Hepatic perfusion abnormalities during treatment with hepatic arterial infusion chemotherapy: value of CT arteriography using an implantable port system

PURPOSE

The purpose of this study was to evaluate CT arteriography (CTA) using an implantable port system in the detection of perfusion abnormalities occurring during hepatic arterial infusion chemotherapy (HAIC).

METHOD

In 51 patients with unresectable primary and metastatic liver tumors, who had implanted port systems for HAIC, CTA examinations through the infusion pump were performed. When perfusion abnormalities were found, selective angiography and/or digital subtraction angiography using the implantable port system were performed to determine the etiology.

RESULTS

Forty-nine perfusion abnormalities were detected in 32 patients. Intrahepatic hypoperfusion was found in 24 cases. Of 11 patients in whom correction of the hypoperfusion was attempted, it was successful in 10. Of 13 patients in whom correction was not attempted, 6 patients showed progressive disease in nonperfused areas. Intrahepatic hyperperfusion was found in 14 cases, which showed no subsequent complication. Extrahepatic perfusion was found in 11 cases.

CONCLUSION

We consider CTA to be useful in detecting perfusion abnormalities that may compromise HAIC.

Detection of the single-stranded DNA of Streptomyces plasmid pSA1.1 and a binding histone-like protein

Streptomyces plasmid pSA1.1 accumulated single-stranded DNA as replication intermediates in S. lividans; therefore, this plasmid was considered to replicate by a rolling-circle mechanism. A DNA-binding protein (pI > 9.7 and about 10 kDa) was purified on a denatured DNA-Cellulose column, then on a native DNA-Cellulose column. The N-terminal amino acid sequence of this protein has a high homology with bacterial histone-like proteins. In the gel retardation assay, this protein bound with the single-stranded DNA of pSA1.1. We propose that this protein may participate in the replication of pSA1.1.

[A clinical study of radial prostatectomy]

BACKGROUND

The objective of this study is to evaluate the efficacy of radical prostatectomy for patients with organ-confined prostate cancer.

METHODS

From 1990 to 1994, a total of 50 patients with prostate cancer underwent radical retropubic prostatectomy.

RESULTS

Eleven patients were in state A2, 34 in stage B and 5 in stage C according to clinical stage. Extended disease was observed pathologically in 45%, and 59% of patients in clinical stages A2 and B, respectively. Preoperative serum PSA levels were closely correlated with pathological extension of the disease. The disease-free rates for organ-confined disease, extended disease without lymph node metastasis and stage D1 disease were 75% (3 years), 82% (2 years) and 80% (3 years), respectively. Four patients had rectal injuries, and three of these underwent temporary colostomy diversion. Two patients had bladder neck contracture and received internal urethrotomy. Urinary incontinence improved in 60% of patients during the first 6 post-operative and in 90% of patients within 12 post-operative months. Urinary incontinence tended to improve earlier in patients with nerve-sparing than those without it. The erectile capacity in nerve sparing patients recovered good.

CONCLUSION

Our results indicate that radical prostatectomy is a safe and temporarily satisfactory treatment for the patient with organ-confined prostate cancer.

Immunolocalization of prolyl 4-hydroxylase in fibroblasts cultured from Tenon's capsule of humans

BACKGROUND

The excessive accumulation of extracellular matrix (ECM) with the repopulation of fibroblasts may lead to an unsuccessful outcome of glaucoma filtering surgery. We examined the immunolocalization of ECM components and prolyl 4-hydroxylase, an enzyme involved in collagen biosynthesis, in cultured Tenon's capsule fibroblasts (TCFs) of humans to evaluate the production of ECM in the cells.

METHODS

We used light microscopy to evaluate the immunolocalization of prolyl 4-hydroxylase and ECM components, collagen types I, III, and IV, cellular fibronectin, and laminin in TCFs. Ultrastructural localization of the enzyme was also evaluated by electron microscopy.

RESULTS

Immunoreactivity with monoclonal antibodies against the alpha and beta subunits of the enzyme or with the polyclonal antibody against it was detected in the cytoplasm of the cells in a fine granular pattern, indicating its localization in the endoplasmic reticulum (ER). Immunoreactivity for the enzyme was detected in the cisternae of the ER on electron microscopy. Types I and III collagen reactivities were also observed in the cytoplasm in a fine granular pattern. Type IV collagen reactivity was present diffusely on the cell surface. The distribution of laminin reactivity in the cytoplasm resembled that of types I and III collagen. Cellular fibronectin reactivity was observed in the ECM in a reticular pattern.

CONCLUSION

Prolyl 4-hydroxylase was located in the cisternae of the ER. TCFs produced a variety of ECM components in vitro. The results provide insight into the fibrotic process during scar formation at the site of a bleb following filtering surgery.

Effects of immunostimulators on involution of lymphoid organs in mice exposed to heat and cold stress

The effects of two immunostimulators, active egg white product (AEWP) and dihydroheptaprenol (DHP), on involution of lymphoid organs were investigated in mice exposed to heat and cold stress. Heat (37 degrees c, 45 min) and cold (4 degrees C, 4-24 hr for 4 days) stress induced involution of the thymus and/or spleen. AEWP was administered orally at a dose of 500 mg/kg for 4 consecutive days after exposure to heat stress or during cold stress. DHP was injected intramuscularly at a dose of 100 mg/kg on the 4th day after exposure to heat or cold stress. In mice exposed to heat and cold, the ratio of thymus to body weight was significantly higher in the AEWP- and DHP-treated groups as compared to the non-treated group (P < 0.01), also the ratio of spleen to body weight was significantly higher in the DHP-treated group as compared to the non-treated group (P < 0.01). These results showed that AEWP and DHP markedly alleviated involution of the thymus and/or spleen due to heat and cold stress.

The streptozocin-diabetic state depresses saliva secretion stimulated by pilocarpine and noradrenaline in mice

We investigated the influence of the streptozocin (STZ)-diabetic state on the dose-response curves for salivary flow and protein content in saliva stimulated by pilocarpine and noradrenaline in mice. The diabetic state increased the relative weights of parotid and sublingual salivary glands but not the weight of submandibular glands, despite body weight loss. In the dose-response curves, (1) the maximal responses to stimulation with pilocarpine and noradrenaline on salivary flow, and with noradrenaline on protein content in saliva, were depressed by the diabetic state, and (2) the value of the 50% effective dose for salivary flow with pilocarpine, but not with noradrenaline, was decreasingly altered by diabetic mice. These results suggest that xerostomia, one of the complications of non-insulin-dependent diabetes mellitus, is caused in part by muscarinic and adrenergic receptor dysfunction in the salivary glands.

Ischemic injury of the small intestine studied by 31P-MRS

In order to examine the efficacy of phosphorus-31 nuclear magnetic resonance spectroscopy (31P-MRS) of the small intestine during superior mesenteric artery occlusion (SMAO) and reperfusion, we compared the beta-ATP level measured by in vivo 31P-MRS and the ATP level measured by high performance liquid chromatography (HPLC) in a rat model. The rat small intestines were subjected to 30 or 90 min of SMAO followed by reperfusion. 31P-nuclear magnetic resonance spectra were taken every 10 min during SMAO and subsequent reperfusion. Specimens for HPLC were taken every 30 min. Metabolite levels measured by 31P-MRS and HPLC demonstrated a linear correlation. This result shows that 31P-MRS can determine the ATP content of the small intestine as well as HPLC. Additionally, the changes of beta-ATP, inorganic phosphate (Pi) and tissue pH in the small intestine during SMAO and reperfusion were examined by 31P-MRS in detail. beta-ATP decreased with longer SMAO times, and the recovery rate of beta-ATP after reperfusion also decreased with longer SMAO times. Therefore, the ATP level measured by 31P-MRS may provide a clinical parameter of tissue damage and organ viability. The levels of Pi and tissue pH changed greatly, but reached a plateau in the early phase of SMAO. Their levels after reperfusion reflected the time of SMAO, and therefore may also provide a clinical parameter of organ viability.

Molecular characterization of seizure-related genes isolated by differential screening

To isolate seizure-related genes, we applied differential screening technique to the cDNA library which constructed from primary cultured cerebral cortical cells treated with pentylenetetrazol (PTZ). Northern blotting analysis of mRNA levels in the cerebra after systemic administration of PTZ confirmed the results of differential screening procedure: 6 clones showed increased mRNA level and 3 clones showed decreased expression with PTZ. Interestingly, 4 genes which were isolated by this technique were related to intracellular calcium action. They were cytosolic phospholipase A2, 78 kDa glucose regulated protein, SEZ-15 which has an EF hand motif and PTZ-17 that causes calcium current in Xenopus oocyte with PTZ application. These data and our previous results suggest that intracellular calcium may play an important role for seizure-related pathophysiological changes in neuronal cells.

Signalling mechanisms of endothelin-induced mitogenesis and melanogenesis in human melanocytes

To understand the signalling mechanisms involved in the dual stimulatory effects of endothelin-1 (ET-1) on DNA synthesis and melanization in cultured human melanocytes, we analysed the biological profile of ET-1 receptor and determined the effects of ET-1 on the protein kinase C, cyclic AMP system and mitogen-activated protein kinase (MAP kinase) in comparison with their relevant stimulants. The photoaffinity labelling of ET-1 receptors with Denny-Jaff reagents revealed an ET-1 receptor with a molecular mass of 51 kDa in human melanocytes. The ET(A) receptor subtype-sensitive antagonist BQ123(50 nM) or pertussis toxin (100 ng/ml) significantly suppressed the ET-1-induced intracellular calcium mobilization, indicating the presence of pertussis toxin-sensitive G-protein-coupled ET(A) receptors. An assay of protein kinase C activity revealed that 10nM ET-1 translocated cytosolic protein kinase C to membrane-bound protein kinase C within 5 min of the start of incubation. In contrast, receptor-mediated melanocyte activation by ET-1 was accompanied by an elevated level of cyclic AMP (4-fold over control) after 10-60 min of incubation, whereas 60 min of incubation of human melanocytes with c-Kit or c-Met ligands such as stem cell factor (10 nM) or basic fibroblast growth factor (10 nM) did not elevate the cyclic AMP level. We have also demonstrated that a specific tyrosine kinase inhibitor, tyrphostin B-42 (10 microM), inhibited the ET-1-induced growth stimulation, suggesting the involvement of the tyrosine kinase pathway in growth stimulation. Consistently, an assay of MAP kinase revealed that ET-1 caused a 10-fold activation of MAP kinase after 5 min of incubation with human melanocytes in a similar way to tyrosine kinase ligands such as stem cell factor and hepatocyte growth factor. Further, the DNA synthesis stimulated by the c-Kit ligand stem cell factor at a concentration of 1 nM was synergistically enhanced by 5 nM ET-1. These results suggest that ET-induced dual cellular events in human melanocytes are closely associated with cross-talk between the protein kinase C and A and tyrosine kinase pathways.

The diabetic state increases the activity but not the number of peritoneal macrophages in the GK rat promoting the tube formation of cultured endothelial cells in rat aorta

The influence of the diabetic state on the number and activity of intraperitoneal macrophages was investigated in the GK rat. This rat is a model of non-insulin-dependent diabetes mellitus and was established from the normal Wistar rat. The cell number of a macrophages preparation in diabetic GK rats (10-15 weeks of age) did not differ from that in normal Wistar rats (9-10 weeks of age). The co-cultured macrophages in diabetic GK rats (9-12 weeks of age) significantly increased the tube formation of aortic endothelial cells (EC) compared with that in age-matched Wistar rats. The conditioned medium obtained from a culture of macrophages from GK rats also increased tube formation more than that from a culture of macrophages from Wistar rats. The effect of macrophages in the GK rat was not influenced by interferon-gamma (160 and 460 pM), but macrophages in normal rats were activated by these concentrations of interferon-gamma. In conclusion, the diabetic state increased the activity but not the number of macrophages in the GK rat, to stimulate tube formation of EC. The tube-forming effect of macrophages in the diabetic state may depend on released factors which differ from that of normal macrophages.

Comparison between the distribution of 7H6 tight junction-associated antigen and occludin during the development of chick intestine

7H6 antigen is a novel tight junction-associated protein first identified in our laboratory with a monoclonal antibody generated by immunizing mice with a bile canaliculus-rich membrane fraction obtained from adult rat liver. Although the antigen is found preferentially at the tight junction of epithelial cells in various organs in adult mammals, the relationship between 7H6 antigen and other tight junction proteins remains obscure. In the present study we examined the relationship between the immunohistochemical distribution of 7H6 antigen and occludin in chick intestinal epithelial cells during development in vivo, since occludin is the only known membrane protein composing tight junctions which is found thus far exclusively in avian tissues. 7H6 antigen was found as coarse dots along the basolateral cell membrane of intestinal epithelium in the chick embryo, whereas it was found as a fine dashed line along the cell border in the chicken. In contrast, occludin was found linearly together with ZO-1 at the cell border of intestinal epithelia both in the chick embryo and chicken. The possible significance of such different localization is briefly discussed.

[Traumatic tricuspid regurgitation: a case report and a review of operated cases in Japan]

A 48-year-old male was admitted with chief complaints of fatigue and palpitation. He had a past history of closed chest trauma without rib fracture due to an automobile accident 7 years ago. He had been complaining of a gradual increase of palpitation since 4 years after the accident. A two-dimensional and transesophageal Doppler echocardiography revealed severe tricuspid regurgitation due to ruptured chorda tendinea of the tricuspid anterior leaflet. Cardiac catheterization revealed an elevated right atrial v wave (16 mmHg). At open heart surgery, complete tear of a chorda tendinea of the anterior leaflet and elongation of chordae tendineae of the posterior leaflet were observed. The valve was replaced with a 31 mm Carpentier-Edwards bioprosthesis. His post operative course was uneventful. A brief review of the reported surgical cases of traumatic tricuspid regurgitation in Japan is also described in this paper.

[Chronic necrotizing pulmonary aspergillosis complicated by pneumothorax]

A 66-year-old man was admitted to the hospital due to a rapidly progressing interstitial shadow in both lower fields on a chest roentgenogram taken on November 30 1993. The diagnosis was idiopathic interstitial pneumonia. A corticosteroid and a neutrophil elastase inhibitor were administered and the interstitial shadow resolved. A new infiltration shadow appeared in the right upper lung field one and a half months after the start of steroid therapy. This shadow gradually grew and Aspergillus fumigatus was detected in sputum cultures. In spite of treatment with FCZ+5-FC and 5-FC+AMPH, the abnormal shadow increased in size and mixed with the cavity, and the patient died of respiratory failure, with a pneumothorax caused by ruptures of the cavity formed by CNPA. The clinical and radiological course were considered to the indicative of chronic necrotizing pulmonary aspergillosis, which was described by Binder et al. in 1982.

[Pneumonia and mortality in patients requiring prolonged mechanical ventilation]

We examined patients who required prolonged (>60 days) mechanical ventilation. A total of 31 patients were studied, 23 with pulmonary disease, 4 with neurologic disease and 4 with other conditions. Many of these patients were elderly. The survival rates one year and two years after the start of mechanical ventilation were 40% and 33%, respectively. Respiratory tract infection was the most common and most serious complication, and ventilator-associated pneumonia was the main cause of death. It is difficult but quite important to prevent these complications, especially ventilator-associated pneumonia.

Correlation between integrin alpha 5 expression and the malignant phenotype of transitional cell carcinoma

We examined the expression of alpha 1, alpha 2, alpha 3, alpha 4, alpha 5 and beta 1 integrin on 36 transitional cell cancers (TCCs) in the bladder by immunohistochemistry. Only alpha 2, alpha 3 and beta 1 were detected on normal transitional cell epithelium, but four TCCs (12.5%) revealed positive staining for alpha 1, seven (19.4%) for alpha 4 and seven (20%) for alpha 5. These altered expressions of integrin alpha chain were more frequent in histologically higher stage or grade of TCC, and a correlation was found between increased alpha 5 expression and histological stage. alpha 5 was positive in 6 (35.3%) of 17 invasive TCCs whereas only 1 (5.9%) of 17 superficial TCCs. Flow cytometric analysis on bladder cancer cell lines showed that T24 and HT1376, which are undifferentiated TCC cell lines, highly expressed alpha 5 and beta 1. Also, SCaBER, which is derived from urinary bladder squamous cell cancer and which is recognised as the most malignant phenotype after metaplasia of transitional epithelium, had alpha 5 and beta 1. However, RT4, which is derived from transitional cell papilloma, showed no expression of alpha 5. Furthermore, reverse transcriptase-polymerase chain reaction (RT-PCR) showed the presence of mRNA of alpha 5 on T24, SCaBER and HT1376, but not on RT4. Taken together, it seems that the presence of alpha 5 integrin might be a more malignant phenotype in transitional cell carcinoma.

Iron accumulation in tissues of magnesium-deficient rats with dietary iron overload

The mineral imbalances in magnesium-deficient rats with dietary iron overload were studied. Forty-four male Wistar rats were divided into six groups and fed six diets, two by three, fully crossed: magnesium adequate or deficient, and iron deficient, adequate, or excess. The concentrations of iron, magnesium, calcium, and phosphorus in tissues of the rats were measured. The results were as follows: (1) The excess iron intake reinforced the iron accumulation in liver and spleen of magnesium deficient rats; (2) The saturation of iron binding capacity was enormously elevated in the magnesium deficient rats fed excess iron; and (3) Dietary iron deprivation diminished the degree of calcium deposition in kidney of magnesium deficient rats. These results suggest that magnesium-deprived rats have abnormal iron metabolism losing homeostatic regulation of plasma iron, and magnesium deficient rats with dietary iron overload may be used as an experimental hemochromatosis model.

Cervical intra-epithelial neoplasia (CIN) III of the uterine cervix in a young female associated with AIDS

A case of cervical intraepithelial neoplasia (CIN) III implying severe dysplasia or carcinoma in situ of the uterine cervix in a 24 year old Japanese female patient with acquired immunodeficiency syndrome (AIDS) is reported. Autopsy revealed marked systemic atrophy of lymph nodes, Pneumocystis carinii pneumonia, pulmonary aspergillosis, acute pancreatitis and CIN III of the portio vaginalis uteri. The human papillomavirus (HPV) genome was detected in sections of the CIN III by polymerase chain reaction. This is the first autopsy report of cervical neoplasia in a patient with AIDS in Japan, and the pathogenesis of CIN III in this case was associated with HPV infection. Gynecological examination should be mandatory for female patients with human immunodeficiency virus infection.

Analysis of a germ line polymorphism of the p53 gene in lung cancer patients; discrete results with smoking history

The p53 tumor suppressor gene is often mutated in various human cancers and a common polymorphism is known at codon 72 of exon 4, with two alleles encoding either arginine (CGC) or proline (CCC). Association of this polymorphism with any human cancer susceptibility has yet to be clarified. We have conducted a case-control study in Japan on the distribution of the three genotypes with 191 lung cancer patients, 152 control patients with non-cancerous pulmonary diseases and 115 colorectal cancer patients. The genotypes were examined by PCR using DNA samples from peripheral blood lymphocytes. Frequency distributions of the three genotypes were quite comparable with each other among groups, with allelic frequencies of approximately 60% for arginine and 40% for proline. The genotypic frequencies in lung cancer patients, however, were largely different between smokers and non-smokers (chi 2 = 13.5, df = 2, P < 0.001). Compared with the control and colorectal cancer patients a significant difference in genotypic frequency was observed only in non-smoker lung cancers (chi 2 = 10.9, df = 2, P < 0.01), with an excess of Arg/Arg homozygotes and a deficit of Arg/Pro heterozygotes. Our present data suggest that the p53 polymorphism affects the risk of lung cancer unrelated to smoking.

The effects of isomaltulose-based oligomers feeding and calcium deficiency on mineral retention in rats

We examined the effects of isomaltulose-based oligomers (IBOs) on the mineral content of the whole blood, kidney, liver and tibia in calcium deficient and calcium sufficient rats. Twenty-eight Wistar rats were divided equally into 4 groups and fed with the following diets ad libitum for 4 weeks: (1) calcium sufficient diet (Ca+, IBOs-), (2) calcium-sufficient-IBOs supply diet (Ca+, IBOs+), (3) calcium-deficient diet (Ca-, IBOs-), (4) calcium-deficient-IBOs supply diet (Ca-, IBOs+). There were no significant differences in final body weights among the groups. Food consumption in the calcium-deficient groups was higher than that in the calcium-sufficient groups. The tibia weight was significantly decreased, and the calcium, magnesium and phosphorous contents significantly decreased, and iron content was significantly increased in the tibia of calcium-deficient rats. On the other hand, in IBOs feeding rats, tibia weight, and calcium, magnesium and phosphorous contents were significantly increased, and iron content was significantly decreased. These findings suggest that IBOs feeding improves mineral retention especially in a state of calcium deficiency.

Lumen and wall morphology of mild coronary dilatation assessed by in vivo intravascular ultrasound

The in vivo features of the wall and lumen of mild coronary dilatation associated with atherosclerosis and the relationship with coronary ectasia were investigated by intravascular ultrasound (IVUS) imaging of 11 patients with angiographically-proven mild coronary dilatation. Maximal luminal diameter, thickness of the inner echogenic layer and echolucent zone, and frequency of calcification of the dilatation sites were compared with those of proximal adjacent normal sites. The results showed that : luminal diameter by angiography was significantly larger at the dilatation site and the ratio of dilatation/normal diameter was 1.27 +/- 0.07; the maximal luminal diameter of the dilatation site by IVUS was greater than that of the normal site (4.56 +/- 0.87 vs 3.94 +/- 0.61 mm, p< 0.01); the thickness of the inner echogenic layer and echolucent zone increased significantly at the dilatation site over the normal site (0.48 +/- 0.12 vs 0.17 +/- 0.14 mm and 0.53 +/- 0.17 vs 0.10 +/- 0.10 mm, p< 0.001, respectively); calcification occurred more frequently at the dilatation site (54.5% vs 9.1%, p< 0.05). The thickened inner echogenic layer and echolucent zone and a high frequency of calcification were observed by in vivo IVUS in the wall of angiographically-defined mild coronary dilatation lesions caused by atherosclerosis.

Effect of low dietary rubidium on plasma biochemical parameters and mineral levels in rats

The effects of low dietary rubidium on plasma biochemical parameters and mineral levels in tissues in rats were studied. Eighteen male Wistar rats, weighing about 40 g, were divided into two groups and fed the diets with or without supplemental rubidium (0.54 vs 8.12 mg/kg diet) for 11 wk. Compared to the rats fed the diet with supplemental rubidium, the animals fed the diet without rubidium supplementation had higher urea nitrogen in plasma; lower rubidium concentration in tissues; lower sodium in muscle; higher potassium in plasma, kidney and tibia, and lower potassium in testis; lower phosphorus in heart and spleen; lower calcium in spleen; higher magnesium in muscle and tibia; higher iron in muscle; lower zinc in plasma and testis; and lower copper in heart, liver, and spleen, and higher copper in kidney. These results suggest that rubidium concentration in tissues reflects rubidium intake, and that rubidium depletion affects mineral (sodium, potassium, phosphorus, calcium, magnesium, iron, zinc, and copper) status.

[Preventive effect of intracisternal methylprednisolone on symptomatic vasospasm after aneurysmal subarachnoid hemorrhage]

A series of 103 patients with ruptured cerebral aneurysms were treated by intracranial irrigation, after aneurysmal clipping, with pH 8.0 Hartmann solution containing 1 mg/ml of methylprednisolone sodium succinate, during operation. Postoperatively, 5 ml/day of the solution was also injected until day 14, percutaneously through an Ommaya reservoir into the cisterns around the clipped aneurysm. Six (5.7%) of the 103 patients suffered symptomatic vasospasm postoperatively. The Glasgow Outcome Scale at discharge of all patients indicated good recovery, Moderately disabled, Severely disabled and Vegetative state in 74 (72%), 18 (17%), 9 (9%) and 2 (2%) patients respectively. As a complication, subdural effusion was noticed in 17 (17%) patients, without any influence on outcome at all.