK) gene transcription, whereas insulin has the opposite effect. In H4IIE cells, the effect of insulin is dominant since it represses cAMP-stimulated transcription. Discrete cis-acting elements in the PEPCK promoter that serve as an insulin response sequence (IRS) and cAMP response element (CRE) have been identified. Here we show that common proteins can bind both elements, since: (i) an almost identical pattern of protein binding is seen when oligonucleotides representing either the IRS or the CRE are used as the labeled probe in a gel retardation assay and (ii) the unlabeled wild-type, but not mutated, CRE oligonucleotide competes for protein binding to the labeled IRS probe, and vice versa. Six homo- and heterodimer complexes interact with these DNA elements; the complexes are composed of three individual protein species: (a) 42-kDa C/EBP alpha, (b) 30-kDa C/EBP alpha, and (c) an unidentified 20-kDa factor termed p20- CRE/IRS Binding Protein (p20-C/IBP). These proteins have a 30-fold greater affinity for the CRE at room temperature, a difference explained by the rapid dissociation rate of protein bound to the IRS, since the association rate of protein binding to both the IRS and CRE is the same. Protease digestion experiments suggest that the proteins bind to the CRE and IRS in different conformations. The IRS and CRE both function in the context of a heterologous promoter to mediate effects of insulin and cAMP, respectively, but, although the PEPCK IRS and CRE bind common proteins, the PEPCK CRE is not a functional IRS and the PEPCK IRS is not a functional CRE.

[Results of annual health examination for the aged provided by the law that are predictive of increased mortality risk]

Possible risk factors associated with mortality were studied in a community using data derived from annual mass health examinations for the aged mandated by law. A total of 1,804 adults (685 men and 1,119 women) aged 40 or older in A-town, located on Tsushima Island, Nagasaki Prefecture, Japan who had participated in annual health examinations at least once between 1984 and 1990, were followed for a mean period of 4.9 years. After adjustment for age using Cox proportional hazards models, in men liver dysfunction (aspartate aminotransferase > 40 U/l or alanine aminotransferase > 35 U/l), fasting blood glucose > or = 110 mg/dl and glucosuria, and in women serum creatinine > or = 1.2 mg/dl, fasting blood glucose > or = 110 mg/dl and proteinuria were found to be associated with a significantly increased risk of total mortality. In multivariate analysis using all independent variables that were significantly associated with mortality in age-adjusted bivariate analysis, in men liver dysfunction and hyperglycemia, and in women hypercreatininemia and hyperglycemia, were significant predictors of mortality. These independent variables remained significant or marginally significant predictors of total mortality even after excluding the effects of 3 pancreatic cancer cases with liver dysfunction or hyperglycemia or 12 deaths within the first year of follow-up, being associated with at least two-fold increased hazard rate ratios. From these results, it is recommended that persons with these risk factors be followed intensively and counseled by public health personnel to modify risk factors.

[Clinical studies on the time-difference combination therapy with netilmicin and minocycline in methicillin-resistant Staphylococcus aureus infections]

Twenty-eight patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were clinically studied for the effectiveness of the time-difference combination use of netilmicin (NTL) and minocycline (MINO). The patients were treated with NTL 100 mg and two hours later, with MINO 100 mg intravenously, twice daily, in the morning and evening for 14 days. Of 26 patients, MRSA was eradicated in 16 (61.5%), decreased in one, and unchanged in nine. Superinfections occurred with Serratia marcescens and Pseudomonas aeruginosa in two patients. The clinical efficacies were assessed in two patients with septicemia, 16 with pneumonia, and eight with chronic bronchitis. The obtained results were excellent in four patients, good in 15, fair in six, and poor in one patient. The rate of effectiveness was 73.1% (19/26). The overall clinical effectiveness judged by the committee was good in 19, fair in five, and poor in two patients. The efficacy rate was also 73.1% (19/26). Coagulase type II of MRSA was found in 23 patients, and coagulase type III in three patients, with overall clinical efficacy rates of 73.9% (17/23) and 66.7% (2/3), respectively. A side effect of eruption was observed in one patient, and its incidence was 3.6% (1/28). Abnormal laboratory test results were observed in 16 patients (57.1%), including abnormal liver function in 14 patients, abnormal kidney function in three, and increased eosinophils in three. Laboratory abnormalities occurred twelve of 16 bedridden patients, and this rate was higher than that in non bedridden patients. However, these abnormalities were all mild, transient, and immediately recovered after the treatment. In conclusion, the time-difference combination therapy using NTL and MINO was effective in the treatment of MRSA infections.

Analysis of intra- and intercellular calcium signaling in a mouse malignant glioma cell line

Intra- and intercellular calcium signaling in glioma cells was examined by mechanical stimulation of a monolayer cell line of methylcholanthrene-induced mouse ependymoblastoma, 203-glioma, with a fine round-tip glass needle. A fura-2 fluorescence image of the glioma revealed a four- to eightfold increase in the cytosolic calcium ion concentration in directly stimulated signal cells. The increased calcium spread to surrounding cells at a speed of 20 microns/sec for a distance of up to 200 microns. Calcium was transmitted between adjacent cells and even in cells up to 200 microns distant from the initially stimulated cell. Microinjection of Lucifer yellow dye showed no gap junctional communication between cells. Depletion of extracellular calcium ion inhibited both cytosolic calcium elevation and propagation to neighboring cells by mechanical stimulus. An intracellular calcium blocker, TMB-8, eliminated the cytosolic calcium mobilization in a mechanically stimulated cell, but had no effect on calcium diffusion to surrounding cells. Nifedipine and verapamil, antagonists of voltage-dependent calcium channels, did not act on the mechanically induced calcium response. This suggests that some stimulating factor may trigger transmission of calcium, which may be ejected directly from single stimulated cells and mediated via a membrane receptor but not through a gap junction. The calcium signaling in a mechanically stimulated cell may be related to both an influx and a redistribution of intracellular calcium from internal stores, while calcium propagation to neighboring cells may involve calcium influx alone.

Hyperresponsiveness of cardiac muscles to histamine in reserpine-treated guinea pigs

The hyperresponsiveness of cardiac tissue to histamine following treatment with reserpine was pharmacologically characterized. Guinea pig hearts were isolated 24 hours after intraperitoneal administration of 5 mg/kg reserpine. This treatment resulted in a complete depletion of tissue norepinephrine. Reserpine treatment potentiated the positive inotropic response of isolated perfused hearts to histamine at doses ranging from 0.3 to 3 micrograms (23 to 57% increase for reserpine-treated animals vs. 14 to 32% increase for control animals). Isolated left ventricular papillary muscle of reserpine-treated guinea pig hearts also showed hyperresponsiveness to histamine at concentrations of 0.1 microM or greater. The hyperresponsiveness of the papillary muscle contraction of the reserpine-treated animals to histamine was abolished in the presence of 1 microM cimetidine, but not attenuated in the presence of 1 microM diphenhydramine. This hyperresponsiveness was not modified by 1 microM bunazosin or 1 microM propranolol. The results suggest that H2-receptor mediated action plays a role in the hyperresponsiveness of cardiac muscles to histamine.

In-vitro effects of antimicrobial agents on Pseudomonas aeruginosa biofilm formation

The in-vitro effects of ten antimicrobial agents on the biofilm formation of Pseudomonas aeruginosa were investigated. The production of alginic acid by mucoid P. aeruginosa cells cultured in agar media with sub-MICs of antimicrobial agents was quantified by high-performance liquid chromatography. Alginic acid production was inhibited by 1/4 MIC of minocycline (P < 0.002) and tobramycin (P < 0.02), and by 1/256-1/1/64 MIC of macrolides (erythromycin, clarithromycin, roxithromycin, and rokitamycin) and clindamycin (P < 0.02), compared with drug-free controls. Piperacillin, ceftazidime, and ofloxacin did not inhibit alginic acid production. The production of exopolysaccharide by non-mucoid P. aeruginosa cells grown on silicone plates in sub-MICs of antimicrobial agents was determined by quantitative tryptophan assay. Exopolysaccharide production was inhibited by 1/16 MIC of macrolides and clindamycin, but not by other antimicrobial agents. Electron microscopy showed that biofilm formation by mucoid and non-mucoid type P. aeruginosa strains was inhibited by sub-MICs of erythromycin and correlated with the in-vitro production of alginic acid and exopolysaccharide. These results suggest that sub-MICs of macrolides and clindamycin suppress biofilm formation by P. aeruginosa and that intractable chronic respiratory tract infections due to P. aeruginosa might be prevented.

Impression of smoothness of a sound stream in relation to legato in musical performance

Physically continuous sounds do not always produce the subjective impression of legato. In the present study, the effect of temporal factors on the impression of smoothness of a sound stream was systematically investigated in relation to the dynamic characteristics of hearing. The results showed that decaying sounds, successively presented, were perceived as being marginally connected when the sounds physically overlapped, while steady-state sounds were perceived as being marginally connected when they were physically separated. It was also shown that judgments by the subjects agreed quite well with the effect intended by the pianist when the passage was given in different temporal interpretations.

[A case of malignant hemangiopericytoma arising from the mediastinum accompanied by hepatocellular carcinoma]

A 65-year-old man was admitted to Oita Medical University Hospital with complaints of right back pain, diplopia and vertigo. A tumor, 33 x 25 mm, was found on the right lateral chest wall on admission. Chest X-ray film and chest CT scan showed a tumor, 50 x 30 mm, in the right posterior mediastinum. The chest wall tumor was diagnosed as malignant hemangiopericytoma by biopsy, and the same diagnosis was made for the mediastinal lesion by aspiration cytology. Brain MRI showed a mass at the skull base, which was found to be a metastatic bone tumor from the mediastinal malignant hemangiopericytoma. Abdominal CT scan showed a massive tumor, 65 x 60 mm, in the right lobe of the liver. The liver tumor was diagnosed as hepatocellular carcinoma by biopsy. Combination chemotherapy, employing cyclophosphamide, vincristine, pirarubicin and dacarbazine (DYVADIC), in conjunction with radiation therapy, produced no response. The patient died 5 months after admission. Malignant hemangiopericytoma arising from the mediastinum is uncommon. Thus, the clinical features of our case, as well as those of previously reported cases in Japan, are discussed herein.

Direct contractile response of isolated gallbladder smooth muscle cells to cholecystokinin in patients with gallstones

To examine whether the contractile response of gallbladder smooth muscle cells to cholecystokinin is reduced in patients with gallstones, smooth muscle cells were isolated from the gallbladders of patients either with or without gallstones and their direct contractile responses to cholecystokinin-octapeptide (CCK-8) were examined at physiological concentrations. The basal cell lengths were similar in patients with cholesterol gallstones (43 +/- 1.2 micron (SEM)), in patients with black pigment stones (42 +/- 1.1), and in the gallstone-free group (42 +/- 1.3). The contractile responses to CCK-8 at physiological concentrations ranging from 10(-13) to 10(-11) M were significantly greater in the gallstone patients compared with those in the gallstone-free patients, while the responses were similar at 10(-10) and 10(-9) M. No difference in contractile response to CCK-8 was found between the patients with cholesterol gallstones and those with black pigment stones. The effective dose of 50% was 1.6 x 10(-13) M in cholesterol gallstone patients, 3.2 x 10(-14) M in black pigment stone patients, and 1.0 x 10(-12) M in gallstone-free patients. The current in vitro study showed that the contractile responses of isolated smooth muscle cells of the gallbladder to CCK-8 are not impaired in patients with gallstones.

[Effects of nilvadipine on membrane potential in cultured neuroblastoma-glioma hybrid NG108-15 cells]

Examination was made of the effects of nilvadipine on membrane potential in cultured neuroblastoma-glioma hybrid NG108-15 cells using the current clamp method. The NG108-15 cells line differentiates into neuronal cells following the addition of 1mM dibutyryl cAMP to the culture medium. This agent (nilvadipine) was found to inhibit both sodium and calcium current on the cell membranes of differentiated NG108-15 cells. The inhibitory effect was reversible in a dose-dependent manner between 10 and 100 microM. A substantial washing-time with normal saline, over 20 minutes, was needed for complete recovery from inhibition. The higher the concentration of nilvadipine, the more suppressive was the action on the membrane potential. A higher dose of nilvadipine, 100 microM, caused the disappearance of the peak membrane potential. This effect appeared irreversible, when cells were incubated in the presence of 100 microM nilvadipine for a longer time. Nilvadipine may thus exert inhibitory effect on the electrophysiological activity of neuronal cells, especially the calcium current of the membrane.

Intratumoral administration of tumor necrosis factor-alpha for malignant gliomas--two case reports

Two patients with histologically verified glioblastoma multiforme and anaplastic astrocytoma were treated with four courses of intratumoral administration of human natural tumor necrosis factor-alpha (TNF) (specific activity 2.0 x 10(6) Japan reference unit [JRU]/mg protein) at intervals of 3-5 months. Each consisted of eight to 10 serial injections, ranging from 5 x 10(3) to 10(4) JRU/injection, at intervals of 3-5 days. There was no simultaneous administration of steroids. Serial neurological examinations and neuroimaging studies with computed tomography and magnetic resonance imaging demonstrated partial responses ranging from 28 and 36 months in duration. No significant TNF-related brain edema, intracerebral bleeding, or neurotoxicity occurred. Local immunotherapy with TNF may be used safely to contribute to therapeutic efficacy.