Outcome of non-immune hydrops fetalis and a fetus with hydrothorax and/or ascites: with some trials of intrauterine treatment

The subject of this study was 38 cases of non-immune hydrops fetalis and 11 cases of fetal hydrothorax and/ or ascites (FH/A), a syndrome characterized by the accumulation of pleural effusion and/or ascitic fluid, without generalized skin edema, due to various etiologies, admitted to the obstetrics ward of Hokkaido University Hospital during the period between 1987 and 1994. Fetal treatment consisted of (1) intravascular transfusion or intra-abdominal transfusion for anemia, (2) frequent centesis or shunt insertion for pleural effusion and ascites, (3) reduction of cystic hygroma by puncturing and OK432 injection, and (4) intravascular or maternal injection with an anti-arrhythmic drugs to treat tachycardia. The outcome of NIHF and FH/A was assessed to be able to make a prognosis in NIHF and to compare the efficacy of fetal therapy in cases with (15 cases: 9 NIHF, 6 FH/A) and without (34 cases: 29 NIHF, 5 HF/A) intrauterine treatment. The average survival rates were 23.1% in NIHF and 54.5% in FH/A. None of fetuses with a chromosomal abnormality or cystic hygroma survived. The average GW at the time of detection of NIHF by ultrasonography was week 24.9 +/- 1.1 (mean +/- S.E., n = 38). The average GW at the time of detection of FH/A by ultrasonography was week 26.6 +/- 1.8 (n = 11). NIHF was detected significantly earlier in the IUFD and early neonatal death group (GW 22.4 +/- 1.4) than in the survivor group (GW 27.6 +/- 1.2) (p < 0.05). FH/A was also detected earlier in the IUFD/early neonatal death group than in the survivor group (GW 21.8 +/- 2.4 vs. 31.1 +/- 1.1, n = 11, p < 0.05). The survival rate in the intrauterine treatment group was higher than in the nontreatment group (treatment group: 10/15; non-treatment group: 5/34, p < 0.001). After the trial of intrauterine treatment in the 15 cases mentioned above, some efficacy was observed in 7 cases (reduction of cysts, effusion or edema, disappearance of arrhythmia).

A case of intrauterine medical treatment for cystic hygroma

We report the first case of an intrauterine treatment for cystic hygroma. Guided by ultrasonography, we first removed intracystic fluid from two cysts and then injected OK-432 into each fetal cyst at 21 and 28 weeks of gestation. No re-enlargement of the cysts was subsequently observed. At 38 weeks of gestation, a male infant was delivered transvaginally. Only a slight skin fold was observed in the nuchal area of the neonate, indicating the effectiveness of OK-432 for the intrauterine treatment of cystic hygroma.

Genotypes of alcohol-metabolizing enzymes and the risk for alcoholic chronic pancreatitis in Japanese alcoholics

Genetic predisposition to alcoholism and alcoholic liver disease has been reported. However, genetic susceptibility to alcoholic pancreatitis is still a matter of debate. To determine it, we examined genotype patterns of aldehyde dehydrogenase (ALDH2), alcohol dehydrogenase (ADH2 and ADH3), and cytochrome P-4502E1 (CYP2E1) in alcoholic pancreatitis patients. In 296 alcoholic patients, 52 cases showed findings of chronic pancreatitis by ultrasonography and x-ray computed tomography and/or had a history of pancreatitis (P+). The remaining 244 patients had neither abnormal findings of the image examinations nor a history of pancreatitis (P-). As for the ADH2 genotype, distribution of 2(1)/2(1), 2(1)/2(2), and 2(2)/2(2) was 22, 37, and 42% in P+ patients, whereas 34, 35, and 30% in P- patients, respectively. The frequency of ADH2(2)/2(2) genotype was significantly higher in P+ patients, compared with that in P- patients. There were no significant differences in the distribution of ADH3, ALDH2, and CYP2E1 genotypes between P+ and P- patients. In 14 alcoholic patients who showed low contents of fecal chymotrypsin, which suggests dysfunction of pancreatic exocrine, the rate of ADH2(2)/2(2) genotype also tended to be higher (50%) than in 74 controls who showed normal contents of the fecal chymotrypsin (28%). No differences were observed in genotypes of ADH3, ALDH2, and CYP2E1. Moreover, the frequency of ADH2(2)/2(2) genotype was significantly higher in autopsy cases with interlobular fibrosis in the pancreas, which suggests alcoholic pancreatic damage, than in cases with only intralobular pancreatic fibrosis. These data suggest that the risk of alcoholic pancreatitis seems to be associated with the presence of ADH2(2)/2(2) genotype.

Reduced messenger RNA expression level of p21 CIP1 in human colorectal carcinoma tissues and its association with p53 gene mutation

p21 Cip1 was first isolated as one of the cyclin-dependent kinase (Cdk) interacting proteins induced by wild-type p53 gene product, and it appears to play an essential regulatory role in the control of cell proliferation as a potent, tight-binding inhibitor of cyclin-Cdk complex that blocks the G1/S transition of the cell cycle. We have now examined the p21 Cip1 mRNA expression levels in 16 surgically excised human colorectal tumor and non-tumor tissues by Northern-blot analysis with reference to the identification of p53 gene mutations. p53 gene mutations were detected in 6 tumor tissues but not in the other 10 tissues by the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) method and following direct sequencing. The mean p21 Cip1 mRNA expression level in tumor tissues was significantly suppressed compared to that of non-tumor tissues, irrespective of p53 gene mutations. In p53 gene mutation-detected cases, the mean expression level of p21 Cip1 mRNAs of tumor tissues was about 60% of that of cases without p53 gene mutation. Moreover, the relative mRNA expression levels of p21 Cip1 significantly decreased as the pathohistological stages progressed by Dukes' staging system, while in patients with liver metastasis these levels were significantly suppressed compared to those of patients without organ metastasis. These results indicate that reduced expression of p21 Cip1 mRNA is critical for growth activity and malignant potential of human colorectal carcinoma, and that the decrease in p21 Cip1 mRNA level is due to p53 gene mutation as well as other mechanisms during human colorectal carcinogenesis.

Molecular cloning and expression of the pyrimidine nucleoside phosphorylase gene from Bacillus stearothermophilus TH 6-2

The pyrimidine nucleoside phosphorylase (Py-NPase) of Bacillus stearothermophilus TH 6-2 is a dimer of 46-kDa subunits and catalyzes the reversible phosphorolysis of uridine and thymidine. The gene encoding this pyrimidine nucleoside phosphorylase (pyn gene) has been cloned and sequenced from B. stearothermophilus TH 6-2. The pyn gene corresponded to an open reading frame of 1299 nucleotides that translates into a putative 433 amino acid protein with a molecular weight of 46,271. The deduced amino terminal sequence of Py-NPase coincided with that previously found for the purified enzyme. The deduced amino acid sequence of Py-NPase shared significant similarity with those of human and Escherichia coli thymidine phosphorylases. The cloned pyn gene was overexpressed in E. coli cells to produce an active enzyme in large quantities that accounted for approximately 20% of the total protein.

Reduced messenger RNA expression level of p21 CIP1 in human colorectal carcinoma tissues and its association with p53 gene mutation

p21 Cip1 was first isolated as one of the cyclin-dependent kinase (Cdk) interacting proteins induced by wild-type p53 gene product, and it appears to play an essential regulatory role in the control of cell proliferation as a potent, tight-binding inhibitor of cyclin-Cdk complex that blocks the G1/S transition of the cell cycle. We have now examined the p21 Cip1 mRNA expression levels in 16 surgically excised human colorectal tumor and non-tumor tissues by Northern-blot analysis with reference to the identification of p53 gene mutations. p53 gene mutations were detected in 6 tumor tissues but not in the other 10 tissues by the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) method and following direct sequencing. The mean p21 Cip1 mRNA expression level in tumor tissues was significantly suppressed compared to that of non-tumor tissues, irrespective of p53 gene mutations. In p53 gene mutation-detected cases, the mean expression level of p21 Cip1 mRNAs of tumor tissues was about 60% of that of cases without p53 gene mutation. Moreover, the relative mRNA expression levels of p21 Cip1 significantly decreased as the pathohistological stages progressed by Dukes' staging system, while in patients with liver metastasis these levels were significantly suppressed compared to those of patients without organ metastasis. These results indicate that reduced expression of p21 Cip1 mRNA is critical for growth activity and malignant potential of human colorectal carcinoma, and that the decrease in p21 Cip1 mRNA level is due to p53 gene mutation as well as other mechanisms during human colorectal carcinogenesis.

Evaluation of bone density in newborn infants by computed x-ray densitometry

We evaluated bone density in term and preterm infants using computed x-ray densitometry, which permits measurement of bone density with minimal disturbance to the infants in their incubators. Bone density, bone width, and bone length of the right radius were determined in 155 infants of appropriate weights for their gestational ages (23 to 41 weeks). A curve for intrauterine bone growth was extrapolated from these data. The mean coefficients of variations for variabilities for intra- and interobserver error for all measurements were < 3.5%. In 18 infants, measurements of the right forearm were obtained in two positions to confirm the validity of densitometric measurements. The mean coefficients of variation were 3.42% for bone density, 3.48% for bone width, and 0.21% for bone length. Bone density was significantly correlated with gestational age (r = 0.924) and birth weight (r = 0.921). Bone width and length were also correlated with gestational age (r = 0.866 and 0.937) and birth weight (r = 0.878 and 0.954). Our results suggest that computed x-ray densitometry is a useful method for evaluation of bone density in preterm infants, including those in an intensive care environment.

A quantitative assay using basement membrane extracts to study tumor angiogenesis in vivo

We describe a quantitative assay for assessing tumor angiogenesis in vivo using basement membrane extracts (Matrigel). Nude mice were injected s.c. with liquid Matrigel mixed with HT1080 human fibrosarcoma cells. Since Matrigel rapidly forms a solid gel at body temperature, the gel containing tumor cells can be removed immediately and then processed for histological studies. Tumor angiogenesis was monitored quantitatively by measuring both the number and the total area of neovessels present in the gels using an image analyzer, which could be achieved approximately 72 hr later. Furthermore, HT1080 cell-conditioned medium, which may contain various tumor-derived factors, promoted the basement membrane degradation, migration, proliferation and tube formation of endothelial cells in vitro, as did Matrigel, although to a lesser extent. In addition, Northern blot analysis demonstrated that the amount of vascular endothelial growth factor (VEGF) mRNA in HT1080 cells was much higher than that in human fibroblasts or NIH3T3 cells. Our results suggest that angiogenesis observed in our assay may be due to the synergic effects of tumor angiogenic factors such as VEGF, and Matrigel. The advantages of our assay are: 1) it is possible to assess early angiogenesis quantitatively; and 2) this assay may be applicable for screening anti-angiogenic therapeutic agents to be used against human neoplasms.

Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining

BACKGROUND

Epidemiologic studies have provided evidence that alcohol abuse is an important risk factor for esophageal carcinoma. However, no systematic screening program has been established yet in the early detection of esophageal cancer in high risk populations of heavy drinkers.

METHODS

A cohort of 629 male alcoholics (54 +/- 8 years old) were consecutively and systematically screened by endoscopy combined with iodine staining and targeted biopsy at the National Institute on Alcoholism (Kanagawa, Japan). For mucosal carcinomas, endoscopic esophageal mucosal resection (EEMR) was used to serve confirmatory diagnostic and therapeutic purposes.

RESULTS

Iodine-unstained lesions, distinctly demarcated, white, and 5 mm or larger in greatest dimension, were observed on the esophageal wall in 162 patients (25.8%). Thirty-six such unstained lesions in 21 of 629 patients, with an unexpectedly high rate of 3.3%, turned out to be squamous cell carcinomas of the superficial type. According to some established criteria, EEMR was performed in 17 of these patients, 3 of whom were given additional irradiation. Esophagectomy was performed in two patients, chemotherapy combined with irradiation in one, whereas still another was followed endoscopically. The cancer invasion was confined within the epithelium in eight patients, to the proper mucosal layer in nine, and to the submucosa in four. Multiple logistic regression revealed that the risks for distinct iodine-unstained lesions and superficial esophageal carcinoma increased independently for users of stronger alcoholic beverages, i.e., whiskey or shochu (odds ratio [OR] = 1.47 and 2.94, respectively) compared with lighter beverages, i.e., sake or beer and 30+ cigarettes/day (OR = 1.68 and 3.85, respectively).

CONCLUSION

Routine application of this program for these high risk individuals yielded an unusually high rate of detection of esophageal carcinoma.

HLA-DR antigen expression in colorectal carcinomas: influence of expression by IFN-gamma in situ and its association with tumour progression

The authors attempted to investigate the host's immune response against colorectal carcinoma through the expression of HLA-DR antigen on carcinoma cells (Ca) on normal epithelia immediately adjacent to carcinoma (AN) in relation to tumour progression. The expression of HLA-DR antigen on Ca and on normal epithelia, both on AN and those 5-10 cm removed from the carcinoma (RN), were examined immunohistochemically. mRNAs of cytokines, IFN-gamma and TNF-alpha, were detected by reverse transcription-polymerase chain reaction (RT-PCR) in both carcinoma and remote normal tissues. The expression of HLA-DR antigen on AN was significantly increased compared with RN. Patients with tumours showing HLA-DR staining both in Ca and AN were in less advanced Dukes' stages (Dukes' A or B) compared with those without the stain. Furthermore, the expression of HLA-DR antigen in normal mucosa coincided significantly with the existence of IFN-gamma mRNA. Detection in carcinoma tissues of IFN-gamma mRNA that leads to the induction of HLA-DR antigen on AN could be an indicator of a host's immune response to carcinoma. These in vivo observations might be clinically applicable to the prediction of patients' immune responsiveness to carcinomas.

Outcome of anterior decompression and stabilization for thoracolumbar unstable burst fractures in the absence of neurologic deficits

STUDY DESIGN

This study investigated the outcome of anterior decompression and stabilization for "unstable" burst fractures without initial neurologic deficits in the thoracolumbar spine.

OBJECTIVE

To determine the pain and work status of the patients, who underwent the anterior decompression and stabilization, to evaluate the relationship between residual back pain and the degree of kyphosis, and to analyze the advantages and disadvantages of surgery for burst fractures without initial neurologic deficits in the thoracolumbar spine.

SUMMARY OF BACKGROUND DATA

A retrospective review was conducted on 45 patients with unstable burst fractures in the thoracolumbar spine treated by anterior decompression and stabilization in our institutions from 1982 to 1993. Nineteen patients were available for this study. Ten patients were men and 9 were women. Their age at surgery ranged from 15 to 76 years (average, 46 years). The duration of follow-up ranged from 24 to 84 months (average follow-up, 54 months).

METHODS

All clinical charts and radiologic data of these patients were reviewed by the first author. Their pain, work, and employment statuses were assessed by the scales proposed by Denis in 1984.

RESULTS

Nine patients were rated P1, 7 were rated P2, 2 were rated P3, 1 was rated P5, 11 were rated W1, 3 were W2, 1 was W3, and 4 were rated W5. Even the physical laborers' return to work averaged 5 months after surgery (range, 3-12 months). The postoperative kyphotic angle ranged from -6 degrees to 45 degrees (average, 11 degrees), and it remained -5 degrees to 45 degrees (average, 12 degrees) at final follow-up. There was no statistical correlation between the kyphotic angle and the pain scale.

CONCLUSIONS

Anterior decompression and stabilization for unstable burst fracture without initial neurologic deficits in the thoracolumbar spine has some advantages in the view of anatomical reduction and rigid stability that allows patients an early rehabilitation, return to work, and gainful employment.

Correlation between cytokine levels of amniotic fluid and histological chorioamnionitis in preterm delivery

The aim of this study was to investigate the correlation between the cytokine levels in the amniotic fluid (AF) and the histological stage of chorioamnionitis (CAM) in premature labor. AF of 6 cases (7 samples of AF were obtained as one was a twin pregnancy) in whom CAM was diagnosed histologically, and 12 cases without CAM were included in this study. Amniotic fluid was obtained within 24 hours prior to delivery. Cytokine levels (IL-2, -4, -6, TNF-alpha, IFN-gamma) in AF were measured by an ELISA method. Levels of IL-2 and -6 in the CAM-positive group (mean +/-S.E., 52.9 +/- 83.9 pg/ml, and 20,537.9 +/- 8853.7 pg/ml, respectively) were higher than those in the CAM-negative group (i.e. undetectable, and 65.6 +/- 27.5, respectively) with a statistical significance of p < 0.05, p < 0.001, respectively. There was a positive linear relationship between IL-6 levels of AF and the placental histological inflammatory stages of Blanc in the CAM-positive group. From these results it would appear that the IL-6 level in AF is the most sensitive test in the detection of extraamniotic infection or intraamniotic infection in preterm labor with intact membranes and also indicates the severity infection.

Anatomic study of the bronchial arteries with special reference to their preservation during the radical dissection of the upper mediastinum lymph nodes

BACKGROUND

The anatomy of the bronchial arteries was studied, with special reference to their preservation during the radical dissection of the upper mediastinum lymph nodes.

METHODS

The bronchial arteries of 71 cadavers were studied macroscopically by use of the surgical field of right thoracotomy. The small branches difficult to identify macroscopically were described by x-ray imaging with digital subtraction angiography. Their anatomic relationship to the adjacent organs was observed microscopically.

RESULTS

The bronchial arteries arising from the intercostal arteries (the intercostobronchial arteries) were observed in 66 of 71 cases. By use of the surgical field of right thoracotomy the intercostobronchial arteries were easily found and preserved. All cadavers also had other bronchial arteries arising from the aorta. These were difficult to preserve because of the depth of the surgical field and the location of their course in the dissected area. Bronchial arteries had established connection with each other via the vascular network in the tracheal proper sheath. India ink injected into the intercostobronchial arteries was observed in the tracheal proper sheath and the submucosa of the trachea.

CONCLUSIONS

Saving the blood supply to the trachea is possible with careful preservation of the intercostobronchial arteries and the tracheal proper sheath during radical dissection of the upper mediastinum.

Molecular and crystal structures of two 1,6-anhydro-beta-maltotriose derivatives

Crystal structures of two 1,6-anhydro-beta-maltotriose derivatives, 1,6-anhydro-beta-maltotriose nonaacetate and 6"-bromo-6"-deoxy-1,6-anhydro-beta-maltotriose octaacetate, have been determined. Both structures are isomorphous and belong to the orthorhombic system, space group of P2(1)2(1)2(1), with cell dimensions of a = 15.659(3) A, b = 20.587(6) A, c = 13.023(2) A and a = 15.402(7) A, b = 19.737(8) A, c = 13.481(5) A, respectively. Each molecule has three alpha-(1-->4)-linked glucose units, and two of them have a typical 4C1 chair conformation, while the glucose unit with the 1,6-anhydro bridge has a 1C4 chair-envelope intermediate conformation. In spite of introducing the 1,6-anhydro bridge and acetyl groups, the conformations of the glycosidic linkages in these molecules are almost the same as those of other alpha-(1-->4)-linked oligosaccharides. Crystal structures are stabilized by hydrophobic interactions and by a weak intermolecular hydrogen bond of C-H. . .O.

Central nervous system disease in a child with primary Sjögren syndrome

A 9-year-old girl had hemiparesis, and a diagnosis of primary Sjögren syndrome was made. The neurologic dysfunction was multifocal, involving both the brain and spinal cord, and was recurrent; the findings mimicked multiple sclerosis. Corticosteroid treatment during episodes of acute neurologic dysfunction appeared to be beneficial.

Serum concentration of endogenous G-CSF in women during the menstrual cycle and pregnancy

Although granulocyte-colony stimulating factor (G-CSF) is commonly used in the field of supportive therapy for cancer treatment, the serum concentration of endogenous G-CSF in healthy women is still obscure due to the low sensitivity (30 pg mL-1) of the usual enzyme immunoassay. With the development of a highly sensitive (1.0 pg mL-1) chemiluminescent immunoassay by Kiriyama et al., we have clarified the changes of serum G-CSF levels in healthy women during the menstrual cycle and pregnancy. The G-CSF concentration showed a peak value of 27.3 +/- 2.5 pg mL-1 (mean +/- SEM) at the ovulatory phase during the menstrual cycle, which is significantly higher than in all other phases (P < 0.0001, unpaired t-test). A significantly higher value compared to the menstrual cycle, except during the ovulatory phase, was also revealed throughout pregnancy (P < 0.0001, unpaired t-test). These results suggest that G-CSF plays an important role in ovulation and the maintenance of pregnancy.

Cyanamide-associated alcoholic liver disease: a sequential histological evaluation

This is the first study that we are aware of that followed the histopathological progression of the liver disease that was caused by the combination of both chronic alcohol use and cyanamide, an antidipsotropic agent. Two sequential liver biopsy specimens were obtained on 29 alcoholics who relapsed with varying histories of cyanamide treatment. Cyanamide induced ground-glass inclusions (GGIs) in the hepatocytes. Two groups were identified, depending on whether GGIs proliferated or regressed, which was, in turn, found contingent on the duration of cyanamide treatment and the drug-free period. Group 1 included 14 cases in which GGIs either emerged only in the second biopsy specimen or else were increased in the second specimen as compared in the initial specimen. Group 2 composed of 15 cases in which GGIs were either not observed in either specimen or decreased in the second specimen as compared in the initial specimen. Acidophilic bodies were sequentially increased in five cases (36%) of group 1 and in none of group 2. The severity of portal inflammation worsened in 10 cases (71%) of group 1 but in 2 cases (13%) of group 2, although the changes in fibrotic process did not differ between two groups. These differences could not be explained on the basis of the daily ethanol consumption and the length of relapses of the two groups. Thus, when cyanamide-treated alcoholics relapsed, the combined effect of cyanamide and alcohol produced the development of acidophilic bodies and portal inflammation along with the emergence of GGIs.

[Anesthesia with transesophageal echocardiography for removal of pheochromocytoma]

A 45-year-old female was scheduled for left adrenalectomy because of a pheochromocytoma. Preoperative general condition was well controlled with alpha- and beta-blockers. Anesthesia was induced with thiamylal and vecuronium, and maintained with isoflurane (0.5-3%) and nitrous oxide in oxygen. Blood pressure was controlled with nicardipine and alpha-blocker during the manipulation of the tumor. After removal of the tumor, dopamine and norepinephrine were used. We used transesophageal echocardiography (TEE) to determine the fluid administration rate and doses of catecholamine. We could observe the wall motion and the mass of the heart, and see changes of the left ventricular enddiastolic volume, the cardiac output and the stroke volume. TEE monitoring seems to be very useful during the resection of pheochromocytoma.

Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining

BACKGROUND

Epidemiologic studies have provided evidence that alcohol abuse is an important risk factor for esophageal carcinoma. However, no systematic screening program has been established yet in the early detection of esophageal cancer in high risk populations of heavy drinkers.

METHODS

A cohort of 629 male alcoholics (54 +/- 8 years old) were consecutively and systematically screened by endoscopy combined with iodine staining and targeted biopsy at the National Institute on Alcoholism (Kanagawa, Japan). For mucosal carcinomas, endoscopic esophageal mucosal resection (EEMR) was used to serve confirmatory diagnostic and therapeutic purposes.

RESULTS

Iodine-unstained lesions, distinctly demarcated, white, and 5 mm or larger in greatest dimension, were observed on the esophageal wall in 162 patients (25.8%). Thirty-six such unstained lesions in 21 of 629 patients, with an unexpectedly high rate of 3.3%, turned out to be squamous cell carcinomas of the superficial type. According to some established criteria, EEMR was performed in 17 of these patients, 3 of whom were given additional irradiation. Esophagectomy was performed in two patients, chemotherapy combined with irradiation in one, whereas still another was followed endoscopically. The cancer invasion was confined within the epithelium in eight patients, to the proper mucosal layer in nine, and to the submucosa in four. Multiple logistic regression revealed that the risks for distinct iodine-unstained lesions and superficial esophageal carcinoma increased independently for users of stronger alcoholic beverages, i.e., whiskey or shochu (odds ratio [OR] = 1.47 and 2.94, respectively) compared with lighter beverages, i.e., sake or beer and 30+ cigarettes/day (OR = 1.68 and 3.85, respectively).

CONCLUSION

Routine application of this program for these high risk individuals yielded an unusually high rate of detection of esophageal carcinoma.