[Gynecological management of climacteric syndrome with psychiatric disorders]

PURPOSE

To discriminate patients with severe mental disorders from those complaining of menopausal symptoms, psychological tests were performed on patients who visited the menopausal clinic. The effectiveness of hormone replacement therapy (HRT) in patients with slight mental disorders was also evaluated.

SUBJECTS AND METHODS

Patients with menopausal symptoms (n = 150, 41-59 yr. old) were interviewed by a psychiatrist (according to DSM-III-R) and classified as the climacteric syndrome group (C) and the mental disorder group (P). The patients were also evaluated by the Menopausal index (MI), Maudsley Personality Inventory (MPI) and Self-rating depression Scale (SDS). The patients with severe mental disorders were eliminated and the remaining patients with menopausal symptoms were treated with conjugated equine estrogen (0.625 mg/day) and medroxyprogesterone acetate (2.5mg/day) for 24 weeks.

RESULTS

1) Thirty six patients were diagnosed as P (24%) and seven of them were diagnosed as having major depression (4.7% of the all patients). 2) MPI-N (neurosis scale) in C was 16.2 +/- 10, and in P was 30.5 +/- 9.0, and SDS in C and P were 39.0 +/- 8.0, and 51.4 +/- 8.9, respectively. In both psychological test, P shows a significantly higher value than C (p < 0.01). 3) Ninety point six % of the patients responded. HRT was not effective in 63.2% of P, but when psychotropic drugs were combined, significant improvement (p < 0.05) was observed.

CONCLUSION

One fourth of the patients were suspected of having mental disorders in the menopausal clinic, and 5% of the patients needed the care of the psychiatrist. And the application of MPI and SDS was useful in helping the gynecologist to differentiate and classify the mental disorders to some extent. The applicability and effectiveness of HRT for patients with mild mental disorders were suggested.

Immunosuppression by anti-ICAM-1 and anti-LFA-1 monoclonal antibodies of free and vascularized skin allograft rejection

Immunosuppression by anti-adhesion molecule antibody of free or vascularized skin allograft rejection was investigated in rats. Lewis (LEW, RT11) rats were used as donors and Fisher (F344, RT11v1) rats as the recipients. When F344 rats were treated intraperitoneally (i.p.) with anti-intercellular adhesion molecule-1 (ICAM-1) mAb (1A29) (3 mg/kg/day) and anti-leukocyte function-associated antigen-1 (LFA-1) mAb (WT.1) (3 mg/kg/day) one day prior to grafting and daily after grafting for nine days, free skin graft survival was prolonged only slightly compared with that in control rats which were injected i.p. with a daily dose of 6 mg/kg of anti-TNP mAbs (H1-6-2) one day prior to grafting and daily after grafting for nine days. (Mean survival time [MST] of the free skin graft was 11.2 +/- 0.6 days in the control group and 13.4 +/- 0.3 days in the 1A29 + WT-1 treated group [p < 0.01], respectively.) On the other hand, the vascularized graft survival was prolonged significantly in anti-ICAM-1/LFA-1 mAbs-treated F344 rats as compared with that in control rats. (The mean vascularized graft survival time was 14.2 +/- 0.7 days in the control group and 21.5 +/- 1.9 days in 1A29 + WT-1 treated group [p < 0.002]). Our results suggest that interaction with ICAM-1 and LFA-1 is more important in the rejection of vascularized skin allografts than that of free skin allografts.

Visualization of protein kinase activities in single cells by antibodies against phosphorylated vimentin and GFAP

Vimentin and glial fibrillary acidic protein (GFAP) are intermediate filament proteins expressed in the cytoplasm of various types of cells. The head domains of these proteins are phosphorylated by various protein kinases. Site- and phosphorylation-specific antibodies which recognize a phosphorylated serine/threonine residue in the head domains and its flanking sequence provide a useful tool to monitor and visualize protein kinase activities in single cells.

A CBP integrator complex mediates transcriptional activation and AP-1 inhibition by nuclear receptors

Nuclear receptors regulate gene expression by direct activation of target genes and inhibition of AP-1. Here we report that, unexpectedly, activation by nuclear receptors requires the actions of CREB-binding protein (CBP) and that inhibition of AP-1 activity is the apparent result of competition for limiting amounts of CBP/p300 in cells. Utilizing distinct domains, CBP directly interacts with the ligand-binding domain of multiple nuclear receptors and with the p160 nuclear receptor coactivators, which upon cloning have proven to be variants of the SRC-1 protein. Because CBP represents a common factor, required in addition to distinct coactivators for function of nuclear receptors, CREB, and AP-1, we suggest that CBP/p300 serves as an integrator of multiple signal transduction pathways within the nucleus.

The possibility of active form of vitamins A and D as suppressors on adipocyte development via ligand-dependent transcriptional regulators

The study aimed to systematically examine the effects of fat soluble vitamins and their analogs on terminal differentiation of adipocytes on the cellular and molecular aspects. It is well known that fat soluble vitamins especially vitamins A and D inhibit the differentiation of adipocytes in cultured cells. Furthermore, it has been revealed that the low level of dietary fat soluble vitamins, especially vitamin A and carotenoid actively stimulate the development of adipose tissue, namely bovine marbling in vivo. We have shown that the expression of retinoic acid receptor (RAR) alpha and gamma, retinoid X receptor (RXR) alpha and beta, and vitamin D receptor (VDR) mRNA were abundant in rat adipose tissue and 3T3-L1 cells. The autoregulated amplification and reduction of RAR, RXR and VDR mRNA by their own ligands, were observed in 3T3-L1 cells. Finally, we proposed the model of vitamins A and D as suppressors on adipocyte development through retinoid/thyroid/vitamin D/fatty acid-activated/peroxisomal proliferator-activated receptor's subfamily.

Plasma levels of interleukin-1 receptor antagonist (IL-1ra) and severity of illness in patients with burns

The present study was conducted to determine whether a plasma interleukin-1 receptor antagonist (IL-1ra) would reflect the severity of burn injury and to examine the relation between IL-1ra and the cytokines. We studied 24 burn patients in whom the total burn surface area (TBSA) accounted for at least 20% of the body surface, and in whom serial blood samples could be obtained beginning immediately after the burn injury. Plasma levels of IL-1ra were determined by enzyme-linked immunosorbent assay (ELISA). Plasma levels of tumor necrosis factor-alpha (TNF-alpha), IL-6, and IL-8 were also determined by ELISA. Endotoxin was measured by an endotoxin-specific synthetic substrate method. There was a significant correlation between the plasma levels of IL-1ra and TBSA during the first week following burn injury. The IL-1ra level was the highest immediately after the burn injury. The level decreased markedly thereafter, and again rose when infection occurred. The IL-1ra level was extraordinarily elevated in patients who developed concomitant sepsis, septic shock or the septic multiple organ dysfunction syndrome. The IL-1ra level on admission and the maximum IL-1ra level during the observation period were significantly higher in the patients who eventually died than in the survivors. There was a significant correlation between the level of IL-1ra and that of TNF-alpha, IL-6 or IL-8 during the observation period. No correlation was found between IL-1ra and endotoxin. The plasma IL-1ra level was closely correlated with the severity of inflammation and the clinical status of the burn patients, regardless of the infection. Results suggest that IL-1ra can serve as an index of the systemic inflammatory response syndrome (SIRS).

Ligand-independent repression by the thyroid hormone receptor mediated by a nuclear receptor co-repressor

Thyroid-hormone and retinoic-acid receptors exert their regulatory functions by acting as both activators and repressors of gene expression. A nuclear receptor co-repressor (N-CoR) of relative molecular mass 270K has been identified which mediates ligand-independent inhibition of gene transcription by these receptors, suggesting that the molecular mechanisms of repression by thyroid-hormone and retinoic-acid receptors are analogous to the co-repressor-dependent transcriptional inhibitory mechanisms of yeast and Drosophila.

Tractional elevation of Henle's fiber layer in idiopathic macular holes

PURPOSE

We sought to clarify the morphologic features of macular hole development.

METHODS

Using scanning laser ophthalmoscopy, we examined 47 eyes with macular holes before and after vitrectomy. Cases included three eyes with stage 1B disease (foveal detachment), 14 with stage 2 (break at the fovea), 21 with stage 3 (full-thickness macular hole), and nine with stage 4 (detached operculum), according to Gass's classification. Ten eyes with central serous chorioretinopathy served as controls.

RESULTS

Radiating striae of Henle's fibers were seen around the elevated rim of the macular cyst or hole when the intraretinal structures were illuminated by helium-neon laser. Granularity was observed on the macular hole floor. A granular reflex corresponding to the macular break or hole, but no radiating striae were seen by argon blue laser. In 40 eyes in which macular holes were successfully closed by vitrectomy, radiating striae of Henle's fiber layer disappeared, and the normal foveal depression was restored. The ten eyes with central serous chorioretinopathy had a normal foveolar depression and no detectable radiating striae of Henle's fiber layer, despite full-thickness retinal detachment in the macular area.

CONCLUSIONS

Tractional elevation of Henle's fiber layer with intraretinal foveolar cyst formation is the initial feature of macular hole development. A macular hole is formed when the anterior cyst wall containing Henle's fiber layer is operculated. Remnants of the photoreceptor cell layer remain on the hole floor in the early stage of macular hole development and subsequently degenerate.

Infrared angiography of the anterior ocular segment

We performed angiography with indocyanine green (ICG) and fluorescein using a scanning laser ophthalmoscope (SLO) in the anterior segments of seven normal and 35 diseased eyes. ICG angiography revealed the radical stromal vessels and minor arterial circle in brown irides, which were not detected by fluorescein angiography. High penetration of infrared fluorescence through the pigmented tissue and absence of extravasation of ICG facilitated demonstration of the fine structure of iris rubeosis and its origins from stromal vessels. In 11 diabetic eyes, the iris rubeosis showed three basic patterns of location: along the pupillary margin; originating from the iris root; and arising from stromal radial vessels near the collarette. ICG gonioangiography with SLO showed fine structure of angle rubeosis because of its high resolution and greater depth in focus. Rubeotic vessels in the chamber angle were perfused by neovascular trunks which arose from the iris root in all 12 rubeotic eyes. Rubeosis in the iris and the angle consistently showed no extravasation of the ICG dye, while fluorescein quickly leaked out. ICG angiography with SLO in the anterior ocular segment proved to be a useful means to study the structure and the hemodynamics of normal and newly formed vessels.

Anterior cranial base reconstruction using a hydroxyapatite-tricalciumphosphate composite (Ceratite) as a bone substitute

The craniofacial approach to cranial base tumors has widened the operability of tumors with intracranial invasion. However, the resulting skull base defect must be reconstructed adequately to prevent postoperative morbidity and mortality. We use hydroxyapatite-tricalciumphosphate ceramic (Ceratite) as a bone substitute material to reconstruct the skull base defect in combination with the pericranial flap, ensuring separation between the sinonasal cavity and epidural cavity. Although the nasal surface of the Ceratite block is left exposed directly to the sinonasal cavity, it was shown to be epithelialized within 6 months postoperatively. Our method is less invasive than any other conventional method and may offer more chance of curative resection of tumors with anterior skull base invasion.

Cloning and sequencing of the gene encoding the mouse vitamin D receptor

The mouse vitamin D receptor (VDR)-encoding cDNA was cloned and the coding regions were sequenced. Comparison of the amino-acid sequence to that of humans and rats revealed high homology in the DNA- and ligand-binding domains. Divergence appeared in the internal region between the two domains.

Free intrathoracic jejunal transfer for thoracic oesophageal reconstruction: a case report

We report the case of a 67-year-old man who had resection of a thoracic oesophageal cancer and intrathoracic reconstruction of the oesophagus with a free jejunal transfer. The jejunal vessels were anastomosed to an internal thoracic artery and vein. The technical and functional results were good.

Composite gastric seromuscular and omental pedicle flap for urethral and scrotal reconstruction after Fournier's gangrene

A new composite gastric seromuscular and omental pedicle flap is described that can provide immediate airtight or watertight closure in the repair of complex defects involving the urethra. This flap was used to repair defects of the urethra, scrotum, and abdominal wall in a patient with Fournier's gangrene. The seromuscular patch was sutured to the urethral defect, and the omentum was applied over the defects of the scrotum and abdominal wall. This new procedure made it possible to close the skin primarily without leakage or infection. The patient had an uncomplicated recovery. Postoperative urethrography demonstrated no leakage or stenosis.

A new composite gastric seromuscular and omental pedicle flap

OBJECTIVE

The authors performed a study to see if gastric seromuscular patch elevation is anatomically feasible and to estimate the maximum size of the patch relative to its blood supply.

SUMMARY BACKGROUND DATA

A flap composed of greater omentum and a full-thickness segment of the greater curvature of the stomach, based on the right gastroepiploic artery, was first described in 1977. Elevation of the greater omentum along with a seromuscular patch of stomach has not been reported previously.

METHODS

Angiography was performed via the right gastroepiploic artery in a stomach obtained from ten patients who underwent gastrectomy, then india ink was injected. The stomach was then fixed in 10% formalin, and histochemical examination was performed to determine if seromuscular patch elevation was possible.

RESULT

Results of the angiography and injection experiment of india ink indicated that the territory of a single gastric ramus was approximately 5 cm x 5 cm in both anterior and posterior walls of the stomach. Histology revealed that the gastric rami lay between the muscular layer and the mucosa.

CONCLUSION

The authors believed that a composite gastric seromuscular patch and omental pedicle flap would be clinically applicable. The authors also believed that the maximum size of the patch was 10 cm x 10 cm. They used this flap to successfully treat three patients with chronic soft-tissue defects--two bronchopleural fistulae and a radiation ulcer.

The prevention of adipose differentiation of 3T3-L1 cells caused by retinoic acid is elicited through retinoic acid receptor alpha

Retinoids, especially all-trans retinoic acid (RA), have been shown to inhibit the differentiation of preadipose cells. It is important to human health, especially to obesity, that the regulatory system for the differentiation of adipocytes is well defined. Previously, we have shown that retinoic acid receptor (RAR) gamma 2 gene expression is up-regulated by RA in 3T3-L1 preadipose cells. In this study, the RAR system was dissected and the RA-regulated function in 3T3-L1 cells was assigned to one given receptor. We used three synthetic retinoids; (1) Ro 41-5253, a selective RAR alpha antagonist, (2) Ch 55, an RAR alpha, beta and gamma agonist, and (3) Am 80, an RAR alpha and beta agonist, which has less affinity to RAR gamma. Ro 41-5253 reverted RA-induced inhibition of the differentiation of 3T3-L1 cells. However, there was no significant reversion in RA-induced RAR gamma mRNA level by treatment with Ro 41-5253. In the case of RAR agonists, both Am 80 and Ch 55 strongly inhibited the differentiation of 3T3-L1 cells. However, Am 80 weakly increased RAR gamma mRNA content less than did Ch 55. These findings suggest, that RAR alpha is involved in the prevention of adipose differentiation by RA in 3T3-L1 cells. Moreover, there seems no causal relationship between the prevention of adipose differentiation by RA and the up-regulation of RAR gamma 2 gene expression by RA in 3T3-L1 cells. We have shown the functional heterogeneity of RA action through different RARs in 3T3-L1 cells.

The phenol red thread tear test: a cross-cultural study

PURPOSE

To examine the results of the phenol red thread tear test in a cross-cultural comparison.

METHODS

Two groups of 500 controlled normal subjects who do not wear contact lenses from the United States and Japan were investigated.

RESULTS

The mean wet length of the thread for the United States was 23.9 mm (SD 9.5 mm). The mean for Japan was 18.8 mm (SD 8.6 mm). There was a significant difference between the two countries (P < 0.05). Males subjects had significantly longer wet lengths than females for both countries (P < 0.05). There was a moderate correlation between right and left eye results for both countries.

CONCLUSIONS

The phenol red thread tear test was found to be easy to administer. Results were in line with current knowledge and theories of the lacrimal system. Results also indicated that this test may disclose subtle differences not previously found with other tear tests.

[Clinical results of radical surgery for prostate cancer]

We reported the clinical results of radical surgeries for 44 patients with prostate cancer performed between November 1984 and December 1992. The patients were aged from 57 to 79-year-old (mean 67.2) and classified as clinical stage A2 (6 cases), B1 (7), B2 (12), C (16) and D1 (3) respectively. Radical prostatectomy was performed in 42 cases and radical cystoprostatectomy with urinary diversion in 2 patients, and thirty-nine of 44 cases underwent endocrine or chemoendocrine therapies prior to the surgeries. In all patients with stage A2-B1, the operations were curative, on the other hand, more than 80% of clinical stage B2 patients had pT3 tumors and 33.3% of them had lymph node involvements. With regard to stage C patients, the incidence of lymph node metastasis and positive margin was more frequent. Postoperative adjuvant therapies were added to the patients with pT3,4 tumors and nodal involvements. Patients without residual tumors (n = 20) remained disease-free for 8-89 months (mean 32.8). Of 24 patients who had incomplete resection of tumors, 2 died of other diseases, other 2 were alive recurrent and 20 were alive free from disease for 3-99 months (mean 33.8). The surgical indication for low-stage (A2-B2) prostate cancer has been widely accepted, however that for high-stage cancer (C,D1) has remained controversial. It was our belief that radical surgeries for high-stage cancer could become a potentially curative therapeutic modality in combination with pre- and post-operative adjuvant therapies.

Effect of pravastatin on human sleep

To evaluate the effect of pravastatin, an HMG-CoA reductase inhibitor, on sleep, the drug or a placebo was administered to 5 healthy adults for 16 days by the double-blind method. Pravastatin caused no changes in sleep parameters. This indicates that it had no effect on human sleep for the following possible reasons: Being hydrophilic, the drug does not readily cross the blood-brain barrier. It does not inhibit prostaglandin D2 synthase, a possible sleep-inducing substance. It was thought that a decrease in the total cholesterol level in the blood has no effect on sleep in healthy adults.

Retinoic acid receptor gamma 2 gene expression is up-regulated by retinoic acid in 3T3-L1 preadipocytes

Retinoids, especially all-trans retinoic acid (RA), have been shown to inhibit the differentiation of preadipose cells. In the present study, the expression of retinoic acid receptors (RAR alpha, beta and gamma) and retinoid X receptors (RXR alpha, beta and gamma) was examined by Northern blot analysis in rat adipose tissue and mouse 3T3-L1 adipose cells. The adipose tissue and/or 3T3-L1 cells expressed mRNAs for a number of nuclear retinoid receptors, including RAR alpha, beta and gamma, and RXR alpha, beta and gamma. RAR alpha, RAR gamma, RXR alpha and RXR beta mRNAs were abundant in adipose tissue and 3T3-L1 cells. RXR gamma mRNA was detected in adipose tissue but not in 3T3-L1 cells. Treatment of 3T3-L1 cells with 1 microM RA led to a 4-5-fold increase in the RAR gamma mRNA level, but only a trace amount of RAR beta mRNA was detected. RAR gamma mRNA expression was rapidly (within 2 h) induced by physiological concentrations of RA in a dose-dependent manner. The response of RAR gamma mRNA expression to RA was reversible; rapid disappearance of RAR gamma mRNA occurred on RA removal. In addition, the induction of RAR gamma expression did not require de novo protein synthesis, but was completely abolished by an inhibitor of RNA synthesis. Using RAR gamma 1 and gamma 2 isoform-specific probes, the patterns of RAR gamma 1 and gamma 2 mRNA expression in 3T3-L1 cells in the presence and absence of RA were examined. RAR gamma 1 mRNA was detected in 3T3-L1 cells but was not affected by RA treatment; however, RAR gamma 2 mRNA was strongly induced by RA.

Combination gastric seromuscular patch and omental pedicle flap for bronchial fistula

We report the successful closure of a recurrent bronchial fistula using a combination gastric seromuscular patch and omental pedicle flap. This new method provided an immediate airtight closure of the bronchial fistula. This technique appears superior to closure by omentum alone.

Vitamin D receptor gene expression is up-regulated by 1, 25-dihydroxyvitamin D3 in 3T3-L1 preadipocytes

Vitamin D3, especially 1, 25-dihydroxyvitamin D3 (1, 25 (OH)2 D3), has been shown to inhibit the differentiation of preadipose cells. In the present study, the expression of vitamin D receptor (VDR) was examined by Northern blot analysis in rat adipose tissue and mouse 3T3-L1 adipose cells. The adipose tissue and 3T3-L1 cells expressed mRNA for VDR. Treatment of 3T3-L1 cells with 1 microM 1, 25 (OH)2 D3 led to a 4-5 fold increase in the VDR mRNA level. VDR mRNA expression was rapidly (within 4 hr) induced by physiological concentrations of 1,25 (OH)2 D3 in a dose-dependent manner. The induction of VDR expression did not require de novo protein synthesis but was completely abolished by an inhibitor of RNA synthesis.

Intrauterine growth retardation and fetal losses are caused by epidermal growth factor deficiency in mice

The plasma concentration of epidermal growth factor (EGF) in female mice increases during pregnancy. Sialoadenectomy (surgical removal of the submandibular glands) on day 13 of gestation attenuates the rise in plasma EGF and significantly reduces the percent of live pups on day 19 of pregnancy to 80% compared with 95% for the control animals. EGF replacement therapy given to the sialoadenectomized mice successfully prevented this reduction in the percent of live pups on day 19. The average weight of the live fetuses from sialoadenectomized mothers was significantly lower than those from the control mothers, i.e., 1.00 +/- 0.14 (SD) g vs. 1.13 +/- 0.07 g. The administration of anti-EGF antiserum to the sialoadenectomized mice further affected fetal viability; only 70% of the pups were alive on day 19, with a mean weight of 0.93 +/- 0.15 g. The mean weight of the fetal body and that of the liver caused by sialoadenectomy were similarly reduced, but the brain was not affected, which shows that the growth retardation was asymmetrical. These findings suggest that EGF plays a physiological role in fetal growth and that EGF deficiency may be a cause of asymmetrical intrauterine growth retardation, which might be due to uteroplacental dysfunction.