[A case of Evans's syndrome in which thrombocytopenia and hemolysis was improved by Sairei-to]

A 51-year-old male diagnosed as having Evans's syndrome in 1991 was treated with 25 mg of prednisolone, but his anemia and thrombocytopenia progressed. Thus, in November 1993, treatment was begun with Sairei-to, a Chinese herbal medicine consisting of several water-soluble plant extracts. Following administration of 9.0 g/day of Sairei-to granules along with prednisolone, the platelet count increased from 6.1 x 10(4)/microliters to 12.3 x 10(4)/microliters after one week, while hemoglobin levels rose from 9.5 g/dl to 12.0 g/dl after three weeks. The patient maintained a good physical condition after the prednisolone dose was reduced, although Coomb's test and PAIgG levels remained positive. Sairei-to-seems to be a promising therapeutic agent for steroid-resistant ITP and AIHA, and seems to have no side effects.

Synergistic gene expressions of cyclin E, cdk2, cdk5 and E2F-1 during the prolactin-induced G1/S transition in rat Nb2 pre-T lymphoma cells

G1 cyclins and some cyclin-dependent kinases (cdks) have been implicated in the G1/S transition during the eukaryotic cell cycle initiation. The present study demonstrates that the genes of cyclin E, cdk2, cdk5 and the transcriptional factor E2F-1 are expressed during the prolactin (PRL)-induced G1/S transition in rat Nb2 pre-T lymphoma cells. The mRNAs for these four cell cycle regulators were synergistically synthesized and degraded after the stimulation by PRL. The maximal levels of these mRNAs were observed at 8 to 12 h after the PRL addition, while DNA replication reached to the maximum between 12 and 16 h. These results suggest that cyclin E, cdk2, cdk5 and E2F-1 play the roles in the G1/S transition being expressed by a common cellular mechanism(s) in the PRL-stimulated pre-T lymphoma cells.

Slipped capital femoral epiphysis associated with hyperparathyroidism. A case report

A case of slipped capital femoral epiphyses is reported which occurred in association with primary hyperparathyroidism. Only two similar cases have been found in the English literature. The patient was a man, 16 years of age, who presented with bilateral slipped epiphyses. Investigation showed that he had primary hyperparathyroidism due to a parathyroid adenoma. At a single operation, the epiphyses were pinned in situ, and the adenoma removed. The result was satisfactory.

Absence of cyclin D1/PRAD1 point mutations in human breast cancers and parathyroid adenomas and identification of a new cyclin D1 gene polymorphism

PRAD1 (cyclin D1) has been implicated in the molecular pathogenesis of a variety of tumors, including parathyroid adenomas, t(11;14)-bearing B-lymphoid tumors, and breast cancer. The sequence of the overexpressed PRAD1 genes has been directly analyzed in only two tumor specimens, a benign parathyroid adenoma and a malignant centrocytic lymphoma. Thus, little is known about PRAD1 sequence in the vast majority of human primary tumors, including breast cancers. Using single-strand conformational polymorphism (SSCP) analysis, we have examined the coding region of the PRAD1 gene in 30 primary breast cancers and 25 parathyroid adenomas. Polymerase chain reaction (PCR)-SSCP analysis of the coding region of exons 1-5 of the PRAD1 gene did not reveal any tumor-specific mutations. During the course of screening for mutations, we found and established the sequence variants of a new DNA polymorphism at codon 241 within exon 4 of the PRAD1 gene. Since this polymorphism is located within the coding region of the PRAD1 gene, it will allow determination of allele-specific expression of the gene and the detection of allele imbalance. At least in breast and parathyroid neoplasms, overexpression of the wild-type PRAD1 sequence, rather than point mutational activation, appears to be the predominant mechanism by which PRAD1 exerts its oncogenic action.

Simultaneous carboplatin and radiotherapy for all stages of head and neck squamous cell carcinoma

The study investigated the toxicity and efficiency of the concomitant administration of radiotherapy and carboplatin to patients with head and neck carcinomas. Sixty-three patients with head and neck squamous cell carcinomas, other than nasopharyngeal cancer and Stage I (UICC) laryngeal cancers, were treated by external radiotherapy and four courses of carboplatin at a dose of 100 mg/m2 per week. In two patients, only three courses were possible due to renal toxicity. In the other 61 patients, toxicities were self-limiting and no patient required interruption of carboplatin administration. No patient required discontinuation of radiotherapy because of acute toxicity. Of 61 evaluable patients, a complete response (CR) was obtained in 11.5% and a partial response (PR) in 60.7% at 40 Gy. In 41 patients treated to 65 Gy (including two patients with maxillary sinus carcinoma, who were treated by debulking surgery), CR was obtained in 76.9% and CR+PR was 100% at the end of treatment. The actuarial survival rate of the 63 patients at 2 years was 69.2%, with a median follow-up period of 24.4 months. One of 12 patients who received salvage surgery after radical radiotherapy has died due to poor wound healing after the surgery. The schedule was safe, providing a weekly check of serum samples was possible. It is likely that the rate of local control and vocal cord preservation in laryngeal tumours might improve if concurrent carboplatin is used. Careful follow-up is required to determine the long-term effect of concomitant carboplatin administration.

Molecular cloning of human cytosolic purine 5'-nucleotidase

The cDNA of human cytosolic purine 5'-nucleotidase (EC 3.1.3.5), which is the supposed regulatory allosteric enzyme of purine nucleotide degradation, has been cloned from a human placenta cDNA library. The predicted open reading fram encodes a protein of 561 amino acids with a molecular mass of 64,966 Da. The deduced amino acid sequence exhibits 95% identity with the sequence of the B type subunit of chicken cytosolic purine 5'-nucleotidase. Northern blot analysis of human placenta poly(A) +RNA revealed a single band of 3.6 kilobases using the cloned cDNA.

Induction of D2 and D3 cyclin-encoding genes during promotion of the G1/S transition by prolactin in rat Nb2 cells

Prolactin has been demonstrated to induce the expression of the genes encoding cyclin D2 and D3 during promotion of the G1/S transition in rat Nb2 pre-T-lymphoma cells. cDNA clones encoding these rat cyclins D2 and D3 were isolated and analyzed.

Pancreatic acinar cells in adult human islets of Langerhans

Pancreatic acinar cells within the islets of Langerhans in human pancreas were investigated both histopathologically and electron microscopically. Acinar cells inside the islets of Langerhans were observed in all 50 adult cases investigated. Between such acinar cells and endocrine tissues, no reticular fiber was observed; they were encapsulated together instead. The acinar cells were immunostained with antiamylase similar to the "extrainsular" acinar cells and were also connected to the small pancreatic duct. Electron microscopically, intercellular junctions of the desmosomal type were found between the acinar cells and the adjacent endocrine cells. Therefore, the acinar cells within the islets of Langerhans were true acinar cells, based on the incomplete demarcation between the islets and the acinar tissue.

[Capillary endothelial cells in sarcoidosis--electron microscopic findings]

The distribution of von Willebrand (vW) factor, thrombomodulin (TM) and fibronectin (FN) in the capillary endothelial cells of the lung of patients with sarcoidosis was investigated using their monoclonal or polyclonal antibodies. The vW factor showed strong reaction with exudation towards outside and irregular dilatation or occlusion in the capillary walls surrounded sarcoid granulomas and capillaries in the remote area. The area showing alveolitis disclosed also strong reaction with exudation by vW factor. TM having a anti-coagulating function showed a very low reactivity in the lung tissues with or without of granulomas in sarcoidosis at light microscopic level, but in electron microscopically, strong reaction and broad distribution in capillary endothelial cells, involving luminal occlusion and reaction in subendothelial region. FN showed new and many capillaries formation in the growing collagenous tissues between the old sarcoid granulomas suggesting neocapillarization originating from endothelial cells. These findings suggest that the capillary endothelial cells participate strongly in formal genesis of sarcoid granulomas.

[Surgical treatment of supravalvular aortic stenosis]

In the last 14 years, 7 consecutive patients with supravalvular aortic stenosis (SVAS) underwent surgical treatment for SVAS and/or for associated lesions. There were 5 male and 2 female patients ranging in age from 3 months to 12 years. Six of them had associated other cardiac anomalies; two had severe multiple peripheral pulmonary stenoses (PPS) and one each had ventricular septal defect (VSD), valvular pulmonary stenosis, coarctation of aorta with patent ductus arteriosus (PDA), total anomalous pulmonary venous return (TAPVR) with pulmonary branch stenosis, PPS and left lower pulmonary venous obstruction. The type of SVAS were localized in all and 5 of them underwent successful surgical repair of SVAS (3 with extended aortoplasty and 2 with patch aortoplasty). In 2 patients with VSD or valvular pulmonary stenosis, associated cardiac anomalies and SVAS were repaired simultaneously. Four patients had undergone previous operations, which included repair of severe multiple PPS by extended peripheral pulmonary arterioplasty (case 4, 6), repair of coarctation of aorta and division of PDA (case 5), repair of TAPVR (Ia + IIa) and pulmonary branch stenosis (case 7). There was no operative death and one patient died late postoperatively (case 7) due to right heart failure in a follow up period of 3 to 14 years. In conclusion, it is important to select the appropriate surgical treatment according to the location and the severity of associated other cardiac anomalies as well as the severity of SVAS, and extended peripheral pulmonary arterioplasty is considered to be a recommended method for the relief of severe multiple PPS associated with SVAS.

[A study of biological characteristics of large bowel adenocarcinomas showing mucin production; examination of histological differentiation and cell kinetics]

In order to clarify the biological behavior of mucin producing cancers of colon, we analyzed 32 cases showing histological heterogeneity in the tumors, by mucin histochemistry. 28 cases were mucinous adenocarcinoma, forming with tubular structures, and the remaining 4 cases were signet-ring cell carcinomas. HID-AB stain demonstrated that the mucin component was almost similar to that of normal mucosa around the cancer. In the tubular forming portions, in which polyploid or aneuploid cells were often detected, the growth fraction of cancers was significantly higher than in that of the other portions.

Developmental changes in spontaneous GABAA-mediated synaptic events in rat hippocampal CA3 neurons

Ongoing spontaneous postsynaptic potentials (SPSPs) were intracellularly recorded at 34-36 degrees C from hippocampal CA3 neurons in slices obtained from postnatal days (P) 0-6 and 7-31. SPSPs occurred randomly, and their frequency distribution was fitted by a single exponential function. They were little affected by kynurenic acid, but were reversibly blocked by bicuculline, implying that they were mediated by GABAA receptors. The mean amplitude was 4.53 +/- 0.89 mV in control conditions and 4.07 +/- 0.79 mV in kynurenic acid. In kynurenic acid (with CsCl-filled microelectrodes), SPSPs reversed polarity at 2.4 +/- 2 mV. When tetrodotoxin (1 microM) was added to kynurenic acid solution, GABAA-mediated miniature postsynaptic potentials (MPSPs) were recorded. Under these conditions large events disappeared. The mean amplitude of MPSPs was 2.51 +/- 0.43 mV. The mean frequency decreased from 2.96 +/- 1.04 Hz in kynurenic acid to 0.4 +/- 0.15 Hz in kynurenic acid plus tetrodotoxin. In contrast with P0-P6, at P7-P31 SPSPs were significantly affected by kynurenic acid. The mean amplitude of SPSPs shifted from 4.71 +/- 0.82 mV in control conditions to 3.79 +/- 0.76 mV in kynurenic acid. At this developmental stage, the reversal potential of GABAA-mediated SPSPs shifted towards more negative values (-23.7 +/- 1.3 mV). Addition of tetrodotoxin to kynurenic acid solution abolished larger events and revealed GABAergic MPSPs. The mean amplitude of MPSPs was 2.72 +/- 0.5 mV, a value very close to that observed at P0-P6. Synaptic currents were recorded at 22-24 degrees C from voltage-clamped CA3 pyramidal neurons (at P6) using the tight-seal whole-cell recording technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of oligosaccharides of human IgG from serum of leukemia patients

The biantennary N-acetyllactosamine type oligosaccharide is attached to asparagine-297 of the human IgG heavy chain, which is an integral part of the tertiary structure of the Fc region, and is quite important in the role of IgG. Pyridylamination and analysis by HPLC can be performed more rapidly and simply than conventional carbohydrate analysis. We applied it to the analysis of the oligosaccharide structures of IgG from the serum of patients with leukemia, CLL and AML. The proportion of oligosaccharide from leukemia patients with a bisecting N-acetylglucosamine residue was almost equal to that of healthy individuals. However, the proportion of fucose and galactose residues differed. These data suggest that the analysis of the fucose and the terminal galactose residue of such oligosaccharides will be useful in the classification of leukemia.

Characterization of a voltage-dependent anionic channel in fused synaptosomes isolated from rat hippocampi

The inside out configuration of the patch-clamp technique was used to study single-channel anionic currents from purified hippocampal synaptosomes fused into liposomes to form giant proteoliposomes. At least six different anionic channels with unitary conductances of 22-150 pS were found. The most frequently observed was the 32-pS conductance channel. This was voltage-dependent; the open probability increased from 0.20 at -40 mV to 0.46 at 40 mV. This channel may be involved in the repolarization of nerve terminal membranes after an action potential, thus, limiting the duration of the spike and the transmitter release.

Mucinous carcinoma of the skin: report of a case with DNA cytofluorometric study

A 62-year-old man with a mucinous carcinoma of the skin on the left cheek is described. The excised specimen showed a characteristic histopathologic picture. The findings from histochemical, immuno-histochemical, and electron microscopic examinations suggested an eccrine differentiation of the tumor cells. The removed tumor was examined using DNA cytofluorometry in order to analyze the cell kinetics and to estimate its biological behavior and prognosis. The tumor cells showed a diploid mode with a small number of polyploid cells. Only a small number of cells in the S and G2/M phase ranges were detected. After four years, there has been no evidence of tumor recurrence nor metastasis. The results of DNA ploidy analysis were thus compatible with the nature of slow growth with a good prognosis in this case.

[Manometric study of the biliary sphincter zone: a comparison between the length of phasic activity and the narrow distal segment]

Motor activity of the sphincter of Oddi has been evaluated in 26 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a single end-lumen perfused catheter. The number of successive 3 mm spaced black marks, observed during the pull-through from the first appearance of the proximal sphincter activity to that of duodenal pressure, was used to measure the length of the sphincter zone. In 14 of 26 patients, the length of phasic activity zone of the sphincter of Oddi was 9 mm. However, the narrow distal segment of the common bile duct was 15.1 +/- 3.6 mm in length. In same patients, the length of phasic activity zone was shorter than the anatomical one. The mean sphincter of Oddi pressure (SOP) at the distance of 6 mm from the papillary pore (77.8 +/- 22.1 mmHg) was greater than that of 9 mm (58.4 +/- 27.0 mmHg) and 12 mm (51.0 +/- 16.9 mmHg). These results suggest that the location of the orifice of catheter should be taken into consideration when comparing the SOP.

[A case report of successful open valvotomy in neonate with critical aortic stenosis]

Open valvotomy was successfully performed in neonate with critical aortic stenosis using cardiopulmonary bypass. The baby was referred to our hospital at the age of 24 days with very grave state, and needed intensive care including endotracheal intubation and inotropic support. Critical valvular aortic stenosis was confirmed by echocardiography. Poststenotic dilatation and enough size of short axis LV dimension were reported, and aortic annulus was measured 6 mm in diameter. Without catheterization and angiography, open valvotomy was performed with moderate hypothermia and ischemic arrest using single dose of cold cardioplegia at the age of 29 days. Bicuspid aortic valve was thick and dysplastic with thick gelatinous cusp edge, however commissurotomy was applicable in two direction. The diameter of aortic opening was enlarged from 2 mm to 7 mm. Total bypass and aortic cross clamp time were 78 and 28 minutes respectively. The baby recovered uneventfully and there was no evidence of significant AS or aortic regurgitation in echocardiography 7 months after surgery. Sorts of reoperation for restenosis or regurgitation were reported. The results of reoperation for regurgitation were reported to be poor, especially in young infants who should be performed aortic valve replacement. However, residual AS could be manipulated with re-valvotomy, PVB, apico-aortic conduit or AVR. As the choice of first relief of critical AS without other anatomical disadvantages including hypoplastic left ventricle, endocardial fibroelastosis, and mitral stenosis, it would be crucial for late results to prevent progression of aortic regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Early and long-term results of sternocostal elevation combined with bridge external traction for funnel chest in children]

The purpose of the present study is to evaluate the effects of addition of a bridge external traction to our conventional sternocostal elevation technique in the surgical management of funnel chest in children. During the period from 1970 to 1979, a total of 29 children with funnel chest were treated surgically using sternocostal elevation technique (Group I). Operative technique consisted of total subperichondral resection of deformed costal cartilages (usually 3rd to 8th, bilaterally), transection of deformed portion of the sternum in 2-3 points and fixation of the sternum in elevated position using 2 Kirschner wires, and shortening resuturing of the opened perichondrium. Since 1980, an addition of the bridge external traction to our conventional sternocostal elevation technique was applied for about 10 days after operation in 82 consecutive children (Group II). The vertebral index (B/A = sagittal diameter of vertebral body/minimum sternovertebral distance), D/C ratio (maximum sagittal depth of depression of sternum/distance from anterior surface of the vertebral body to the sternum at Louis's angle) and E/C ratio (E = minimal sagittal distance from anterior surface of the vertebral body to the sternum) were measured in all cases and compared before and after operation and also between the two Groups. Preoperatively, there was no significant difference in all 3 indices between the two Groups. Postoperative B/A, D/C and E/C ratio in Group I were 0.28 +/- 0.06, 0.14 +/- 0.19, 1.09 +/- 0.32 (mean +/- SD), respectively. There were a significant drop in D/C ratio and a significant elevation in E/C ratio after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of circulating intercellular adhesion molecule-1 in hepatocellular carcinoma

Serum levels of circulating intercellular adhesion molecule-1 (cICAM-1) were measured in 23 patients with chronic hepatitis (CH), 22 with liver cirrhosis (LC) and 45 with hepatocellular carcinoma (HCC) using an ELISA. Serum samples from all patients showed significantly higher cICAM-1 levels than serum from 50 normal controls. The cICAM-1 level was significantly increased in LC or HCC when compared with CH, but no differences were noted between LC and HCC. Levels of cICAM-1 correlated well with serum bilirubin, retention rate of indocyanine green, hyaluronic acid, type IV collagen 7-S and type III procollagen peptide levels but not with tumor size or circulating tumor markers (alpha-fetoprotein and des-gamma-carboxyprothrombin). Our findings indicate that the measurement of cICAM-1 is useful for the determination of the severity of liver disease and hepatic fibrosis. HCC tissues obtained from 10 patients were immunohistochemically stained for ICAM-1. Enhanced ICAM-1 expression was found on the tumor cell membranes. Sequential measurements of cICAM-1 levels showed that they changed in a similar manner to those of alpha-fetoprotein during the course of treatment of HCC in a patient with very high pretreatment levels of both markers. These results suggest that HCC cells shed ICAM-1 into the circulation. We conclude that cICAM-1 is not a diagnostic marker for HCC, but may be useful for monitoring the response to treatment.

[Blalock-Taussig shunts in infants less than 6 months of age with special reference to the long-term administration of prostaglandin E1]

Classical Blalock-Taussig (B-T) shunt operation was performed in 14 neonates (group N) and 22 infants (group P). A mean age of group N patients was thirteen days and that of group P patients was two months. Preoperatively prostaglandin E1 (PGE1) was administered in all patients and was continued for a mean of 7 days (range 2 hours to 21 days) in group N, and a mean of 78 days (range 42 to 158 days) in group P. Body weight (4359 +/- 339 g), size of subclavian artery (3.7 +/- 0.5 mm in diameter) and size of pulmonary artery (6.4 +/- 1.2 mm in diameter) at operation of group P patients were larger than those (3212 +/- 490 g, 3.4 +/- 0.4 mm, 5.1 +/- 1.3 mm) of group N. But there were no differences in operation time (165 +/- 22 minutes in group N vs 174 +/- 25 minutes in group P) and clamp time of pulmonary artery (31 +/- 10 minutes in group N vs 30 +/- 5 minutes in group P) between 2 groups. There was no operative death in both groups. There were one late death in group N and three late death in group P. Five patients in group N and nine patients in group P required additional B-T shunt at the mean follow up interval of two years.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunohistochemical, quantitative immunoelectron microscopic, and DNA cytofluorometric characterization of chemically induced rat malignant fibrous histiocytoma

Malignant fibrous histiocytoma (MFH) was induced in rats by injection of 9,10-dimethyl-1,2-benzanthracene. Using cell suspensions prepared from the heterotransplanted nude mouse tumor as immunogen, a monoclonal antibody, (MAb), MEP-1, against fibroblastlike MFH tumor cells was generated. In the primary rat tumors and transplanted rat or nude mouse tumors, MEP-1 reacted specifically with the fibroblastlike cells but not with the histiocytelike cells or xanthoma cells. Anti-rat macrophage MAbs RM-1 and TRPM-3 did not stain the fibroblastlike cells, but both were reactive with the histiocytelike cells. Double stainings with both MEP-1 and RM-1 or TRPM-3 did not detect any double positive cells. Immunoelectron microscopy using these MAbs showed that the fibroblastlike cells were the major cell component of the primary and transplanted rat tumors and that their cell membrane was stained positively with MEP-1, but not for RM-1 or TRPM-3. By the double staining method using a MAb against prolyl 4-hydroxylase beta and MEP-1 or TRPM-3, this enzyme was demonstrated in MEP-1-positive cells but not in TRPM-3-positive cells. Results obtained by DNA cytofluorometry with 4,6-diamidino-2-phenylindole dihydrochloride staining or by the combined method of DNA cytofluorometry and indirect immunofluorescence, using MEP-1, RM-1, and TRPM-3, indicate that MEP-1-positive cells are neoplastic cells of rat MFH having proliferation activity. In the transplanted nude mouse tumors, no differentiation of MEP-1-positive rat tumor cells into histiocytelike cells was detected, and all histiocytelike cells were immunostained by F4/80 and most of them were positive for M5/114. These results suggest that fibroblastlike cells and intermediate cells are tumor cells of 9,10-dimethyl-1,2-benzanthracene-induced rat MFH showing differentiation toward fibroblasts and that histiocytelike cells are infiltrated macrophages.

Long-term palliation after systemic-to-pulmonary artery shunt using an internal mammary artery

We report the long-term results after systemic-to-pulmonary artery shunts using the internal mammary arteries in 2 patients. The systemic-to-pulmonary artery shunts using the internal mammary arteries were created in 2 children. Both of them are doing well 11 years and 7 years after operation. This procedure could be a reasonable alternative to classic Blalock-Taussig shunt for patients with diminutive pulmonary arteries as it offered good long-term palliation.

[Cell proliferation and maturation of ectopic submucosal glands of the stomach]

Stomachs with multiple submucosal glands keep our attention because of their high risk for having gastric carcinomas, but little is known about the relationship between submucosal glands and occurring cancers. So we investigated the structure of submucosal glands including location of proliferating cells. We labeled proliferating cells of three stomachs with cancerous lesions by circulating artificial blood through the isolated organs with bromodeoxyuridine (BrdU). Serial sections of submucosal glands were stained with hematoxylin eosin, periodic acid Schiff, Alcian blue, high iron diamine-Alcian blue, concanavalin A paradox, galactose oxidase Schiff as well as anti-BrdU immunohistochemically. Results showed that most of submucosal glands were composed of functionally matured cells and these cells made regular structure just like those of mucosal layer. Labeling index of BrdU of these submucosal glands were low (0.2%-0.7%). Two atypical glands were seen, and labeling index were 2.6% and 22.2% respectively. In conclusion, submucosal glands of the stomachs were thought to be made by moving proliferating cells from mucosal layer to submucosal layer. So we saw these submucosal glands paracancerous lesions rather than precancerous ones. But we couldn't deny the possibility to occur cancerous lesions from atypical glands in submucosal glands.

Inhibitory effects of a cholecystokinin antagonist, loxiglumide (CR-1505), on the growth of freshly separated and xenografted human pancreatic cancer

The effects of cholecystokinin (CCK) and a CCK antagonist, loxiglumide (CR-1505), on four freshly separated and six xenografted human pancreatic cancers, were investigated. The level of DNA synthesis in only one of five tested pancreatic cancers was enhanced by CCK at concentrations of 0.01-10 nM, while in the other four cancers DNA synthesis was not affected. The levels of DNA, RNA, and protein synthesis (by 3H-thymidine, 3H-uridine, and 3H-leucine incorporation tests, respectively) in all the tested cancers were dose-dependently inhibited by loxiglumide at concentrations of 20-2000 microM, and the IC50 of loxiglumide for DNA synthesis in pancreatic cancers was 156 +/- 80 microM (means +/- SD). The in vivo effect of loxiglumide was assessed using a xenografted line (PC-HN) transplanted in nude mice. The in vivo 50% lethal dose of loxiglumide for nude mice was about 500 mg/kg. Death was caused by respiratory failure due to severe congestion of the lung after the administration of a large dose of loxiglumide. The growth of a PC-HN transplanted in the nude mice was significantly inhibited by subcutaneous loxiglumide at 250 mg/kg, twice a day for 28 days, which did not cause death. It is suggested that loxiglumide inhibits the in vivo and in vitro growth of human pancreatic cancer, perhaps independently of its action as a CCK antagonist, and this study also suggests that loxiglumide may be a new type of therapeutic agent to be used for the treatment of human pancreatic cancer.

[A study of changes in distribution pattern of proliferating cells associated with progression of human colorectal benign and malignant tumor using PCNA immunohistochemistry]

We studied cell kinetics of colo-rectal neoplasms using PCNA (the auxiliary protein of DNA polymerase-delta) immunohistochemistry. We analyzed the distribution pattern of PCNA positive cells on normal colon mucosa, adenoma (6 cases) and cancer (early: 33 cases, advanced: 6 cases). PCNA positive index (PI) was calculated as the percentage of PCNA positive tumor cells in relation to the total number (about 1000) of the tumor cells. PCNA positive indices were 30% in normal colon mucosa, 49% in adenoma and 72% in cancer, respectively. There were statistically significant differences between three mean values (p < 0.01). In normal colon mucosa PCNA positive cells are localized at the lower part of mucosa, but, in adenoma, they are found at the more upper part of mucosa too. In cancer, PCNA positive cells were localized diffusely and their immunoreactivity is higher than those of the normal mucosa and adenoma. In conclusion, our results suggests that the ratio of PCNA positive cells almost equivalents to growth fraction, and is correlated with the histological grading of colo-rectal tumor, but not correlated with depth of carcinoma. It is presumed that carcinoma has a higher ratio of PCNA positive cells than adenoma, and therefore carcinoma has higher proliferating cell density than adenoma.

Cloning and characterization of four types of cDNA encoding myeloperoxidase from human monocytic leukemia cell line, SKM-1

Four cDNA clones encoding myeloperoxidase were isolated from a cDNA library of monocytic leukemia SKM-1 cells. The sequences of two of them were identical to those of cDNA clones previously isolated from a HL-60 cell cDNA library. The sequences of the other two cDNA clones, MP-S34 and MP-S29, differed from those previously described. There was a deletion of 57 bp in the MP-S34 sequence, which was generated by partially skipping exon 9. MP-S29 had a 171 bp deletion, which was generated by completely skipping exon 10. Thus MP-S34 and MP-S29 encoded polypeptides lacking 19 and 57 amino acids, respectively. Both deletions were located on the sequence encoding the heavy subunit. These results indicate that the heterogeneity of the heavy subunit of MPO observed in leukocytes or leukemia could be in part produced by partial or complete skipping of an exon.

[Analysis of proliferative activity in gastric biopsy specimens by combined BrdU and DNA polymerase alpha immunohistochemistry]

To evaluate correctly the proliferative activity of tumor cells, it is necessary to clarify not only S-phase fraction but also the growth fraction of tumor tissues. We used combined BrdU and DNA polymerase alpha (pol-alpha) immunohistochemistry to gastric biopsy specimens, and analyzed the proliferation of the neoplastic lesions of various degrees of malignancy. The results were as follows: The distribution of pol-alpha positive cells were almost the same as that of BrdU positive cells, but the percentage of pol-alpha positive cells was higher than that of BrdU positive cells irrespective of the mucosal specimens. In the adenomas, both BrdU and pol-alpha positive cells distributed generally superficially in the mucosal layer. In the well differentiated adenocarcinomas, both BrdU and pol-alpha positive cells distributed diffusely in the deeper layer of the mucosa. The ratio of the number of BrdU positive cells to that of pol-alpha positive cells, which means the S-phase fraction in the growth fraction, was higher in the tumor and that higher in the well differentiated adenocarcinomas than that of the adenomas. In conclusion, the combined BrdU and pol-alpha immunohistochemistry in gastric biopsy specimens are useful to evaluate the degree of malignancy.

Localization of transglutaminase 1 mRNA in normal and psoriatic epidermis by non-radioactive in situ hybridization

We examined the expression of the transglutaminase 1 (TGase 1) gene in frozen sections of normal and psoriatic epidermis by means of non-radioactive in situ hybridization with digoxigenin-labelled cRNA probes. TGase 1 mRNA was expressed in the granular layer of normal epidermis, regardless of ortho- or hyperkeratosis. However, in psoriatic epidermis, TGase 1 mRNA was detected in the suprabasal spinous layer, but not in the subcorneal layer. These results indicate that TGase 1 gene expression is limited to the last stage of keratinization in normal epidermis and this regulation is disturbed in psoriasis.

Expression of sialyl-Tn antigen is correlated with survival time of patients with gastric carcinomas

Expression of sialyl-Tn antigen (STN) was examined by an immunohistochemical method in 85 primary gastric carcinomas. The STN expression occurred in 53 (62.4%) cancers, and the positive staining was correlated with degree of gastric wall and lymph vessel invasion, lymph node metastasis, and stage of tumour. Five-year survival rates of patients with STN-positive cancers (47.2%) were significantly lower than those with STN-negative cancers (84.4%) (P < 0.01), and patients with STN-positive cancers at stage III and stage IV had a worse prognosis. In the cancers with serosal invasion, patients with STN-positive cancer disclosed a significantly poorer prognosis than those with STN-negative cancers (P < 0.01). Therefore, it is suggested that a careful follow-up study and intensive postoperative therapy are needed for patients with advanced gastric cancers with positive STN expression.

The monocytic cell line SKM-1 strongly expresses the myeloperoxidase gene

A newly established human monocytic cell line, SKM-1, showed strong expression of myeloperoxidase mRNA, to the same extent as in HL-60 cells. We studied the cell morphology and myeloperoxidase expression of this cell line, which was established from a patient with myelodysplastic syndrome who had an abnormal chromosome on the upstream region of 17p13. Electron micrographs showed the cells to have a fragile and irregular cell surface. SKM-1 cells were peroxidase-positive. About 60% of myeloperoxidase (MPO) was released to the culture fluid from SKM-1 cells but only a few percent of MPO was released from HL-60 cells into the culture fluid. The predominant mRNA size of SKM-1 myeloperoxidase was 3.3 kb although there was a smaller size as well. Fluorescent in situ hybridization of MPO mRNA showed strong staining in 5% to 10% of SKM-1 cells and of bone marrow cells from patients with myelogenous leukemia, while all cells from HL-60 were positive.

[Long-term results of the Blalock-Taussig shunts]

One-hundred and thirty-six patients received the classical Blalock-Taussig shunts between 1980 and 1990. Their age range at operation was 4 days to 12.8 years and their median age was 13 months. The operative mortality rate was 0.7% (1/136). The survivors were followed up from 1 month to 11.5 years, 5.4 years in average. Twenty-five patients required another shunt and the mean interval to that procedure was 2.4 years (modified Blalock-Taussig 23, classical Blalock-Taussig 2, Glenn 1, internal mammary artery-pulmonary artery shunt 1). Forty-five patients received corrective operations, there were four operative deaths (Fontan 2, Rastelli 2). There were 15 late deaths of which three deaths were not cardiogenic. One year after operation, 91.0% of patients remained in well-palliated condition. At three years after operation, 76.4% of patients continued to be in well-palliated condition. There were twelve neonates in this series. Their age range was 4 to 26 days and their median age was 13 days. There was no operative death. Five patients required second shunt. There were two late deaths. At present, six patients continue to be in well-palliated condition 8 months to 9 years after first operation. Angiographic findings showed the stenotic change of the vascular anastomoses in 49.3% (35/71) of patients. This study suggests that polydioxanone suture (PDS) will be useful for the growth of the anastomoses in Blalock-Taussig operation.

Analysis of adenoid cystic carcinoma treated by radiotherapy

The records of 41 patients with adenoid cystic carcinoma of the head and neck region who had been treated with radiotherapy were reviewed. Local control was achieved in 72.3% in the cases with primary lesions at 5 years. The prognosis for tumors that arose in the major salivary glands was better than that for tumors that arose in the minor salivary glands; however, the difference was not statistically significant. In the minor salivary glands, early-stage tumors were well controlled with the use of radiation therapy alone. In spite of the high local control rate, the disease-free survival rate of the patients at 10 years was only 20.8%. Lung metastasis determined the prognosis.

[A case of pheochromocytoma in pregnancy]

A 29-year-old woman was referred to our hospital at the 34th week of her first pregnancy with a diagnosis of severe pregnancy-induced hypertension. A diagnosis of pheochromocytoma was made by elevated values of serum and urinary noradrenaline. Ultrasonography and computed tomography revealed a left adrenal tumor. Caesarean section combined with removal of the tumor at the 36th week of gestation was performed with a satisfactory result obtaining a healthy mother and an infant. Current management of patients with a pheochromocytoma during pregnancy is discussed.

Structure of the chicken growth hormone-encoding gene and its promoter region

We have cloned the chicken (c) growth hormone (GH)-encoding gene cGH and analyzed its nucleotide sequence including 500 bp of the 5'-flanking region. The cGH gene consists of five exons and four introns as has been observed in the mammalian GH genes. However, the size of the cGH gene is significantly larger than that of analogous mammalian genes, because of its intron size which expands it to 3.5 kb. The transcription start point was determined to be 56 bp upstream from the start codon by the primer-extension analysis. The promoter region of the cGH gene has no overall homology with the corresponding regions of mammalian genes, but contains a short (24 bp) sequence which is highly homologous to the antisense strand sequence of the proximal binding site for a pituitary-specific transcription factor, GHF-1/Pit-1, in the promoter region of the rat GH gene.

Increased soluble CD4 and decreased soluble CD8 molecules in patients with Sjögren's syndrome

PURPOSE

A new enzyme-linked immunosorbent assay for soluble CD4 (sCD4) and soluble CD8 (sCD8) molecules has been developed. We estimated the concentrations of these molecules in patients with Sjögren's syndrome and in patients with systemic lupus erythematosus (SLE) serving as a control population for non-Sjögren's inflammatory disease, since several findings suggestive of an aberration of immunocompetent cells have been reported in these autoimmune diseases.

PATIENTS AND METHODS

The study population consisted of 41 patients with Sjögren's syndrome (28 cases of the primary form and 13 cases of the secondary form), 66 patients with SLE, and 43 normal individuals. Serum samples and clinical and laboratory data were collected from each patient and control. Assays of the sCD4 and sCD8 molecules were performed using an enzyme-linked immunosorbent kit developed by T Cell Science Inc., Cambridge, MA.

RESULTS

The concentration of sCD4 was significantly increased in patients with both primary and secondary Sjögren's syndrome as compared with that in the control subjects. In contrast, sCD8 was significantly decreased in patients with primary disease but not in patients with secondary disease. A low or high concentration of sCD8 was significantly correlated with the presence of anti-SS-A antibody or hypocomplementemia, respectively. A similar significant correlation was noted between an increased sCD4 concentration and increased serum IgG level. In patients with SLE, the levels of both sCD4 and sCD8 were significantly increased.

CONCLUSION

These observations represent the first evidence of an increased level of the sCD4 molecule and a decreased level of the sCD8 molecule and an association with immunologic abnormalities in Sjögren's syndrome. The increased and decreased levels of these soluble molecules observed may play a pathologic role in patients with Sjögren's syndrome.

Cardiac fibroma. Long-term fate after excision

Between 1980 and July 1983 three infants and children with cardiac fibromas underwent surgical resection at Kobe Children's Hospital. Two of them survived and have an excellent clinical result 6 years and 7 years postoperatively. The results of late follow-up with the use of 24-hour dynamic electrocardiography, two-dimensional echocardiography, thallium-201 myocardial scintillation scan, and technetium 99m sodium pertechnetate-gated blood pool imaging have proved that the patients are free of arrhythmic episodes, free of recurrence of tumor, have no significant myocardial perfusion defect, and have normal left ventricular function.

In situ hybridization for the demonstration of bovine leukemia virus transcripts in lymphosarcoma cells using biotinylated probes

Bovine leukemia virus (BLV) RNA was demonstrated in peripheral blood lymphocytes treated with concanavalin A or phytohemagglutinin from a BLV-infected ox, and in lymphosarcoma cells cultured without mitogen from an enzootic bovine leukosis cow by in situ hybridization using biotinylated DNA probes.

[Results of open heart surgery in neonates--comparison between profound hypothermia with circulatory arrest and deep hypothermic bypass]

To investigate factors affecting surgical outcome of open heart surgery in neonates, a retrospective review was carried out on 38 patients operated in the 9 years period from May 1981 to August 1990, in our institution (TAPVR19, TGA7, HLHS7, and others 5). In the former 3 years and 9 month period, 12 patients were operated with the use of profound hypothermia and circulatory arrest (Group I) and in the latest 5 year and 5 month period, continuous deep hypothermic bypass was used in all but for 7 patients with HLHS (Group II). In the group of neonates with TAPVR, operative mortality improved to 7% (1 of 14) in Group II compared to that of 60% (3 of 5) in Group I. CVP and LAP measured immediately after cessation of cardiopulmonary bypass (CPB) were lower in Group II and the value of CPK-MB was significantly lower in Group II. There was a significant negative correlation (r = -0.695, p less than 0.05) between CPB time and urine volume for 72 hours after operation. A significant negative correlation (r = -0.899, p less than 0.01) was also obtained between CPB time and urine volume in the group of 7 neonates with TGA. There was no significant difference in urine volume between patients with TAPVR and TGA despite of significantly longer CPB time in patients with TGA. It is concluded that, 1) improved protection of cardiac and renal function was obtained in neonates operated with the use of continuous deep hypothermic bypass, 2) surgical outcome was influenced by the method of CPB, CPB time and differences in cardiac function ascribed to primary lesions.

The necessity of dietary vitamin B6 to selenium biopotency for tissue selenium and glutathione peroxidase in rats

Necessity of dietary vitamin B6 to the biopotency of selenium (Se) for the levels of Se and glutathione peroxidase (GSH-Px) in tissues was investigated. Male Wistar 12-week-old rats were fed a vitamin B6-Se-deficient basal diet for 3 weeks, and then the rats were divided into 6 groups. One group was fed the basal diet, the others were fed the diet supplemented with 250 micrograms vitamin B6/100 g as pyridoxine.HCl, or 0.25 mg Se/kg as Na2SeO3 (SeL) or DL-selenomethionine (Se-Met), or both (SeL+B6 or Se-Met+B6) for 10 week. The levels of Se and GSH-Px in erythrocytes and muscle were significantly higher in vitamin B6-supplemented groups than in vitamin B6-deficient groups. There was little effect of this vitamin deficiency on Se level in liver of rats fed SeL; however, a higher Se level in liver was observed in vitamin B6-deficient rats fed Se-Met than in the corresponding B6-supplemented rats. A significant decrease of GSH-Px activity in liver was found in vitamin B6-deficient animals fed Se-Met compared with vitamin B6-supplemented animals, whereas no significant decrease was observed in those fed SeL. These results suggest that this vitamin is involved in the transport and deliverance of Se in plasma to the other tissues and the incorporation of Se from Se-Met to GSH-Px in liver.

Alternating current induced otoacoustic emissions in the guinea pig

Injection of alternating current (AC) into the scala media of the guinea pig cochlea induced otoacoustic emissions (OAEs) at the frequency of the AC fundamental, together with harmonic and intermodulation distortion products. Although the waveform of the injected ACs was distorted, probably due to nonlinear polarization of the metal electrodes, and was composed of the fundamental plus distortion products of every order, only a few of the lowest order distortion products were selectively emitted with the fundamental. AC injection at a basal site extended the high frequency limit of OAEs. Electrical stimulation of the crossed olivocochlear bundle inhibited the sideband emissions with little change in the fundamental. OAE was reduced reversibly by temporary impairment of the cochlea due to exposure to fatiguing sound, by intravenous application of furosemide and by temporary anoxia. Irreversible reduction resulted from intracochlear perfusion with excess K+ solution, acoustic trauma and cardiac arrest. These facts imply that AC-induced OAE is not an artifact generated electrically; rather, such emissions originate in the cochlea and normal metabolic activity in the cochlea is essential. A proposed mechanism of generation includes two components: 1) electromechanical transduction from AC to mechanical vibration in the cochlea and 2) a distortion-producing process; the contribution of each component to the receptor mechanism is discussed.

[Successful surgical treatment of primary chylopericardium in infant--a usefulness of intraoperative thoracic ductgraphy]

Asymptomatic eight-year old girl was admitted to our surgical department from ophthalmology complaining enlarged heart size at the routine check before operation of strabismus. By pericardiocentesis it was confirmed that pericardial effusion was chyle biochemically and microscopically. In spite of several medical trials (i.e. diuretics, pericardial drainage, complete starvation with parenteral nutrition), copious amount of chyle discharge, measured 180 ml per day, couldn't be controlled. Mediastinal mass lesion and thoracic duct anomaly were excluded by both thoracic CT and lymphangiography, and primary chylopericardium without thoracic duct anomalies was suspected preoperatively. The diagnosis of primary pericardium was confirmed by intraoperative thoracic ductography which visualized thoracic duct and it's tributaries more clear than that of preoperative lymphangiography. Low thoracic duct ligation with resection of duct 55 mm in length and fenestration of the pericardium through right thoracotomy was successfully carried out. She was discharged on 8th day after surgery without any problems. She is doing well 7 months postoperation after discharge with reduced heart size and returns to normal activity. We concluded that intraoperative thoracic ductography had some advantages in terms of more clear visualization of thoracic duct anastomosis, precise diagnosis of etiology and choice of surgical options.

[Closed stuck valve diagnosed by echocardiogram immediately after mitral valve replacement: a case report]

The patient was a 52-year-old woman who suffered from mitral valve regurgitation due to torn chordae. Mitral valve replacement (Medtronic-Hall 27 mm) was performed on Jan. 30, 1990. Immediately after the operation cardiac pacing was necessary for bradycardia, but one hour later cardiac rhythm changed to atrial fibrillation and the patient received an injection of verapamil. After the treatment of tachycardia, electro-mechanical dissociation (EMD) appeared on monitor. Bed side M-mode echocardiogram disclosed a restriction of the disc opening, but abnormal structures were not detected by B-mode echocardiogram. By repeated echocardiogram, the disc opening was normally demonstrated on M-mode, but B-mode showed an abnormally high echo structure in the left ventricle just below the prosthetic valve. Under the diagnosis of stuck valve in the closed position due to remnants of chordae, reoperation was performed. An eight mm remnant of chorda was found on the posteromedial side of the posterior leaflet, and it was supposed that the compression of the remnant between the disc and the valve ring restricted the valve opening. The remnant was resected through the large orifice of the Medtronic-Hall valve. After the reoperation, EMD was not detected and prosthetic valve insufficiency was not noted on echocardiogram. The patient left the hospital in a good condition three weeks after MVR.

Novel oligomannose-type sugar chains derived from glucose oxidase of Aspergillus niger

The primary structure of the N-linked sugar chains of glucose oxidase from Aspergillus niger was investigated. These sugar chains were released from the polypeptide backbone by hydrazinolysis, and the reducing ends of the sugar chains were pyridylaminated. HPLC of the pyridylamino sugar chains with an amide-silica column showed at least seven sugar chain peaks. Chemical and exoglycosidase digestion and 400 lMHz H-NMR studies of the sugar chains of lower molecular weight showed that these were novel oligomannose-type sugar chains, (Man)5-7 (GlcNAc)2, with the structure: +/- Man alpha 1----3Man alpha 1----3(Man alpha 1----6)Man alpha 1----6(+/- Man alpha 1----3Man alpha 1---3)Man )Man beta 1----4GlcNAc beta 1----4GlcNAc.

Synthesis and expression of genes encoding tuna, pigeon, and horse cytochromes c in the yeast Saccharomyces cerevisiae

Genes encoding tuna, pigeon, and horse cytochromes c were constructed with synthetic oligodeoxyribonucleotides having preferred codons and portions of the iso-1-cytochrome c-encoding gene from the yeast Saccharomyces cerevisiae. The genes were ligated into an expression vector, which contains the normal 5'- and 3'-untranslated regions of the yeast iso-1-cytochrome c gene, and were integrated in single copy into the chromosome. Yeast strains were also constructed with multiple integrated copies of the pigeon gene. The heterologous and normal mRNA levels of the single-copy strains were equivalent. Although the N-terminal methionines were completely cleaved in the heterospecific proteins, the levels of trimethylation of Lys72 and acetylation of N-terminal glycines ranged from 39-78% and 10-70%, respectively. Horse cytochrome c was produced at a nearly normal level, whereas the pigeon and tuna cytochromes c were produced at approx. 40% of the normal levels. The levels of the cytochromes c and growth of the mutant yeast strains indicated that the heterospecific cytochromes c had approx. 50% specific activity in vivo.

Pleomorphic xanthoastrocytoma. Ultrastructural, immunohistochemical, and DNA cytofluorometric study of a case

A case of right frontal pleomorphic xanthoastrocytoma that occurred in a 7-year-old boy is reported clinicopathologically. The patient underwent surgery on September 29, 1988. Histologic diagnosis of pleomorphic xanthoastrocytoma was made because, in addition to the unique pleomorphic histologic features, positive glial fibrillary acidic protein in immunohistochemical staining and characteristic ultrastructural features, i.e., cytoplasmic intermediate fibrils and lipid vacuoles, basal lamina, and abundant reticulin networks were demonstrated. The DNA cytofluorometric analysis of the nuclei of the tumor cells disclosed the main mode to be diploid with polyploid classes (4, 8, 16, and 32C) without any aneuploidy. Despite the presence of many pleomorphic nuclei, DNA histogram of the tumor disclosed very few DNA synthetic cells indicating a biologically inactive nature of the tumor. The patient is still alive and totally asymptomatic 20 months postoperatively.

Pulmonary origin of left anterior descending coronary artery in tetralogy of Fallot

We report the case of a 4-year-old girl with an anomalous origin of the left anterior descending coronary artery from the pulmonary artery in association with tetralogy of Fallot. Creation of an intrapulmonary tunnel from a newly created aortopulmonary window to the coronary ostium in the pulmonary trunk and total repair of tetralogy of Fallot were successfully carried out. The advantage of intrapulmonary tunnel technique (Takeuchi method) for this very rare combination is stressed.