Laparoscopic radical nephrectomy for renal cell carcinoma: early experience

We developed a laparoscopic radical nephrectomy for malignant disease of the kidney and successfully performed the operation in six patients between July 1992 and October 1993. This procedure is basically derived from that of Clayman and associates. A CO2 pneumoperitoneum is induced, and five trocars are introduced into the abdominal cavity through the lateral abdominal wall. The kidney is removed en bloc together with the adrenal gland, perirenal fatty tissue, and Gerota's fascia. The free kidney is put into a laparoscopy sack, and the sack is pulled out through a 5- to 6-cm incision in the abdominal wall without morcellation to allow complete pathologic examination. By this procedure, right nephrectomy was performed in four patients and left nephrectomy in two patients. The mean operative time was 6 hours and 13 minutes, and the mean blood loss was 430 mL. There were no severe complications. The average hospital stay was 11 days, and the average time to full convalescence was 21 days. Pathologic examination revealed renal cell carcinoma in five patients and nephroblastoma in one. Of the patients with renal cell carcinoma, the stage was pT1pN0pM0 in three patients and pT2pN0pM0 in two. There has been no recurrent disease in these six patients with a mean follow-up period of 9.5 months.

[Trigonoplasty for vesicoureteral reflux--from open surgery to endoscopic surgery]

To evaluate endoscopic trigonoplasty compared to open trigonoplasty for vesicoureteral reflux, we analyzed clinical results, complications, the use of analgesics for postoperative pain and bladder irritability and postoperative length of hospitalization. One of six patients undergoing endoscopic trigonoplasty subsequently underwent open trigonoplasty due to failure of trocar placement, therefore, 7 patients having vesicoureteral refluxy renoureteral units underwent open trigonoplasty and 5 patients with vesicoureteral reflux 7 renoureteral units underwent endoscopic trigonoplasty. Mean operative time was 143 +/- 48 minutes for open surgery and 185 +/- 54 minutes for endoscopic surgery. Vesicoureteral reflux disappeared in 8 renoureteral units but was worse in one unit after open trigonoplasty, while vesicoureteral reflux subsided in 6 units and improved in one unit from grade II to grade I after endoscopic trigonoplasty. There were no intraoperative complications after open surgery, while one patient had pneumoperitoneum due to inadequate placement of a trocar during endoscopic surgery. There were no early postoperative complications after endoscopic surgery. However, 2 patients developed hematuria after open surgery. The degree of postoperative pain and irritability following endoscopic trigonoplasty was lower than that after open trigonoplasty and analgesics were used less frequently after endoscopic surgery. The mean postoperative hospital stay was 16.7 +/- 3.2 days for open surgery and 14.4 +/- 2.9 days for endoscopic surgery. These results indicate that endoscopic trigonoplasty is a useful procedure for vesicoureteral reflux because it is minimally invasive.

Mapping of transcriptional regulatory domains of pseudorabies virus immediate-early protein

The 180 kilodalton immediate-early protein (IE180) of pseudorabies virus functions as a strong transactivator of several different promoters and also as a repressor of its own transcription. To map the functional domains of IE180, we prepared various truncated mutants and analyzed their transcriptional regulatory activities using the chloramphenicol acetyl transferase (CAT) assay. Analysis of mutants truncated from the carboxy-terminal end of the 1,460-amino acid polypeptide showed that a polypeptide possessing amino acids 1 to 1,081 retained significant functions of transactivation and autoregulation potential. On the other hand, removing amino acids 1 to 131 resulted in a complete loss of transactivation potential, indicating that the domain responsible for transactivation is located in the amino-terminal end of IE180. Additional amino-terminal truncation up to amino acid 453 did not affect the autoregulation activity, indicating that the region between amino acids 454 and 1081 has autoregulation potential.

Gas chromatography/mass spectrometric analysis of 24R,25-dihydroxyvitamin D3 using 24R,25-dihydroxy[6,19,19-2H]vitamin D3 as internal standard

Gas chromatography/mass spectrometric (GC/MS) analysis of 24R,25-dihydroxyvitamin D3 (24,25-(OH)2D3, 1a) in rat serum is examined using 6,19,19-trideuterated derivative (24,25-(OH)2[6,19,19-2H]D3, 1c) as an internal standard. Pyro- and isopyro-24,25-(OH)2D3 (2a and 3a) are synthesized and the structures are determined unambiguously by their spectral data including nuclear overhauser enhancement study of the NMR spectra. The two peaks which appear on the total ion chromatogram of 24,25-cyclic n-butyl boronate-3-trimethylsilyl derivative of 24,25-(OH)2D3 are identified to be those of the pyro and isopyro isomers (2a and 3a) by direct comparison with the synthetic standards. Analysis of the GC/MS spectrum of 24,25-(OH)2[6,19,19-2H]D3 (1c) indicated that the CH3(19) is preferentially eliminated in the fragmentation giving rise to a base peak (M-TMSOH-Me)+. Thus the molecular ion peak, which is about 20% of the base peak, rather than the base peak is used for GC/MS assay of 24,25-(OH)2D3 in serum.

Contemporaneous bilateral postero-ventral pallidotomy for early onset "juvenile type" Parkinson's disease. Case report

Early onset "juvenile type" Parkinson's disease is commonly associated with disabling bilateral levodopa-induced dyskinesias. We report here a successful contemporaneous bilateral postero-ventral pallidotomy performed on a 46-year-old male with juvenile type Parkinson's and associated levodopa incited symmetric dyskinesias. A comparison of various surgical alternatives is included. Preoperative and postoperative evaluation, operative method and posteroventral pallidotomy's therapeutic mechanism are presented.

Digital nerve conduction velocity as a sensitive indication of peripheral neuropathy in vibration syndrome

Digital nerve conduction velocities in the median and ulnar nerves were measured in order to obtain a more accurate indication of peripheral nerve impairment induced by hand-arm vibration. The subjects were 26 patients with vibration syndrome and 28 healthy controls, both groups of about the same age. Two pairs of surface electrodes were attached to the finger and one pair was positioned on the palm, while electrical stimulation was applied to the nerve at the wrist and elbow. Then sensory nerve conduction velocities were antidromically measured within the finger, and also from the wrist to the palm and from the elbow to the wrist. Slowed conduction within the finger was mostly found among the patients. The slowing was also encountered from the wrist to the palm across the carpal tunnel. Abnormalities were observed in the digital nerve segment in about 50-70% of the patients, and in the wrist-to-palm segment in about 10-25% of them. The present study indicates that digital nerve impairment predominantly occurs in the vibration-exposed patients, and that measurement of digital nerve conduction velocity can be a useful objective means to detect peripheral neuropathy in vibration syndrome.

Integrin regulatory switching in development: oscillation of beta 5 integrin mRNA expression during epithelial-mesenchymal interactions in tooth development

Integrin receptors for extracellular matrix molecules are thought to play important roles in morphogenesis since they mediate aspects of embryonic cell adhesion and migration. Using in situ hybridization, the mRNA expression pattern of the beta 5 integrin receptor subunit was examined during murine tooth development, a classical system for studying morphogenesis. In developing tooth, high-level expression of beta 5 integrin mRNA alternates from epithelium to mesenchyme and back to epithelium. Each switch in localization occurs within one day. These results demonstrate that an integrin mRNA can be precisely and rapidly up- and down-regulated over unexpectedly short time spans, and that expression can oscillate between adjacent, interacting epithelial and mesenchymal tissues during morphogenesis. This rapid modulation of mRNA expression suggests a potential regulatory role for the beta 5 integrin receptor in morphogenesis.

Locally delivered minocycline and guided tissue regeneration to treat post-juvenile periodontitis. A case report

A case of post-juvenile periodontitis in a 28-year-old female patient is described along with new periodontal treatment modalities. Administration of minocycline-HCl with local drug delivery system was introduced as a part of initial periodontal therapy following microbiological and immunological examinations. The lesions were subsequently treated by guided tissue regeneration, which resulted in considerable gain of attachment with minimal recession of marginal gingiva. This observation suggests that the local delivery of antibiotics and regenerative therapy may prove to be effective alternative modalities in treatment of post-juvenile periodontitis.

Analysis of the VNTR locus D1S80 in a Japanese population

A population study on the VNTR locus D1S80 was carried out in a sample of 377 unrelated Japanese individuals living in and around Gifu Prefecture (central region of Japan). A total of 29 different alleles was distinguished. Alleles 18, 24 and 30 were found to be the 3 most common alleles in this population sample and their frequencies were 0.147, 0.200 and 0.162, respectively. Out of the 435 possible phenotypes, 120 were observed. The observed heterozygosity was 0.88 and the power of discrimination was 0.98. No significant deviations from Hardy-Weinberg equilibrium could be found in this Japanese population sample.

Histologic and immunohistochemical study of clinically non-functioning pituitary adenomas: special reference to gonadotropin-positive adenomas

Seventy-five clinically non-functioning pituitary adenomas were characterized in terms of their histologic and immunohistochemical features. Fourteen adenomas (18.7%) were positive for hormones other than gonadotropins. These included two somatotroph adenomas, three lactotroph adenomas, four thyrotroph adenomas, four corticotroph adenomas and one unusual plurihormonal adenoma. Fifty-five adenomas (73.3%) were exclusively positive for one or more gonadotropin subunits (beta-follicle stimulating hormone, beta-luteinizing hormone, and alpha-subunit of glycoprotein hormones), but negative for other hormones such as growth hormone and beta-thyrotropin. Histologically, a papillary arrangement along the capillary was most characteristically observed in the gonadotropin-positive adenomas. Five of six adenomas negative for any pituitary hormones exhibited the typical papillary structure. Thus, approximately 80% of clinically non-functioning adenomas constituted a single tumor group that shared the common histologic features of gonadotroph adenomas. These findings suggest that nearly all tumor types of clinically non-functioning adenomas can be diagnosed solely by light microscopy in combination with immunohistochemistry, and that the vast majority of them may be gonadotroph adenomas.

Analysis of methyl isothiocyanate in wine by gas chromatography with dual detection

Methyl isothiocyanate (MITC) was extracted from a 5 mL wine sample with 2 mL dichloromethane, and the extract was washed with 5% sodium chloride solution. MITC was determined by gas chromatography with a dual nitrogen-phosphorus detector (NPD) and a flame photometric detector (FPD, S mode) (DB-210 column, 30 m x 0.53 mm id, column temperature, 70 degrees C). The limit of detection and quantitation of MITC with NPD-GC were 0.003 and 0.01 ppm, respectively. Average recoveries of MITC added to wine at 1 and 0.1 ppm were over 95%. This method is simple and rapid for routine analysis of MITC in wine.

Biological activities of 24-fluoro-1 alpha,25-dihydroxyvitamin D-2 and its 24-epimer

Biological activities of two epimeric 24-fluorinated vitamin D-2 analogs, 24-fluoro-1 alpha,25-dihydroxyvitamin D-2 [24-F-1,25-(OH)2D2] and its 24-epimer [24-epi-24-F-1,25-(OH)2D2], were studied and compared with 1 alpha,25-dihydroxyvitamin D-3 [1,25-(OH)2D3] and 1 alpha,25-dihydroxyvitamin D-2 [1,25-(OH)2D2]. 24-F-1,25-(OH)2D2 was nearly as active as 1,25-(OH)2D3 and 1,25-(OH)2D2 both in regulating calcium metabolism in vivo including bone mineral mobilization and intestinal calcium transport and in inducing differentiation of HL-60 cells. While 24-epi-24-F-1,25-(OH)2D2 showed distinct properties in these two types of the actions. Though the 24-epimer was nearly as potent as 1,25-(OH)2D3 in inducing differentiation of HL-60 cells, it showed little activity in regulating calcium metabolism in vivo. The fluorine atom introduced at the 24-position of either 1,25-(OH)2D2 or its 24-epimer had no potentiating effect. This is in sharp contrast with the cases of 24- and 26,27-multifluorinated analogs of active vitamin D-3.

Immune response and in vivo distribution of the virus in chickens inoculated with the cell-associated vaccine of attenuated infectious laryngotracheitis (ILT) virus

Chickens inoculated with the cell-associated (CA) vaccine acquired higher protective immunity to ILT. In chickens vaccinated with CA or cell-free (CF) vaccine, respectively, virus-neutralizing and IgG- and IgM-ELISA antibodies were detected in the serum, but no antibody was detected in the tracheal washes of the vaccinated chickens. More apparent antibody response was seen in chickens vaccinated with the CA vaccine than with the CF vaccine. The antibody titers did not correlate closely with the protection against challenge with ILT virus. After subcutaneous injection of either CA or CF vaccine, ILT virus was isolated from the liver, spleen, thymus, lungs and other organs of the chickens from 1 to 6 days after injection, and there was no correlation of the isolation rate for the CA-vaccinated and the CF-vaccinated chickens.

[Effects of mianserin hydrochloride on delirium: comparison with the effects of oxypertine and haloperidol]

Mianserin (10-60 mg), haloperidol (2-6 mg) and oxypertine (20-60 mg) were administered once before bedtime in patients with delirium in Kurume University Hospital. The therapeutic effects of these drugs were investigated in the pre- and post-treatment using Delirium Rating Scale (DRS: Trzepacz et al., 1988). Mianserin was observed to be effective on 67% of the cases, and haloperidol and oxypertine in about 60%. Based on the clinical results and on the measurement of plasma concentration of mianserin, mianserin was considered to be an effective drug particularly against delirium in elderly patients because the effect and plasma concentration of mianserin were observed in the early stage of treatment without any side effects. The reduction of plasma free-MHPG was accompanied with improvement in the delirious state. The reason for the changes in plasma free-HVA was unclear.

Intracytoplasmic granulofilamentous inclusion bodies in a meningioma. Immunohistochemical and ultrastructural studies

A case of cerebellar tentorial meningioma, with abundant, large, eosinophilic intracytoplasmic inclusions, was studied immunohistochemically and ultrastructurally. These intracellular inclusions were periodic acid-Schiff negative and ultrastructurally appeared as a condensation or aggregation of numerous intracytoplasmic intermediate filaments. These inclusions were not related to microvillus-lined ductules, indicating that these inclusions were distinct from pseudopsammoma bodies. In addition, these inclusions were intensely immunopositive for vimentin, whereas staining for glial fibrillary acidic protein, epithelial membrane antigen, cytokeratin, neurofilament, desmin, actin, or type IV collagen was negative. To our knowledge, this is the second reported case of meningioma with such unusual inclusions, but the first one to demonstrate that the intracytoplasmic intermediate filaments and their related inclusions were mainly composed of vimentin.

Construction of recombinant infectious laryngotracheitis virus expressing the LacZ gene of E. coli with thymidine kinase gene

We constructed the recombinant infectious laryngotracheitis virus (ILTV), CE strain, containing the LacZ gene of E. coli in the thymidine kinase gene. The growth property of the recombinant virus was almost the same as parental CE strain in chicken embryo fibroblasts. The recombinant CE strain of ILTV could be used as a live vaccine vector.

Angiotensin II receptor subtypes in bovine and human ventricular myocardium

Angiotensin II (AII) binding sites in bovine and human ventricular myocardium were characterized by a radioreceptor assay. The specific binding of [125I]AII to myocardial membranes appeared to be saturable, and it was of high affinity with apparent dissociation constants of 1.60 nM (bovine) and 1.09 nM (human). The Bmax values were 39.7 fmol/mg protein (bovine) and 6.07 fmol/mg protein (human). Both losartan (angiotensin type 1 receptor subtype selective antagonist) and PD123177 (the angiotensin type 2 receptor subtype selective antagonist) inhibited specific [125I]AII binding to bovine myocardium, and their Hill coefficients were less than unity. Nonlinear least-squares regression analysis has suggested the existence of two populations of [125I]AII binding sites that have high and low affinity for losartan or PD123177. The relative proportions of high- and low-affinity sites for losartan in bovine myocardium were 68% and 32%, and those for PD123177 were 33% and 67%, respectively. On the other hand, specific [125I]AII binding in human myocardium was inhibited by losartan with much lower affinity and also by PD123177 with higher affinity, compared with bovine myocardium. The Hill coefficients for both drugs were close to one. Dithiothreitol enhanced specific [125I]AII binding to bovine myocardium in the presence of losartan, but it reduced [125I]AII binding in the presence of PD123177. This agent markedly enhanced specific [125I]AII binding to human myocardium. Thus, it is possible that bovine myocardium has both angiotensin type 1 receptor and the angiotensin type 2 receptor subtypes of AII receptors whereas human myocardium has predominantly the angiotensin type 2 receptor subtype.

Structural studies on the oligosaccharides isolated from bovine kidney heparan sulphate and characterization of bacterial heparitinases used as substrates

We prepared a series of oligosaccharides from commercial bovine kidney heparan sulphate after limited digestion with heparitinase I from Flavobacterium heparinum, and determined the structures of eight tetrasaccharides and a hexasaccharide by enzymatic analysis, fast atom bombardment mass spectrometry and 500 MHz 1H NMR spectroscopy. The tetrasaccharides share the common core structure delta 4,5HexA alpha 1-4GlcN alpha 1-4HexA1-4GlcN (where delta 4,5HexA is 4-deoxy-alpha-L-threo-hex-4-enopyranosyluronic acid and HexA is hexuronic acid), with zero, one or two sulphate groups. Seven of them contain non-sulphated glucuronic or iduronic acid, and the other, 2-O-sulphated iduronic acid at the internal position. Although they contain ordinary structures which should be widely distributed in the relatively low-sulphated region of heparan sulphate, five of the tetrasaccharides were isolated for the first time as discrete structures. The structure of the hexasaccharide was determined as delta 4,5HexA alpha 1-4GlcNAc alpha 1-4GlcA beta 1-3Gal beta 1-3Gal beta-1-4 Xyl and is derived from the carbohydrate-protein linkage region of the heparan sulphate chains. The hexasaccharide seems to have been released by the alkaline treatment used to prepare the heparan sulphate. The Gal residues were non-sulphated as are those in the porcine intestinal heparin chains, but in contrast to the sulphated Gal structures previously demonstrated in the carbohydrate-protein linkage region of chondroitin sulphate chains. These oligosaccharides were used to investigate the substrate specificity of heparitinases I and II from F. heparinum. The results revealed that heparitinase I cleaves hexosaminidic bonds linked to non-sulphated glucuronic or iduronic acid residues. The glucosaminidic linkage of the hexasaccharide was sensitive to heparitinase I, but resistant to heparitinase II, demonstrating the differential specificity of these enzymes towards the carbohydrate-protein linkage region.

Primary malignant fibrous histiocytoma of the diaphragm: report of a case

We present herein the case of a 55-year-old man with primary malignant fibrous histiocytoma (MFH) of the diaphragm. He was admitted to our hospital with right anterior chest pain, where diagnostic imaging showed a huge tumor in the right diaphragm with a tumor thrombus in the vena cava, spreading to the left lobe of the liver and the pericardium. Although invasion into the right lung was identified at the time of surgery, the entire tumor was removed. Histopathological examination of the resected specimen revealed the characteristics of MFH. We discuss the clinical features of this patient in comparison with the few previous reports on MFH of the diaphragm.

[Shigella boydii strains having a provisional serovar isolated from travellers' diarrhea in Tokyo]

Two Shigella strains (85-634 and 94-30) isolated from two sporadic travellers with diarrhea who returning to Tokyo from abroad, did not react to any antisera to Shigella prepared commercially. These strains had the typical biochemical characteristics of S. boydii and were biochemically identical, and were positive in the Serény test and other tests for invasiveness; these indicate that they can cause shigellosis in humans. The results of serological analyses using the antisera to 6 kinds of provisional Shigella serovars, showed that both strains had provisional S. boydii serovar E16553. Although the serovar has been reported by Gross et al in the United Kingdom, this may be the first report in Japan.