Choriocarcinoma in infant and mother: a case report

We present a case of gestational choriocarcinoma that developed in a pregnant woman with metastases to her baby. In this case, severe anemia and hepatomegaly of the baby were noticed after delivery. Despite intensive treatments, the tumor progressed rapidly, and the baby died at the age of 38 days. Accurate diagnosis was made after autopsy. When the baby's mother visited our hospital again at 4 months postpartum, there were widespread multiple metastases to her lungs and liver. We want to emphasize that if a neonate or infant has anemia and/or hepatomegaly, it is necessary to be aware of the possibility of infantile choriocarcinoma with the presence of an occult tumor in the mother and to examine the mother's and infant's hCG levels immediately.

Unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries

To extend the indications for corrective operation in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries, surgical procedures were done to unify the blood sources for pulmonary perfusion. Since December 1985, 50 patients have undergone unifocalization at ages from 2 months to 26 years with a mean of 6 +/- 7 years. In total, 84 staged unifocalization procedures and 5 other palliative procedures were done in 49 patients. These included several operative procedures: simple ligation of major aortopulmonary collateral arteries in 8; pulmonary angioplasty in 29 including reconstruction of the pulmonary arterial tree by direct anastomosis or interposition between the central pulmonary arteries and the intrapulmonary arteries; construction of artificial central pulmonary arteries with use of a xenograft pericardial tube graft in 36 with no native central pulmonary arteries detected; and construction of supplemental central pulmonary arteries also with use of a pericardial tube graft in 10. The pericardial tube graft, if used, was anastomosed to the intrapulmonary arteries on one end and connected to a prosthetic tube on the other end so as to perfuse the reconstructed pulmonary arteries. The anastomosis was made inside the lung through the divided interlobar fissure. Five patients died after operation among those undergoing these 89 preparative operative procedures. Deaths were related either to bleeding caused by anticoagulation therapy administered to prevent thrombosis within the xenograft pericardial tube graft used or to progressive congestive heart failure as a result of an excessive amount of pulmonary blood flow. Twenty-six patients have undergone intracardiac repair after previous unifocalization. In 16 patients the artificial central pulmonary arteries surgically constructed were connected to each other and then an external conduit was placed. In another patient, intracardiac repair and unifocalization could be concomitantly achieved via a median sternotomy. The right ventricle to left ventricle systolic pressure ratio immediately after intracardiac repair in 27 patients ranged from 0.24 to 0.91 with a mean of 0.54 +/- 0.17. One patient (4%) died shortly after intracardiac repair because of thrombosis within the pulmonary arteries. Postoperative catheterization showed that pulmonary vascular resistance was correlated significantly with the number of pulmonary vascular segments functioning rather than with the condition of the central pulmonary arteries. We conclude that surgical unifocalization is a feasible procedure before subsequent intracardiac repair, even in patients with critically hypoplastic or absent central pulmonary arteries.

The sites of origin and termination of afferent and efferent components in the lingual and pharyngeal branches of the glossopharyngeal nerve in the Japanese monkey (Macaca fuscata)

Afferent and efferent components in the lingual and pharyngeal branches of the glossopharyngeal nerve (Li and Ph) of the Japanese monkey (Macaca fuscata) were examined. After injecting wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) unilaterally into the central cut end of the Li and Ph, or into the stylopharyngeal muscle, labeled neuronal cell bodies and terminal labeling were observed in the medulla oblongata, peripheral ganglia of the glossopharyngeal and vagus nerves, and cervical ganglia of the sympathetic trunk. The following conclusions were deduced from the results. The Li contains efferent fibers from the inferior salivatory nucleus, and superior cervical ganglion. The afferent fibers in the Li are composed mainly of peripheral processes of ganglion neurons in the superior and petrous ganglia of the glossopharyngeal nerve, and additionally of those of ganglion neurons in the jugular ganglion of the vagus nerve. The afferent fibers in the Li terminate mainly in the lateral division of the nucleus of the solitary tract, and additionally in the dorsal aspect of the lateral marginal region of the interpolar spinal trigeminal nucleus. The Ph is mainly composed of efferent fibers from the ambiguous nucleus and superior cervical ganglion; only a small number of afferent fibers from the sensory ganglia of the glossopharyngeal and vagus nerves are contained in the Ph. Stylopharyngeal motoneurons are distributed in the retrofacial part of the ambiguous nucleus.

[Appearance of antibacterial activity of oxacillin against methicillin resistant Staphylococcus aureus (MRSA) in the presence of catechin]

We previously reported that tea catechin shows bactericidal activity against various bacteria including methicillin resistant Staphylococcus aureus (MRSA) and that bactericidal catechin damages the lipid bilayer of bacterial cell membranes. Here we describe that oxacillin (MPIPC) shows antibacterial activity against MRSA in the presence of catechin below MIC. Twenty clinical isolates of MRSA were examined by a cup method. In the absence of catechin, MPIPC even at a concentration of 40 micrograms/ml did not show antibacterial activity against all isolates of MRSA. However, when catechin below MIC (25-100 micrograms/ml) was mixed with the agar medium, MPIPC (5-12.5 micrograms/ml) showed antibacterial activity against all MRSA isolates. By counting the numbers of viable bacteria in a broth culture, only MPIPC (5 micrograms/ml) or catechin (100 micrograms/ml) showed similar growth curves to the control. But addition of both MPIPC and catechin reduced the number of viable bacteria to 1/100-1/10000 after 24 hours of cultures. Besides MPIPC, in the presence of catechin below MIC methicillin (12.5 micrograms/ml), aminobenzylpenicillin (32 micrograms/ml), tetracycline (2.5 micrograms/ml), and chloramphenicol (12.5 micrograms/ml) showed antibacterial activities against multiple drug resistant MRSA to antibiotics mentioned above. These findings suggest a possible use of catechin in the treatment of MRSA infection.

HYS2, an essential gene required for DNA replication in Saccharomyces cerevisiae

To investigate cell cycle regulation at the S or G2 phase in Saccharomyces cerevisiae, we have isolated mutants displaying supersensitivity to hydroxyurea (HU), a chemical that inhibits DNA replication. Such mutants, which we have named hydroxyurea sensitive (hys), defined four linkage groups and we characterized the hys2 mutation in this study. The hys2-1 mutant displays temperature sensitive growth and a constellation of phenotypes indicating defective DNA metabolism. At the restrictive temperature, hys2-1 cells arrest as large budded cells with a single nucleus at the neck of the bud and a short spindle. The hys2-1 mutant exhibits increased rates of chromosome loss and recombination. Additionally, hys2-1 appears to accumulate incompletely replicated DNA that can be detected by a pulse field electrophoresis assay. Finally, deletion of RAD9 in a hys2-1 strain decreases the percentage of arrested cells, suggesting that an intact RAD9-checkpoint is required for the cell cycle arrest in hys2-1 cells. HYS2 encodes a 55 kDa protein that is essential for viability at all temperatures. Taken together, these data suggest that Hys2 plays a role in DNA replication.

An anterograde-retrograde labeling study of the carotid sinus nerve of the Japanese monkey (Macaca fuscata)

The sites of origin and termination of efferent and afferent fibers in the carotid sinus nerve (CSN) were investigated in the Japanese monkey. After application of a mixture of horseradish peroxidase (HRP) and wheat germ aggulutinin-conjugated HRP to the central cut end of the CSN, sensory ganglion neurons were labeled in the jugular ganglion of the vagus nerve, as well as in the superior and petrosal ganglia of the glossopharyngeal nerve. Many sympathetic ganglion neurons were also labeled retrogradely in the superior cervical ganglion. In the brain, many labeled terminals were seen ipsilaterally in the lateral division of the nucleus of the solitary tract (NST). A few neuronal cell bodies were also labeled ipsilaterally in a reticular region dorsomedial to the caudal one-third of the facial nucleus. The results indicate that the CSN of the Japanese monkey is composed mainly of afferent fibers terminating in the NST, that the afferent fibers in the CSN originate not only from the superior and petrosal ganglia of the glossopharyngeal nerve but also from the jugular ganglion of the vagus nerve, and that efferent fibers contained in the CSN arise from the medullary reticular formation and superior cervical ganglion.

Changes in prostatic thickness and the location of ejaculatory ducts in autopsy prostates

OBJECTIVE

To measure prostatic thickness and the depth of ejaculatory ducts from the urethral surface to prevent ejaculatory duct damage during transurethral balloon laser thermotherapy.

MATERIALS AND METHODS

In 47 prostates obtained at autopsy, the prostatic thickness and the depth of ejaculatory ducts from the urethral surface were measured in eight directions from the centre of the urethra.

RESULTS

The depth of ejaculatory ducts was approximately 6 mm from the urethral surface regardless of prostatic weight. Increase in prostatic weight was associated with increase in the thickness in all directions except the posterior one; the thickness ranged from 9 to 20 mm. The posterior thickness at the level of the transition zone was 10 mm regardless of prostatic weight.

CONCLUSION

When benign prostatic hypertrophy is treated transurethrally, using laser or microwave equipment, care should be taken to avoid heating the posterior region of the prostate.

Defective blood coagulation is not causative of hepatic haemorrhage induced by microcystin-LR

Male rats were intraperitoneally administered a lethal dose of microcystin-LR (a toxin of cyanobacteria). Prior to haemorrhage in the liver, blood coagulation and platelet aggregation activities were measured. The number of cellular components, white blood cells, red blood cells and, especially, platelets, decreased 1-1.5 hr after the injection. Plasma kaolin-activated partial thromboplastin time was prolonged and fibrinogen concentration was reduced, but antithrombin III activity and fibrin degradation product concentration were not significantly changed. Platelet aggregation was not affected for up to 0.5-1.0 hr after administration. Sequential analyses of those parameters and hepatotoxic markers indicate that those hematologic changes as well as the hepatic injury occur suddenly after the massive bleeding. These results suggest that microcystin-LR does not directly act on the haemostatic system to cause a disseminated intravascular coagulation-like state. The decrease in blood coagulation activity and platelet particle concentration may be the results of secondary consumptive effects following the hepatic haemorrhage.

Developmental toxicity study of piperonyl butoxide in CD rats

Piperonyl butoxide was administered to pregnant rats by gavage at a level of 0 (control), 630, 1065, and 1800 mg/kg bw on days 11-12 of gestation. The animals were killed on day 20 of gestation. Average maternal body weight gain (gestational days 11-20) was significantly reduced in the 1065 and 1800 mg/kg bw groups. Total resorption rate was significantly increased in the 1800 mg/kg bw group and those effects were significantly dose-related. The average fetal body weight of each sex was significantly reduced in the 1065 and 1800 mg/kg bw groups. External limb deformity (oligodactyly, syndactyly, and polydactyly) was significantly increased in the 1065 and 1800 mg/kg bw groups in a dose-related manner. The dose levels of piperonyl butoxide in the present study produced limb deformities in rats.

Haemorrhagic toxicity of a large dose of alpha-, beta-, gamma- and delta-tocopherols, ubiquinone, beta-carotene, retinol acetate and L-ascorbic acid in the rat

Antioxidants occasionally have become prooxidants when a large amount was ingested. The haemorrhagic toxicity of butylated hydroxytoluene, a synthetic antioxidant, may involve such a mechanism. This study investigated whether haemorrhage is induced by overdoses of tocopherols, beta-carotene, ubiquinone or L-ascorbic acid, which are representative biological antioxidants. Male Jcl:SD rats (six rats/group) were fed d-alpha, d-beta, d-gamma or d-delta-tocopherols, ubiquinone Q-10, beta-carotene or retinol acetate at a level of 0.5%, or L-ascorbic acid at 5% in the diet for 7 days. Only two rats given retinol acetate died with lung haemorrhages. Haemorrhages were observed in five or six, six, one, one, one or one of six surviving rats given d-alpha, d-beta or d-gamma-tocopherols, ubiquinone Q-10, beta-carotene or retinol acetate, respectively (except for a retinol group in which four rats survived). Major haemorrhages were noted in the epididymis. In the alpha-, beta- and gamma-tocopherol, ubiquinone Q-10, beta-carotene or retinol acetate-treated groups, prothrombin and kaoline-activated partial thromboplastin time indices were 26-28, 37, 59, 42, 63 and 65% or 27-28, 35, 65, 38, 59 and 28%, respectively, of the control values. Only the prothrombin index was significantly decreased to 67% in delta-tocopherol-administered rates, whereas controls and those receiving L-ascorbic acid showed no signs of bleeding or coagulation defect. The same tendency was also seen in the decreasing effect on vitamin K-dependent blood coagulation factors. These results suggest that the four naturally occurring tocopherols have a tendency to cause haemorrhage in the order of alpha > beta > gamma > delta, and ubiquinone Q-10 and beta-carotene als0o have relatively strong and weak haemorrhagic effects, respectively, with regard to prothrombin and partial thromboplastin time indices.

Distribution of GABA-immunoreactive premotor neurons projecting to the trigeminal motor nucleus in the rat

The distribution of neuronal cell bodies with gamma-aminobutylic acid (GABA)-like immunoreactivity projecting to the trigeminal motor nucleus were examined in the rat brainstem by the retrograde transport of horseradish peroxidase (HRP) and immunofluorescence methods. After HRP injection into the unilateral trigeminal motor nucleus, retrogradely labeled neurons which showed GABA-like immunoreactivity were observed throughout the parvocellular reticular nucleus in the pons with ipsilateral predominance. A few neurons were encountered in the contralateral supratrigeminal nucleus, ipsilateral caudal pontine reticular nucleus. All labeled neuronal cell bodies were small or of medium size; no large cells were labeled. The results indicated that cell bodies of GABAergic premotor neurons projecting to the trigeminal motoneurons were mainly located in the bilateral parvocellular reticular nucleus of the pons.

Piperonyl butoxide induces hepatocellular carcinoma in male CD-1 mice

Male CD-1 mice in groups of 52, 53 or 100 were administered piperonyl butoxide (alpha-[2-(2-butoxyethoxy)ethoxy-4,5-methylenedioxy-2-propyltol uene) in the diet at levels of 0 (control), 0.6 and 1.2% for 12 months. Hepatocellular carcinoma was induced in treated groups in a dose-dependent manner but not in the control group. The incidences of hepatocellular carcinoma were 11.3 and 52.0% in mice given 0.6 and 1.2% piperonyl butoxide, indicating that piperonyl butoxide can cause hepatocellular carcinoma in mice as it is known to do in rats.

[Successful aortic root replacement with pulmonary autograft in two infants]

Two infants with congenital aortic valve stenosis underwent successful aortic root replacement with pulmonary autograft. One of the patients was 9 months and weighted 4.2 kg, and the other was 10 weeks weighing 4.6 kg. The former had undergone balloon valvotomy with a resultant severe aortic regurgitation. Operative method was basically similar to that taught by Ross. In terms of the right ventricular outflow reconstruction, however, left atrial appendage was utilized as the posterior wall while equine pericardial monocusp patch formed the anterior wall in the former patient. In the latter, morphology of the left atrial appendage was not suitable for the same kind of reconstruction, and nonvalved equine pericardial tube was used. Both of the patients eventually gained satisfactory circulatory condition. Advantages of aortic root replacement with pulmonary autograft are good competence without residual stenosis, avoidance of anticoagulation, and the high potential of future growth. So this operation is especially indicated for neonates and infants with left ventricular outflow obstruction.

Developmental toxicity evaluation of piperonyl butoxide in CD-1 mice

Piperonyl butoxide was administered to pregnant mice by gavage at a level of 0 (control), 1065, 1385 and 1800 mg/kg body weight only on day 9 of gestation. The animals were sacrificed on day 18 of gestation. Early and late foetal deaths were significantly increased in the higher dose groups and those effects were significantly dose-related. The average body weights of male and female foetuses were significantly reduced in a dose-related fashion. The external malformation of oligodactyly in forelimbs was significantly increased in higher treatment groups in a dose-related manner. The dose levels of piperonyl butoxide in the present study produced adverse effects on developmental parameters.

[The significance of six sextant biopsy for prostate cancer]

The significance of six sextant ultrasound guided biopsies of the prostate (SS-biopsy) was evaluated in a total of 114 patients. The presence of prostate cancer was suspected (Pca) in 59 subjects through mass screening (MS) for Pca and in 47 patients in out-patient clinics (OPC). The recurrence (REC) was suspected in 3 patients diagnosed previously as Pca. All of them had elevated PSA, abnormal digital rectal examination (DRE) and/or abnormal transrectal ultrasonography (TRUS). All of these tests in 5 patients with benign prostate hypertrophy (BPH) were normal. Moreover, in 34 patients among them, oriented biopsies were performed to the area where Pca was suspected by DRE and or TRUS. Twelve Pca patients were detected in MS group (20.3%), 17 Pcas in OPC group (36.2%) and 3 Pcas in REC group (100%). No Pca patients were detected in BPH group. In 12 Pca patients with T1 or T2, only one Pca patient (8.3%) had over 3 Pca samples among the samples obtained by SS-biopsy. In 20 patients with T3 or T4, 13 patients (65%) had over 3 Pca samples. There was significant relationship between T category and Pca sample numbers among 6 samples obtained by SS-biopsy (p < 0.01). Ten of 12 Pca patients in MS group (83.3%) and 8 of 17 patients in OPC group (47.1%) had less 3 Pca samples. Pca was detected in 9 of 34 patients examined by the oriented biopsy. However al of these Pca were detected by SS-biopsy. It may be not necessary to examine Pca suspected patients by the oriented biopsy if they were examined by this SS-biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic toxicity studies of piperonyl butoxide in F344 rats: induction of hepatocellular carcinoma

Male and female F344 rats (30-33 rats/group) were administered piperonyl butoxide (alpha-[2-(2-butoxyethoxy)ethoxy]-4,5-methylenedioxy-2-propylto luene) in the diet at levels of 0 (control), 0.6, 1.2, and 2.4% for nearly 2 years. Beginning at about 40 weeks, 10 rats in the 1.2% treated male group died due to cecal hemorrhages. Piperonyl butoxide induced hepatocellular carcinoma in both sexes in a dose-dependent manner. Hepatocellular carcinoma was found even in the 1.2% treated male group (incidence, 26.7%), and incidences in the 2.4% groups of males and females were 80.0 and 57.7% respectively of all those surviving. Piperonyl butoxide also caused essential thrombocythemia with a dose-response relationship. Hemorrhages in stomach and cecum, anemia, degenerative lesions of alveoli, and nephrotoxicity were also observed related to exposure. These results indicate that piperonyl butoxide is a hepatocarcinogen to the rat.

Solution structure of HIV-1 protease-allophenylnorstatine derivative inhibitor complex obtained from molecular dynamics simulation

Structures of two enzyme-inhibitor complexes of human immunodeficiency virus-1 protease with allophenylnorstatine derivatives were obtained from molecular dynamics simulation in aqueous solution. The stronger inhibitor gave considerably smaller fluctuation at P3 site, which formed hydrogen bonding with the enzyme flap region.

A large dose of ergocalciferol does not cause deficient blood coagulation but is extremely toxic to rats

Male Jcl:SD rats were fed vitamin D2 (ergocalciferol) at levels of 0 (control), 0.39, 0.63 and 1.00% or 0 (control), 0.0195, 0.0315 and 0.050% in the diet for 7 days. All rats of the 0.39-1.00% groups expired on days 2 and 3, while some rats of the 0.0195-0.050% groups died on days 3-6. LD50 (median lethal 7-day cumulative dose calculated from food intake) is 110.5 mg/kg (0.0354% dietarily). In expired and surviving treated rats, several organs (kidney, heart, etc.) were found to be mineralized; there were also renal tubular injuries and pulmonary bleeding. Centrilobular necrosis of liver was detected only in dead rats. Treatment also caused hypercalcemia but did not decrease blood coagulation factors. These results suggest that vitamin D does not have the effect of impeding blood coagulation but that it is extremely toxic, probably due to the hypercalcemia it causes.

Three generation toxicity study of butylated hydroxytoluene administered to mice

Butylated hydroxytoluene (BHT) was administered to mice, from 5 weeks of age of the F0 generation to the weaning of the F2 generation, in the diet at levels of 0 (control), 0.015, 0.045, 0.135, and 0.405%, and some reproductive and neurobehavioural parameters were measured. There was no consistent significant effect on number of litters, litter size, and litter weight at birth for each generation. The body weight of the pups of the 0.015% BHT group was increased at birth and during the lactation period for each generation. In the F2 generation, the body weights of the pups of other treatment groups were increased during the lactation period, particularly at postnatal day (PND) 21. In the neurobehavioural parameters, a few parameters were increased in treatment groups; i.e., surface righting at PND 7 in the F1 generation, surface righting at PND 4 and negative geotaxis at PND 7 in the F2 generation. The dose levels of BHT in this study showed little adverse effect on reproductive and neurobehavioural parameters on mice.

[Evaluation of surgical treatment in patients over 80 years of age with lung cancer]

Seventeen lung cancer patients over 80 years of age were treated surgically at Kanazawa University Hospital from 1973 to 1991. The operative procedures were lobectomy (six patients), segmentectomy (seven patients), partial resection (three patients) and exploratory thoracotomy (one patient). Absolutely curative resection was done in two patients, relatively curative resection in two, relatively non-curative resection in ten, absolutely non-curative resection in two. The three-year survival rate after operation for all seventeen patients was 60.2%. Postoperative complication developed in eleven patients (64.7%). Patients who had lobectomy with mediastinal lymph node dissection had a high incidence of postoperative complications. In recent years, pulmonary resections have been performed in patients over 80 years of age who have been managed with pulmonary rehabilitation, resulting in better course. It is concluded that the limited resections produce good prognosis in patients over 80 years of age with lung cancer.

[Surgical management of tetralogy of Fallot with absent pulmonary valve in infancy]

Between November, 1987 and May, 1990, definitive operation was performed in 7 infants for tetralogy of Fallot with absent pulmonary valve. Preoperative respiratory failure was serious in 5 patients and semi-emergency operation was done. Surgical procedure consisted of closure of ventricular septal defect, reconstruction of right ventricular outflow tract using heterograft valved pericardial roll and plication of aneurysmally dilated pulmonary artery with or without pulmonary artery suspension in 5 infants with severe respiratory distress and heart failure, operated on 26 days to 5 months of age. In the other two less symptomatic infants, operated on at 13 months of age, reconstruction of right ventricular outflow tract was performed by transannular bovine pericardial patch with monocusp. There were no operative death and six infants are doing well 6 months to 3 years postoperatively, but one patient died of prolonged respiratory infection and respiratory failure one year after operation. Postoperative pulmonary arteriogram revealed a 42 to 61 (mean 54) percent reduction in right and left pulmonary artery size in 3 patients who underwent extensive plication of pulmonary artery. We suggest that definitive plication with or without suspension of pulmonary artery, together with closure of ventricular septal defect and reconstruction of right ventricular outflow tract is supposed to eliminate air way obstruction.