New Bis(Indole) alkaloids of the topsentin class from the sponge spongosorites genitrix

Four bis(indole) alkaloids of the topsentin class, including two new brominated compounds (1 and 2), have been isolated from the sponge Spongosorites genitrix collected from Jaeju Island, Korea. The structures of the novel compounds were determined by spectroscopic methods. These compounds exhibited moderate cytotoxicity against a human leukemia cell-line (K-562).

Sleep patterns during 20-m nitrox saturation dives

The sleep patterns were examined through three simulated 20-m nitrox saturation dives. The standard polysomnography of 12 divers was recorded respectively for a total of 204 nights, as were patterns of change or consistency in sleep variables. For the 11 divers in their 20s and 30s there was nothing unusual about their sleep variables. However, a reduction of total sleep time in accordance with the lengthening of sleep latency was observed. This was recognized from the latter part of the bottom period to the postdive period. This tendency was notable for the diver in his 50s. These findings suggest that the decompression environment and the psychological stress of the long-term closed environment of a hyperbaric chamber have effects on divers' sleep.

A sandwich enzyme immunoassay for human muscle-specific beta-enolase and its application for the determination of skeletal muscle injury

A sensitive sandwich enzyme immunoassay for human beta-enolase was developed and used to examine beta-enolase in blood or bloodstains as a marker for the determination of skeletal muscle injury. Human beta-enolase was purified from human skeletal muscle, and then an antibody against it was prepared. Polystyrene balls coated with rabbit anti-human beta-enolase IgG were incubated with human beta-enolase and then with anti-human beta-enolase Fab'-peroxidase conjugate. Peroxidase activity bound to the polystyrene balls was assayed by fluorometry using 3-(4-hydroxyphenyl)propionic acid as a hydrogen donor. The detection limit for human beta-enolase was 2.6 pg (30 amol) per assay. The degree of cross-reaction of the sandwich enzyme immunoassay for other organs except for heart (1/10) was about 1/150 or less. Moreover, the localization of beta-enolase in various human tissues was examined by Northern blot analysis, and this confirmed that beta-enolase was expressed only in skeletal and cardiac muscle. Antigenic activity in bloodstains containing beta-enolase was recovered well after storage for 60 days at room temperature. The ratio of beta-enolase to total protein in bloodstains made from non-traumatic blood, nasal hemorrhage and menstrual blood, was within the normal range. In contrast, the ratio of beta-enolase in bloodstains from traumatic blood was obviously elevated (10-30 fold) in comparison with non-traumatic blood. Furthermore, the ratio of beta-enolase was proved to be higher in stains adhering to weapons that had passed through skeletal muscle, indicating that detection of beta-enolase in bloodstains could be used to distinguish crime weapons. These results suggest that beta-enolase is a useful marker for identification of skeletal muscle injury as well as for detecting the origin of bleeding.

New acetylenic enol ethers of glycerol from the sponge Petrosia sp

Ten acetylenic enol ethers of glycerols, including six new compounds (1-6) and a linear acetylenic alcohol (7), have been isolated from a sponge of the genus Petrosia. The structures of the novel compounds were elucidated by spectroscopic methods. The absolute stereochemistry of 1-7 was determined by chemical transformations and the Mosher method. Some of these compounds exhibited weak cytotoxicity against a human leukemia cell-line (K-562).

Outcomes of stent-graft treatment of false lumen in aortic dissection

BACKGROUND

Stent-graft treatment for aortic disease promises to lead to a less invasive therapy than conventional surgical therapy. However, this treatment has not been established as a therapy for aortic dissection. The aim of this study was to examine the effect of stent-graft treatment of aortic dissection, as measured by follow-up data on entry site closure, clotting in the false lumen, and the outcome of the false lumen from the acute to chronic phase after operation.

METHODS AND RESULTS

We used a stent-graft of our own design to close the entry site of aortic dissection in 21 cases: 9 were acute (< 14 days), 8 subacute (< 6 months), and 4 chronic (> 6 months). Nine were type A and 12 were type B. In 15 cases, the stent-graft was inserted through the transverse arch, which had been surgically opened under median sternotomy. In the other 6 cases, the stent-graft was inserted by means of a transcatheter through a femoral artery. Using computed tomographic scans, we followed and examined clot formation in the false lumen and reduction in size of the false lumen at 3 levels: at the level of maximum aortic diameter, at the distal end of the stent-graft, and 50 mm distal to the stent-graft. The entry sites were successfully closed in 19 cases (90.4%); in the remaining 2 (both treated with a transcatheter) there was perigraft leakage into the false lumen. The hospital mortality rate of these stent-graft treatments was 14.3% (3 of 21). At 2 weeks after operation, the false lumen had completely clotted, respectively, in 100%, 77%, and 38% of cases at the 3 measurement levels. Substantial shrinkage (> 50% in diameter) of the false lumen at 6 months after the operation was observed in 72%, 60%, and 38% of cases at the respective levels. Shrinkage of the false lumen was particularly enhanced in patients treated within 6 months from the onset of dissection: The false lumen shrank by > 50% in 93%, 75%, and 50% of patients.

CONCLUSIONS

In cases of aortic dissection, the stent-graft is an effective tool for closing the entry site and promoting clot formation in the false lumen and for reducing the size of the false lumen within 6 months of the onset of dissection if the entry site has been closed.

Sequence polymorphism of mitochondrial DNA control region in Japanese

Sequence polymorphisms of the mitochondrial DNA (mtDNA) control region, hypervariable regions I and II, from 100 unrelated Japanese were determined by PCR amplification and direct sequencing. Sequences of 404 nucleotides for hypervariable region I and 379 nucleotides for region II were obtained. Variable sites (85 and 45) were revealed in region I and region II, respectively, as compared to the reference sequence, and a total of 96 different genetic patterns from both regions I and II were determined. A point mutation heteroplasmy was observed at the ratio of approximately 50:50 from one individual at the sequence position 151 showing a nucleotide transition from C to T. The probability of identity was estimated as 2.3% for region I, 3.9% for region II, and 1.1% combined for both regions. These results suggest that sequence polymorphism of mtDNA control region would be very useful in forensic practice as a marker for individual identification.

Selective detection of biexponential relaxation in isotropic solutions by mixed coherence filtering NMR

This is a trial to simplize sequences to get the relaxation function f31(t), which is usually detected by the double- or triple-quantum filtered (DQF or TQF) NMR in an isotropic phase. The results indicate that only two phase cycling is needed to get the f31(t) function, which shows the advantage of S/N (signal-to-noise ratio) in a minimum acquisition time. The filtering of coherence levels in the creation time need not be limited to double- or triple-quantum coherences. An 87Rb signal from a 4% (w/w) agar powder in 500-mM RbCl solution is recorded at 130.9 MHz as a Larmor frequency using a Bruker MSL 400 spectrometer.

New secosteroids from a gorgonian of the genus Muricella

Calicoferols F-I (2-5), four new 9,10-secosteroids, have been isolated from a gorgonian of the genus Muricella collected from Jaeju Island, Korea. The structures of these compounds have been determined by combined spectroscopic methods. Calicoferols exhibited significant cytotoxicity and inhibitory activity against PLA2.

Proton double-quantum filtered MRI--a new method for imaging ordered tissues

The imaging of connective tissues such as cartilage and tendons using standard MRI techniques is hampered by their low signal relative to the surrounding tissues. 1H double-quantum filtered (DQF) MRI is an imaging method that detects molecules associated with ordered structures, while the signal from isotropic fluids is filtered out, thus creating a new type of contrast. The technique is demonstrated on an intact rat tail, where the image of the tendons is highlighted. Although the signal-to-noise ratio is inferior to that in gradient-echo MRI, the contrast between the tendons and the surrounding tissues is significantly better in the DQF MRI. It is demonstrated how, by adjusting the parameters of the DQF imaging pulse sequence, one can modify the contrast and enhance the images of specific compartments within an organ. A comparison with 2H DQF imaging of the same tissue is also given.

Tandem repeat structure of the duplicated Y-chromosomal STR locus DYS385 and frequency studies in the German and three Asian populations

The Y-chromosomal short tandem repeat (STR) locus DYS385 can be typed using PCR amplification and separation of the resulting polymorphic fragments by non-denaturing high resolution polyacrylamide gel electrophoresis followed by silver staining. The PCR primers amplify a duplicated repeat sequence on the Y chromosome revealing a two-band pattern in male individuals. To determine the internal repeat structure as a basis for a consensus nomenclature, DNA sequence analysis was carried out after subcloning of PCR-amplified fragments revealing the uniform 4-bp repeat structure 'GAAA'. The shortest allele observed consisted of 10 repeat units thus providing the basis for the designation 'allele 10'. Except for isolated point mutations, no systematic differences could be observed either in the repeat sequence or in the flanking regions between the two fragments of a given individual. Thus it was not possible to discriminate between the two loci of the DYS385 system. Four population samples of German (n = 146), Chinese (n = 100), Japanese (n = 100), and Thai (n = 95) origin were studied. In the four groups, alleles 10 to 24 could be observed and genotype frequencies differed significantly. In Germans only one common genotype was present (11-14; 33.8% frequency). In the Asian populations, the frequencies were more evenly distributed with the 13-13 genotype (9%) in Chinese, the 13-17 genotype (14%) in Japanese and the 14-18 genotype (7%) in Thai being the most common. Overall, 69 different genotypes were found, of these 36 were observed in Germans, 36 in Chinese, 33 in Japanese and 44 in Thai. No mutations were detected in 62 father-son pairs. Thus DYS385 is a highly polymorphic STR system with population-specific genotype distributions.

Apoptosis following gamma knife radiosurgery in a case of acoustic schwannoma

A 25-year-old woman with a large acoustic schwannoma underwent surgical excision 18 months after Gamma Knife radiosurgery because of transient expansion of the tumor causing ataxia. Histopathologial investigation by the TUNEL method revealed the presence of some apoptotic cells. The findings were compared with findings from a control group of 7 operated cases where radiosurgery had not been used. There was no apoptosis found in any of these cases. In addition, another case which resulted in a regrowing tumor following Gamma Knife treatment also showed no apoptosis. These findings suggest apoptosis may be a possible mechanism in reducing tumor size following Gamma Knife radiosurgery.

Five new polyacetylenes from a sponge of the genus petrosia

Petrocortynes D-H, novel C46 polyacetylenes, were isolated from a sponge of the genus Petrosia collected from Keomun Island, Korea. Petrocortyne D (2) is a 4,5-dihydro derivative of a diastereomer of petrocortyne A (1), and petrocortynes E-H (3-6) possess an additional allylic-hydroxyl group. The structures of these compounds were determined by combined chemical and spectral methods, and absolute configurations of most of the asymmetric carbon centers were determined by the modified Mosher's method. Limitations on the application of Mosher's method to allylic alcohols is discussed. Petrocortynes D-H exhibited moderate cytotoxicity and inhibitory activity against PLA2.

Energy consumption associated with fluid and electrolyte transport in the mandibular and parotid glands

The driving force for Cl- secretion in the salivary acinar cell is believed to be provided by the secondary active uptake of Cl- by Na+ dependent basolateral transporters. The energy cost of primary fluid secretion should therefore reflect the ratio of Na+ entry per mole of Cl- secreted. In the present study, we measured oxygen consumption (QO2) and fluid secretion in perfused mandibular and parotid glands from the rat, and estimated the energy cost of fluid secretion as the ratio of deltaQO2/delta(fluid secretion). During acetylcholine stimulation, the energy cost of fluid secretion by secretory endpieces was higher in the parotid gland than in the mandibular gland. The excess energy cost in the parotid gland may be attributable to other costs than the fluid and electrolyte transport. During bicarbonate-free perfusion in the mandibular gland, bumetanide abolished fluid secretion and QO2 decreased by ca 35%. The remaining QO2 was attributed to Na+ transport activity by basolateral antiports. Assuming values for the energy costs of each transporter and applying these to the total energy cost of the endpieces, the fraction of the total Na+ flux due to Na+/K+/2Cl- cotransport in Na+ handling was estimated to be 0.67. On the other hand, during perfusion with bicarbonate, after subtraction of the bumetanide-sensitive QO2 and the QO2 for antiports, about 19 microl/g/min of QO2 remained, which may be due to activation of Na+/HCO3- cotransport. Thus the inclusion of bicarbonate in the perfusate appears to alter the relative contributions of the various Na+-dependent basolateral transporters to total Na+ handling.

Regulation of cell volume and diffusion of intracellular water in salivary acinar cells

The regulation of acinar cell volume and the properties of intracellular water were investigated in perfused rat mandibular salivary glands by proton nuclear magnetic resonance (NMR) spectroscopy. Using an inversion-recovery pulse sequence, and an extracellular relaxation reagent (10 mM Gd-DTPA) to suppress the proton NMR signal from extracellular water, acinar cell volume (intracellular water content) in unstimulated glands was shown to depend upon Cl- uptake by basolateral Na+-K+-2Cl- cotransport. Muscarinic and beta-adrenoceptor stimulation induced shrinkage and swelling respectively. In pulsed-field-gradient NMR experiments, the diffusion coefficient of intracellular water was found to be more than an order of magnitude smaller than that of extracellular water. Using this intrinsic difference in diffusivity between the two compartments, cell volume regulation was investigated in intact, perfused glands in the absence of relaxation reagents. Using both NMR techniques, acinar cells in perfused glands were observed to behave like simple osmometers in response to anisosmotic media, and did not show the volume regulatory responses described in dissociated acinar cells.

NMR studies of salivary glands: from energy metabolism to morphology

Nuclear magnetic resonance (NMR) spectroscopy has been used to study various physiological functions of salivary glands. This short review summarizes results on energy metabolism and acid-base balance (31P and 14N NMR), electrolytes transport (23Na, 39K, 35Cl and 87Rb NMR) and water transport (1H NMR). The latest development of 1H nuclear magnetic resonance imaging (MRI) allows the three-dimensional structure of salivary glands to be observed with ca. 60 microm resolution, and it is also possible to observe circulation, flow, and volume changes during secretion. The combination of NMR and MRI may open up new fields in the study of exocrine secretion.

Magnetic resonance imaging of experimental subacute spinal cord compression

STUDY DESIGN

Subacute compression of the spinal cord was applied to rats. The animals were chronologically observed using magnetic resonance imaging for more than 8 weeks after surgery and were killed for histopathologic examination.

OBJECTIVES

To investigate the correlation of changes in signal intensity on magnetic resonance images with those observed in histopathologic study and with the degree of spinal cord compression and paralysis.

SUMMARY OF BACKGROUND DATA

No consensus has been reached concerning the correlation of magnetic resonance images to clinical symptoms of compressive myelopathy. Few reports are available in which magnetic resonance imaging findings are compared with histopathologic features in chronic or subacute experiments.

METHODS

In rats under general anesthesia, the T11 lamina was thinned and a slow increase in volume was applied. Hind limb paralysis appeared 1 week after the procedure and spontaneously subsided thereafter. The degree of spinal compression and signal intensity was observed chronologically using magnetic resonance imaging. The signal intensity on the final MR images was rated on a four-point scale and compared with histopathologic findings.

RESULTS

As spinal compression increased, the incidence of high signal intensity on long spin-echo images became higher. Low signal intensities on short spin-echo images were visible in animals in which compression and paralysis were the most severe. In these animals, cavitation and a dilated central canal were visible. High signal intensities on long spin-echo images reflected various pathologic changes.

CONCLUSIONS

Changes in signal intensity on MR images are visible after the induction of myelopathy by high-pressure compression. These signal intensities may be useful in predicting the outcome of compressive myelopathy.

Sequential methothrextate and 5-fruororacil therapy for diffuse bone metastasis from gastric cancer

We herein present a case of diffuse bone metastasis from early gastric cancer with disseminated intravascular coagulation (DIC) in a 40-year old man, who had undergone a curative gastrectomy and had no evidence of recurrence for five years after surgery. The patient was treated with an intravenous administration of sequential methothrexate (MTX) and 5-fluorouracil (5-FU), and demonstrated a favorable clinical course without any severe pain. Despite the fact that the presence of diffuse bone metastasis from gastric cancer plus hematologic disorders tends to indicate a significantly poor prognosis, the patient survived for a relatively long period (11 months) following chemotherapy. We thus conclude that MTX/5-FU sequential therapy seems to be a clinically useful regimen to improve both the symptoms and survival for cases of diffuse bone metastasis from gastric cancer.

Submucosal gastric cancer with lymph node metastasis

BACKGROUND AND OBJECTIVES

The intraoperative assessment of lymph node metastasis of gastric cancer remains difficult and the characteristics of recurrence after gastrectomy are not well known regarding submucosal cancer.

METHODS

We examined 452 patients with submucosal gastric cancer and compared the clinicopathologic features as well as recurrence patterns between the 71 cases with lymph node metastasis (group I) and the 381 without it (group II).

RESULTS

The mean tumor sizes were 44.8 and 33.5 mm, respectively (P < 0.01). The incidences of lymphatic invasion and vascular invasion were 91.5% (65/71) and 45.1% (32/71) in group I, which were significantly higher than those in group II (36.7 and 14.2%, 140/381 and 54/381, respectively, P < 0.01). A total of 21 patients (4.6%, 21/452) experienced recurrence after undergoing a gastrectomy and hematogenic recurrence was the most frequent type of recurrence (2.0%, 9/452). However, in group I, lymphatic recurrence was most frequently observed (7.0%, 5/71), and it was more frequent than in group II (0.3%, 1/381, P < 0.01). The median intervals between gastrectomy and recurrence were 34.5 and 64.0 months in groups I and II, respectively (P < 0.05).

CONCLUSIONS

The submucosal cancer with larger size, lymphatic invasion, and vascular invasion has high risks for lymph node metastasis. Furthermore, a strict follow-up for lymphatic as well as hematogenic recurrence is important for the patients with node positive submucosal cancer, especially within 5 years after operation.

Mapping strain exerted on blood vessel walls using deuterium double-quantum-filtered MRI

A technique is described for displaying distinct tissue layers of large blood vessel walls as well as measuring their mechanical strain. The technique is based on deuterium double-quantum-filtered (DQF) spectroscopic imaging. The effectiveness of the double-quantum filtration in suppressing the signal of bulk water is demonstrated on a phantom consisting of rat tail tendon fibers. Only intrafibrillar water is displayed, excluding all other signals of water molecules that reorient isotropically. One- and two-dimensional spectroscopic imaging of bovine aorta and coronary arteries show the characteristic DQF spectrum of each of the tissue layers. This property is used to obtain separate images of the outer layer, the tunica adventitia, or the intermediate layer, the tunica media, or both. To visualize the effect of elongation, the average residual quadrupole splitting <delta nu q> is calculated for each pixel. Two-dimensional deuterium quadrupolar splitting images are obtained for a fully relaxed and a 55% elongated sample of bovine coronary artery. These images indicate that the strong effect of strain is associated with water molecules in the tunica adventitia whereas the DQF NMR signal of water in the tunica media is apparently strain-insensitive. After appropriate calibration, these average quadrupolar splitting images can be interpreted as strain maps.

Multiple primary colorectal and gastric carcinoma in Japan

We investigated the occurrence of multiple primary colorectal and gastric cancer (MPCGC) in 1277 colorectal cancer patients between 1972 and 1996. MPCGC was found in 65 (5.1%). In the 28 synchronous cases, gastric or colorectal cancer was accidentally detected by pre-, intra-, or postoperative examinations. In 23 of the 37 metachronous cases, colorectal cancer developed on average 83 months after the operation for gastric cancer. In the other 14 cases, gastric cancer developed on average 70 months after the operation for colorectal cancer. Therefore, careful pre-, intra-, or postoperative examinations are strongly called for in order to not overlook the presence of colorectal or gastric lesions in MPCGC cases.

Second primary extracolonic cancers in Japanese hereditary nonpolyposis colorectal cancer

We examined the occurrence of second primary extracolonic cancers in 1,170 patients with nonpolyposis colorectal cancer who underwent a resection between 1972 and 1994. Such cancers occurred more often in cases with hereditary nonpolyposis colorectal cancer (HNPCC) than in those without (11.1% vs. 3.6%, P=0.0286). Five HNPCC cases developed 6 cancers in the stomach, endometrium, ovary, and ureter. The mean interval between the first and second operation was 66 months (range: 18-153). These findings thus indicate the importance of targetted surveillance for any second primary cancers in the upper gastrointestinal, female genital, or upper urologic tract, especially in HNPCC patients.

Changes in sleep patterns during He-O2 saturation dives

During simulated hyperbaric saturation diving experiments of He-O2 mixture at the depths of 150, 180 and 230 m the standard polysomnography of four divers, as well as their subjective feelings of fatigue, were recorded for 268 nights. In all three diving conditions, during the bottom period and the decompression period, wakes after sleep onset and Stage 1 sleep increased while Stage 4 sleep decreased. In deeper diving conditions stage 4 sleep tended to decrease and subjective feelings of fatigue increased. When the results are considered it can be assumed that the deeper the diving depths, the increased sleep disturbances and fatigue. However, it is believed that a fundamental sleep pattern will be maintained.

The clinicopathological characteristics and outcome of patients with right colon cancer

We compared the characteristics between the 281 cases with right colon cancer (RCC) and 438 cases with left colon cancer (LCC) who underwent a resection for the disease at our hospital between 1972 and 1995. The mean patient age was significantly higher for RCC than for LCC (62.5 years vs 60.4 years). The mean tumor size was also significantly larger in RCC than in LCC (6.1 cm vs 4.8 cm). The type of recurrence or survival was similar between RCC and LCC. Elderly patients were also found to be more likely to develop RCC than younger patients. This cancer often grows to a large size before being diagnosed. These findings, therefore, suggest the need for targeted examinations for the early detection of RCC, especially in the elderly.

[Transcatheter stent-graft implantation for the treatment of acute aortic dissection--rupture of aneurysm because of perigraft leakage]

An 82-year-old woman was diagnosed as having acute type B aortic dissection. At bed rest, her systolic blood pressure was kept less than 120 mmHg. Four days later the aneurysm threatened to rupture. Because she presented a high operative risk for open-chest surgery, a stent-graft was implanted across the dissection site via transcatheter. The entry site to the aneurysm was closed by the stent-graft, and postoperative aortograph demonstrated that contrast medium did not enter the false lumen except for a trivial projection. A CT scan 6 days after the stent-graft implantation unexpectedly demonstrated the false lumen not only had not thrombosed, but had expanded. As a result, 8 days after the operation the aneurysm ruptured into the left pleural cavity, and the patient died. An autopsy revealed the stent-graft was exactly implanted across the entry site, but that the diameter of the graft was slightly larger than that of the aorta. Consequently, a portion of the rim of the graft had been wraped after implantation, causing perigraft leakage. Leakage is one of the gravest complications of the stent-graft implantation, to prevent it, a new design for stent-graft device is essential.

Clinical significance of serum hyaluronic acid as a fibrosis marker in chronic hepatitis C patients treated with interferon-alpha: histological evaluation by a modified histological activity index scoring system

The aim of the present study was to investigate the histological changes effected by interferon (IFN) treatment and to evaluate the clinical significance of serum hyaluronic acid (HA) as a marker of fibrosis. Forty-nine patients with chronic hepatitis C treated with IFN-alpha were divided into three groups according to the existence of viraemia: sustained complete responders (CR), complete responders with relapse (PR) and non-responders (NR). Needle biopsy sections of the liver taken before and at the end of IFN treatment were assessed according to the modified histological activity index (HAI) scoring system. Serum fibrosis markers, including HA, were measured at needle biopsies. Biopsies of CR at the end of treatment showed a significant improvement in fibrosis and necroinflammatory scores. More significant correlation was observed between fibrosis scores and serum levels of HA before IFN treatment (r = 0.607, P < 0.0001) than those between fibrosis scores, on the one hand, and peptide of type III procollagen (PIIIP; r = 0.531, P = 0.0004) or type IV collagen 7S domain (type IV-C; r = 0.241, P = 0.1062) on the other. Moreover, serum HA levels fell significantly in patients in whom fibrosis improved (P = 0.011). This is the first paper describing the advantages of the modified HAI scoring system over others in estimating the effect of IFN-alpha; the results also indicate that serum HA can be useful in monitoring liver fibrosis in chronic hepatitis C patients treated with IFN-alpha.

Second primary extracolonic cancers in Japanese hereditary nonpolyposis colorectal cancer

We examined the occurrence of second primary extracolonic cancers in 1,170 patients with nonpolyposis colorectal cancer who underwent a resection between 1972 and 1994. Such cancers occurred more often in cases with hereditary nonpolyposis colorectal cancer (HNPCC) than in those without (11.1% vs. 3.6%, P=0.0286). Five HNPCC cases developed 6 cancers in the stomach, endometrium, ovary, and ureter. The mean interval between the first and second operation was 66 months (range: 18-153). These findings thus indicate the importance of targetted surveillance for any second primary cancers in the upper gastrointestinal, female genital, or upper urologic tract, especially in HNPCC patients.

Multiple primary colorectal and gastric carcinoma in Japan

We investigated the occurrence of multiple primary colorectal and gastric cancer (MPCGC) in 1277 colorectal cancer patients between 1972 and 1996. MPCGC was found in 65 (5.1%). In the 28 synchronous cases, gastric or colorectal cancer was accidentally detected by pre-, intra-, or postoperative examinations. In 23 of the 37 metachronous cases, colorectal cancer developed on average 83 months after the operation for gastric cancer. In the other 14 cases, gastric cancer developed on average 70 months after the operation for colorectal cancer. Therefore, careful pre-, intra-, or postoperative examinations are strongly called for in order to not overlook the presence of colorectal or gastric lesions in MPCGC cases.

Stent placement for recurrent vasospastic angina resistant to medical treatment

The successful stent placement for treatment of recurrent vasospastic angina in a patient with nonstenotic coronary arteries is described. Use of the Palmaz-Schatz stent resulted in successful vasodilation that completely prevented anginal attacks. This procedure represents an alternative treatment for patients with vasospastic angina refractory to aggressive medical therapy.

Sesquiterpenoids of the drimane class from a sponge of the genus Dysidea

Ten sesquiterpenoids, including seven new ones, have been isolated from an undescribed sponge of the genus Dysidea. Compounds 1-8 are sesquiterpenoids of the drimane class, while 9 and 10 are 12-norsesquiterpenoids of the same structural class. The structures of novel compounds have been determined by combined spectroscopic methods. These compounds exhibited moderate antimicrobial and enzyme inhibitory (Na+/K(+)-ATPase and PLA2) activities.

Discrimination between the different compartments in sciatic nerve by 2H double-quantum-filtered NMR

The 2H double-quantum-filtered (DQF) NMR spectrum of isolated rat sciatic nerve, equilibrated with deuterated saline, is composed of three quadrupolar-split water signals. On the basis of the time course of their shift by Co-EDTA2- and CoCl2, the signals with quadrupolar splittings of about 120, 470, and 9 Hz were assigned to water in the epineurium, endoneurium, and intra-axonal compartments, respectively. The signal of the bulk water, which experiences isotropic motion, was eliminated by the DQF pulse sequence. As the maximum intensities of the water signals in the three anisotropic compartments occur at different creation times, in the DQF pulse sequence, it is possible to resolve the signals and measure their properties, such as relaxation times, independently, without perturbing the system with shift reagents.

Lentinan potentiates immunity and prolongs the survival time of some patients

For the selection of patients responding well to lentinan, we performed two immunological analysis of patients. Flow cytometric analysis was obtained from peripheral blood lymphocytes; the patients who had greater than 2.5 ratio of [CD11(-) CD8(+)/CD11(+) CD8(+) after treatment]/[CD11(-) CD8(+)/CD11(+) CD8(+) before treatment] at 10 days after lentinan administration showed prolonged survival. The analysis of the- levels of soluble factors such as IL-6, sIL-6R, TNF-alpha, G-CSF, sICAM-1, IAP, and PGE2 and the decreasing levels of G-CSF, IL-6, and PGE2 after lentinan administration had a statistically significant correlation with the ratio of [CD4(+) CD29(+)/CD4(+) CD29(-) after treatment]/[(CD4(+) CD29(+)/CD4(+)CD29(-) before treatment]. The decrease in IL-6, G-CSF, and PGE2 levels after lentinan administration indicated an increase in immunine potential. From these results, we belive that patients with over 2.5-fold increase in [CD11(-) CD8(+)/CD11(+) CD8(+) after treatment]/[CD11(-) CD8(+)/CD11(+) CD8(+) before treatment] and showing a decrease in IL-6, G-CSF, and PGE2 levels after lentinan administration should continue treatment with lentinan for a long period.

Effectiveness of aldose reductase inhibitors for diabetic gastroenteropathy with constipation

We present a diabetic patient with long-standing constipation complicated by paralytic ileus and septic shock. She successfully recovered from a critical condition, and her diabetes was well controlled. However, the constipation did not improve even after the administration of conventional medications. Epalrestat, an aldose reductase inhibitor (ARI), improved her bowel motility and autonomic cardiovascular dysfunction, as evident from her heart rate and blood pressure response. Gastroenteropathy is a major diabetic complication which may cause disturbed bowel motility leading to serious enterobacterial infections, thus, its amelioration is important. ARI may be beneficial in the treatment of diabetic gastroenteropathy refractory to conventional therapies.

A case of liver metastasis of malignant peritoneal mesothelioma successfully treated by surgery

We herein report a very rare case of liver metastasis of malignant peritoneal mesothelioma occurring in a 47-year-old old woman, who had undergone a right lobectomy of the liver, and is still alive and well more than 2 years after the initial surgery. There is little information on how to successfully treat liver metastasis of this disease. Since mesothelioma cells rarely respond to chemotherapy cr radiation, we conclude that surgery plays an important role in the management of liver metastasis of malignant peritoneal mesothelioma.

A sandwich enzyme immunoassay for brain S-100 protein and its forensic application

A sensitive sandwich enzyme immunoassay for identification of brain S-100 protein in blood or bloodstains containing brain tissue is described. A polystyrene ball coated with rabbit anti-S-100 protein IgG was incubated with human S-100 protein, and then with anti-S-100 Fab'-peroxidase conjugate. Peroxidase activity bound to the polystyrene ball was assayed by fluorometry using 3-(4-hydroxyphenyl)propionic acid as the hydrogen donor. The detection limit of human S-100 protein was 0.6 pg (30 amol) per assay tube. The cross-reaction of this sandwich enzyme immunoassay to other organs was approximately 1/100 or less. Antigenic activity of S-100 protein in bloodstains containing brain extracts was detectable after storage for 36 days at room temperature. The ratio of S-100 protein to total protein (ng/mg) in bloodstains when brain tissue was mixed with normal human blood at concentrations of 5-500 mg/ml was approximately 100-fold those of other samples (liver, heart, intestine, and skeletal muscle). These results indicated that bloodstains mixed with brain tissue were clearly distinguishable from others. Thus, in forensic practice, measurement of S-100 protein or the ratio of S-100 protein to total protein is useful to identify blood and bloodstains containing brain tissue.

[Pyrimidine nucleoside phosphorylase activity, 5-fluorouracil concentration and thymidylate synthase inhibition rate in colorectal cancer after oral administration of 5'-doxifluridine]

To assess the mechanism of the anticancer effect of doxifluridine (5'-DFUR), a clinicopharmacological study was performed. So far, no comparative study has been reported between the thymidylate synthase (TS) inhibition rate and the 5-FU concentration in colorectal cancer after oral administration of 5'-DFUR. In 37 patients with colorectal cancer, 5'-DFUR was administered orally/preoperatively (800 mg/day x more than 4 days before operation and 300 mg on the day of operation). The mean total dosage was 6.9 g. Specimens of tumor and normal intestinal tissue were obtained 4.4 hours on average after final administration. The TS inhibition rate as well as the 5-FU concentration and the activity of pyrimidine nucleoside phosphorylase (PyNPase) were analyzed in both tissues. The PyNPase activity was significantly higher in the tumor tissue than in the normal tissue (137.9 +/- 10.8 vs. 31.0 +/- 4.7 micrograms FU/mg protein/hr, p < 0.0001). The 5-FU concentration was also significantly higher in the tumor tissue than in the normal tissue (101.3 +/- 30.6 vs. 23.2 +/- 5.5 ng/g, p = 0.024). The TS inhibition rate correlated with the 5-FU concentration in the tumor tissue (r = 0.527, p = 0.047). These findings suggest that the TS inhibition rate may be an index of the anticancer effect of 5'-DFUR in colorectal cancer.

A preliminary study on the emotional distress of patients with terminal-stage cancer: a questionnaire survey of 1380 bereaved families over a 12-year period

To clarify the emotional distress of terminal cancer patients, questionnaires were sent to 2826 families of patients who died at the National Kyushu Cancer Center; 1380 replies were obtained. Among the 1380 patients, 37.7% had been aware of the disease name and 19.8% had been unaware. Of the 1380 patients, 43.5% had prepared for and calmly accepted death, but 12.4% had greatly feared and 11.7% rejected death. Patients aware of the disease name had tended to prepare better for death but also had a stronger fear compared with those who were unaware. Patients informed of the exact nature of their disease by their physicians tended to value their remaining life more than those informed by others. Those who had desired notification of the disease name also tended to value their remaining life more than those who had not. They also spent their remaining life more usefully, and were less discouraged after being informed than those who had not expressed a wish to be informed. Thus: 1. The emotional state of the cancer patient should be clearly established before deciding to inform the patient of the true diagnosis. 2. The patient should be notified of the disease by the doctor, even if he/she is already aware of the diagnosis through others. 3. The ability to share bad news with the patient is of crucial importance for physicians when caring for terminal- stage cancer patients.

A newly established mouse model of peritoneal dissemination in human pancreatic cancer

Tissue from a Suit-2 cell line derived from human pancreatic cancer was transplanted into the normal pancreas of Balb/c nu/nu mice using a physiological fibrin adhesive kit (Beriplast P). A minced tissue specimen (2-5 x 10(2) mg) was transplanted into normal pancreas in each nude mouse, and immediately thereafter 10 microliters of type A solution and 10 microliters of type Bsolution of Beriplast P were administered simultaneously at the transplanted area. The tumor tissue promptly adhered to the normal pancreas. Ten days after the implantation of cancer tissue, neovascularization had also already formed around the cancer tissue. The transplantation ratio of cancer tissue in normal pancreas was 100% (20/20). The capsule around the cancer tissue had not clearly formed. Twenty-one days after transplantation, the cancer cells were observed to be disseminated and closely fixed to the mesentery. The dissemination ratio of this cell line in the mouse mesentery was 85% (17/20) at 21 days after transplantation. This nude mouse model might thus be useful for investigating the development of human pancreatic cancer.

Overexpression of SAP-1, a transmembrane-type protein tyrosine phosphatase, in human colorectal cancers

SAP-1 is a human transmembrane-type protein tyrosine phosphatase that is abundant in colon and pancreatic cancer cell lines. The expression of SAP-1 in surgically excised human colorectal cancer specimens has now been investigated by immunohistochemical staining and in situ hybridization. Normal colon tissue or adenomas with mild dysplasia showed no detectable expression of SAP-1. In contrast, 2 of 17 adenomas with moderate or severe dysplasia and 19 of 48 (40%) adenocarcinomas expressed SAP-1, SAP-1 was localized predominantly to the apical surface of colonic cells in adenoma tissue showing moderate dysplasia, but it was also observed in the cytoplasm and at the basal surface of both adenoma cells showing severe dysplasia and adenocarcinoma cells. In situ hybridization with a SAP-1 antisense RNA probe detected SAP-1 mRNA in 6 of 9 colorectal cancers, but not in the surrounding mesenchymal tissue or normal mucosa. Sequencing of the K-RAS gene revealed that 10 of 15 (67%) SAP-1-positive cancers contained a mutation in codon 12. The serum concentration of carcinoembryonic antigen was normal in approximately half of the patients with SAP-1-positive colorectal cancers. These results suggest that SAP-1 is frequently overexpressed in human colorectal cancers and that such overexpression may occur relatively late in the adenoma-carcinoma sequence.

A medico-legal approach to the myocardial changes caused by transthoracic direct current countershock

The myocardial damage caused by transthoracic direct current countershock was evaluated serologically and histologically. Countershock energy of between 12 and 240 watt-second (ws) discharge was given to rabbits. Total creatine kinase (total CK) and creatine kinase-MB isozyme (CK-MB) activities in plasma were increased after the countershock, with peak values averaging 5690 IU/L (total CK) and 35 IU/L (CK-MB) within 6 h, whereas the CK-MB activity of a rabbit subjected to countershock in the femoral region was within normal range of less than 3 IU/L. Histologically, epicardial alteration was found in electrode-shaped areas which confined to the superficial epicardium in all rabbits. The heart from rabbits that died within a few minutes after countershock showed epicardial alteration in right and left ventricles, and subendocardial alteration with focal hemorrhage was evident in the left ventricle. Subendocardial necrosis and interstitial edema were also revealed in the left ventricle 72 h after countershock. These myocardial damages appeared in the transthoracic pathway between the electrodes. Thus, we conclude that the myocardial damage caused by countershock is distinguishable from heart disease in terms of the characteristic areas and measuring CK levels.

Micro-magnetic resonance imaging of the inner ear in the guinea pig

We applied a magnetic resonance microscopy at 7.05 T with a gradient coil unit to image the fine structure of the guinea pig cochlea. First, a three-dimensional MR image of the surface of the cochlea was obtained to select the location of cross-sectional images. Then, cross-sectional images of the basal turn, the second turn and the apical turn of the cochlea were obtained. Based upon the different protein concentrations of the endolymph vs the perilymph, the scala vestibuli, scala tympani and the cochlear duct could be clearly distinguished. This allowed a determination of the location of both the basilar membrane and Reissner's membrane. We raise the possibility that MRM may become useful in the diagnosis of endolymphatic hydrops (Meniere's disease).

Early effects of gamma knife radiosurgery on brain metastases: assessment by 201TlCl SPECT and 99mTc-DTPA-human serum albumin SPECT

Thallium-201 chloride (201TlCl) single photon emission computed tomography (SPECT) was used to determine tumor viability, and the early and delayed images of technetium-99m-diethylenetriaminepenta-acetic acid-human serum albumin (99mTc-HSA-D) SPECT were used to assess tumor vascularity and permeability, respectively, in 17 patients with 18 brain metastases. SPECT was performed before, 1 week after, and 1 month after radiosurgery. The ratios of 201Tl and 99mTc-HSA-D uptake in a tumor were expressed as a ratio to uptake in the corresponding normal contralateral areas (uptake index). Magnetic resonance imaging with gadolinium was used to determine tumor volume. 201Tl index decreased significantly 1 week (p < 0.05) and 1 month (p < 0.005) after radiosurgery. In contrast, 99mTc-HSA-D indices of early and delayed images obtained at 1 week after radiosurgery were not significantly different from the pretreatment values. However, both were significantly low (p < 0.05) 1 month after radiosurgery. No change in tumor volume was detected 1 week following radiosurgery, but there was a significant decrease (p < 0.005) after 1 month. The reduction in tumor viability that occurs before the appearance of evidence of tumor shrinkage represents the early effect of radiosurgery on brain metastases. Reduction in tumor size, vascularity, and permeability occur subsequently.

A clinicopathological study of asymptomatic gastric cancer

The clinicopathological profiles of 419 patients with asymptomatic gastric cancer (AGC) first detected by gastric screening, were reviewed and compared with those of the 1727 patients with symptomatic gastric cancer (SGC). The incidence of AGC increased gradually and has amounted to 30% of the total resected cases in recent years. About 75% of AGC cases were of early cancer and 84% were negative for lymph node metastases. In contrast, only 33% of SGC cases were of early cancer and 57% were node positive. Curative resection was done in 97% of AGC and 75% of SGC. The cumulative 5 and 10 year survival rates of patients with curatively resected AGC were 85.2% and 72.2%, respectively, while those for patients with SGC were 66.8% and 55.4%. These data demonstrated that most patients with asymptomatic gastric cancers could expect a curative resection, i.e. have a better clinical outcome, than those with symptomatic cancer.

Isolation of guaianoid pigments from the gorgonian Calicogorgia granulosa

Three pigments of the guaiazulene class have been isolated from the gorgonian Calicogorgia granulosa. Structures of these compounds have been determined as guaiazulene, 2,2'- diguaiazulenylmethane, and a new compound, 2,2'-biguaiazulenyl, by combined chemical and spectroscopic methods. 2,2'-Biguaiazulenyl exhibited moderate antimicrobial activity.

Advantages and safety of local treatment with MMC/Beriplast P for cancer tumors

To target the treatment of small points of cancer, Beriplast P, already used clinically as a physiological tissue adherent drug carrier, was mixed with the anticancer drug, mitomycin C (MMC). In this in vitro study, MMC did not release quickly from the clot of MMC/Beriplast P. The antitumor effect of this mixture was examined for its effect on cancer growth. In one series of experiments, tumor tissues were inoculated with MMC/100 microliters Beriplast P and in another series, MMC/100 microliters Beriplast P was injected into tumors at a weight of 300 mg. In the first series of experiments, tumor tissue treated with 0.3 mg MMC/100 microliters Beriplast P was replaced with plasma cells and lymphocytes, and no viable cancer cells could be found. In the second series, MMC/100 microliters Beriplast P delayed tumor growth, and the survival of Balb/c mice injected with 0.08 mg MMC/100 microliters Beriplast P was significantly longer than that of mice injected with 0.08 mg MMC/100 microliters saline solution (P = 0.026). In addition, the abdominal aorta, vena cava, and intestine around the area of treatment with 1.6 mg MMC/100 microliters Beriplast P were not damaged. These results indicate that the mixture of Beriplast P and MMC is more effective than MMC solution alone in the local treatment of residual cancer.

[Continuous hepatic arterial infusion chemotherapy with low-dose CDDP plus 5-FU for liver metastases from colorectal carcinoma]

Seven patients with unresectable liver metastases from colorectal carcinoma were treated with low-dose CDDP plus 5-FU continuous hepatic arterial infusion chemotherapy. A hepatic artery catheter was placed into the gastroduodenal artery at laparotomy or percutaneously placed into the proper hepatic artery via left subclavian artery. Through an injection port placed beneath the skin, 5-FU (300 mg/m2/day) was continuously infused for 5 days; CDDP (6 mg/m2/day) was infused for 5 successive days a week. One cycle consisted of 4 weeks. The response rate was 71% (1 CR, 4 PR, 2 NC). The CEA level decreased in all cases. The median survival was 17 months. Major toxicities were abdominal pain and appetite loss due to extrahepatic perfusion of the drugs. Failure in maintaining the catheter was a problem in most cases. The pharmacokinetic study demonstrated high hepatic extraction of CDDP and 5-FU (40% and 90%, respectively). These results suggest that continuous hepatic arterial infusion chemotherapy with low-dose CDDP plus 5-FU is effective for patients with unresectable liver metastases from colorectal carcinoma.

Effect of gamma knife irradiation on relaxation and contraction responses of the common carotid artery in the rat

This report concerns a pilot study of the short- and long-term effects of gamma knife radiosurgery on vascular responses. The investigation was carried out on male Sprague-Dawley rats, and the relaxation and contraction responses of the right common carotid artery (CCA) were assessed following irradiation (100 Gy). The non-treated CCA of the same animals served as internal controls. Non-irradiated rats were used to control the effect of normal aging on vascular function. Isometric tension was determined on in vitro preparations of arterial rings. Acetylcholine-mediated, endothelium-dependent relaxation was impaired one month after radiosurgery, as was endothelium-independent relaxation induced by sodium nitroprusside, but the effect on the latter was minimal. The irradiated CCA was also impaired with respect to contraction responses induced by norepinephrine, endothelin-1 or phorbol dibutyrate. This impairment appeared to be biphasic, as it was evident one day after radiosurgery, followed by a partial recovery one week later, and again manifest after one month. At the light microscope level, the carotid arteries appeared to be well preserved throughout the experiment. However, obvious ultrastructural changes were noted in endothelial and smooth muscle cells of specimens obtained three months after radiosurgery. The present data indicate that high dose gamma knife radiosurgery affects the functions of both, the vascular endothelium and the vascular smooth muscles in an apparent time-dependent fashion. Because of its increasing application to patients, there is the need for studying the effects of gamma knife radiosurgery on cerebral arteries, since functional vascular changes may occur in the absence of obvious histological alterations. Our results on CCAs point to the feasibility of such experimental investigations.