Complete avulsion of the hamstring tendons from the ischial tuberosity. A report of two cases sustained in judo

Rupture of the hamstring tendon is a rare injury. Two cases of complete rupture of the hamstring tendons sustained while playing judo are reported. The diagnosis of a rupture of the hamstring tendons was difficult from physical examination because of severe pain on knee or hip joint movement. Magnetic resonance imaging was non-invasive and showed the lesion clearly. In one of these two cases the less satisfactory results of non-operative treatment were clearly shown in both isokinetic muscle force evaluation and sports activities.

[Hypoplastic mixed lineage leukemia successfully treated with low-dose cytosine arabinoside]

A 54-year-old male was admitted because of dyspnea on exercise. His peripheral blood revealed pancytopenia with severely hypoplastic bone marrow. Bone marrow aspiration showed a marked hypocellular marrow with 62.4% of blast cells. Cytochemical studies showed that peroxidase activity, alpha-nephtyl buthylate esterase activity and PAS reaction were negative, and that only ASD-chroloacetate esterase activity was positive. Surface marker analysis of blast cells showed positive result for CD5, 7, 33 and 34 antigens. The T-cell receptor beta gene was rearranged, but the immunoglobulin H chain gene showed a germ line configuration. Terminal Deoxynucleotydyl Transferase (TdT) was positive, but cellular surface and cytoplasmic immunoglobulin were not recognized. A diagnosis of hypoplastic mixed lineage leukemia was made and treated with low dose cytosine arabinoside, he resulted in complete remission. The relation between hypoplastic leukemia, AML-M0 and mixed lineage leukemia was also discussed.

[Liddle syndrome]

In 1963 Liddle et al. described a disorder that simulated primary aldosteronism, characterized by severe hypertension and hypokalemia but with negligible secretion of aldosterone. They theoried that this was a disorder in which the renal tubules transport ions with such abnormal facility that the end result simulates that of a mineralcorticoid excess. Later, it was postulated that this disorder could be related to the abnormality of amiloride sensitive Na channel. The activity of amiloride-sensitive Na channels constitutes the rate limiting step for Na reabsorption in Na transporting epithelia. Recently, the primary sequence of the rat amiloride-sensitive epithelial Na+ channel (rENaC) was determined by functional expression cloning and shown to be composed of three homologous subunits: alpha, beta, and gamma. Its expression of all three subunits in Xenopus oocytes markedly increased the magnitude of these currents. Analysis of subjects with Liddle's syndrome demonstrates the mutation of carboxy-terminal domain in alpha, beta, and gamma subunits. The mutations are either premature termination, frameshift mutation, or missense mutations.

Progressive dysphagia due to adult Chiari I malformation mimicking amyotrophic lateral sclerosis

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Ultrastructural study of synapses in the anterior horn neurons of patients with amyotrophic lateral sclerosis

This report concerns an ultrastructural examination of the synapses present on the surface of somata of anterior horn neurons of the lumbar spinal cord of seven patients with amyotrophic lateral sclerosis (ALS). Specimens from six age-matched, neurologically normal control individuals were included for comparison. Examination of presynaptic terminals revealed a wide range of changes not only in degenerated neurons (central chromatolytic neurons), but, to a lesser extent, in normal-appearing neurons. The alterations included dense conglomerates of aggregated dark mitochondria and presynaptic vesicles, bundles of neurofilaments, as well as marked increase of presynaptic vesicles. Our observations suggest that in patients with ALS a substantial synaptic alteration does take place in the early stages of anterior horn neuron degeneration and degeneration of axosomatic synapses of anterior horn neurons in ALS may be of consequence on lower motor neuron degeneration.

Determination of enamel protein synthesized by recombined mouse molar tooth germs in organ culture

Epithelial-mesenchymal interaction is a prerequisite for tooth morphogenesis. To study this interaction, inner enamel epithelium and dental papilla mesenchyme of molar tooth germs from a 16.5-day mouse embryo were dissociated enzymatically and cultured alone or after recombination. Characteristic matrix protein synthesized and secreted by recombined tooth germ was determined quantitatively by enzyme-linked immunosorbent assay. The protein was detected in the culture of recombined tooth germ but not of dissociated enamel epithelium alone. The amount of enamel protein increased until 8 days in culture. Morphological differentiation of the recombined epithelial rudiment into ameloblasts and enamel protein production were confirmed.

The mode of rabbit platelet shape change and aggregation induced by theonezolide-A, a novel polyketide macrolide, isolated from the Okinawan marine sponge Theonella sp

Theonezolide-A (TZ-A), a novel polyketide macrolide, isolated from the Okinawan marine sponge Theonella sp., caused a marked platelet shape change at low concentrations (0.2-0.6 microM). Increasing concentrations of TZ-A to 6 microM or more caused shape change followed by a small but sustained aggregation. In a Ca(2+)-free solution, TZ-A-induced aggregation was markedly inhibited, although the marked shape change was still observed. Aggregation stimulated by TZ-A increased in a linear fashion with increasing Ca2+ concentrations from 0.1 to 3.0 mM. Furthermore TZ-A markedly enhanced 45Ca2+ uptake into platelets. Aggregation induced by TZ-A was inhibited by Arg-Gly-Asp-Ser, an inhibitor of fibrinogen binding to glycoprotein IIb-IIIa, H-7 and staurosporine, protein kinase C inhibitors, or genistein and tyrphostin A23, protein tyrosine kinase inhibitors, whereas shape change was blocked by genistein and tyrphostin A23. H-7 or staurosporine did not affect the TZ-A-induced shape change. These results suggest that TZ-A-induced platelet shape change is not dependent on external Ca2+, whereas TZ-A-induced aggregation is caused by an increase in Ca2+ permeability of the plasma membrane. It is also suggested that both aggregation and shape change induced by TZ-A are associated with protein phosphorylation by protein kinase C and tyrosine kinase.

Blood pressure at health screening as a predictor of coronary heart disease in Kyoto

AIM

Most epidemiologic studies that have evaluated coronary risk factors have measured either mortality or morbidity of coronary artery disease (CAD) as endpoints. However, earlier detection and elimination of coronary risk factors are crucial. We therefore performed Master's double (i.e. 1.5 min x 2 = 3 min) two-step exercise electrocardiograph (ECG) test in apparently healthy asymptomatic subjects (men, n = 2274; women, n = 959) to elucidate the risk factors for early-stage CAD or silent myocardial ischemia.

METHODS

We examined the possible association of blood pressure at health screening and other suspected risk factors with exercise ECG test performance. The ischemic ECG response was determined by (1) > or = 0.5 mm horizontal or sagging S-T segment depression, (2) > or = 2.0 mm J-shaped S-T segment depression, or (3) T inversion in post-exercise ECG.

RESULTS

We found that 4.7% of men and 10.6% of women exhibited ischemic responses. Among males, the ischemic responders to the exercise ECG test had higher systolic and diastolic blood pressure. In addition, the male ischemic responders were older, had a higher obesity index, higher serum cholesterol, triglyceride, low-density lipoprotein (LDL)-cholesterol, protein, glucose, and uric acid levels, and a lower serum potassium level than normal responders. In contrast, the female ischemic responders to the exercise ECG test had higher systolic pressure, and higher serum cholesterol, LDL-cholesterol, and protein levels than normal responders. Mean blood pressure was correlated positively with most of the other coronary risk factors, and mild hypertensives and hypertensives had abnormal lipid, glucose, and uric acid levels in both sexes. A comparison of risk factors by age group revealed that only younger and middle-aged ischemic responders had higher blood pressure, serum cholesterol, and glucose levels than normal responders of both sexes, and that in older subjects all the differences between normal and ischemic responders became insignificant.

CONCLUSIONS

Elevated blood pressure at health screening, together with abnormal lipid and glucose metabolism, might be risk factors predicting early-stage or silent CAD. The elimination of these risk factors in younger men and women seems to be important.

Ovariectomy decreases osteogenetic activity in rat bone

The purpose of this study was to investigate the effect of ovariectomy on osteoinductive activity in the bone in rat. Homograft implantation of decalcified humeral diaphysis from ovariectomized or sham-operated rats was performed and harvested after several time periods. A significant decrease in bone induction was found in terms of soft X-ray photography, alkaline phosphatase activity, mineral content and expression of osteocalcin (BGP; bone gla-protein) in the implants from the ovariectomized group in comparison to those from the sham-operated animals. This result suggested that the level of osteoinductive activity, probably due to bone morphogenetic protein, decreased in ovariectomized animals.

[Acute appendicitis caused by mucorales in a patient with severe aplastic anemia: report of an autopsy case]

A male patient with severe aplastic anemia was admitted for bone marrow transplantation. While waiting for a donor, high doses of methylprednisolone, anabolic steroid and granulocyte colony stimulating factor were given without response. Deferoxamine was administered for prophylaxis of hemochromatosis because of high level of ferritin. Acute right lower abdominal pain and pyrexia developed. A diagnosis of acute appendicitis was made and appendectomy was performed. The histopathological examination of the resected appendix revealed necrotizing hemorrhagic appendicitis with numerous hyphae of Mucorales. Though anti-fungal agent (amphotericin B) administration was continued, he subsequently developed ileo-cecal abscess and eventually died due to myoglobinuric nephropathy caused by extensive necrosis of the iliopsoas muscle. Autopsy revealed dissemination of hyphae of Mucorales in lungs, kidneys, large vessels and muscle of the bilateral lower limbs. Systemic vascular invasion and embolization of fungal hyphae were also observed. However, culture of exudate sampled from ileocecum yielded no Mucorales. It was emphasized that antemortem diagnosis and effective anti-fungal treatments are essential for the management of intestinal mucormycosis. The relation ship between mucormyocosis and deferoxamine was also discussed.

Immunohistochemical study of proteoglycans in D-galactosamine-induced acute liver injury in rats

In this study, we carried out an immunohistochemical investigation of time-dependent alterations in the distribution of proteoglycans, and the proliferation profiles of hepatocytes and fat-storing cells (FSCs) in the livers of rats intoxicated with D-galactosamine (GalN). The proliferative cells were analyzed by proliferative cell nuclear antigen (PCNA) staining. In untreated rats, heparan sulfate, dermatan sulfate, and chondroitin/chondroitin sulfate were detected within the portal spaces and the central veins, and, with the exception of chondroitin, also within the reticular fibers. After administration of GalN, the number of PCNA-positive cells (FSCs and hepatocytes) and FSCs increased, reaching maximal on the 2nd and 3rd days, respectively. Heparan sulfate showed complicated changes. Dermatan sulfate decreased in portal spaces from the 2nd to the 3rd day, and in reticular fibers from 12 h to the 6th day. Chondroitin/chondroitin sulfate staining was observed from 2 h to the 6th day in the sinusoidal endothelia, which suggests that the sinusoidal endothelia may produce chondroitin/chondroitin sulfate transiently during liver damage as part of the mechanism of regeneration. Heparan sulfate and chondroitin/chondroitin sulfate were detected in necrotic regions, but dermatan sulfate was not. These observations suggest that heparan sulfate and chondroitin/chondroitin sulfate are involved in cell proliferation or morphogenesis and that the dermatan sulfate plays a role in the differentiation or functional maintenance of cells in liver regeneration.

Dendritic synapses of anterior horn neurons in amyotrophic lateral sclerosis: an ultrastructural study

This ultrastructural study deals with the synapses of primary dendrites of the anterior horn neurons in the lower lumbar spinal cords of seven patients with amyotrophic lateral sclerosis (ALS) who had mild neuronal depletion. Specimens from seven age-matched, neurologically normal individuals served as controls. In each instance, the autopsy was performed within 6 h after death. Our results indicate a statistically significant increase in degenerative changes in the dendrite presynapses of normal-appearing neurons of the ALS patients. The alterations included aggregation of electron-dense synaptic vesicles and dark mitochondria with dense cristae, and bundles of neurofilaments. However, we found no significant difference between controls and patients with respect to cross-sectional area and length of the dendrites, number of synapses per dendrite, and lengths of individual synapses and their active zones in the normal-appearing neurons, even though the patients' neurons had a smaller cross-sectional area. In chromatolytic neurons, the number of synapses and the length of the active zone of the primary dendrites were significantly diminished. These findings suggest that despite degenerative changes of the presynapses, the synapses in the primary dendrites of the anterior horn neurons are preserved at the early stage of ALS. The preservation of these synapses may be due to their relative resistance to degenerative processes, or may represent a compensatory mechanism of the synapses for diminished synaptic function in distal dendrites.

The estrogen receptor locus is associated with a major gene influencing litter size in pigs

Identification of individual major genes affecting quantitative traits in livestock species has been limited to date. By using a candidate gene approach and a divergent breed cross involving the Chinese Meishan pig, we have shown that a specific allele of the estrogen receptor (ER) locus is associated with increased litter size. Female pigs from synthetic lines with a 50% Meishan background that were homozygous for this beneficial allele produced 2.3 more pigs in first parities and 1.5 more pigs averaged over all parities than females from the same synthetic lines and homozygous for the undesirable allele. This beneficial ER allele was also found in pigs with Large White breed ancestory. Analysis of females with Large White breed background showed an advantage for females homozygous for the beneficial allele as compared to females homozygous for the other allele of more than 1 total pig born. Analyses of growth performance test records detected no significant unfavorable associations of the beneficial allele with growth and developmental traits. Mapping of the ER gene demonstrated that the closest known genes or markers were 3 centimorgans from ER. To our knowledge, one of these, superoxide dismutase gene (SOD2), was mapped for the first time in the pig. Analysis of ER and these linked markers indicated that ER is the best predictor of litter size differences. Introgression of the beneficial allele into commercial pig breeding lines, in which the allele was not present, and marker-assisted selection for the beneficial allele in lines with Meishan and Large White background have begun.

Firing characteristics of neurones in the superior colliculus and the pontomedullary reticular formation during orienting in unrestrained cats

Cats were trained to fixate a center LED or light spot for 1-10 s and to orient to a target (LED or light spot), which appeared simultaneous with the disappearance of the fixation light. Firing characteristics of neurones in the superior colliculus (SC) and the pontomedullary reticular formation were examined systematically in cats performing the above orienting task. In the head-free condition, a majority of the superficial neurones in the SC was activated when a target appeared in a particular area in the visual field (receptive field) as in head fixed animals. We identified a new group of neurones in superficial layers of the SC, superficial fixation neurones, which fired tonically when fixated on a target light with little activity at fixating a center fixation light. In the intermediate and deep layers of the SC, many neurones fired when directed to a particular area in the visual field (movement field). In addition to these neurones, we found new groups of neurones fired tonically in a particular phase of orienting. These neurones were divided into three principal types, target activated, target suppressed and center fixation activated neurones. Target activated neurones fired tonically during the fixation of a target, but not during fixation of a center spot. Target suppressed neurones were characterized by a pause during fixation of targets irrespective of their location. They had clear phasic and tonic components. The phasic component was characterized by a movement field resembling that seen in a typical intermediate layer neurone. Center fixation activated neurones discharged during fixation of the center spot and exhibited suppression during fixation of the target. Many neurones in the pontomedullary reticular formation fired during orienting. Four major types of neurones, phasic, phasic sustained, pause and tonic neurones, were differentiated on the basis of their firing patterns. Phasic units were characterized by brief phasic firing during orienting and could be divided into four subtypes. Long lead phasic neurones began to fire 50-100 ms prior to the onset of a gaze shift and stopped well before the end of the gaze shift and the total number of firing was best correlated with the total angle of head rotation. Short lead phasic neurones started to fire 10-20 ms prior to a gaze shift and were further subdivided into decrement and plateau types. The decrement type exhibited a brief burst just prior to gaze shift and stopped discharging prior to the end of the gaze shift, while the plateau type fired tonically during the gaze shift and stopped firing after the gaze shift. Total number of discharges of both type was related to maximal angular velocity. The fourth type, gaze neurone, began firing coincident with the onset of the gaze shift and stopped firing at the completion of the gaze shift and the total number of discharges was closely related to total angle of head rotation Phasic sustained (PS) neurones fired 50-100 ms before the onset of a gaze shift and their discharges continued after the end of the gaze shift and were divided into three subtypes: augmenting, pause and plateau. The augmenting type was characterized by a transient increase of firing during the gaze shift and a maintained slow rate of firing following the gaze shift. Total number of discharges related to head movement amplitude and the sustained activity was correlated with head position. The pause type was suppressed during the gaze shift and was tonically active during a head movement. The plateau type had a weak phasic component and discharged at a fairly constant rate. The pause and plateau types appeared to be related to head amplitude and head position, respectively. Tonic units were classified into several types. Target fixation neurones exhibited sustained firing when the cat was fixating a target, irrespective of its location, but did not show sustained firing when the animal fixated the fixation light. Fixation neurones fired tonical

Role of vasopressin V2 receptor in acute regulation of aquaporin-2

Aquaporin-2 (AQP-2) has been shown to be a vasopressin-sensitive water channel in collecting duct (CD) cells of the kidney. To prove the role of the vasopressin V2 receptor (V2R) in the regulation of intracellular AQP-2 shuttling, we examined the acute effects of vasopressin and V2R antagonist on the distribution of AQP-2 in the cells. Normal Wistar rats were given continuous infusions of vasopressin, vasopressin V2R antagonist (OPC31260), or both. The kidneys were then processed for immunofluorescent studies with an affinity-purified specific antibody to AQP-2. One hour after the infusion of the V2R antagonist, AQP-2 staining was diffusely distributed in the CD cells from the cortex to the inner medulla. This tendency was not changed by the concomitant infusion with vasopressin. Vasopressin infusion without antagonist, however, induced intensified AQP-2 staining of the apical membrane in the CD cells. The ratio of the fluorescence intensity of the apical to subapical region was determined by confocal laser microscopy. In the inner medulla, this ratio was significantly increased in the vasopressin treatment group (2.26 +/- 0.76) as compared to the V2R antagonist group (1.03 +/- 0.34) and the combined treatment group (0.84 +/- 0.43). The increase in the ratio was also demonstrated in the cortex and the outer medulla in the vasopressin-treated group. In addition, Northern blotting studies clearly revealed that mRNA of AQP-2 in the vasopressin-treated group was increased when compared to the combined treatment animals. Our present results reveal that localization and gene expressions of AQP-2 are acutely regulated via vasopressin V2R.

A survey of blood pressure distribution in Pygmy and Bantu populations in Cameroon

A blood pressure survey was performed in isolated Pygmy communities and Bantu population samples living either in close relationship with the Pygmies or in separate areas within the same region. The Pygmies are still living as hunter-gatherers, whereas the Bantus rely on agriculture for food provision. Mean blood pressures in Pygmies were 130/85 mm Hg in males and 126/80 mm Hg in females and in Bantus were 137/87 mm Hg in males and 136/84 mm Hg in females. In spot urine the mean urinary sodium concentration was higher in Bantus than Pygmies (86 versus 37 mmol/L in males; 95 versus 56 mmol/L in females). In the total population urinary potassium concentration was very high (150 mmol/L), calcium concentration very low (0.4 mmol/L), and urea concentration low (6.9 g/L). After adjustment for age, height, weight, and sex, no racial differences in blood pressure were present. Blood pressure increased with age but body mass index did not. Diastolic pressure correlated significantly but negatively with urinary sodium in multiple regression analysis. Our study demonstrates that blood pressure increases with age in hunter-gatherer populations on a low to moderately high sodium diet in the presence of a low urinary excretion of calcium coupled with a low protein intake.

Detection of sex-determining region in a male with chromosomal abnormality (46,X+mar) and hypospadias

A 1-year-old boy was referred to us because of abnormal external genitalia; that is, his penis was kinked toward the perineal region. We diagnosed hypospadias. Chromosomal examination was performed on a sample of peripheral blood, the karyotype was 46,X+mar. Detailed karyotypic analysis revealed that the short arm of the marker chromosome originated on the ninth chromosome, but we could not determine whether the long arm was part of the Y chromosome, even with the use of quinacrine mustard. The sex-determining region of the Y was detected using the polymerase chain reaction method, which suggested that the long arm of the marker chromosome was delivered from the short arm of the Y chromosome.

Molecular structure of the mouse amelogenin genomic DNA

A genomic DNA clone (14.5 kbp) for amelogenin, a tooth enamel specific protein, has been isolated from a mouse genomic library. The nucleotide structure of this DNA was determined by the polymerase chain reaction and sequence analysis. The result indicated that the cloned DNA contained all the exons in addition to approximately 5.5 kbp of upstream sequence.

[Chronic myelocytic leukemia associated with cytomegalovirus induced sialoadenitis after unrelated allogeneic bone marrow transplantation]

A 26-year-old male with chronic myelocytic leukemia was admitted for unrelated allogeneic bone marrow transplantation (BMT). After BMT, he developed swelling of biateral submandibular glands accompanied with pneumonitis possibly due to cytomegalovirus (CMV). Biopsy from the left submandibular gland showed giant cells with nuclear inclusion bodies that were positive for anti-CMV-IE monoclonal antibody, there fore cytomegalic sialoadenitis was diagnosed. The administration of ganciclovir resulted in resolution of the pnumonitis and submandibular gland swelling. Although cytomegalic sialoadenitis is not a life-threating complication in BMT patients, it should be noted that biopsy is very useful for the diagnosis of systemic cytomegalovirus infection.

[One-stage urethroplasty with the modified OUPF IV for proximal hypospadias]

BACKGROUND

We previously performed one-stage urethroplasy with OUPF IV in 17 patients with proximal hypospadias and experienced meatal stenosis in 3 and meatal regression in 2.

METHODS

Because these complications seemed to be caused by diminished vascularity, we modified the technique to preserve the vascularity to the peripheral site of the neourethra. The modified OUPF IV (Koyanagi) was used to treat 6 patients with proximal hypospadias during the last 3 months.

RESULTS

Urethrocutaneous fistulas developed in 2 patients but meatal stenosis and meatal regression did not occur.

CONCLUSION

We think this modification is suitable for severe proximal hypospadias.