Membrane topology of NADPH-cytochrome P450 reductase on the endoplasmic reticulum

Topology of the membrane-anchoring segment of mouse NADPH-cytochrome P450 reductase in the endoplasmic reticulum membrane was elucidated. An N-glycosylation site was generated in the amino-terminal hydrophilic sequence of the reductase, and the mutated protein was expressed in a cell-free system in the presence of microsomal vesicles. The in vitro synthesized reductase protein was integrated into the microsomal membrane and N-glycosylated depending on the presence of signal recognition particles. We conclude that the amino-terminal membrane-anchoring segment of the reductase is a type I signal-anchor sequence which shows amino-terminus-lumen and carboxy-terminus-cytoplasm topology.

CBF change with aging in moyamoya disease

The change of cerebral blood flow (CBF) with aging was analyzed in 9 cases of moyamoya disease whose age ranged from 16 years old to 58 years old. CBF decreased more prominently in the various lobes with aging than control subjects and the decrement was more rapid in the affected side than in the non-affected side. CBF was thought to decrease with the hemorrhagic attack and the accompanying neurological deterioration. However the gradually-deteriorating brain damages caused by the chronic hypoperfusion also might be engaged in this CBF decrement.

[Neurinoma arising from the first branch of the trigeminal nerve: a case report]

A case of a neurinoma arising from the first branch of the trigeminal nerve in a 40-year-old female is reported. The patient was admitted with the chief complaint of loss of Lt. visual acuity and mild hypoesthesia in the area of the first branch of the trigeminal nerve. A CT scan and MRI revealed a tumor extending through the superior orbital fissure into the orbita. Subtotal resection of the tumor was performed by a fronto-orbito-zigomatic approach and a histological diagnosis of neurinoma was made. Although the hypoesthesia remained, the visual acuity was markedly improved postoperatively. A neurinoma arising from the first branch of the trigeminal nerve is very rare. To our knowledge, including our case, only five cases which were described for clinical and diagnostic features and surgical management have been reported. There were three males and two females, and the age ranged from 1 to 57 years. Neurologically, all cases presented hypoesthesia in the area of the first branch of the trigeminal nerve and exophthalmus on admission. Visual disturbance was found in three cases. Radiologically, the enlargement of the superior orbital fissure was revealed in two cases. Angiography performed in three cases demonstrated the avascular mass. Three patients received CT scan and only the present case used MR imaging. Surgical resection was performed in all cases through various approaches. The fronto-orbito-zygomatic approach which was chosen in our case was useful for obtaining a sufficient operative view. As in our case, excellent outcome was achieved in three other cases due to successful tumor resection.

HLA-DRB1 alleles contribute to determining the prognosis of Japanese diabetes mellitus positive for antibodies to glutamate decarboxylase

Diabetes mellitus positive for antibodies to glutamate decarboxylase is heterogeneous as far as the degree of impairment of endogenous insulin release, though antibodies to glutamate decarboxylase are the most useful marker for future insulin deficiency. To investigate what determines the prognosis of diabetes mellitus positive for antibodies to glutamate decarboxylase, we measured HLA-DRB1 alleles in three groups: 77 cases of insulin-dependent diabetes mellitus (IDDM), 44 of non-insulin-dependent diabetes mellitus (NIDDM) with secondary failure of oral hypoglycemic therapy, and 22 of NIDDM well controlled by diet and/or sulfonylurea agents. The proportion of susceptible and resistant alleles to IDDM determined the degree of insulin deficiency, and comparison of IDDM to NIDDM well controlled by diet and/or sulfonylurea agents revealed significant differences in DRB1*0405 (P < 0.05; RR = 2.82 and RR = 0.89, respectively) and DRB1*1502 (P < 0.001; RR = 0.02 and RR = 2.19, respectively). This study revealed that HLA-DRB1 alleles contribute to determining the prognosis of Japanese diabetes mellitus positive for antibodies to glutamate decarboxylase.

Effect of glycerol on blood flow distribution in tumoral and peritumoral brain tissue

The effect of glycerol on blood flow in tumoral and peritumoral tissue was measured in 32 patients with brain tumor, 17 gliomas and 15 meningiomas. Blood flow before and after the administration of glycerol was measured by stable xenon-enhanced computed tomography. The tumor part of glioma was significantly hypoperfused. In contrast, the tumor part of meningioma was significantly hyperperfused. Peritumoral edema of both glioma and meningioma was hypoperfused. After the administration of glycerol, blood flow increased in all regions except for the tumor part of glioma. Vascular responses to glycerol may be different in these two tumor types. The steal phenomena of blood flow might occur in cases of glioma.

Choroidal osteoma in an infant

PURPOSE

To report an 8-month-old infant with choroidal osteoma.

METHOD

Case report.

RESULTS

The patient, who had bilateral yellow stippling at the posterior pole, was followed up for 8 years. Both fundi developed creamy, irregular scalloped lesions. Computed tomography showed a bony plate at the posterior pole bilaterally.

CONCLUSION

We believe that this is the youngest patient reported to have choroidal osteoma.

Abnormal cerebral blood flow associated with antiphospholipid antibody syndrome--four case reports

Patients with antiphospholipid antibody syndrome manifesting as neurological symptoms (one patient with twice repeated cerebral ischemic symptoms in the left parietal and frontal lobes, and the other patient with cerebral infarction of the right temporal lobe) and non-neurological symptoms (one patient with occlusion of the superior mesenteric artery and the other patient with thrombophlebitis) underwent cerebral blood flow (CBF) studies using xenon-enhanced computed tomography. The patients with neurological symptoms had decreased CBF at the affected sites. The patients with non-neurological symptoms had decreased CBF in the left parietal and temporal lobes and/or corona radiata. Subtle preclinical thrombosis may cause chronic cerebral hypoperfusion in patients with antiphospholipid antibody syndrome.

Effect of cisternal papaverine on cerebral blood flow in patients with subarachnoid hemorrhage--three case reports

Three patients presenting with subarachnoid hemorrhage due to aneurysmal rupture underwent cerebral blood flow (CBF) measurements before and after cisternal injection of papaverine hydrochloride. One patient showed prominent increases in CBF in the frontal lobe and basal ganglia after injection of papaverine, but paradoxical decreases in the parietal lobe and corona radiata. The other two patients had poor CBF response. Dense clotting in the basal cisterns may have prevented diffusion of the agent so that only the proximal trunks of the internal carotid, anterior cerebral, and middle cerebral arteries were dilated in the former case. The dilation of proximal trunks of cerebral arteries might steal blood flow from the parietal lobe and corona radiata, where the intraparenchymal arteries were maximally dilated and cerebrovascular reserve capacity was poor.

MYCL genotypes and loss of heterozygosity in non-small-cell lung cancer

Some studies have suggested that the S allele of the MYCL oncogene, which results from an intragenic EcoRI restriction fragment length polymorphism (RFLP), may be associated with cancer susceptibility. In addition, this allele has also been linked to metastases and adverse survival in certain cancers, although studies of lung cancer patients from different populations have yielded controversial results. We studied 108 cases of surgical resected non-small-cell lung cancer (NSCLC) and found no evidence that MYCL genotypes were associated with tumour progression or a worse prognosis. However, the presence of loss of heterozygosity (LOH) at this chromosome 1p32 locus correlated significantly with regional lymph node involvement, as well as advanced TNM stage. These data indicate the existence of a chromosome 1p candidate tumour-suppressor gene(s), possibly in linkage disequilibrium with the EcoRI RFLP in specific populations, which appears to play a role in determining tumour progression in NSCLC. Refined mapping of the critical region of loss should help attempts to identify and clone the candidate gene.

[Relationship between the stage of diabetic nephropathy and serum lipoprotein (a) concentrations--influence of hypoproteinemia]

Lipoprotein (a) [Lp(a)] has been reported to be an independent risk factor for coronary heart disease. Elevated levels of Lp(a) in diabetic subjects have also been reported, especially in subjects with nephropathy. However, the mechanism and the clinical implication of Lp(a) elevation in diabetics remain obscure. In the present study, to verify the change in Lp(a) concentration with the progression of nephropathy, serum Lp(a) levels were measured in 546 NIDDM patients, 33 hemodialysis NIDDM patients, and 145 non-diabetic controls.

RESULTS

1) The serum Lp(a) levels in diabetics were significantly higher than those in the non-diabetic controls. 2) Serum Lp(a) concentrations in microalbuminuric subjects were significantly higher than those in normoalbuminuric subjects, and were further increased in macroalbuminuric subjects. 3) In macroalbuminuric subjects, serum Lp(a) concentrations were inversely correlated with serum protein concentrations, but not with serum creatinine. 4) Once hemodialysis was started, the decrement of both serum Lp (a) and LDL-C concentrations were associated with the increment of serum protein concentrations. These data indicate that elevation of serum Lp (a) concentration in overt nephropathy could be, at least in part, due to hypoproteinemia.

TIMP1 and adverse prognosis in non-small cell lung cancer

The tumor inhibitor of metalloproteinase (TIMP) family is a natural inhibitor of several matrix metalloproteinase enzymes which are involved in the process of tumor cell invasion through the extracellular matrix. The aim of this study was to examine TIMP1 RNA expression levels in relation to the clinicopathological features in resected primary non-small cell lung cancer (NSCLC). Total cellular RNA, obtained from 45 cases of NSCLC and adjacent normal lung tissue, was examined using Northern blot analysis. TIMP1 RNA expression levels were heterogeneous in NSCLC but was significantly higher in the adenocarcinoma compared to the squamous cell carcinoma subtype. Although the TIMP1 RNA levels did not correlate with sex, smoking, tumor, node, or TNM stage, there was a statistically significant survival disadvantage for cases with relatively high TIMP1 RNA expression, suggesting a role for TIMP1 in determining the prognosis of resected NSCLC.

Comparative alterations in p53 expression and apoptosis in the irradiated rat small and large intestine

Temporal and spatial relationships between radiation-induced apoptosis and expression of p53 mRNA and protein were compared in rat small and large intestine. Apoptosis was quantified using morphological criteria, and p53 expression determined by immunohistochemistry or whole-tissue Northern analysis. In the small intestine, peak levels of apoptosis appeared earlier (4 h) than in the large intestine (6 h). p53 mRNA transcript levels in small and large intestine were not significantly altered from control levels at any time after treatment. However, in treated small and large intestine, cells showed increased positivity for p53 protein, increasing 10-fold over control levels 4-5 h after irradiation. A strong spatial relationship was found between high incidence apoptosis and p53 protein positivity. We compared published data of stem cell population positions for small and large intestine with our results. Target cells for apoptosis and p53 expression occurred at approximately fifth position from the crypt base of the small intestine, a zone coincident with stem cell population. Target cell position for apoptosis and p53 expression in the large intestine was again at fifth or sixth position from the base, but this zone is not the reported stem cell position (first or second position) for large intestine. Results from our model of radiation-induced intestinal apoptosis indicate that p53 protein is closely associated both temporally and spatially with the induction of apoptosis, and support the work of others in suggesting that p53 expression is modulated post-transcriptionally. Furthermore, our results support a hypothesis that apoptotic targeting of damaged stem cell populations, early response for apoptotic removal of DNA-damaged cells and/or early repair of these damage cells are all important parameters that determine differences in levels of tumorigenesis in the small and large intestine.

[Radiosurgery of cavernous sinus meningiomas with gamma-knife]

The treatment results of cavernous sinus meningioma with gamma-radiosurgery are reported. There were 18 cases of cavernous sinus meningioma, including 2 males and 16 females, whose age ranged from 39 to 63 with an average of 51.0 years. As prior treatments, operative tumor resection or biopsy had been carried out in 14 cases, and the pathology was verified. The other 4 cases were diagnosed clinically with radiological studies. The mean tumor diameter was 28.3mm (17.7-35.0) during the radiosurgery. The maximum dose ranged from 22 to 36Gy (mean 28.0Gy), with the marginal tumor dose ranging from 11 to 18Gy (mean 13.9Gy). Irradiation to the near-by optic nerves was less than 10Gy. Follow-up period ranged from 12 to 50 months with a mean of 25.5 months. MRI showed a minor tumor shrinkage in 9 (50.0%) and no obvious change in 8 (44.4%), and tumor progression in 1 (5.6%), which required a 2nd radiosurgery. Neurologically facial pain and facial dysesthesia were well improved (7/13). However the ophthalmoparesis was usually unchanged and only 1 out of 11 (9.1%) improved after radiosurgery. Deterioration of neurological signs was rare. Symptomatic edema presenting neurological signs was not seen. In conclusion, radiosurgery with a gamma-knife is one of the useful alternatives to operative intervention in the treatment of cavernous sinus meningiomas, not only for tumor control, but also for relief from the symptoms.

Coagulation and fibrinolysis study after local thrombolysis of a cerebral artery with urokinase

Coagulation and fibrinolysis factors were studied in six patients after local thrombolysis with urokinase (720,000 IU). Transient abnormalities, such as prolonged prothrombin time, decreased plasminogen and alpha 2-antiplasmin activities, decreased fibrinogen, and increased fibrin degradation products were seen on the day after thrombolysis, but tended to return to the normal range on the 4th day except for one patient who suffered from disseminated intravascular coagulation. Antithrombin III activity did not change so much. Therefore, the dosage of urokinase should be as low as possible to prevent fluctuations in the coagulation and fibrinolysis system.

Expression and localization of clusterin mRNA in the small and large intestine of the irradiated rat: its relationship with apoptosis

Apoptotic elimination of intestinal cells following irradiation has been studied in the small and large intestine of the rat, and correlated with the level of expression and localization of clusterin mRNA. Clusterin was moderately expressed in normal intestine where only small levels of apoptosis were found. After irradiation, however, there was a temporal correlation between an increased apoptotic index and increased clusterin expression. Localization of clusterin mRNA by in situ hybridization identified extensive labelling in the lower part (Paneth cell region) of small intestinal crypt, whereas epithelial cells in the large intestine were diffusely labelled. Clusterin expression was not localized over apoptotic cells and its role may be as a cell protection factor for surviving cells, as had been suggested by others. Clusterin may also be involved in remodelling of the intestinal crypt after radiation damage, a process that includes altering cell-to-cell contact, apoptosis, and sloughing of the dead cells from the intestinal villi. Our results do show a close temporal link between apoptosis and clusterin expression, and, as such, expression of the gene may be a useful indicator of presence of apoptosis in the irradiated intestine.

[Gamma knife treatment of AVM of the basal ganglia and thalamus]

Arteriovenous malformatios (AVMs) in the basal ganglia (BG) and thalamus (Thal) are difficult to treat by microsurgery or intravascular embolization alone, and the role of stereotactic gamma radiosurgery (gamma knife) of these AVMs is discussed. We have treated 324 cases of AVM with gamma knife since May 1991, and in 71 of these cases (19%) the AVM was in the BG or Thal. The results of gamma radiosurgery on AVMs of the BG and Thal were compared with the results of treating AVMs at other intracranial locations by gamma radiosurgery. The nidi were small (mean diameter: 16.4 mm), and they were treated with a mean maximum dose of 36.4 Gy and marginal dose of 19.9 Gy. The results were evaluated angiographically in 39 (55%) of the 71 cases, with a mean follow-up period of 23 months. The complete obliteration rate of AVMs in the BG and Thal 1 and 2 years after treatment was 54.3% and 92.0%, respectively, and the rate at the other locations was 42.9% and 76.0%, respectively. Adverse effects of this treatment in the AVM cases overall were rebleeding from the nidus in 5 cases (1.5%) and radiation necrosis in 4 cases (1.2%). In conclusion, AVMs of the BG and Thal were effectively and safely treated with the gamma knife, and stereotactic radiosurgery is a definitive alternative treatment for deep seated AVMs.

[The results of gamma knife radiosurgery for malignant skull base tumors]

The results of gamma knife radiosurgery for malignant skull base tumors were analyzed using repeated magnetic resonance imagings and neurological examinations. Nineteen malignant skull base tumors were treated and followed up for 22.3 months (5-40 months) using MR imagings. The mean age was 54.4 years old (ranging from 16-85). Ten were male and 9 were female. Prior to the radiosurgery, removal of the tumors in 17 cases, conventional radiation therapy in 7, and chemotherapy in 4 etc. were performed. The pathological diagnoses were chordoma in 6 cases, metastatic tumors in 5, epipharyngeal carcinoma in 2, adenoid cystic carcinoma in 2, and others in 4. The locations of tumors were the clivus in 8, the parasellar region in 5, the epipharynx in 2, the paranasal sinus in 2, C-P angle in 1, and intraorbital region in 1 (14 were intracranial and 5 were extracranial). The mean diameter of the tumor was 33.5mm. The mean maximum dose was 26.8Gy and the mean marginal dose was 12.9Gy during treatment. Repeated MR imagings revealed decrease of tumor size in 12 cases, no change in 1, and increase of tumor size in 5 (unknown in 1). Follow-up neurological examinations showed improvement in 3 cases, no change in 9, and deterioration in 7. There were 11 deaths during a mean follow-up period of 17.8 months (5-32 months) and another 8 cases are alive for a mean follow-up of 30.5 months (20-40 months) after the radiosurgery. Although the tumor size was large at the time of treatment, the results of gamma knife radiosurgery were promising. Considering the quality of life of patients with malignant skull base tumors, it is emphasized that gamma knife treatment is the method of choice compared with radical removal of the tumors.

Growth control of cranial base meningiomas by stereotactic radiosurgery with a gamma knife unit

The effect of gamma knife radiosurgery for cranial base meningiomas was analyzed using magnetic resonance (MR) imaging in 33 patients followed up for a mean 26.5 months. There were 10 male and 23 female patients aged from 38 to 87 years (mean 54.5 yrs). Twenty-three patients had already had more than one open surgery before radiosurgery. The mean tumor volume was 16.8 cm3. The mean maximum dose was 29 Gy and the mean marginal dose was 15.1 Gy. Four patients were treated by two-stage treatment at 1- to 4-month intervals. Follow-up MR imaging revealed a decrease in tumor size in 10 patients, a small low intensity area in the tumor center in three, increase in tumor size in two, and no change in 18. After radiosurgery one patient had marked edema on MR imaging and showed cognitive deficits, and another three patients had neurological deterioration. All other patients were unchanged or improved. Growth control of cranial base meningiomas without severe neurological deficits can be achieved by radiosurgery.

Comparison between adult and pediatric arteriovenous malformations treated by Gamma Knife radiosurgery

More than 290 cases of cerebral arteriovenous malformation have been treated at our hospital by Gamma Knife radiosurgery since May 1991, of which 99 were followed with angiography for 1 year or more. The results from adult and pediatric age groups were compared. There were 70 adults and 23 children. Previous hemorrhage had occurred in 73.7% of the adults and 91.3% of the children. The mean volume of the nidus was similar in both groups: 4.2 cm3 in adults and 4.8 cm3 in children. In both groups approximately 70% of the cases fell into Spetzler and Martin grade III. The mean margin dose was 20.0 Gy in the adults and 20.5 Gy in the children. Complete nidus occlusion at 1 year occurred in 45% of the adults and 74% of the children. The rates at 2 years were 81 and 94%, respectively. Complications occurred only in adults and consisted of 2 rebleeds, 1 radiation edema and 1 radiation necrosis. Gamma Knife radiosurgery is considered to be safer and have a higher success rate in children than in adults.

Loss of heterozygosity frequently affects chromosome 17q in non-small cell lung cancer

Although the short arm of chromosome 17, which contains the p53 gene, is frequently affected by loss of heterozygosity (LOH) in lung cancer, little is known about similar changes on the long arm. We found that LOH affected one or more of six loci along chromosome 17 in 59% of 102 informative non-small cell lung cancer (NSCLC) cases. Specifically, the frequency of LOH at 17q was 42%, approaching that at 17p (54%), and two distinct 17q regions were implicated. LOH at D17S4 on 17q was more frequent in adenocarcinomas than in squamous cell carcinomas, whereas squamous cell carcinomas had more LOH at 17p than at 17q, findings that indicate molecular genetic heterogeneity between the major NSCLC subtypes. In addition, LOH at 17q correlated with higher T stages and a significantly worse prognosis. In comparison, 25% of cases had mutations of p53 exons 5-8 but these were not associated with stage or survival. The data suggest that independent of p53, there are important tumor suppressor gene(s) on 17q that may influence NSCLC pathogenesis, progression, and survival.

[The comparison between adult and pediatric AVMs treated by gamma knife radiosurgery]

More than 290 cases of cerebral AVM had been treated by gamma knife radiosurgery since May, 1991, among which ninety-nine cases were angiographically followed up for at least one year. Comparison of the results between adult and pediatric AVMs were made. There were seventy six adult and twenty three child cases. Intracerebral hemorrhages in their past history were found in 73.7% of adult and 91.3% of child cases respectively, and the rate of intracranial hemorrhages in the pediatric group was higher than that in the adult group. The volume of the nidus of AVM in both groups was 4.2 ml in adults and 4.8 ml in children. Grade III of the Spetzler grading system occupied about 70% of all cases and was the most common grade in both groups. Treatment was performed with a mean marginal dose of 20.0Gy in adults and 20.5Gy in children. The complete occlusion of the nidus was obtained in 45% of the adult group and 74% of the pediatric group one year after, and in 81% and 95% respectively two years after the treatment was begun. As side effects, these were two rebleedings, one radiation necrosis and one radiation-induced edema in adults. However, no side effects were observed in children. It is considered that, when using gamma knife radiosurgery, pediatric AVMs are more likely to be occluded successfully and safely than adult AVMs.

[A new strategy for the treatment of jugular foramen tumors using radiosurgery]

A new treatment strategy for jugular foramen tumors using radiosurgery is reported. Six jugular foramen tumors, including 2 glomus tumors and 4 lower cranial neurinomas, were involved. Among them only one tumor was confined in the jugular foramen, but the others extended into the posterior fossa, the upper cervical portion or both. As an initial treatment, 3 cases underwent operative resection from suboccipital or transcervical route. The tumor sizes at radiosurgery ranged from 14.3 to 36.1 mm with a mean of 22.4 mm in diameter. They were treated with a marginal dose between 13 to 16.5 Gy (mean 15.6 Gy). Follow-up MRI showed an apparent tumor shrinkage in 4 and no change in 2. Central tumor necrosis was found in 4 cases, but tumor progression was never observed in the mean follow-up period of 19 months. No complication occurred during and after the radiosurgery. These results indicate that radiosurgery is effective for the control of jugular foramen tumors with acceptable risk. Large tumors extending to the upper cervical portion and posterior fossa can be treated by operative resection combined with radiosurgery.

Subarachnoid hemorrhage of unknown origin associated with Weber-Christian disease--case report

A 58-year-old female, who had suffered from Weber-Christian disease for 26 years, presented with subarachnoid hemorrhage. Cerebral angiography showed dilatation of the basilar tip. An operation was performed in the chronic stage. The wall of dilated basilar artery was tough, but that of the right superior cerebellar artery was very thin and three small aneurysms were found on the right middle cerebral artery. Blood levels of fibrin degradation products, plasmin-alpha 2-plasmin inhibitor complex, and thrombin-antithrombin III complex were increased. The abnormality of the coagulation-fibrinolysis system and the fragility of the cerebral arteries related to Weber-Christian disease were probably the cause of the subarachnoid hemorrhage.