[Immunohistochemical analysis of expression of angiogenic factors and tumor angiogenesis in superficial bladder cancer]

PURPOSE

We evaluated expression of angiogenic factors, tumor vessel density and recurrence in superficial bladder cancer by immunohistochemistry.

METHODS

Fourty tumor specimens from bladder preserving operation and 11 normal epithelia were stained for factor VIII-related antigen, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and acidic fibroblast growth factor (aFGF). Maximum vessel density (MVD) was counted in a 200x field in the highest vascularized area stained for factor VIII. Superimposing a 4 x 4 square ocular grid on the boundary between epithelium and interstitium, average vessel density (AVD) and vascular surface density (VSD) were calculated by dividing the vessel number in the grid and the intersection number of vessel walls on the lattice lines by the area of interstitium calculated from the number of the gird cross points, respectively.

RESULTS

Positive rates of VEGF, bFGF and aFGF by immunohistochemistry were 50%, 23% and 43% in the superficial bladder cancer, respectively. The positive rate of VEGF staining was higher in G2-3 tumors than in G1 tumors. All normal epithelia, except one which was positive for aFGF, was negative for those three factors. T1 tumors had a higher MVD than that of Ta. AVD and VSD of the tumor were higher than those of normal epithelium, but negative correlation between the number of positive angiogenic factors and the vessel density was revealed. The recurrence group had a lower vessel density and a higher ratio of VSD/AVD than those of the non-recurrence group.

CONCLUSION

These findings suggest that the expression of VEGF, bFGF and aFGF was not reflected by the tumor angiogenesis, the angiogenesis is required topically at the invasive front of the superficial bladder cancer, and the tumor which had fewer and broader tumor vessels has a high tendency to recur.

Alterations of retinal microcirculation in response to scatter photocoagulation

PURPOSE

To perform acridine orange digital fluorography on rats after scatter photocoagulation to investigate alterations of retinal microcirculation at the capillary level, the authors used leukocyte dynamics as a parameter.

METHODS

Twenty-five pigmented rats (Long-Evans) were studied. Argon laser photocoagulation, extending 6 disc diameters from the optic disc, was delivered to one half of the retina, and the other half was untreated. The total number of burns was 200 +/- 10. Leukocyte hemodynamics in retinal microcirculation were evaluated 4, 7, 14, and 28 days after photocoagulation by acridine orange digital fluorography. The fundus image was obtained by using an argon laser in a scanning laser ophthalmoscope and was recorded on magnetic tapes at a video rate. The images were analyzed by a personal computer-based image analysis system.

RESULTS

Leukocyte velocities in the retinal capillaries were significantly decreased immediately after photocoagulation. In the laser-treated area, mean capillary leukocyte velocities were 0.73, 0.92, 1, and 1.3 mm/second on days 4, 7, 14, and 28, respectively (velocity in normal control animals 1.4 mm/second). In addition, leukocyte hemodynamics were compromised in the untreated retina: Mean capillary leukocyte velocities were 0.88, 1.1, 1.2, and 1.3 mm/second on days 4, 7, 14, and 28, respectively. Twenty-eight days after photocoagulation, the velocities recovered to normal values in the treated and the untreated areas of the retina.

CONCLUSIONS

Retinal capillary hemodynamics were impaired after scatter photocoagulation, and the hemodynamics in the untreated retina were also affected. Photocoagulation to the retina may influence capillary hemodynamics by diffusible chemical substances and by direct tissue injury.

In vivo evaluation of leukocyte dynamics in retinal ischemia reperfusion injury

PURPOSE

To evaluate quantitatively leukocyte dynamics in vivo in the rat retinal microcirculation during ischemia reperfusion injury with the use of acridine orange digital fluorography.

METHODS

Retinal ischemia was induced in anesthetized pigmented rats by a temporary ligation of the optic nerve. After 60 minutes of ischemia, leukocyte behavior in the retinal microcirculation was evaluated, with acridine orange digital fluorography--consisting of a scanning laser ophthalmoscope and the fluorescent nuclear dye, acridine orange--during reperfusion at 1, 2, 4, 6, 12, 24, 48, 96, and 168 hours. The obtained images were recorded on videotape and analyzed with a computer-assisted image analysis system.

RESULTS

Rolling leukocytes along the major retinal veins were observed in treated rats during the reperfusion period; no rolling leukocytes were observed in the control rats. The number of rolling leukocytes gradually increased and peaked at 102 +/- 40 cells/minute 12 hours after reperfusion; few rolling leukocytes were observed at 96 hours. The velocity of rolling leukocytes at 12 hours (19.1 +/- 3.5 microns/second; P < 0.05) was significantly lower than that at the other three times. No rolling leukocytes were observed along the arterial walls throughout the experiments. The number of accumulated leukocytes increased as time elapsed, peaked at 931 +/- 187 cells/mm2 24 hours after reperfusion, and decreased thereafter.

CONCLUSIONS

Leukocyte dynamics in the retinal microcirculation can be quantitatively evaluated during ischemia reperfusion injury.

Pharmacokinetics and pharmacodynamics of acetazolamide in patients with transient intraocular pressure elevation

OBJECTIVE

To characterize the pharmacokinetics and pharmacodynamics of acetazolamide in patients with transient intraocular pressure (IOP) elevation and to provide individual patients with the optimal dosage regimen for this drug.

METHODS

We studied 17 patients with transient IOP elevation, who were given 62.5-500 mg acetazolamide orally as single or repetitive doses. Plasma acetazolamide concentration and IOP were measured at approximately 1, 3, 5, and 9 h after the last acetazolamide administration. Pharmacokinetics and pharmacodynamics were analyzed by nonlinear mixed-effect modeling using the program NONMEM.

RESULTS

The plasma concentration profile of acetazolamide was characterized by a one-compartment model with first-order absorption. The apparent oral clearance was related to the creatine clearance (CCR) which was estimated by the Cockcroft and Gault equation, as follows: 0.0468 x CCR1 x h(-1). The estimated apparent oral volume of distribution, first-order absorption rate constant, and absorption lag time were 0.231 l x kg(-1), 0.821 x h(-1), and 0.497 h, respectively. IOP after oral acetazolamide administration was characterized by an Emax model. The maximal effect in lowering the IOP (Emax) was 7.2 mmHg, and the concentration corresponding to 50% of the maximal effect (EC50) was 1.64 microg x ml(-1). As 70% of Emax was achieved at a plasma concentration of 4 microg x ml(-1), this concentration was considered satisfactory for lowering IOP. The recommended dosage was calculated so that the minimum plasma concentration at steady state exceeded this target concentration; 250 mg t.i.d., 125 mg t.i.d., 125 mg b.i.d., and 125 mg once daily for the patients with CCR values of 70, 50, 30, and 10 ml min(-1), respectively.

CONCLUSION

Measuring plasma concentrations of acetazolamide and subsequent pharmacokinetic and pharmacodynamic analyses are useful for estimating its concentration-dependent effectiveness in lowering the IOP in individual patients. The dosage regimen presented in this study is expected to improve the benefits of acetazolamide pharmacotherapy in most elderly patients with transient rises in IOP following intraocular surgery.

Effect of hepatic invasion on the choice of hepatic resection for advanced carcinoma of the gallbladder: histologic analysis of 32 surgical cases

The purpose of this study was to assess the patterns of hepatic invasion in advanced carcinoma of the gallbladder by histologically examining surgical specimens obtained in 32 cases of hepatectomy for that carcinoma. Two modes of microscopic tumor extension were observed. The expansive pattern was restricted to liver-bed carcinomas, in which the tumor extends into the liver, primarily from the liver bed. Most of the infiltrating patterns were found with hepatic-hilar carcinomas, in which the tumor invades the hepatic hilum along Glisson's sheath, especially tumors exhibiting a discontinuous front of tumor invasion. The average width for wedge resection of the liver bed was 15.6 +/- 2.9 mm, in contrast to 25.6 +/- 8.1 mm for resection of segments IVa and V and 44.1 +/- 10.3 mm for extensive hepatic resection (both p < 0.01). When the hepatic invasion distance is more than 20 mm, the tumor should be selectively managed by extensive hepatic resection, such as extended right hepatic lobectomy or central bisegmentectomy. The results suggest that wedge resection of the liver bed and resection of segments IVa and V are advisable for carcinoma localized to the gallbladder alone and for liver-bed carcinoma with slight hepatic invasion and an expansive tumor growth pattern. Extensive hepatic resection, however, is recommended for carcinoma of the invasive liver-bed type and carcinoma of the hepatic-hilar type.

Fluorophotometric detection of intravitreal peroxides after panretinal laser photocoagulation

PURPOSE

To develop a highly sensitive method for in vivo quantitation of intravitreal peroxides by vitreous fluorophotometry with 2',7'-dichlorofluorescin (DCFH), a hydrogen peroxide (H2O2)-sensitive fluorescent dye, and to measure peroxides in the vitreous humor after panretinal laser photocoagulation (PRP).

METHODS

In the presence of H2O2 and lipid hydroperoxides, nonfluorescent DCFH was oxidized to highly fluorescent 2',7'-dichlorofluorescein (DCF; excitation, 495 nm; emission, 520 nm), which is detectable by vitreous fluorophotometry. Reactions of DCFH, including hematin with various concentrations of H2O2, were investigated in vivo. Fluorophotometry with DCFH was performed 1, 7, 14, and 28 days and 2 months after argon laser PRP. Untreated eyes served as the controls.

RESULTS

Exogenously applied H2O2 oxidized DCFH to DCF in a dose-dependent manner, ranging from 6 x 10(-8) mol/l to 6 x 10(-5) mol/l in concentration in vivo. Intravitreal DCF concentration was 83.7 +/- 6.8 nmol/l in control eyes. A significant increase of DCF was detected 1 day after PRP (330.7 +/- 123.8 nmol/l, P < 0.002). The increase peaked on day 7 (352.4 +/- 239.5 nmol/l, P < 0.002) and remained elevated at 2 months after PRP (161.8 +/- 51.4 nmol/l, P < 0.01).

CONCLUSIONS

This method allowed a highly sensitive quantitation of intravitreal peroxides in vivo. The authors' findings indicated that PRP induces increased production of peroxides in rabbit vitreous for 2 months. The data suggested that persistently high levels of peroxides in the vitreous humor affect the development of vitreous liquefaction after PRP.

Apa I polymorphism in the vitamin D receptor gene may affect the parathyroid response in Japanese with end-stage renal disease

Vitamin D [1,25(OH)2D3] plays a key role in the pathogenesis of secondary hyperparathyroidism. A polymorphism in the vitamin D receptor (VDR) gene is reported to be involved in bone mineral density and the serum level of intact-osteocalcin (i-OC) in patients with osteoporosis. We investigated the relationship between VDR gene polymorphisms and the levels of intact PTH (i-PTH) and i-OC in 129 Japanese patients with end-stage renal disease (ESRD). The VDR gene sequences were PCR-amplified, and the product was cleaved with the restriction enzymes Bsm I and Apa I. Undigested alleles were designated as B and A, and the digested alleles as b and a, respectively. The frequencies for the Bsm I polymorphism were 0.0% BB, 19.4% Bb, and 80.6% bb, while those for Apa I polymorphism were 14.2% AA, 47.2% Aa, and 38.6% aa. The Bsm I polymorphism of VDR was greatly biased in Japanese people. The i-PTH level in the aa group was about twice as high as those in the both AA group and Aa group (P < or = 0.04). The i-OC concentrations in the aa group was also approximately double those in both the AA group and Aa group (P < or = 0.03). In contrast, no significant differences in age, duration of dialysis, male/female ratio, or the incidence of diabetic nephropathy were observed among these three groups. On the other hand, there was no significant differences in i-PTH and i-OC between the Bb and bb groups. These results suggest that VDR gene polymorphisms can affect parathyroid response in ESRD patients, and the Apa I polymorphism is more informative in Japanese patients than the Bsm I polymorphism. The VDR a gene allele may define the pathogenesis of secondary hyperparathyroidism and of high turnover bone disease in patients with ESRD.

Surgical results of pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation for complications of proliferative diabetic retinopathy

BACKGROUND AND OBJECTIVE

To evaluate the effectiveness and safety of combining phacoemulsification (PEA), pars plana vitrectomy (PPV), and intraocular lens (IOL) implantation.

PATIENTS AND METHODS

Combined operations of PEA and PPV were performed in 76 eyes of 54 patients with cataract complicated by proliferative diabetic retinopathy (PDR). The mean follow-up period was 24.4 months. Gas tamponade was employed in 15 eyes. IOLs were implanted during surgery.

RESULTS

Visual acuity improved by 2 lines or more in 59 eyes (78%). Forty-seven eyes (77%) without tamponade and 12 eyes (80%) with tamponade had improved visual acuity. Postoperative complications included fibrin reaction in 8 eyes (10%), posterior synechia of the iris in 11 eyes (14%), and recurrence of retinal detachment in 8 eyes (10%). The incidence of these complications and of additional operations was higher in eyes that required tamponade, which corresponded with the severity of each case and the complexity of the surgical procedures.

CONCLUSIONS

Although further studies are indicated, this study suggests that the combined operation of PPV, PEA, and IOL implantation is safe and effective for patients with PDR. The choice of IOL may be correlated with postoperative complications.

Surgical strategies for carcinoma of the hepatic duct confluence

BACKGROUND

This study was conducted to clarify the clinicopathological factors influencing appropriate surgical strategy and survival in patients with carcinoma of the hepatic duct confluence.

METHODS

A total of 66 patients who underwent local resection of the bile duct with (n = 44) and without (n = 22) hepatectomy were reviewed retrospectively.

RESULTS

Fifteen of the 44 patients who had hepatectomy and two of the 22 who did not suffered major postoperative complications (P < 0.05). As the pT category rose, the incidence of microscopic tumour extension increased significantly. Invasion at the surgical margins was more frequent in the patients who did not have hepatectomy than in those who did. Extramural tumour extension was found in 23 of 28 patients, and its prevalence was higher in the hepatic direction than the duodenal direction. Cancer invasion to the caudate lobe was found in nine of 21 patients. Thirty of 44 patients who underwent hepatectomy had a curative resection compared with six of 22 who did not have hepatectomy (P < 0.01). The cumulative survival rates after curative resection were significantly higher than after non-curative resection (P < 0.01).

CONCLUSION

Hepatectomy with caudate lobectomy improves the curability and prognosis because these tumours frequently invade the surgical margins. However, operative morbidity is higher with this procedure.

Essential role of platelet-derived growth factor receptor alpha in the development of the intraplacental yolk sac/sinus of Duval in mouse placenta

Platelet-derived growth factor receptor alpha (PDGFRalpha) is expressed in multiple tissues and exerts its function throughout mouse embryogenesis. Upon screening the PDGFRalpha-expressing tissues in mouse embryos by immunohistochemistry using our established monoclonal antibody against murine PDGFRalpha, we found its expression in an epithelium lining a sinusoidal structure in placenta. This structure was proven to be the sinus of Duval, and the PDGFRalpha-positive epithelium to be the intraplacental yolk sac (IPY). The IPY has been postulated to be a derivative of primitive endoderm because of its morphology and its expression of vitamin D-dependent 9-kDa calcium-binding protein, and to play some roles in materno-fetal transport. In this study, we demonstrated that the IPY develops from primitive endoderm by its invagination into chorioallantoic placenta and continues to strongly express PDGFRalpha until the prenatal stage. Moreover, we found that the IPY is completely absent in PdgfraPh/PdgfraPh mutant embryos, which lack the Pdgfra gene, suggesting that the function of PDGFRalpha is essential to its formation. Hence, PDGFRalpha expressed in the IPY should be listed as a component of the cytokine network of murine placental development.

[Reoperative coronary artery bypass grafting without cardiopulmonary bypass]

Between October 1995 and February 1997, 2 men and 4 women aged 53 to 75 years (mean, 66.3) underwent reoperative coronary artery bypass grafting without cardiopulmonary bypass. Isolated reoperative circumflex or intermediate artery bypass was performed through a left thoracotomy (n = 2), reoperative bypass to the left anterior descending coronary artery was performed through a median sternotomy (n = 3), and bypass to the right coronary artery was performed through an upper median laparotomy (n = 1). Single coronary bypass grafting utilizing arterial grafts (left internal thoracic artery: 3, right gastroepiploic artery: 3) was performed in all cases. There were no operative deaths. All cases required neither cathecolamine nor intraaortic balloon pumping). Peri/post operative blood transfusion was necessary in only one case. Postoperative coronary angiography revealed that the 6 arterial grafts were patent. Reoperative coronary artery bypass grafting without cardiopulmonary bypass can be performed with low perioperative morbidity and mortality, easy postoperative management, satisfactory graft patency, and good symptomatic improvement.

[An autopsy case of carbon dioxide intoxication]

A 44-year-old male, engaged in the transportation of dry ice, was found dead on the floor of the freezer of his refrigerator car which was parked in front of the place where he was scheduled to make a delivery. Autopsy was performed to investigate the cause of death. Apart from the signs of acute death, no other significant findings were obtained, either macro or microscopically; carbon dioxide poisoning was thus strongly suspected. We created a simulation experiment by using the refrigerator car to reproduce the events of the accident. The oxygen concentration in the freezer was 21.0% as indicated by oxygen sensors, but decreased to 17.1-17.4% when the engine was stopped. This decrease in oxygen concentration supposedly results from the production of carbon dioxide by the vaporization of dry ice. Carbon dioxide concentration in the air could be calculated from the change in the oxygen concentration in the closed space of the freezer. The concentration was assessed at 17.1-18.6%. An oxygen concentration of 17.1-17.4% does not of itself cause serious hypoxia, but a carbon dioxide concentration of 17.1-18.6% probably causes serious intoxication, because this value is beyond that of intoxication levels published in references. Therefore, we concluded that the cause of death in this case was carbon dioxide intoxication.

Fluorophotometric quantitation of oxidative stress in the retina in vivo

PURPOSE

To establish a new fluorophotometric method to quantitate oxidative stress in the retina in vivo with a hydrogen peroxide (H2O2)-sensitive fluorescent dye.

METHODS

For in vitro fluorophotometric study, nonfluorescent 2',7'-dichlorofluorescein (DCFH) was incubated with H2O2 (10 pM to 100 nM), and the production of fluorescent 2',7'-dichlorofluorescein (DCF) was measured with fluorophotometric analysis. The inhibitory effect of catalase was also examined. For in vivo fluorophotometric study, rabbit eyes received vitrectomy and were perfused with 5 microM 2',7'-dichlorofluorescein diacetate (DCF-DA) or 2',7'-dichlorofluorescein diacetate (DCFH-DA). For oxidative stress, 300 microM H2O2 was infused after perfusion of DCFH-DA. Fluorophotometric measurements of the chorioretinal peak were performed. The eyes were enucleated for fluorescent microscopic examination to determine the localization of DCF fluorescence.

RESULTS

H2O2 converted DCFH to DCF in a dose-dependent manner, which was inhibited by catalase dose dependently. In vivo fluorophotometric study showed DCF-DA and DCFH-DA caused production of 2006 +/- 274 picomole/ml (mean +/- SD, n = 5) and 8.35 +/- 1.11 picomole/ml (n = 5), respectively, in the chorioretinal peak. DCFH-DA with stimulation by H2O2 induced 30.7 +/- 13.1 (n = 4) picomole/ml DCF. Fluorescent microscopy showed DCF production in the retina was significant in the eye treated with DCF-DA and minimal in the eye treated with DCFH-DA. Moderate DCF production in the nerve fiber layer was observed in the eye treated with DCFH-DA and H2O2.

CONCLUSIONS

This new fluorophotometric method with DCFH-DA may be useful in quantitatively evaluating oxidative stress in the retina in vivo.

Cloning, functional expression and dietary regulation of the mouse neutral and basic amino acid transporter (NBAT)

The Na+-independent dibasic and neutral amino acid transporter NBAT is among the least hydrophobic of mammalian amino acid transporters. The transporter contains one to four transmembrane domains and induces amino acid transport activity via a b0,+-like system when expressed in Xenopus oocytes. However, the physiological role of NBAT remains unclear. Complementary DNA clones encoding mouse NBAT have now been isolated. The expression of mouse NBAT in Xenopus oocytes also induced an obligatory amino acid exchange activity similar to that of the b0,+-like system. The amount of NBAT mRNA in mouse kidney increased during postnatal development, consistent with the increase in renal cystine and dibasic transport activity. Dietary aspartate induced a marked increase in cystine transport via the b0,+ system in mouse ileum. A high-aspartate diet also increased the amount of NBAT mRNA in mouse ileum. In the ileum of mice fed on the aspartate diet, the extent of cystine transport was further increased by preloading brush border membrane vesicles with lysine. Hybrid depletion of NBAT mRNA from ileal polyadenylated RNA revealed that the increase in cystine transport activity induced by the high-aspartate diet, as measured in Xenopus oocytes, was attributable to NBAT. These results demonstrate that mouse NBAT has an important role in cystine transport.

IDC Embolization of Aneurysms

SUMMARY

Embolization using IDC was carried out for 33 aneurysm cases in the last 3 years. The indication for the embolization was that the direct surgery was considered to be difficult, because of 1) technically impossible to do clipping, 2) aneurysm of the posterior fossa, 3) reject of patients. Regarding the location of aneurysm, 27 cases were seen in the anterior circulation, and 6 cases in the posterior circulation. Count of 33 cases, 11 cases were ruptured and 22 cases were non-ruptured. The procedure of embolization of aneurysms are generalized as compared to direct surgery, but there remain some technical problems. 33 cases in our series had no significant complication, except for one which had ruptured again. We emphasize that the weak point of IDC which was so hard, had no variations, especially if it happens to migrate during locking procedure. These complications can be prevented, if we use GDC(5,6,7) instead of IDC.

False aneurysm of the popliteal artery treated successfully by surgery: report of two cases

Blunt trauma to the popliteal artery may result in pseudoaneurysm formation. We herein report two patients who had a pseudoaneurysm of the popliteal arteries without any orthopedic injuries. One patient, who had been struck by an iron plate in the midthigh portion, demonstrated a pulsatile mass in this area 2 months later. The other patient had a pseudoaneurysm that was diagnosed by a histological examination; however, he could not remember having suffered any noticeable trauma.

Human dural thickness measured by ultrasonographic method: reflection of intracranial pressure

We measured changes in dural thickness to estimate intracranial pressure. The dural thickness on magnetic resonance imaging with contrast enhancement was compared in a hydrocephalic patient before and after shunt operation. Dural thickness also was measured directly using a micrometer at craniotomy for aneurysmal clipping in 11 patients. A small ultrasound probe (5 MHz) was held against the temporal scalp of 10 volunteers to extract convoluted interference echoes from the dura mater using a computer--based system for fast Fourier transform-Cepstrum analysis and maximum entropy analysis. The degree of intracranial pressure in the supine position was varied in the volunteers with transient neck compression. The enhanced dural thickness of the patient with hydrocephalus, barely visualized before shunt operation, increased after surgery. Dural thickness measurements obtained ultrasonographically in the supine position were similar to direct measurements of thickness. Changes in dural thickness on ultrasonography reflect changes in intracranial pressure.

Biodegradable scleral implant for intravitreal controlled release of fluconazole

PURPOSE

To evaluate the feasibility of using a biodegradable polymeric scleral implant containing fluconazole (FLCZ), a bis-triazole antifungal agent, as a potential intravitreal-controlled drug delivery system.

METHODS

The scleral implants, loaded with 10, 20, 30, and 50% FLCZ, were prepared with biodegradable polymers of poly (DL-lactide-co-glycolide). Those with all loading doses were used for the in vitro release studies; those with 30% FLCZ were used for the intravitreal release studies in pigmented rabbits. The in vitro and in vivo release rates of FLCZ from the implants were measured periodically with spectrophotometry and high performance liquid chromatography, respectively. The effects of the implants on ocular tissues were evaluated ophthalmoscopically, histologically, and electrophysiologically.

RESULTS

The scleral implants loaded with 10, 20, and 30% doses gradually released FLCZ over 4 weeks in vitro; those with 50% FLCZ released most of the drug in one week. FLCZ concentration in the rabbit vitreous remained within the 99% inhibitory concentration for Candida albicans for 3 weeks after implantation. The scleral implant gradually biodegraded, and it disappeared by 4 months after implantation. The electrophysiologic and histopathologic findings demonstrated no substantial toxic reactions in the ocular tissues.

CONCLUSION

The current study suggests that a biodegradable, polymeric scleral implant containing FLCZ may be a promising intravitreal drug delivery system to treat fungal endophthalmitis.

Long-term prognosis of extracapsular cataract extraction and intraocular lens implantation in diabetic patients

Although cataract extraction with intraocular lens implantation (IOL) is being used for increasing numbers of patients, there is still insufficient information regarding the long-term outcome for these patients. In this retrospective study of 140 eyes of 102 patients, 97 eyes (69%) achieved a best visual acuity of 20/40 or better. After a minimum 6-month postoperative period, 26 eyes (19%) had developed retinopathy: eight eyes progressed from nonproliferative to proliferative retinopathy. Glycosylated hemoglobin levels and fasting blood glucose were significantly higher at time of surgery in the eight that progressed than in those who did not (P = 0.002, P = 0.034). There were 65 unilateral IOL implantations; in 10 (15%) of these eyes, retinopathy progressed. Retinopathy also progressed in 70% of the fellow eyes of these patients. In patients whose retinopathy did not progress, 95% of the fellow eyes also showed no progression. Also, patients with progression in the pseudophakic eye frequently had progression in the fellow unoperated eye. Postoperative progression was symmetrical (P = 0.0001). Our analysis suggests that progression of diabetic retinopathy following IOL implantation can be correlated to diabetic control at the time of surgery.

Retinal leukocyte behavior in experimental autoimmune uveoretinitis of rats

In vivo retinal leukocyte behavior in the experimental autoimmune uveoretinitis (EAU) of rats was investigated using acridine orange digital fluorography. The technique employed high resolution images obtained from a scanning laser ophthalmoscope (SLO) subsequent to staining with the fluorescent nuclear dye, acridine orange. Two weeks after immunization with synthetic peptides of retinal soluble antigen (S-Ag), acridine orange was intravenously injected, and fundus images were generated by SLO. Many rolling leukocytes were observed along the venous walls as slowly moving fluorescent dots; moreover, leukocytes infiltrating into the vitreous cavity were also noted especially over the retinal veins, but not over the retinal arteries. In addition, major retinal vessels were significantly dilated. The diameters of the retinal veins at a distance of 1 disc diameter away from the center of the optic disc were 49.8+/-4.5 micron for the normal rats and 88.2+/-3.6 micron for the EAU rats, respectively (P<0.001). Similarly, the diameters of retinal arteries were 32.6+/-3.7 micron for the normal rats, 53.8+/-1.5 micron for the EAU rats, respectively (P<0.01). The dilation was more prominent in the veins than in the arteries. These results suggest that it is possible to visualize the retinal involvement of EAU in vivo. The results also suggest that leukocyte-endothelial interaction and extravascular infiltration in the retinal venous vasculature may play significant roles in the early stages of posterior segment inflammation in EAU.

A method of ultrasonic 3-D computed velocimetry

A method of ultrasonic three-dimensional (3-D) vector velocimetry, which is derived by extending the previously proposed two-dimensional (2-D) vector velocimetry, is presented. In the proposed method, the three vector components of velocity to be measured are defined as the velocity in the beam axial direction, and angle velocities in two transverse directions. To derive the three components of velocity, signals detected by a 2-D array transducer are first 2-D Fourier transformed in the spatial domain parallel to the 2-D array transducer and then are one-dimensional (1-D) Fourier transformed in the time domain. The advantage of the proposed method is that it uses a linear signal processing, so it can simultaneously measure individual velocities of multiple scatterers. Computer simulations clearly demonstrate the effectiveness of the proposed method.

Radiation therapy for ocular choroidal neovascularization (phase I/II study): preliminary report

PURPOSE/OBJECTIVE

Choroidal neovascularization (CNV) is a major cause of severe loss of visual acuity in some ocular diseases such as age-related macular degeneration (ARMD) and angioid streaks. Laser photocoagulation has been used to treat patients with subfoveal neovascular lesions with well-demarcated boundaries. However, the treatment method is usually associated with a large decrease in visual acuity. Therefore, indications for this treatment are very limited. Recently, some investigators reported the effect of low dose irradiation on the subretinal neovascular membranes in CNV. We conducted a Phase I/II study to determine the toxicity and efficacy of external photon beam radiotherapy in patients with CNV.

METHODS AND MATERIALS

Between April, 1994 and July, 1995, 36 patients with choroidal neovascularization (34 with ARMD and 2 with angioid streaks) were treated with radiation therapy. Treatment planning was performed using a CT simulator that enables real-time treatment planning from multiple CT slices. The clinical target volume that included the macula and optic disc received a dose of 10 Gy/5 fractions/1 week (first 18 eyes) or 20 Gy/10 fractions/2 weeks (last 18 eyes). All eyes were irradiated with a single lateral 6 MV photon beam, angled 10 degrees posteriorly to exclude the ipsilateral lens and the contralateral eye from the radiation field. The ipsilateral lens was irradiated with less than 10% of the total reference dose. The field size averaged 3.0 x 2.5 cm. Records of the 17 eyes with CNV referred to our hospital in 1993, which satisfied the eligibility criteria for this study, were retrospectively analyzed for comparison.

RESULTS

There was no significant acute morbidity. All patients were followed regularly by both ophthalmologists and radiation oncologists. Cataract formation after 1 year of the treatment was observed in one patient who had received a dose of 20 Gy. One patient who had received 20 Gy complained of transient dry-eye sensation 2 months after treatment, but this had disappeared spontaneously by the fourth month. The subjective symptoms, visual acuity, and size of the neovascular membrane were evaluated at 6 and 12 months after treatment in each patient. In the group of patients irradiated with 10 Gy and with 20 Gy, respectively, subjective symptoms improved in five and seven eyes, did not change in seven and four eyes, and deteriorated in six and six eyes at 12 months. Although visual acuity was significantly decreased in the control group, the patients in both irradiated groups did not show such a decrease in visual acuity. The size of the neovascular membrane in the control group progressed significantly. However, the patients in the 20 Gy group showed significant regression of the membrane, although those in the 10 Gy group showed no significant change in size.

CONCLUSION

This Phase I/II study including a dose escalation study showed that radiation therapy seems to be useful for CNV. The dose of 20 Gy in 10 fractions was more useful in treating neovascular membranes than the dose of 10 Gy in five fractions. These results have encouraged us to start a multicenter randomized prospective study of the treatment of CNV with radiation therapy.

Role of leukocytes in diabetic microcirculatory disturbances

Various rheological abnormalities of the blood have been widely reported in diabetes. However, it remains unclear which one affects blood flow at the level of microcirculation, an important site in the pathogenesis of diabetic microangiopathy. To differentiate which blood component leads to microcirculatory disturbances in diabetes, we studied the hemorheological properties of diabetic patients using an array flow analyzer that has microchannels simulating capillaries. Venous blood was collected from 19 diabetic patients and 24 control subjects. Three blood samples were prepared: plasma alone, erythrocyte suspension (ES) at 10% hematocrit (Ht), and erythrocyte and leukocyte suspension (ELS) having leukocyte counts of 1000/microl at 10% Ht. These samples were forced to flow through microchannels (equivalent diameter 6 micron, equivalent length 30 micron, 2600 in parallel) by applying a pressure difference of 20 cm H2O. Transit times for 100 microl of samples were measured, and the flow behavior of cells through the microchannels was recorded with a video-microscope. The transit time of ELS was 52.5 +/- 6.2 sec (mean +/- SD) in the diabetic group and 47.7 +/- 3.3 sec in the control group; there was significant prolongation in the transit time of diabetic ELS (P = 0.005), whereas the transit times of plasma alone and ES showed no significant differences between control and diabetic groups. Leukocytes were occasionally observed to plug the microchannels during the measurements of ELS from some diabetic patients. Our results imply that reduced deformability of leukocytes in diabetes may contribute to flow disturbances in the microcirculation. Leukocytes could play a potential role in the pathogenesis of diabetic microangiopathy.

Biodegradable polymeric device for sustained intravitreal release of ganciclovir in rabbits

PURPOSE

A scleral plug made of biodegradable polymer implanted at the pars plana was evaluated to determine its ability to control the intravitreal release of ganciclovir.

METHODS

Scleral plugs containing 25% ganciclovir were prepared with poly(lactic-glycolic acid) (molecular weight, 121 kDa). The release of ganciclovir was evaluated in vitro by spectrophotometry. In vivo intravitreal ganciclovir concentrations were measured by high performance liquid chromatography following plug implantation in pigmented rabbits. The biocompatibility of the device was determined by indirect ophthalmoscopy, electroretinography, and light and electron microscopy.

RESULTS

The in vitro study showed that the plug released ganciclovir throughout a 10-week period. The in vivo study demonstrated that the plugs maintained the drug concentration in the vitreous in a therapeutic range adequate to treat cytomegalovirus (CMV) retinitis for 12 weeks. No significant retinal toxicity was observed.

CONCLUSIONS

This study demonstrated that this drug delivery system can potentially be useful to treat CMV retinitis.

Association of Sjögren's syndrome with hereditary angioneurotic edema: report of a case

A case of hereditary angioneurotic edema (HANE) associated with Sjögren's syndrome is presented. One of the members of a pedigree of HANE due to deficiency of C1 inhibitor (C1INH) had a positive titer for anti-SS-A and anti-SS-B antibodies in the serum, complaining of symptom of dry eyes and dry mouth. A lip biopsy revealed lymphocytic infiltration of minor salivary glands. The patient had renal tubular acidosis (RTA). Thus the patient was diagnosed as suffering from Sjögren's syndrome with RTA.

PDGFR alpha expression during mouse embryogenesis: immunolocalization analyzed by whole-mount immunohistostaining using the monoclonal anti-mouse PDGFR alpha antibody APA5

We investigated the cells that express platelet-derived growth factor receptor alpha (PDGFR alpha) during mouse embryogenesis. PDGFR alpha expression has been identified by in situ hybridization or immunohistochemistry using polyclonal antibodies on tissue sectins. Because no immunostaining study using whole-mount specimens has been published to date, we established a new monoclonal antibody (MAb), APA5, for this purpose. Our results differed in that APA5 stained only the paraxial mesoderm, whereas other investigators concluded that most if not all mesodermal cells expressed PDGFR alpha. Moreover, we did not find PDGFR alpha expression in embryonic erythrocytes, which have been previously suggested to express PDGFR alpha. On the basis of our present results, we wish to revise the proposed PDGFR alpha expression as follows. At the pregastrulation stage, PDGFR alpha is expressed only in primitive endoderm, particularly that in the ectoplacental cone. On gastrulation, it is expressed at high levels in the paraxial mesoderm. This expression continues after its differentiation into the somite. Along with the differentiation and migration of the sclerotome, PDGFR alpha + cells begin to become distributed throughout the embryonal mesenchyme. During organogenesis, particularly intense staining is detected in regions of epithelial and mesenchymal interaction, such as the tooth bud and bronchi. In addition to mesodermal derivatives, the developing lens, apical ectodermal ridge, glial precursor, cardiac valves, and choroid plexus express PDGFR alpha. Our results with whole-mount immunostaining show that PDGFR alpha is abundantly expressed and may play important roles during embryogenesis.

Sudden death due to diabetic coma in insulin-department diabetes mellitus: an autopsy report

Sudden death caused by the acute onset of diabetic coma is reported. A 15-year-old female had been suffering from insulin-dependent diabetes mellitus for the prior 8 years and had a fever and vomiting for the past few days. On the 4th day, after the onset of fever and vomiting, she died suddenly, and was autopsied to clarify the cause of death. Macroscopic examination revealed that the pancreas was atrophic (40 g) whereas the liver was markedly enlarged (2,740 g). Histological findings were: 1) The islets of Langerhans were decreased in size and number. They were not positive for aldehyde-fuchsin staining, 2) There were severe fatty changes in the liver cells. The retained blood in the left ventricle was analyzed: glucose, 1,016 mg/dl; acetone, 345 mg/l; acetoacetate, 5.91 mmol/l: D-3-hydroxybutyrate, 4.17 mmol/l; hemoglobin A1c, 10.2%; fructosamine, 416 mumol/l; total serum cholesterol, 220 mg/dl; triglycerides, 205 mg/dl; free fatty acid, 8.0 mEq/l; urea nitrogen, 40 mg/dl. Although the biochemical estimation of the glucose and ketone levels in post-mortem body fluids was recognized as being unreliable, many of these values were far elevated in comparison with those of normal individuals. Thus, we concluded that the cause of death was diabetic ketoacidosis. We also discuss the diagnostic problems of postmortem blood chemistry.

Prednisolone, platelet-activating factor receptor antagonist, or superoxide dismutase reduced leukocyte entrapment induced by interferon alpha in retinal microcirculation

PURPOSE

Interferon (IFN) alpha has been suggested as a possible treatment for choroidal neovascularization. However, the pathogenesis of retinal complications after IFN therapy still is unknown. Previously, we have shown that IFN alpha induced leukocyte entrapment in retinal microcirculation. The current study was designed to determine if leukocyte entrapment can be reduced by the agents that modulate leukocyte-endothelial adherence.

METHODS

Interferon alpha was administered intravenously in rats. Simultaneously, prednisolone (PSL), platelet-activating factor receptor antagonist (CV-6209), or superoxide dismutase (SOD) was given to the rats. Leukocyte dynamics were observed with acridine orange (AO) digital fluorography, which uses a nuclear fluorescent dye of AO and scanning laser ophthalmoscopy. The number of trapped leukocytes in each group was assessed with a personal computer-based image analysis.

RESULTS

Interferon alpha induced leukocyte entrapment in retinal microcirculation and increased leukocyte adherence to the vessel walls. The simultaneous administration of PSL, CV-6209, or SOD inhibited leukocyte adherence to the venous walls and significantly reduced the number of trapped leukocytes.

CONCLUSIONS

Acridine orange digital fluorography was helpful to quantitate leukocyte-endothelial interactions in retinal microcirculation. The results suggested that increased leukocyte adherence after IFN alpha administration was reduced significantly by PSL, CV-6209, or SOD. These agents may be useful to prevent IFN-induced microcirculatory disturbances.

[Effects of administration of Clostridium butyricum to patients receiving long-term tube feeding]

In patients who require total parenteral or enteral nutrition the intestinal lining may atrophy and the ability to absorb nutrients may be lost. To prevent atrophy of the small intestine, we administered a suspension of Clostridium butyricum to elderly patients receiving tube feeding, and then measured the activation of serum diamine oxidase and the number, form, water content, and bacteria content of stools, indicators of intestinal structure. We found a significant increase in diamine oxidase activity and an improvement in stool condition: the number of stools per day decreased, form improved, and water content and the number of aerobic bacteria decreased significantly. These results indicate that in patients receiving long-term tube feeding, administration of Clostridium butyricum can restore condition to a near-normal state.

[A suicidal case of electrocution with hypnotic drug poisoning: an autopsy report]

A 28-year-old male was found dead on a bed in a hotel. He had two electric wires, the ends of which were fastened to each coin (50 and 100 yen); the coins were attached to a left hypochondrial region and a left side of the chest. The other ends of the wires were connected to a time switch, which had been connected to a plug top (100 V, 60 Hz alternating current). An empty box of a commercially available hypnotic (bromvalerylurea), a suicide note and a manual book for suicide were found at the spot. As autopsy findings, both burns on the left hypochondrial region and on the left side of the chest were carbonized at their central parts and erythemas were also noted around them. Histological findings were consistent with electric marks and the burns showed vital reactions. Copper stain was slightly positive; iron stain was negative. Bromvalerylurea concentrations in blood, urine, brain, liver and kidney samples were 14.5, 37.7, 5.8, 5.2 and 6.2 micrograms/ml or g, respectively. The blood level showed that he had been moderately intoxicated by the drug, but not fatal. The cause of death was thus judged to be suicidal electrocution. It seems that suicide was influenced by a "Manual Book of Suicide", which was found in his bag.

Cloning and molecular analysis of the Arabidopsis gene Terminal Flower 1

The Arabidopsis gene Terminal Flower 1 (TFL1) controls inflorescence meristem identity. A terminal flower (tfl1) mutant, which develops a terminal flower at the apex of the inflorescence, was induced by transformation with T-DNA. Using a plant DNA fragment flanking the integrated T-DNA as a probe, a clone was selected from a wild-type genomic library. Comparative sequence analysis of this clone with an EST clone (129D7T7) suggested the existence of a gene encoding a protein similar to that encoded by the cen gene which controls inflorescence meristem identity in Antirrhinum. Nucleotide sequences of the region homologous to this putative TFL1 gene were compared between five chemically induced tfl1 mutants and their parental wild-type ecotypes. Every mutant was found to have a nucleotide substitution which could be responsible for the tfl1 phenotype. This result confirmed that the cloned gene is TFL1 itself. In our tfl1 mutant, no nucleotide substitution was found in the transcribed region of the gene, and the T-DNA-insertion site was located at 458 bp downstream of the putative polyadenylation signal, suggesting that an element important for expression of the TFL1 gene exists in this area.

[An autopsy case of pulmonary thromboembolism: a delayed complication of a victim by traffic accident]

A 35-year-old male had fallen down from his motor bike caused a fracture of the medial condyle of the right tibia and the acromion of the left scapula. He had received screw fixed operation for his right tibia and had been in the hospital for one month. He died suddenly in the hospital and was autopsied to find out the cause of death. On external examination, it was found that affected leg was bruised and swollened. Partially organized thrombosis in the posterior tibial vein was revealed and bilateral pulmonary arteries were packed with reddish massive thromboemboli. The causes of the posterior tibial vein thrombosis were intimal damage and decreased venous flow, attributable to bed rest for long days and external fixation of the lower extremity. We presumed that direct cause of death was a large thromboemboi which were migrated from posterior tibial vein and lodged at the bifurcation of the pulmonary artery causing obstruction of pulmonary blood flow. Finally we opened the direct cause of death was pulmonary thromboembolism due to leg injury. Clinical instability may hinder the diagnostic elevation and delay therapeutic intervention, it is the most often happened in sudden death cases within the hospital. The importance of early diagnosis and early prevention is underscoped, because the symptoms of pulmonary thromboembolism are not always produced. To prevent fatal pulmonary thromboembolism in trauma, prophylactic use of low-dose heparin therapy and/or the use of oral anticoaglant (warfarin) have been effective and recommended in USA and Western Europe. The routine use of these therapy has not yet been spread in Japan, because the incidence is still apparently lower than in USA and Western Europe as well as the risk of hemorrhage. If the victims of road traffic accident receive the prophylactic use of low-dose heparin and/or oral anticoaglant (warfarin), it might be an effective way to reduce mortality.

[Coronary artery bypass grafting without cardiopulmonary bypass]

From October 1995 until April 1996. CABG (coronary artery bypass grafting) was performed under the beating heart without CPB (cardiopulmonary bypass) in nine cases. They consisted of 7 males and 2 females ranging in age from 31 to 79 years old (mean 64.7 years). Single bypass grafting was performed in 6 cases, and double bypass grafting was done in 3 cases, involving 2 re-do cases. With regard to the major associated diseases, two patients had required chronic hemodialysis three time a week, four patients were administered with insulin for diabetes mellitus. There were other three patients with renal dysfunction not requiring hemodialysis, two patients had pulmonary problems, and one patient had Parkinson's disease. Further more two patients were older than 75th years in age. Graft anastomosis to the coronary artery was performed with 7-0 polypropylene. In one case, left thoracotomy was done to approach the heart for the anastomosis to intermediate artery, and in the other eight cases, median sternotomy was done. The grafts used in the nine cases were 4 right internal thoracic arteries, 6 left internal thoracic arteries, one gastroepiploic artery and one saphenous vein, 12 grafts in total. Subtotal gastrectomy for gastric cancer and cholecystectomy for cholecystitis was done in one patient for each. Heterologous blood transfusion was required two cases (22.2%). The postoperative course was very good in all cases. Eleven grafts in postoperative angiographed 8 cases were all patent, although presenting the string sign in one case, and angina pectoris disappeared in all cases. CABG under the beating heart without CPB was considered to be useful for the patients with considerable other diseases from the point of view of safety and ease of postoperative managements. We think that this procedure should be considered particularly for patients on chronic hemodialysis who required CABG.

Lethal drug interactions of sorivudine, a new antiviral drug, with oral 5-fluorouracil prodrugs

Rats were orally co-administered sorivudine (SRV: 1-beta-D-arabinofuranosyl-(E)-5-(2-bromovinyl)uracil), a new oral antiviral drug for herpes zoster, with the oral anticancer drug tegafur (FT: 1-(2-tetrahydrofuryl)-5-fluorouracil) as a prodrug of 5-flourouracil (5-FU) once daily to investigate a toxicokinetic mechanism of 15 Japanese patients' deaths recently caused within a brief period by the drug interaction of these drugs. All the rats showed extremely elevated levels of 5-FU in plasma and tissues, including bone marrow and small intestine, and died within 10 days, whereas the animals given the same dose of SRV or FT alone were still alive over 20 days without any appreciable toxic symptom. Before their death, there was marked damage of bone marrow, marked atrophy of intestinal membrane mucosa, marked decreases in white blood cells and platelets, diarrhea with bloody flux, and severe anorexia as reported with the Japanese patients. Data obtained by in vivo and in vitro studies strongly suggested that (E)-5-(2-bromovinyl)uracil generated from SRV by gut flora was reduced in the presense of NADPH to a reactive form by hepatic dihydropyrimidine dehydrogenase (DPD), a key enzyme determining the tissue 5-FU levels, bound covalently to DPD as a suicide inhibitor, and markedly retarded the catabolism of 5-FU.

An electrocution death of an infant who had received an electric shock from an uncovered oval shaped lamp switch in his mouth while in a hospital

A male infant aged one year and nine months was found dead on a bed after admission to hospital with suspected pneumonia. The patient apparently put an uncovered oval shaped lamp switch (pendant switch) into his mouth and died of electric shock after contacting the exposed wires of the switch (100 V, 60 Hz alternating current). There were extensive first- to fourth-degree burns on the inner surface of the both lips. Because the histological findings were consistent with electric burns and the burns showed vital reactions, electric shock was judged to be the cause of death. The pendant switch is normally a very convenient piece of bedside equipment for inpatients. However, when the patient is an infant who naturally puts all the objects into the mouth, such a switch should be placed out of reach, and it should be certain that the cap is not loose.

Experimental IgA nephropathy induced by a low-dose environmental mycotoxin, nivalenol

Based on the hypothesis that IgA nephropathy (IgAN) is triggered by some exogenous antigen(s) which induces dysregulation of the mucosal immune system, we developed an experimental model of orally induced IgAN by an environmental mycotoxin, nivalenol (NIV), which often contaminates agricultural products in Southeast Asia and Japan. In the present study, low doses of oral NIV reproducibly induced significant IgA deposits in the glomerular mesangium and elevated serum IgA levels in mice irrespective of the strain; the degree of immunopathological changes analogous to human IgAN was associated with the dose and duration of NIV treatment. Furthermore, a competitive enzyme-linked immunosorbent assay with an NIV analogue-protein conjugate disclosed that the IgA antibody in the sera from the NIV model mice had a higher affinity to the mycotoxin. Conclusively, these findings suggest that NIV induces some pathological changes in mice which resemble those in human IgAN, and that this mycotoxin is associated with pathogenesis in some types of glomerulonephritis.

New technique for inducing reversible obstructive jaundice in the rat

We present a new animal model of reversible obstructive jaundice, in which two polyethylene tubes were inserted into the common bile duct, one towards the liver and the other towards the duodenum. The ends of the tubes were tunneled subcutaneously and tied shut to establish obstructive jaundice. Biliary drainage was achieved without a second laparotomy by connecting the tubes with a 1-cm segment of a 24-gauge needle. Serum concentrations of total bilirubin (TB), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), alkaline phosphatase (ALP), and albumin (Alb.) were measured before and after obstruction and decompression. TB, GOT, GPT and ALP increased and Alb. decreased 7 days after the onset of biliary obstruction. All values normalized 14 days after biliary drainage at the latest. Our model is reproducible and allows for evaluation of biliary decompression. Unlike previous models, it can be used for long-term investigation of chronic obstructive jaundice.

Sequential changes in full-length genomes of hepatitis B virus accompanying acute exacerbation of chronic hepatitis B

BACKGROUND/AIM

During the course of persistent hepatitis B virus infection, viral replication markedly decreases after acute exacerbation of liver inflammation accompanied by emergence of antihepatitis B e antibody (anti-HBe) and/or anti-hepatitis B surface antibody (anti-HBs). In some cases, however, persistent viral replication continues even after such exacerbation with or without HBeAg/anti-HBe seroconversion. The aim of the present study was to investigate the extent of genetic variations of HBV in this phenomenon.

METHODS

Full-length HBV genomes were amplified by polymerase chain reaction from sera of three patients before and after acute exacerbation and were directly sequenced.

RESULTS

In the whole genomes of 3215 nucleotides, only six nucleotide mutations for six amino acid substitutions (2 in the surface gene, 2 in the X gene, 1 in the core gene and 1 in the polymerase gene) were observed in patient 1, 15 mutations for 14 amino acid substitutions (1 in the pre-core codon 28, 4 in the surface gene, 4 in the core gene and 5 in the polymerase gene) were observed in patient 2, and 5 mutations for 6 amino acid substitutions (2 in the surface gene, 2 in the X gene, pre-core stop codon mutation and 1 in the polymerase gene) were observed in patient 3. Substitution in the a determinant of the surface gene, which encodes target epitopes for neutralizing antibodies, as well as those in the pre-core/core gene, which encodes epitopes for cytotoxic T cells, were mainly found.

CONCLUSION

HBV that remained after the emergence of anti-HBe and anti-HBs are considered to possess mutations in epitopes for both humoral and cellular immunity. These mutant HBV may be involved in the pathogenesis of persistent hepatic injury after acute exacerbation.

Stereoscopic synthesized brain-surface imaging with MR angiography for localization of a peripheral mycotic aneurysm: case report

A patient with subacute bacterial endocarditis and a peripheral mycotic aneurysm is presented. We used a combined multi-slice surface anatomy scanning (SAS) and contrast-enhanced MR angiography image to determine the exact location of the small lesion by applying a skin marker on the scalp and visualizing the relationship of the marker to the brain surface structures and to the lesion. This technique was useful for the removal of a small peripheral aneurysm using only a limited craniotomy.

In vivo quantification of leukocyte behavior in the retina during endotoxin-induced uveitis

PURPOSE

The interaction between leukocytes and vascular endothelial cells plays an important role in various inflammatory disorders. This study evaluated leukocyte behavior in the retina during endotoxin-induced uveitis (EIU) in vivo.

METHODS

EIU was induced in female Lewis rats by footpad injection of lipopolysaccharide (LPS). The time-course changes of retinal leukocyte behavior were followed at 1.5, 3, 4.5, 6, 12, 24, 48, 72, and 120 hours after LPS treatment using acridine orange digital fluorography, consisting of high-resolution images from a scanning laser ophthalmoscope and a fluorescent nuclear dye of acridine orange.

RESULTS

Major retinal vessels were significantly dilated (P < 0.05) at 4.5 hours after LPS injection. The vasodilation, marked in veins, became maximum at 24 hours and subsided at 72 hours. Leukocytes were observed rolling along the walls of major veins at 4.5 hours. The number of rolling leukocytes gradually increased and reached a peak level of 33.8 +/- 3.4 cells/minute per major vein at 12 hours. Leukocyte rolling was still observed at 72 hours. No rolling of leukocytes was observed along the arterial walls throughout any experiments. The velocities of rolling leukocytes were determined at 6, 12, 24, and 48 hours. The leukocyte rolling velocity at 6 hours was significantly slower (33.3 +/- 2.8 microns/second, P < 0.05) than at the other three times (average, 46.6 microns/second). Cellular infiltration into the vitreous cavity was detected at 24 hours and reached its maximum at 48 hours.

CONCLUSIONS

This study demonstrates that it is possible to evaluate EIU by investigating retinal leukocyte behavior and that vasodilation of major retinal vessels and leukocyte-endothelial interactions precede inflammatory cell emigration into the vitreous. This method may be useful to quantify the severity of inflammation in EIU.

Isolation and characterization of cDNA clones corresponding to the genes expressed preferentially in floral organs of Arabidopsis thaliana

Seventeen cDNA clones of genes corresponding to mRNAs expressed preferentially in floral organs of Arabidopsis thaliana were obtained by differential screening of a flower bud cDNA library, and classified into five groups (1A, 17A, 1B, 4B and 5B) by cross-hybridization and restriction analysis. Sequence analysis revealed that the 1A-1 and 17A-1 clones encode vegetative storage proteins (VSPs). The VSP mRNAs were detected in a small amount in leaves and increased to a limited level by wounding. Both 1B-1 and 5B-1 clones were homologous to transmembrane protein cDNAs. The protein encoded by 4B-1 clone contained a proline-rich region, but no homologous proteins were found in databases.

Rapid and clear detection of ABO genotypes by simultaneous PCR-RFLP method

We reported a new approach of ABO genotyping by a polymerase chain reaction and restriction fragment length polymorphism method. Instead of amplifying the loci containing the positions of nucleotides 258 and 700 of cDNA of the A transferase separately, we successfully amplified these 2 loci together in one reaction mixture using 2 sets of primers. The amplified DNA products were digested at the same time with restriction enzymes Kpn I and Alu I. The digested DNA products were then separated by electrophoresis on polyacrylamide gel. In addition, we evaluated the influence of various amplification parameters (concentration of template DNA, primers, Taq DNA polymerase, MgCl2, and number of cycles). In particular, high Mg2+ concentration (3.5 mM) made effective amplification of this locus without producing any unspecific band. By using that optimized condition for PCR, together with a simultaneous approach, our study proved to be time saving, more economic, and convenient in interpreting the results.

Pathophysiological changes caused by occlusion of blood flow into the liver during hepatectomy in dogs with obstructive jaundice: effects of intestinal congestion

Obstructive jaundice was produced in adult mongrel dogs by cholecystectomy and ligation of the common bile duct. Two weeks later 40% hepatectomy was performed during 10 min occlusion of hepatic inflow (group I). Liver tissue lipid peroxide levels increased significantly and superoxide dismutase activity decreased. The portal endotoxin (Et) concentration increased markedly after reperfusion and peripheral blood Et and serum beta-N-acetyl hexosaminidase levels increased markedly, beginning 3 h after reperfusion. The phagocytic index increased transiently after reperfusion, but decreased markedly thereafter. Hepatocyte degeneration and necrosis became severe, intestinal villi were damaged and the 1 week survival rate was 23.1%; deaths were due to liver failure. These changes were prevented by construction of a portosystemic bypass and a 1 week survival rate of 70% (group II) was achieved. When the ischaemic time was prolonged to 20 min with the portosystemic bypass (group III), the pathological changes resembled those seen in group I, although no changes were observed in portal or peripheral blood Et levels. These findings suggest that major hepatectomy in the presence of severe jaundice should be carefully performed so that the ischaemic time is minimized during portosystemic bypass in an attempt not only to prevent production of Et in portal venous blood due to intestinal congestion, but also to reduce ischaemia-reperfusion injury.

Visualization of leukocyte dynamics in the choroid with indocyanine green

PURPOSE

To report a method to evaluate leukocyte dynamics in the choroidal circulation with indocyanine green (ICG) angiography.

METHODS

Nonpigmented and pigmented rats were administered ICG solution intravenously. The fundus image was obtained with a scanning laser ophthalmoscope and recorded on magnetic tapes at a video rate (30 frames/second). The images were analyzed with a personal computer-based image analysis system.

RESULTS

On ICG angiography, hyperfluorescent dots were seen moving along the choroidal vessels and in the retinal vessels several minutes after injection. These fluorescent dots were thought to be circulating leukocytes stained with ICG. The micrographs of blood smears after ICG injection showed intense fluorescence of leukocytes. Computer-assisted image analysis allowed tracing of these fluorescent dots using a frame-by frame method.

CONCLUSIONS

Results of this study indicated that ICG can be used for vital staining of leukocytes and that it is possible to evaluate leukocyte movement in the choroidal circulation in vivo in rats.

Effects of new titanium cerebral aneurysm clips on MRI and CT images

We studied the effects of newly developed aneurysm clips made of a titanium alloy (manufactured by Aesculap, A.G.) on the quality of MR and CT images. Prior to clinical application in twenty patients, the effects of five types of conventional aneurysmal clips on MR images were examined utilizing a phantom. When compared with conventional aneurysm clips, the new titanium clips produce only limited artifacts and yielded improved images in patients who underwent aneurysm clipping post-operative.