Reactivation of an inactive human X chromosome introduced into mouse embryonal carcinoma cells by microcell fusion with persistent expression of XIST

An inactive human X chromosome was introduced by microcell fusion into two mouse embryonal carcinoma cell lines, PSA1-TG8 and OTF9-63, each of which has a single X chromosome. The donor cell line was a mouse-human somatic cell hybrid, CF150, retaining one or more inactive human X chromosome(s) per cell as its only human element. Twenty hybrid clones isolated retained EC morphology and contained the intact human X chromosome(s) or its truncated derivative(s). Replication banding analysis showed that the introduced human X chromosome(s) or its derivative(s) replicated synchronously with other mouse chromosomes, suggesting reactivation of the human X chromosomal elements after transfer. Reversal of inactivation was further confirmed by the expression of five human X-linked genes repressed in CF150, although the XIST (X inactive specific transcript) gene continued to be active. The level of XIST expression in our hybrid cells was almost identical to that of parental CF150 cells. Methylation status of 5' end of the active XIST gene varied considerably from almost full methylation to unmethylation in these hybrids. Thus, mouse EC cells used in this study were capable of altering methylation status of the human XIST gene in a manner lacking consistency and unable to repress its transcription. Furthermore, we failed to obtain any positive evidence for the occurrence of X chromosome inactivation in differentiating monochromosome EC hybrids. Taken together, these findings suggest that the human X chromosome inactivation center including the XIST gene is unable to function effectively in mouse cells.

[T4 lung cancer: surgical indications based on results of surgical treatment]

During the period of 1981 and 1995, 54 patients with T4 lung cancer underwent pulmonary resection in our institutes. The actuarial survival rate of them was 30% at three years and 12% at five years. The five-year survival rate of 12 patients with complete resection was 33%. On the other hand, the five-year survival rate of 30 patients with incomplete resection was 9%. The five-year survival rates of 17 patients with N0 disease, 9 patients with N1 disease, and 22 patients with N2 disease were 13%, 40%, and 5%, respectively. There was a significant difference in survival between patients with N1 and N2 disease. Four patients survived for more than five years after the operation : two patients had invasion to the left atrium and two had a slight degree of pleural dissemination. Radical pulmonary resection may yield long-term survival in T4 lung cancer patients having invasion to the left atrium.

Benign tumors of the lung: a 20-year surgical experience

In the following report, we describe our investigation of the diagnosis and operative methods for benign tumors of the lung, in which the surgical treatment was selected due to suspicious malignancy. This study included 22 patients with benign tumors. The patients' mean age was 55 years old. The histological diagnosis was made postoperatively prior to 1985 and intraoperatively after 1986. Hamartoma was the most common of the benign tumors. In benign tumors, the preoperative diagnosis was almost the same as the postoperative one. Of the patients with benign tumors, 78% underwent lobectomy or segmentectomy prior to 1985, and none have undergone any invasive procedures since 1986. Malignant tumors are sometimes difficult to distinguish from benign tumors preoperatively. Therefore, intraoperative histological examinations are necessary in cases in which malignancy is suspected. In such cases, a smaller invasive procedure should be selected due to the possibility of the tumor being benign.

The efficacy of radiofrequency catheter ablation for the treatment of ventricular tachycardia associated with cardiomyopathy

We performed radiofrequency catheter ablation (RF ablation) for ventricular tachycardia (VT) in 2 patients with dilated cardiomyopathy (DCM) and 1 patient with arrhythmogenic right ventricular dysplasia (ARVD). Patient 1 had incessant VT associated with DCM. RF ablation was performed where diastolic potentials were recorded and concealed entrainment was demonstrated. VT was terminated by RF ablation. Patient 2 had drug-resistant VT associated with ARVD. RF ablation was performed where perfect pace-mapping was obtained during sinus rhythm, diastolic potentials were recorded and concealed entrainment was demonstrated. VT was terminated by RF ablation. Patient 3 had 2 morphologically distinct VTs associated with DCM. The target for RF ablation was 1 of the 2, which was a drug-resistant type. Perfect pace mapping was obtained where delayed potentials were recorded. As the current strength of pacing was reduced, the QRS complex configuration switched to the other type. This site was thought to be the common slow conduction zone for the re-entry circuit of the 2 types and RF ablation was performed at this site. In these 3 cases, VT did not recur after ablation. RF ablation is effective for the treatment of VT associated with cardiomyopathy.

Preoperative intra-arterial infusion chemotherapy for invasive thymoma: a case report

A 24-year-old man was diagnosed as having mixed-type thymoma by preoperative percutaneous needle biopsy. A chest computed tomogram showed a tumor measuring 12x9 cm. Selective intra-arterial infusion chemotherapy was first selected because invasion to the superior vena cava was suspected. Bolus injection of 50 mg/m2 cisplatin and 20 mg/m2 adriamycin was performed once into the right internal thoracic artery. The resulting decrease in tumor size was 81%. Neither complications due to the infusion procedure nor side effects due to the anticancer drugs were encountered. An extended thymectomy with partial resection of the mediastinal pleura was safely performed. The histological diagnosis of the resected tumor was thymic hyperplasia. The patient was transferred to a radiologist for additional radiotherapy. Selective intra-arterial infusion chemotherapy for invasive thymoma is an effective therapy, producing no significant side effects and allowing safe resection.

Thymic hyperplasia in patients with Graves' disease. Identification of thyrotropin receptors in human thymus

Thymic size and density were studied in 23 untreated patients with Graves' disease and 38 control subjects using computed tomography. Both thymic size and density were higher in untreated patients with Graves' disease than in control subjects in the age-matched group. After treatment with antithyroid drugs, both thymic size and density were significantly reduced, with a concomitant decrease in thyrotropin receptor antibodies. PCR of human thymic cDNA using primers for human thyrotropin receptor amplified a fragment in a size expected for the receptor, and its nucleotide sequence was identical to human thyrotropin receptor cDNA in the thyroid. Northern blot analysis of human thymic poly(A)+ RNA demonstrated the presence of the full length form of thyrotropin receptor mRNA. Western blot analysis of human thymic membrane using anti-thyrotropin receptor peptide antibodies demonstrated a band of 100 kD that was also observed in the thyroid membrane. Immunohistochemistry of thymic tissue using mouse antihuman thyrotropin receptor monoclonal antibodies demonstrated the immunostaining of epithelial cells. These results indicate that thymic hyperplasia is apparently associated with Graves' disease and suggest that thymic thyrotropin receptor may act as an autoantigen that may be involved in the pathophysiology of development of Graves' disease.

A case of adenosine-sensitive ventricular tachycardia in a very elderly male

The best-known type of adenosine-sensitive ventricular tachycardia is idiopathic and of right ventricular outflow origin; however, there is little information about other types of adenosine-sensitive ventricular tachycardia. Idiopathic adenosine-sensitive ventricular tachycardia is common in the young. An 87-year-old man with ventricular tachycardia was admitted to our hospital. His ventricular tachycardia was sensitive to adenosine triphosphate, edrophonium, verapamil, and Valsalva's maneuver. He had experienced no anginal episodes. His ventricular tachycardia was thought to be idiopathic. We report this very rare case of adenosine-sensitive ventricular tachycardia, which was not derived from the right ventricular outflow tract, in a very elderly male.

Benign tumors and tumor-like lesions of the lung

We detail an investigation of the diagnosis and operative method for benign tumors and tumor-like lesions of the lung. In benign tumors, the preoperative diagnosis was almost the same as the postoperative one. In tumor-like lesions, the correlation of preoperative and postoperative diagnosis was poor. Since 1986, no patient with benign tumors has undergone invasive methods, but this has been required in some tumor-like lesions. Malignant tumors are easily distinguished from benign tumors but difficult from tumor-like lesions, preoperatively. Therefore, open biopsy is necessary in cases of suspicious malignancy. Then small invasive procedure should be selected due to the possibility of benign tumors.

Use of an intratracheal silicone prosthesis (Dumon type) for the treatment of tracheoesophageal fistula due to advanced lung cancer

A 49-year-old woman with a tracheoesophageal fistula due to advanced lung cancer was successfully treated by a stent using an intratracheal silicone prosthesis (Dumon type). The use of a Dumon tube proved to effectively palliate the fistulization and thus resulted in a dramatic improvement of the patient's quality of life.

Family history-related risk of gastric cancer in Japan: a hospital-based case-control study

In Japan, there have been a few reports on the familiar factors of gastric cancer (GC) and on the GC risk related to family history (FH) at other cancer sites. We analyzed the association between GC occurrence and a positive FH of cancer of the stomach and of other sites in a hospital-based case-control study. The subjects included cases histologically confirmed as incident cancer of the stomach (n = 136; 86 male and 50 female patients) and sex and age (+/- 1 year)-matched controls. GC risk was high when a subject had a parental history of GC [Mantel-Haenszel odds ratio adjusted for sex and age (OR)=2.3; 95% confidence interval (95% CI):1.1-5.0]. GC risk was almost unity for a cancer FH of any other cancer site, even among closer relatives, suggesting little or no contribution to GC occurrence. The familial occurrence of GC found in this study suggests the existence of a genetic susceptibility to cancer of the stomach. Further, females tended to show higher GC risks than males, when reporting an affected mother (OR=6.0; 95% CI:1.1-31.4 and OR= 1.4; 95% CI:0.4-4.8, respectively), whereas males showed a slightly higher risk than females when reporting an affected father (OR=2.4; 95% CI:0.8-7.5 and OR=2.3; 95% CI:0.4-15.6, respectively). This suggests a possible gender difference in how environmental factors influence GC occurrence. The development of gastric tumors seems to be due to a complex and unknown interaction between environmental and genetic factors.

A malignant Triton tumor in the anterior mediastinum requiring emergency surgery: report of a case

We report herein the case of a 17-year-old woman with von Recklinghausen's disease who was diagnosed as having a giant malignant Triton tumor located in the anterior mediastinum, which had adhered to the heart and the great vessels. An emergency operation was performed to relieve the tracheobronchial stenosis and congestive heart failure caused by the pressure of the tumor. Extracorporeal circulation was not required and the tumor could be excised only piece by piece. To our knowledge, this is the first report of a malignant Triton tumor being located in the anterior mediastinum.

Genomic imprinting and chromosomal localization of the human MEST gene

We have isolated a human homologue (MEST) of the mouse mesoderm-specific transcript (Mest) gene that shares about 70% nucleotide sequence homology. Northern blot analysis showed that the MEST gene was expressed in all major fetal organs and tissues so far examined, i.e., amnion, brain, heart, lung, stomach, gut, adrenal, kidney, muscle, and liver, which does not contradict with mesoderm-specific expression. MEST was abundantly expressed in hydatidiform moles of androgenetic origin, whereas it was barely detectable in dermoid cysts of parthenogenetic origin. Thus, it seems likely that the MEST gene, mapped to 7q32 by fluorescence in situ hybridization, is maternally repressed as the mouse homologue.

Changes in clinical features of fungemia in a Japanese University Hospital over a 12-year period

Forty-five patients with fungemia during 1982-1993 (periods I = 1982, II = 1986-1989, III = 1990-1993) in a Japanese university hospital were reviewed to follow changes in the clinical features of fungemia. The percentage of fungi among microorganisms isolated from blood cultures was almost constant (6-10%) throughout the study period. Fungemia was highly associated with use of intravascular catheters, and some changes in clinical features were observed: 1) Candida albicans, C. parapsilosis and C. glabrata were the main isolates, and the number of fungal species showed a tendency to increase. 2) The percentage of patients over 65 years old increased from 36 to 50%. 3) The percentage of patients who were treated with anti-fungal agents and/or removal of catheter increased from 50 to 89 and to 86%. 4) The percentage of patients who died within 28 days after isolation of fungus decreased from 64 to 27%. The improved prognosis was thought to be due to the development of new anti-fungal agents and faster removal of intravascular catheter when infection was suspected.

Sweet syndrome in a child with aplastic anemia receiving recombinant granulocyte colony-stimulating factor

PURPOSE

To elucidate the pathogenesis of Sweet syndrome, one patient with aplastic anemia was evaluated.

PATIENT AND METHODS

A 15-year-old girl presented with intermittent fever and progressive pallor for 3 months after non-A, non-B, non-C hepatitis. Aplastic anemia was diagnosed and therapy was begun with recombinant granulocyte colony-stimulating factor (G-CSF), methylprednisolone pulse therapy, antilymphocyte globulin and cyclosporin A. There was only an increase in the neutrophil counts. We continued G-CSF therapy of 300 micrograms/m2 on alternate days for 7 months. At this time the white blood cell count was 10,000/microliters and the patient developed high-grade fever and a painful, erythematous, tender plaque (3 X 3 cm) on the left thigh. We diagnosed the lesion as a skin infection and stopped G-CSF therapy and started antibiotics. Cultures were negative. The lesion slowly resolved, G-CSF was restarted after 2 months, and 1 month later disseminated lesions occurred. Antibiotic therapy was not effective.

RESULTS

Biopsy of the lesion demonstrated infiltration of the dermis by sheets of neutrophils. We stopped G-CSF and began corticosteroid therapy. The skin lesions resolved rapidly.

CONCLUSION

We postulated that Sweet syndrome was induced by G-CSF treatment.

Nosocomial septicemias due to methicillin-resistant staphylococcus aureus and Pseudomonas aeruginosa in a university hospital over a 12-year period--the same intractable infections

Clinical features of nosocomial bacteremias due to methicillin-resistant Staphylococcus aureus (MRSA) (M group, n = 71) and Pseudomonas aeruginosa (P group, n = 25) in a university hospital during 1982-1993 were retrospectively analyzed. The majority of these patients had an underlying disease, and bacteremia occurred in hospital. There were no differences in the male to female ratio and the mean age of the patients between the two groups. The ratio of medical wards to surgical wards was higher in the P group (18/7 = 2.6) than for the M group (38/33 = 1.2). P. aeruginosa was more frequently isolated from patients with hematological malignancies and MRSA with solid tumors. The percentage of MRSA among gram-positive bacteremia and of P. aeruginosa among gram-negative bacteria has shown a tendency to increase in recent years, and antibiotic sensitivity of these two organisms showed, on a whole, a tendency to decrease. Attention should be called to the increase of these two pathogens.

Determination of the 8-methyl ether of xanthurenic acid in human serum by high-performance liquid chromatography with fluorescence detection

We developed a simple and sensitive assay for the 8-methyl ether of xanthurenic acid in serum by high-performance liquid chromatography with fluorescence detection (excitation at 340 nm, emission at 450 nm). The compound under study in serum samples was extracted with Sep-Pak C18 cartridge and the extract was applied to an octadecylsilane-bonded column (Nucleosil 5C18, 150 x 4 mm I.D.). The mobile phase used was a mixture of 0.05 M sodium acetate buffer (pH 6.0), containing 5 mM sodium 1-octanesulfonate and 0.1 mM Na2EDTA, and acetonitrile (93:7, v/v). The 8-methyl ether of xanthurenic acid from serum samples was sufficiently separated to be clearly distinguishable. The quantification limit was 2 x 10(-14) mol, which was sensitive enough to detect 8-methyl ether of xanthurenic acid in serum from normal subjects. The method was applied to samples from patients with deficiency in tryptophan metabolism, xanthurenic acid/3-hydroxy kynurenineuria and showed a striking elevation in serum 8-methyl ether of xanthurenic acid.

Analysis of phosphorylation pathways of antiherpesvirus nucleosides by varicella-zoster virus-specific enzymes

The inhibitory activities of acyclovir (ACV), 1-beta-D-arabinofuranosyl-E-5-(2-bromovinyl)uracil (BV-araU), ganciclovir (GCV), 9-(2-deoxy-2-hydroxymethyl-beta-D-erythro-oxetanosyl)guanine (OXT-G), and (+)-9-[(1R,2R,3S)-2,3-bis(hydroxymethyl)Cyclobutyl]guanine (cOXT-G) on the replication of wild-type and thymidine kinase (TK)-negative strains of herpes simplex virus types 1 and 2 and varicella-zoster virus (VZV) and the wild-type strain of human cytomegalovirus were tested to clarity whether the phosphorylation of these compounds is catalyzed by viral TK or other enzymes. ACV and BV-araU had little effect on the replication of TK-negative virus strains. On the other hand, GCV, OXT-G, and cOXT-G inhibited the replication of TK-negative VZV at concentrations 10 times higher than those at which they inhibited wild-type VZV, indicating that a kinase other than TK phosphorylates GCV and OXT-G in VZV-infected cells. GCV phosphorylation activity was not detected in VZV-infected cell lysates; therefore, this activity was evaluated in COS 1 cells expressing viral TK and viral protein kinase (PK). The COS 1 cells expressing VZV TK were shown to be susceptible to all compounds tested. In contrast, VZV Pk-expressing COS 1 cells were susceptible to only GCV, OXT-G, and cOXT-G. These results suggest that VZV PK phosphorylates some nucleoside analogs, for example, GCV, OXT-G, and cOXT-G. This phosphorylation pathway may be important in the anti-VZV activities of some nucleoside analogs.

A point mutation in exon 3 (His 107-->Tyr) in two unrelated Japanese patients with carbonic anhydrase II deficiency with central nervous system involvement

We have analyzed two unrelated Japanese patients with carbonic anhydrase II deficiency born to consanguineous parents. We have identified the same mutation as that reported to be homozygous in a Belgian family and compound heterozygous in an American family. It comprises to C-to-T transition that results in the amino acid substitution of Tyr (TAT) for His (CAT) at position 107. This point mutation creates an AccI site that can be conveniently screened by the polymerase chain reaction/restriction fragment length polymorphism method using a restriction enzyme for gene tracking. Our patients exhibit severe mental retardation, not seen in the Belgian and American patients.

[A course of pirarubicin vesical irrigation at thirty mg effectively prevents post-TUR recurrence of superficial bladder cancer]

In order to study its safety and anti-cancer dose-effectiveness in the prevention of cancer recurrence, two groups of patients having superficial bladder cancer (TUR-Bt) had their bladder intravesically irrigated post-surgically with 20 or 30 mg aliquots of (2''R)-4'-0-tetrahydropyranyl-adriamycin (THP). A total of 74 patients with bladder cancer were entered in the study. Four cases proved ineligible, and 30 could not complete the planned treatment. THP vesical irrigation of 14-17 sessions was regarded as a condition for eligibility: Clinical evaluation was feasible with 19 patients of 20 mg and 21 of 30 mg THP. Non-recurrence rates at 1, 2, 3 and 4 years were 89.5, 53.3, and 26.6%, respectively, for the 20 mg group, and 95.2, 84.3, 75.9 and 75.9%, respectively, for the 30 mg THP group. The incidence of side effects appeared slightly greater in the 30 mg THP group than in the 20 mg group, and there were no systemic adverse reactions. Topical reaction of cystitis was noted to be as low as 12.5%. Thus, THP vesical irrigations at 30 mg were found tolerable and effective for the prevention of local recurrence following TUR-Bt.

Successful treatment of Wolff-Parkinson-White syndrome with concomitant mitral stenosis by simultaneous surgery

We report the case of a 61-year-old man with type B Wolff-Parkinson-White (WPW) syndrome associated with a right atrioventricular (AV) accessory pathway and concomitant mitral stenosis, who underwent successful operative treatment by simultaneous surgery. His preoperative course had been characterized by cardiac failure and repeated episodes of atrial tachyarrhythmia, in the form of fibrillation and flutter, which were difficult to control by conventional medication. Preoperative electrocardiograms (ECGs) had suggested that the accessory pathway was located in the right posterior to posteroseptal wall; however, at the time of surgery, epicardial electrophysiological mapping with sock electrodes revealed a preexcitation area in the AV groove at the lateral right margin of the heart. This discrepancy was thought to have been due to the presence of mitral stenosis or multiple accessory pathways. Thus, division and cryoablation of the accessory pathway by an endocardial approach, in addition to mitral valve replacement, were performed under cardiopulmonary bypass. His postoperative course was uneventful, and subsequent ECGs revealed that the delta waves had disappeared. The successful outcome of this patient demonstrates the effectiveness of simultaneous surgery for WPW syndrome associated with valvular disease.

Enhanced expression of beta-adrenergic receptor kinase 1 in the hearts of cardiomyopathic Syrian hamsters, BIO53.58

We cloned an entire encoding sequence of beta-adrenergic receptor kinase 1 (beta ARK1) cDNA from the hearts of Syrian hamsters through reverse transcription and subsequent polymerase chain reaction. The cloned cDNA contained 2067 nucleotides coding 689 amino acids. The sequence had 95% homology to rat beta ARK1 and 90% homology to human homologue. Cardiomyopathic Syrian hamster, BIO53.58, has been used as a model animal of congestive heart failure. M-mode echocardiography confirmed that left ventricular contractility of 20-week-old BIO53.58 was markedly reduced. The expression of beta ARK1 mRNA in the hearts of BIO53.58 was significantly increased compared to control hamsters, F1b, suggesting that the enhanced beta ARK1 expression is acting as a negative feedback mechanism in order to maintain intracellular homeostasis against accelerated stimulation by catecholamines via phosphorylation of beta-adrenergic receptor.

Use of ultrasound-guided percutaneous needle biopsy in the diagnosis of mediastinal tumors

We herein report the usefulness of ultrasound-guided percutaneous needle biopsy for histological diagnosis in 18 patients with mediastinal tumors. Computed tomography revealed these tumors to be in contact with the chest wall. The preoperative diagnosis was thymoma in 7 patients, germinoma in 5, neurogenic tumor in 3, and "other" in 3. The most commonly encountered indication for an ultrasound-guided percutaneous needle biopsy was an anterior mediastinal lesion (78%; 14 of 18 patients). In 16 (89%) of the 18 patients, the biopsy diagnosis corresponded to the postoperative diagnosis. No complications were encountered in any of the patients. This new technique of ultrasound-guided percutaneous needle biopsy is both relatively simple and highly accurate and may thus be useful for outpatients. Preoperative ultrasound-guided percutaneous needle biopsy is thus considered to be a safe and reliable method for the histological diagnosis of mediastinal tumors, and a good alternative to traditional biopsy techniques such as mediastinoscopy or thoracotomy.

Polysaccharides in fungi. XXXVII. Immunomodulating activities of carboxymethylated derivatives of linear (1-->3)-alpha-D-glucans extracted from the fruiting bodies of Agrocybe cylindracea and Amanita muscaria

Immunomodulating activities of three carboxymethylated derivatives (AG-AL-CMS, AG-AL-CMI, and AM-APP-CM) of linear (1-->3)-alpha-D-glucans from Agrocybe cylindracea and Amanita muscaria were evaluated with murine peritoneal macrophages playing an important role in tumor immunity. The ratio of macrophages in peritoneal exudate cells increased more than 50% after the administration of three carboxymethylated (1-->3)-alpha-D-glucans. These carboxymethylated (1-->3)-alpha-D-glucans exhibited higher potentiating activities for macrophages than carboxymethylated linear (1-->3)-beta-D-glucan (CMPS) in the potency of reduction of nitro blue tetrazolium, products of nitric oxide and the soluble cytotoxic factor, the amount of glucose consumption, and the activation of acid phosphatase. AG-AL-CMS, AG-AL-CMI, and AM-APP-CM were found to induce the tumor regressing factor in mouse serum, although the ability of the induction of this factor was weaker than that of CMPS. The reticuloendothelial system-potentiating activation of three carboxymethylated alpha-D-glucans was similar to that of the carboxymethylated beta-D-glucan. AG-AL-CMS and AG-AL-CMI, but not AM-APP-CM, were suggested to possess a higher-order structure, resulting from the formation of a fluorescent complex with aniline blue.