[A case of spontaneous mesenteric fibromatosis occurred from the mesentery of the small intestine]

The fibromatosis is benign tumor which is characterized by the remarkable proliferation and the invasive growth of fibrous tissue and no distant metastasis. It usually occurs from the abdominal wall or the extremities, and rarely from the mesentery. A 54-year-old male complained of an epigastralgia and emesis. He was diagnosed through imaging as the obstructive ileus by abdominal tumor. The laparotomy was performed and a round, egg sized tumor was found wear by dilated ileum. The tumor was considered to occur from the mesentery, and the iliectomy with the tumor was completed. It was suggested that ileus occurred in the early stage because the tumor was located just by the ileum.

[Lecithin: cholesterol acyltransferase (LCAT)--the genetic analysis of familial LCAT deficiency and fish eye disease]

Lecithin: cholesterol acyltransferase (LCAT) is the enzyme that catalyze the esterification of free cholesterol in plasma proteins. The functional abnormalities of LCAT are known to cause two diseases characterized by severe corneal opacity; familial LCAT deficiency that is accompanied with anemia and frequently, though not invariably, renal failure, and fish eye disease (FED) without any other severe symptoms. Notably, it has been shown that the clinical symptoms and biochemical features are highly variable in each patient with the diseases. Recent genetic studies on the cases of LCAT deficiency or FED revealed both diseases to be caused by respective mutations of the LCAT gene. These findings suggest the abnormal or defective LCAT by each gene mutation underlies the heterogeneity in the biochemical and, possibly, clinical characteristics observed in LCAT deficiency and FED.

Pathologic Assessment of Surgical Margins on Frozen and Permanent Sections in Breast Conserving Surgery

The diagnostic value of frozen section was evaluated in the histologic assessment of surgical margins obtained by wide excision of breast tumors. There were 87 patients with unilateral breast cancer, and 5 with bilateral breast cancers. The periphery of the excised breast tissue was peeled like an orange and histologically examined by frozen and permanent section. If either in situ or infiltrating microscopic tumor was found at the margin, it was considered positive. Using frozen sections, the margin was judged histologically positive or suspicious in 30 tumors (31%) and negative in 67(69%) tumors. Positive surgical margins were histologically confirmed by permanent section in 20(67%) of the 30 tumors diagnosed as positive or suspicious on frozen section. Another 10 tumors had negative margins. In 4 tumors, however, while the initial or re-excised margin was negative on frozen section, the margins were positive by permanent section. These surgical margins were positive due exclusively to the presence of ductal carcinoma in situ (DCIS). Evaluation of surgical margins in breast cancer by frozen section, thus exhibited a diagnostic accuracy of 86&prtcnt;, a sensitivity of 83%, and a specificity of 86%. It is concluded that frozen sections are useful in the determination of involvement of surgical margins after the wide excision of breast cancer. It must be pointed out that frozen sections will ofter overestimate involvement of the surgical margins.

Collimation of emissions from a high-power multistripe laser-diode bar with multiprism array coupling and focusing to a small spot

Twelve beams emitting from twelve stripes, with 200-microm apertures spaced 800 microm apart, of a 1-cm linear diode array were collimated by a multiprism array consisting of fourteen 800-microm-wide prismlets. The spatial intensity distribution of each beam was twisted around its optical axis through three total reflections in a prismlet, transforming a series arrangement of emitters into a parallel arrangement to prevent overlap of adjacent beams. Collimated beams were focused to a spot of ~200 microm (FWHM).

[The role of gallium-67 citrate scintigraphy in Crohn's disease]

We investigated the usefulness of gallium scintigraphy and its importance in the choice of a treatment method for Crohn's disease. The subjects for the study were 30 patients diagnosed as Crohn's disease. After intravenous injections of 67Ga-citrate 111 MBq, planar and SPECT images were taken at 48 and 72 hrs. The overall positive rate was 42.1%, and among the positive cases, 78.6% required surgical treatment. On the other hand, surgical treatment was only performed in 18.8% of the negative cases, which was significantly low percentage. However, since 75% of the cases, in whom surgical treatment was performed, showed preoperative positive 67Ga results, positive cases detected by 67Ga scintigraphy were considered to be high-risk cases requiring surgical treatment.

Structural and functional differences of subspecies of apoA-I-containing lipoprotein in patients with plasma cholesteryl ester transfer protein deficiency

ApoA-I-containing lipoproteins exist in plasma in two main forms: one contains only apoA-I (LpA-I) while the other contains both apoA-I and apoA-II (LpA-I/A-II). We characterized structural and functional changes of these lipoproteins in six patients with cholesteryl ester transfer protein (CETP) deficiency. In these patients, the amount of LpA-I and LpA-I/A-II had increased significantly. Sixty-five percent of plasma apoA-I was associated with LpA-I/A-II, which indicated that LpA-I/A-II was predominant. The chemical composition of both LpA-I and LpA-I/A-II was characterized by increased ratios of neutral to polar lipid, compared with findings in normal subjects. Particle sizes of these lipoproteins shifted to larger diameter ranges, as compared to the size seen in normal subjects. Incubation of patients' LpA-I and LpA-I/A-II with CETP markedly corrected the chemical and physical abnormalities in these lipoproteins. Cholesterol-reducing capacities of these lipoproteins from macrophage foam cells were significantly lower than in normal controls. Cholesterol esterification rates in LpA-I, LpA-I/A-II, and plasma were significantly lower in patients than in normal controls. We propose that the structure and function of LpA-I and LpA-I/A-II are severely affected in the presence of CETP deficiency.

Regeneration of the tunic cuticle in the compound ascidian, Botrylloides simodensis

The tunic cuticle of Botrylloides simodensis, a colonial ascidian, is an electrondense sheet overlaying the tunic in which zooids are embedded. When the margins of colonies were cut off and the colonies were incubated in running seawater, the tunic cuticle regenerated at the cut surface of the tunic matrix by the following process: 1) Electron-dense fibers appeared at the cut surface within a few minutes. 2) Fiber formation proceeded during the next several hours, and the number of fibers greatly increased. 3) In 12 to 24 hours, the fibers aggregated and formed a continuous layer, which was the newly regenerated cuticle. 4) Minute protrusions appeared in the new cuticle after 3 to 5 days. Fiber formation occurred even in fragments of colonial margins that were incubated in a bottle of seawater. It was inhibited under some experimental conditions including low pH and the presence of some proteases or protease inhibitors.

Increased corticomotoneuronal excitability after peripheral nerve stimulation in dopa-nonresponsive hemiparkinsonism

Corticomotoneuronal excitability was examined in 7 patients with dopa-nonresponsive progressive hemiparkinsonism (DNRHP) and 10 with dopa-responsive hemiparkinsonism (Parkinson's disease: PD), as well as in 10 normal subjects, by measuring change in motor evoked potentials (MEPs) using transcranial magnetic stimulation of the motor cortex after peripheral nerve stimulation. Corticobasal degeneration (CBD) was suspected clinically for the progressive dopa-nonresponsive hemiparkinsonism. Conditioning stimulation of the median nerve on the rigid side greatly increased MEP size (500-1300%) in 4 DNRHP patients as compared to the increase for the normal subjects (140-380%) at conditioning test (C-T) intervals of 40-80 ms, but stimulation on the contralateral side did not. There was no abnormal MEP facilitation on the rigid side in 10 PD patients. None of the patients with CBD had an increase in somatosensory evoked potential (SEP) size, and no patient showed hyperexcitability in SEP-recovery during C-T intervals at which there was abnormal MEP facilitation. These results indicate that there is an exaggerated effect of afferent input on corticomotoneuronal excitability in some patients with DNRHP.

Effects of anesthesia and surgery on plasma endothelin levels

To investigate the clinical significance of endothelin (ET), a potent and long-acting vasoconstrictor peptide in anesthesia and surgery, we measured plasma ET-like immunoreactivity (ET-LI) levels by using radioimmunoassay in patients undergoing various kinds of surgery under general anesthesia. No significant changes in plasma ET-LI levels were observed in patients undergoing relatively minor surgery under general anesthesia with nitrous oxide and halothane (n = 6), enflurane (n = 6), or isoflurane (n = 5). Although plasma ET-LI levels after surgery in patients undergoing total knee replacement (12.4 +/- 0.9 [mean +/- SEM] pg/mL, n = 7), hysterectomy (11.4 +/- 0.6 pg/mL, n = 8) or cholecystectomy (14.8 +/- 1.2 pg/mL, n = 9) were no different from those before surgery, plasma ET-LI levels after surgery in patients undergoing gastrectomy (20.4 +/- 1.9 pg/mL, n = 15), esophagectomy (24.7 +/- 2.5 pg/mL, n = 12), hepatectomy (27.5 +/- 3.4 pg/mL, n = 12), or heart surgery (43.1 +/- 4.1 pg/mL, n = 18) were higher than those before surgery (P < 0.05). Changes in plasma ET-LI levels during surgery had positive correlations with the duration of the operation (n = 100, r = 0.51, P < 0.01) and intraoperative blood loss (n = 100, r = 0.30, P < 0.01). In patients undergoing subtotal esophagectomy, the plasma ET-LI level did not increase during the initial 2 h, but increased gradually during surgery, reached a peak within a few hours after surgery, and declined slowly thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

Induction of gene expression for immunomodulating cytokines in peripheral blood mononuclear cells in response to orally administered PSK, an immunomodulating protein-bound polysaccharide

The protein-bound polysaccharide extracted from a fungus, PSK, has been used as a biological response modifier in the treatment of cancer patients in Japan for over 16 years. The administration of PSK to tumor-bearing rodents inhibited tumor growth and modulated immune responses. Recently, an in vitro study has revealed that PSK is a strong inducer of cytokine gene expression and production in human peripheral blood mononuclear cells (PBMC). To establish whether PSK has cytokine-inducing activities in vivo, we have orally administered PSK (1 g, the clinical dose) to 12 healthy volunteers and 9 gastric cancer patients who had undergone gastrectomy, and assessed the gene expression for cytokines in PBMC of each subject. As determined by the reverse-transcribed polymerase chain reaction method, the induction of gene expression for both tumor necrosis factor alpha and interleukin-8 (IL-8) was detected in PBMC from 5 of the 12 healthy volunteers (42%) and 4 of the 9 patients (44%). Furthermore, the concentration of serum IL-8 was elevated in 5 healthy volunteers given PSK orally, who had shown induction of IL-8 gene expression, as detected by enzyme-linked immunosorbent assay. These findings indicate that responsiveness of PBMC to PSK, in terms of gene expression and production of cytokines, varies among individuals. Thus, when using PSK to treat cancer patients, it seems advisable to select patients on the basis of their responsiveness to PSK. We speculate that the cytokines induced by PSK might mediate the immunoenhancing action of this agent in vivo.

Cellular localization of human herpesvirus-6 in the brains of children with AIDS encephalopathy

Human herpesvirus-6, the etiologic agent of exanthem subitum, is a ubiquitous virus that infects almost all children by the age of 2 years and that has previously been shown to be neuroinvasive. These characteristics suggest that human herpesvirus-6 may be important in the neuropathogenesis of acquired immune deficiency syndrome (AIDS) in children. To address this hypothesis, we evaluated postmortem pediatric brain tissues for the presence of human herpesvirus-6 infection. Using in situ hybridization with a digoxigenin-labeled DNA probe for the large tegument protein gene of human herpesvirus-6, we detected nuclear signals in postmortem brain tissue from 4/5 children with human immunodeficiency virus-1 encephalitis. Human herpesvirus-6 DNA was found in numerous oligodendrocytes of the white matter and less frequently in astrocytes, macrophages, microglia and neurons. The human herpesvirus-6 positive cells detected by in situ hybridization were not immunoreactive either for human herpesvirus-6 early nuclear phosphoproteins or for surface glycoproteins associated with productive infection. Only rare human herpesvirus-6 infected cells were found in age-matched control brain tissues. No human herpesvirus-6 infected cells were found in human fetal brain tissue. These data suggest that human herpesvirus-6 is more extensively disseminated in neural cells in the presence of human immunodeficiency infection and immunodeficiency in pediatric AIDS patients, and it may contribute to the pathogenesis of AIDS encephalopathy.

[TSH-secreting fibrous pituitary adenoma showing calcification: a case report]

TSH-secreting pituitary adenoma with calcification and proliferation of the collagen fibers was presented. A 42-year-old man had shown general fatigue and thyroid hypertrophy caused by hyperthyroidism for 3 years. CT and MRI revealed pituitary adenoma with calcification extending into the cavernous sinus and sphenoid sinus. The patient was operated on using the transsphenoidal route twice, but the tumor was not able to be removed totally, partly due to the hardness of the tumor. The tumor in- and around the left cavernous sinus as well as the hardest part of the tumor itself due to the calcification could not be removed. Histopathological examination revealed chromophobe adenoma with proliferation of the collagen fibers. Immunohistological and electronmicroscopic examination demonstrated TSH-secreting adenoma. Postoperatively, thyroid function improved and the patient's symptoms due to hyperthyroidism disappeared.

A fruiting body-specific cDNA, mfbAc, from the mushroom Lentinus edodes encodes a high-molecular-weight cell-adhesion protein containing an Arg-Gly-Asp motif

A cDNA clone (designated mfbAc), encoding 2157 amino acids (aa), was isolated from a mature fruiting-body cDNA library of the edible mushroom Lentinus edodes. The mfbA transcript was abundant in mature fruiting bodies, detectable in immature fruiting bodies but absent in earlier developmental stages and in the vegetative mycelium. Although more abundant in the pileus than the stipe, only low levels were found in the gill tissue. The deduced MFBA protein (234.5 kDa) contained a cell-surface attachment-promoting Arg-Gly-Asp (RGD) motif. MFBA was produced in Escherichia coli using a maltose-binding protein (MBP) fusion vector, but it was cleaved into four fragments even in a protease-deficient host. A 425-aa MFBA peptide containing the RGD motif (named MFBA(582-1006) peptide) was successfully produced using the phage T7 expression system. This MFBA(582-1006) peptide exhibited a cell adhesion and spreading activity toward mammalian cells. This activity of the MFBA fragment was competitively inhibited by the Gly-Arg-Gly-Asp-Ser-Pro peptide but not by the Gly-Arg-Gly-Glu-Ser-Pro peptide, showing that the RGD motif of MFBA is essential for the cell-binding activity.

Differentiation-inducing factor of D. discoideum raises intracellular calcium concentration and suppresses cell growth in rat pancreatic AR42J cells

DIF (differentiation-inducing factor) is a putative morphogen that induces stalk cell differentiation in the lower eukaryote, Dictyostelium discoideum. In this study, we have examined the effects of DIF on growth and the intracellular calcium concentration ([Ca2+]i) in rat pancreatic acinar AR42J cells. Growth of AR42J cells was inhibited when DIF was present in the media, and approximately 50% growth inhibition was attained with 20 microM DIF. DIF was also found to raise [Ca2+]i in a dose-dependent manner (1-40 microM), both in the presence and absence of extracellular Ca2+. These results suggest that DIF elicits both calcium influx from the extracellular space and calcium release from intracellular pool(s), thereby inhibiting cell growth in AR42J.

Three conserved glycine residues in valine activation of gramicidin S synthetase 2 from Bacillus brevis

The translated product from the gene fragment containing the second and third domains of gramicidin S synthetase 2 was purified to an essentially homogeneous state. It showed valine- and ornithine-activating activity and the second domain was proved to be the valine-activating domain. Three mutant genes from Bacillus brevis Nagano, BI-3, E-4, and E-5 strains, which encode defective valine-activating domains of gramicidin S synthetase 2, were sequenced. By comparison with the wild-type gene, single point mutations of guanine to adenine were found at the three conserved glycine codons; the 5303rd guanine in BI-3, the 5378th guanine in E-4, and the 4967th guanine in E-5, which corresponded to codon changes of the 1768th glycine to glutamic acid and the 1793rd and the 1656th glycine to aspartic acid. Loss of valine-adenylation activity by mutation at the 1656th glycine proved the direct participation of the TSGT/STGXPKG motif in the adenylation reaction, and suggests that this glycine residue with the conserved lysine residue of the motif forms the phosphate-binding loop for ATP-binding. The 1793rd glycine is a member of the YGXTE motif which was also conserved among adenylate-forming enzymes except acetyl-CoA synthetases. The 1768th glycine residue appears to maintain the conformation of the active site for aminoacyl adenylation since this residue is retained among the adenylate-forming enzymes, though flanking regions are not conserved. These results suggest that these glycine residues are essential for adenylate formation in the antibiotic peptide synthetase family and some other adenylate-forming enzymes.

Treatment of retinal breaks with autologous serum in an experimental model

PURPOSE

The standard treatment for retinal breaks is thermal adhesion. Breaks in the posterior pole (i.e., macular holes) recently have been treated using vitrectomy and the recombinant cytokine transforming growth factor-beta. This has been shown to achieve closure of the retinal breaks by stimulating localized fibrocellular proliferation. Serum has been shown to contain chemoattractants and mitogens for many types of cells. The authors studied the clinical and histologic effect of autologous serum application to retinal breaks in an experimental model.

METHOD

Twenty-four rabbits underwent pars plana lensectomy, vitrectomy, retinectomy, fluid-air exchange, application of test solution (12 with Hank's buffered salt solution and 12 with autologous serum), and air-gas exchange. Clinical examination with indirect ophthalmoscopy was performed, and animals were killed 5, 14, and 28 days after treatment. Tissue sections through the retinectomy were studied by light microscopy, electron microscopy, and immunocytochemistry.

RESULTS

None of the serum-treated eyes showed retinal detachment at the site of the retinectomy by evaluation with indirect ophthalmoscopy at each of the time points. In contrast, in control eyes retinal detachment developed at the retinectomy site from 0% at day 5 to 50% at day 14 and 75% at day 28. By light microscopy, serum-treated eyes contained multilayers of fibroblast-like cells adhering the retinectomy edges to the underlying retinal pigment epithelium and choroid. The control eyes had nonadherent retinal edges at the retinectomy site with little sign of fibrocellular response. Results were confirmed by electron microscopy. The fibroblast-like cells by immunocytochemistry contained vimentin, cytokeratin 18, and/or glial fibrillary acidic protein.

CONCLUSION

This study suggests that serum induces a localized fibrocellular response at the retinectomy edges compared with control eyes. This response, characterized by light microscopy, electron microscopy, and immunocytochemistry, appears to involve a mixed population of glial, retinal pigment epithelial, and/or fibroblastic cells. These cells seem to enhance adhesion and subsequent reattachment of the edges of the retinectomies at the time points studied when compared with controls.

Adult-onset Still's disease with submassive hepatic necrosis

We present a 74-year old woman who was hospitalized because of typical spiking fever, evanescent rash, polyarthralgia, lymphadenopathy, and marked elevation of serum transaminases and lactate dehydrogenase (LDH) due to adult-onset Still's disease (AOSD) with submassive hepatic necrosis. All of the symptoms and abnormal laboratory findings were dramatically improved after treatment with prednisolone. The clinical course of this patient indicates that AOSD with severe hepatic necrosis can successfully be treated with early administration of corticosteroid, although it remains unknown whether the disease can remain in remission with no or minimal treatment.

Purification and properties of branched chain amino acid aminotransferase from gramicidin S-producing Bacillus brevis

The branched chain amino acid aminotransferase [EC 2.6.1.42] was purified to a homogeneous state from a gramicidin S-producing strain of Bacillus brevis. The enzyme had a molecular weight of about 93,000 and consisted of two identical subunits, each with a molecular weight of about 47,000. One pyridoxal phosphate is bound per subunit. In addition to branched chain amino acids, the enzyme uses L-phenylalanine and L-tryptophan as the amino donor, indicating that B. brevis branched chain amino acid aminotransferase has a broad substrate specificity for the amino donor. The enzyme utilized 2-oxoglutarate as the amino acceptor. The purified enzyme exhibits its absorption maxima at 332 and 427 nm at neutral pH.

[Endoscopic treatment of colorectal cancer]

Endoscopic polypectomy should be applied only for early colorectal carcinomas. Intramucosal carcinoma do not have a risk of lymph node metastases. However, there is an about 10% risk of lymph node metastases among carcinomas showing submucosal invasion (sm carcinoma). When risk factors revealed to be positive after polypectomy, subsequent surgical resection of the large bowel with lymph nodes dissection is needed, because these sm carcinomas are considered to have a high risk of lymph node metastases. Therefore, accurate diagnosis of depth of invasion is essential to prevent subsequent surgical resection following endoscopic polypectomy. Endoscopy, barium enema and endoscopic ultrasonography (EUS) are all considered to be effective for an accurate diagnosis of depth of invasion. Endoscopic polypectomy includes hot biopsy, snare polypectomy and endoscopic mucosal resection (EMR). Appropriate maneuver must be chosen, considering the characteristics of the lesion. Major complications after endoscopic polypectomy are bleeding and perforation of the large bowel. Including an establishment of a new risk factors, further efforts must be made to prevent unnecessary additional surgical resection of the large bowel following endoscopic polypectomy.