Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time, and technical factors on obliteration rate

During the authors' initial 4-year experience with radiosurgery using the Leksell cobalt-60 gamma unit, they treated 121 patients with cerebral arteriovenous malformations (AVMs). The radiosurgical dose to the margin of the nidus was 20 Gy for lesions less than 2.0 cm in diameter (volume < or = 4.2 cm3); 18 Gy for malformations 2.1 to 3.0 cm in diameter (volume 4.2-14.1 cm3); and 16 Gy for malformations greater than 3.0 cm (volume > 14.1 cm3). Fifty-one patients underwent follow-up angiography between 1 and 3 years after treatment, and complete obliteration of the nidus was confirmed in 38 (74.5%) of these patients. Thirty-two (74.4%) of 43 AVMs with volumes of 10 cm3 or less and six (75%) of eight larger AVMs (volume 11-30 cm3) showed complete obliteration. Analysis of the time course of AVM nidus shrinkage and obliteration showed that most of the radiosurgically induced effect had occurred by 36 months after treatment. Retrospective analysis of the dose plans for 10 AVMs that were not obliterated by 36 months after gamma knife radiosurgery at the authors' institution (eight cases) or elsewhere (two cases) revealed that six AVMs had not been covered completely by the prescribed isodose. Six (5%) of the 121 patients developed neurological deficits as a direct result of radiosurgical treatment. The authors infer from these data that malformations up to 30 cm3 in volume (approximately 4.0 cm in average diameter) can be treated effectively with an acceptably low complication rate using a radiosurgical dose of 16 Gy to the margin of the nidus. The obliteration rate for the larger malformations that were treated with a dose of 16 to 18 Gy appears to be similar to that for smaller ones treated with 18 to 20 Gy. As more experience accrues using radiosurgery to treat AVMs, patient selection criteria and the variables associated with successful obliteration of the nidus should become more clearly defined.

Expanded cavum septi pellucidi and cavum vergae associated with behavioral symptoms relieved by a stereotactic procedure: case report

CASE REPORT

A 6-year-old boy had symptoms such as unstable gait, behavioral symptoms, and irregular appetite, evacuation, and sleep. Giant cavum septi pellucidi and cavum vergae of 3 x 3 x 5 cm were revealed by computed tomography (CT) and magnetic resonance imaging (MRI). After stereotactic cyst-peritoneal shunting, regression of the cavities was revealed by CT and MRI, in association with marked improvement in the above-described symptoms. In the corpus callosum particularly, which had been preoperatively revealed on sagittal MRI sections to be extended circumferentially as a result of compression by a cyst; the compression was relieved postoperatively, and compression of the pericallosal brain tissue was also relieved.

CONCLUSIONS

Compression of the brain tissue around the cyst (limbic system, etc.) was considered the most important cause of the behavioral symptoms in this patient.

Km genotyping by polymerase chain reaction (PCR) using allele-specific amplification primers

We developed a method for identifying genetic polymorphisms of the human immunoglobulin kappa light chain, namely the Km allotypes, by allele-specific amplification by means of the polymerase chain reaction (PCR). This procedure consisted of first and second PCR. In the first PCR, the 353 bp fragment of the human immunoglobulin kappa light chain constant gene was amplified without differentiating individual alleles. In the second PCR, the specific sequence in each of the three alleles Km*1, Km*1,2 and Km*3, in the first PCR product was specifically amplified using allele-specific primers. The product of the second PCR was separated by electrophoresis on a polyacrylamide gel and the band was observed by means of UV trans-illumination after staining with ethidium bromide. From DNA extracted from lymphocytes, the specific sequence of each Km allele was selectively amplified, and the Km genotype was identified. Moreover, the Km genotype could be ascertained from whole blood, saliva and hair roots without DNA extraction. No genetic contradiction was found in the results of Km genotyping among parents and their children. The estimated gene frequency of 115 Japanese individuals living in Okayama Prefecture, Japan, was: Km*3 = 0.739 and Km*1,2 = 0.261.

Localization of rat endothelin-converting enzyme to vascular endothelial cells and some secretory cells

Endothelin is a potent vasoconstrictive peptide that is produced by vascular endothelial cells; it is formed from its precursor, big endothelin, by endothelin-converting enzyme (ECE). In this work, ECE was studied using specific monoclonal antibodies. In immunoblotting, ECE was estimated to be a 300 kDa protein on SDS/PAGE under non-reducing conditions, and 130 kDa under reducing conditions. Cross-linking experiments revealed that ECE is composed of two disulphide-linked subunits. Localization of ECE was studied at the cellular and subcellular levels in various rat tissues and cells. High-level expression of ECE was observed in membrane fractions of simian virus 40-transformed rat endothelial cells by immunoblotting, but the immunoreactive band was absent form aortic smooth muscle cells and cytosolic fractions of endothelial cells. In immunohistochemical analysis, ECE was found to be localized in the endothelial cells of the aorta, lung, kidney, liver and heart. Confocal immunofluorescent microscopy showed that most of the ECE in endothelial cells and cells transfected with ECE cDNA was clustered along the plasma membrane. Intact COS or CHO cells transfected with ECE cDNA rapidly and efficiently cleaved big endothelin-1 added to the culture medium. Thus endothelial cells express ECE on the plasma membrane and the active site of the enzyme faces outside the cells, i.e. it is an ectoenzyme. Other than endothelial cells, ECE was also present in some secretory cells. The enzyme was abundant in the adrenal gland, and localized in chromaffin cells. ECE was also highly condensed in pancreatic islet beta cells. It is concluded that ECE and endothelin may be involved in the regulated secretion of hormones.

Structure of an exocellular polysaccharide of Lactobacillus helveticus TN-4, a spontaneous mutant strain of Lactobacillus helveticus TY1-2

Lactobacillus helveticus strain TN-4, a spontaneous mutant strain of Lactobacillus helveticus TY1-2, produced an exocellular polysaccharide from reconstituted skim milk. On the basis of the results of methylation analysis, enzymatic digestion, mild Smith degradation, mild acid hydrolysis, acetolysis, and 1D and 2D 1H-NMR spectroscopy, it was concluded that the polysaccharide has a D-galactofuranose containing hexasaccharide repeating unit with the following structure: [formula see text]

On the fractal nature of heart rate variability in humans: effects of vagal blockade

The purpose of the present study was to investigate the effects of the vagal blocker atropine on the fractal nature of human heart rate variability (HRV) at rest. Approximately 10-min segments of beat-to-beat heartbeat intervals, i.e., HRV, of 10 normal subjects and 11 cardiac disease patients were measured before and after intravenous injection of 0.5-0.75 mg atropine sulfate. HRV data were analyzed by coarse graining spectral analysis (Y. Yamamoto and R. L. Hughson, Physica 68D: 250-264, 1993) to break down their total power into harmonic and nonharmonic (fractal) components. The harmonic component was used to calculate the contribution of high (> 0.15 Hz)-frequency components to total HRV power (%HF). From the fractal component, the contribution of the fractal component to total HRV power (%fractal), the spectral exponent beta, and Hurst scaling exponent (H) were calculated. For both normal subjects and cardiac patients, atropine resulted in significantly (P < 0.05) less mean HRV and significantly (P < 0.05) greater beta compared with control, whereas mean values for %fractal were as high as 70% and were not significantly (P > 0.05) different between atropine and control. The mean value of H with atropine was significantly (P < 0.05) greater than that for control. Directional changes in %HF and beta were consistent with only one exception for a patient who had the smallest change in log %HF by atropine. The normally irregular fractal pattern of resting HRV was decreased by atropine as shown by the decrease in %HF and the increase in beta.(ABSTRACT TRUNCATED AT 250 WORDS)

Morphology of the interdigital glands of a Formosan serow (Capricornis crispus swinhoei)

The morphology of the interdigital glands of a male 9-year-old Formosan serow was examined. The glands were sock-shaped depression of the skin and were present in four feet. The glands were composed of a neck and a body. The epidermis of inner wall of the glands was keratinized stratified squamous epithelium. Apocrine glands were developed, while the sebaceous glands and hair follicles were very poorly developed. Contents, probably dirt, were small in the interdigital glands. These findings resemble to the interdigital glands of the Japanese serow and suggest that the interdigital glands have very low activity of secretion.

Excitation and inhibition by cisapride of spontaneous and evoked electrical responses in smooth muscles of guinea-pig stomach

In isolated circular smooth muscles of the guinea-pig stomach, cisapride depolarized the membrane, increased the amplitude and interval of slow waves, and enhanced the cholinergic excitatory junction potential, with no change in the nonadrenergic noncholinergic inhibitory junction potentials. Methysergide mimicked the excitatory actions of cisapride on junction potentials. Results showed that cisapride has dual actions on gastric muscles; excitation by facilitating the release of ACh possibly via 5-HT receptor blockade and also by depolarizing the smooth muscle membrane, and inhibition by reducing the frequency of slow waves, possibly by acting directly on the pacemakers.

Kidney-limited recurrence in a patient with microscopic polyarteritis

A 58-year-old woman with kidney-limited recurrence of microscopic polyarteritis (MPA) is described. The patient had a history of histologically-confirmed MPA 7 years previously, which had been in remission with corticosteroid treatment for 30 months followed by no medication thereafter. However, in February 1994, clinical manifestations including leg edema and proteinuria developed, followed by rapidly progressive renal insufficiency. Renal biopsy revealed crescentic glomerulonephritis with necrotizing vasculitis. Furthermore, at the same time antimyeloperoxidase antibody (MPO-ANCA) was detected in plasma. She was diagnosed as having kidney-limited recurrence of MPA without systemic presentation. Corticosteroid therapy was reinstituted, and the renal function improved, with a decrease in the titer of MPO-ANCA.

[Empyema caused by perforation of metastatic colon cancer: a case report]

The patient was a 51-year-old female, underwent total gastrectomy for gastric cancer 6 years ago. She was admitted to a local hospital with the complaint of fever, the chest X-ray showed niveau in the left pleural cavity. Fecal material flowed out by drainage. Barium enema showed fistula of diaphragma from transverse colon. She was transferred to our hospital. Partial transverse colon resection and removal of the diaphragma fistula were performed. The colon tumor was histologically determined to be metastasis from gastric cancer with thoracic empyema.

Autoantibody against 70 kD heat shock protein in patients with autoimmune liver diseases

BACKGROUND/AIMS

It has recently been suggested that heat shock proteins are implicated in the pathogenesis and teh pathophysiology of various immunological disorders, and the presence of antibodies against heat shock proteins has been reported in several autoimmune diseases.

METHODS

We investigated autoantibodies against the two major human heat shock proteins (hsp70 and hsp90) in sera from patients with primary biliary cirrhosis and autoimmune hepatitis, the two major autoimmune liver disease. Reactivity with human heat shock proteins obtained from phytohemagglutinin stimulated cells was investigated by immunoblots with sera at 1:20 dilution.

RESULTS

Reactivity with human hsp90 was not found in any sera from patients or normal controls. In contrast, reactivity with human hsp70 was found in 16 of 35 (45.7%) primary biliary cirrhosis patients and in 9 of 17 (52.9%) autoimmune hepatitis patients, but similar reactivity was found in only 2 of 15 patients with chronic hepatitis B and 1 of 13 patients with chronic hepatitis C. All the normal controls showed a negative reaction. Two-dimensional immunoblots and immunoabsorption experiments established that the autoantibody recognized only human hsc70 (73 kD/pI 5.5), a constitutive form of the hsp70 family.

CONCLUSIONS

Although the pathological significance of the autoantibody against hsc70 in these autoimmune liver diseases remains unknown, the serum autoantibody detected in primary biliary cirrhosis patients is closely related to clinical variables including serum total bilirubin, alanine aminotransferase, IgG, IgM, titers of antimitochondrial antibodies, and major symptoms (pruritus and/or icterus). These observations may suggest that the anti-hsc70 antibody is an indicator for the disease activity of primary biliary cirrhosis.

Clinical significance of childhood acute myeloid leukemias expressing lymphoid-associated antigens

The clinical significance of the expression of lymphoid-associated antigens in leukemic cells was studied in 66 children with newly diagnosed acute myeloid leukemia (AML). Among 66 AML cases, 17% were CD7-positive, 15% were CD19-positive, 8% were CD2-positive, and 5% were CD10-positive. In 23 (35%) of the 66 AML cases, at least one lymphoid-associated antigen was expressed in the leukemic cells. When the clinical features and laboratory findings were compared at diagnosis between the 23 Ly+ and the 43 Ly- AML cases, no statistically significant difference was found. The expression of CD34 was significantly more frequent in Ly+ AML cases (91%) than in Ly- AML cases (31%). Chromosomal analysis revealed t(8;21) in 6 of the 21 Ly+ AML cases examined. No other specific chromosome aberration was noted. The 3-year event-free survival rates of Ly+ AML cases and Ly- AML cases were 34% +/- 12% and 26% +/- 8%, respectively. There was no statistically significant difference between the two groups. Further studies are required to determine the prognostic significance of lymphoid-associated antigen expression.

Two-dimensional analysis of hemodynamic changes in axial and random pattern flaps

The present study was performed to evaluate the time course of hemodynamic change in axial and random pattern flaps two-dimensionally. The axial pattern flap, including the central auricular artery and vein, and the random pattern flap without these vessels were created in the auricles of the rabbit. The blood flow of these flaps was investigated and assessed using laserflowgraphy, which provides a two-dimensional analysis of microcirculation. In the axial pattern flap, a gradient of blood flow toward the short axis of the flap and decreased blood flow in the surrounding area were noticed immediately after operation. The hemodynamic changes became less marked with time. In the random pattern flap, a gradient of blood flow toward the long axis of the flap was noticed around 6 hr after operation and the blood flow in the surrounding area increased throughout the investigations.

Protective effect of heat shock pretreatment with heat shock protein induction before hepatic warm ischemic injury caused by Pringle's maneuver

BACKGROUND

Induction of heat shock proteins is thought to have a > cytoprotective effect against environmental stress and to result in a better ischemic tolerance. The protective ability of heat exposure and heat shock protein 72 (HSP 72) induction before warm ischemia caused by Pringle's maneuver was evaluated in rats.

METHODS

Heat exposed rats (HS) were compared with control animals (C). The gene expression (messenger RNA) of HSP 72 and HSP 72 were detected by Northern and Western blot analyses. During 40 minutes of in situ reperfusion, liver energy metabolism and levels of standard liver enzymes were evaluated. The survival rate was determined after postoperative day 7.

RESULTS

After heat exposure and recovery, messenger RNA of HSP 72 and HSP 72 can be detected strongly in HS group but not in C group. During reperfusion HS group exhibited a significantly (p < 0.01) improved energy metabolism, and the release of liver enzymes was significantly (p < 0.001) reduced compared with C group. Seven-day survival rate was 100% in HS group but at 50% was significantly impaired (p < 0.05) in C group.

CONCLUSIONS

Heat exposure associated with HSP induction has a significant protective effect against warm ischemic liver injury, which results in a relevant improvement of survival rate.

Serum concentrations of hepatocyte growth factor in breast cancer patients

Hepatocyte growth factor (HGF) was first identified as a potent stimulator of hepatocyte growth and DNA synthesis. Later, it was shown that HGF can promote cell motility and cell proliferation in various types of cells, including tumor cells and endothelial cells. We have examined serum concentrations of HGF in breast cancer patients using an ELISA. Of 134 primary breast cancer patients, 49 (36.6%) showed a significant increase in the circulating level of HGF as compared to healthy controls. The increase in the HGF level was significantly associated with axillary lymph node metastases and histological evidence of venous invasion. No significant correlation between serum HGF concentrations and intratumoral HGF concentrations was found; however, the removal of the primary tumor clearly decreased the serum HGF level, suggesting that the elevation of HGF in the serum was tumor related. Twenty-nine (82.9%) of 35 patients with recurrent breast cancer had an increase in the serum HGF level. The HGF level was significantly higher in patients with liver metastases compared to those with other sites of metastases. Postoperative sequential examinations confirmed that the increase in the serum HGF level was associated with the appearance of relapse. In conclusion, the serum HGF level was significantly increased in breast cancer patients. Circulating HGF might play important roles in tumor progression in this malignancy.

Chronological study of peripheral benzodiazepine binding sites in the rat brain stab wounds using [3H] PK-11195 as a marker for gliosis

Chronological studies of the development of the peripheral benzodiazepine receptor sites were undertaken with the goal of evaluating the sensitivity of this marker for the study of the gliosis development in the injured brain. No significant increase in [3H] PK-11195 binding occurred in the rat brain stab wound one day following the puncture. A significant increase in the receptor density (Bmax) from the second day onward was observed. The Bmax reached its highest levels in the grey matter on the sixth day after a 23-gauge needle wound (8.75 +/- 0.09; pmol mg-tissue-1) and on the seventh day after an 18-gauge needle wound (8.98 +/- 0.31 pmol mg-tissue-1). In the white matter, the Bmax was greatest seven days after the wound (3.42 +/- 0.07; pmol mg-tissue-1; 23-gauge needle and 3.56 +/- 0.1 pmol mg-tissue-1 in the 18-gauge needle injury). Between 30 and 60 days after the wound, the Bmax was significantly lower than the Bmax observed between 6 and 14 days. The Bmax in the wound produced with needles was seven to eight times greater than the Bmax in the grey matter of the ipsilateral and contralateral cortices. Histological examination showed that there were no astrocytes or macrophages in the stab wound one day after the lesion. However, the glial fibrillary acidic protein positive cells and macrophages appeared on D3 after an injury. Gliosis, as measured by the PK-11195 binding, was also observed in the remote contralateral cortex. Data shows that PK-11195 binding is a very sensitive method of evaluating brain injury and could be of great value in studying progressive injuries in the living human brain in conjunction with positron emission tomography.

[Diagnostic usefulness of myocardial SPECT with 123I-beta-methyl-iodophenyl pentadecanoic acid and 201Tl in unstable angina]

The purpose of this study is whether 123I-BMIPP detects a culprit lesion in patients with unstable angina. Twenty-six patients with unstable angina underwent 123I-BMIPP (BMIPP) and 201Tl (Tl) imaging at rest. BMIPP image was compared with Tl imaging. BMIPP imaging revealed defects or low uptake corresponding to myocardial ischemic areas predicted by coronary angiography in 19 (73.1%) of 26 patients. Tl imaging showed defects or low uptake corresponding to coronary angiographic findings in 14 (53.8%). BMIPP demonstrated significantly less uptake than Tl (p = 0.001). Severity of reduced BMIPP activity was greater than that of Tl (p < 0.001). We concluded that BMIPP imaging was excellent to detecting of culprit lesions in patients with unstable angina. BMIPP SPECT is a sensitive method for detecting myocardium exposed to transient schemia that cannot be detected by Tl imaging.

Possible function of SP-22, a substrate of mitochondrial ATP-dependent protease, as a radical scavenger

SP-22 was found to be a substrate protein of a mitochondrial ATP-dependent protease in bovine adrenal cortex. Its amino acid sequence was homologous to that of some prokaryotic and eukaryotic proteins such as thioredoxin peroxidase (formerly called thiol-specific antioxidant) in yeast and mammalian brains and the C22 component of alkyl hydroperoxide reductase in Salmonella typhimurium. In the present study, we found SP-22 to have the ability to scavenge reactive oxygen species, thus protecting radical-sensitive proteins such as tryptophan hydroxylase, glutamine synthetase and hemoglobin from oxidation. The protecting activity was enhanced by the addition of horse serum. The "serum factor(s)" seemed to be protein(s), since the physiological roles of SP-22 in adrenocortical mitochondria are discussed.

Methylcobalamin attenuates the hypoxia/hypoglycemia- or glutamate-induced reduction in hippocampal fiber spikes in vitro

The effects of methylcobalamin, a vitamin B12 analogue, on the hypoxia/hypoglycemia- or glutamate-induced reduction in hippocampal CA1 presynaptic fiber spikes elicited by Schaffer collateral stimulation in rat brain slices were evaluated. Hippocampal slices were exposed to 15 min of hypoxia/hypoglycemia, and then these slices were returned to oxygenated and glucose-containing buffer for 3 h. Hypoxia/hypoglycemia reduced CA1 presynaptic potentials in vitro. Treatment with 10 microM methylcobalamin attenuated the impairment of CA1 presynaptic potentials induced by hypoxia/hypoglycemia or glutamate application (10 mM). Daily injection of methylcobalamin (0.5 mg/kg i.p./day) for 3 days in vivo also attenuated the hypoxia/hypoglycemia- or glutamate-induced reduction in presynaptic potentials in hippocampal slices. Pretreatment with cyanocobalamin at 10 microM failed to attenuate the impairment of CA1 presynaptic potentials. However, daily injection of cyanocobalamin (0.5 mg/kg i.p./day) for 3 days caused a protective action against the hypoxia/hypoglycemia- or glutamate-induced functional deficit. Furthermore, co-treatment of L-arginine (100 microM), a substrate for nitric oxide synthase, with methylcobalamin in vitro reversed the methylcobalamin-induced functional recovery. The present results demonstrate that methylcobalamin application in vivo or in vitro leads to functional recovery from hypoxia/hypoglycemia- or glutamate-induced impairment of CA1 presynaptic potentials. Neuroprotection was obtained by in vivo application of cyanocobalamin, but not by its in vitro application. It is reported that in vivo injected cyanocobalamin converted to methylcobalamin in the hepatic cells. Therefore, the results suggest that a transmethylation reaction in the hippocampal regions may be involved in the methylcobalamin-induced functional recovery from ischemic impairment.

Receptor-mediated toxicity to pericytes of advanced glycosylation end products: a possible mechanism of pericyte loss in diabetic microangiopathy

The influence of advanced glycosylation end products (AGE) on bovine retinal pericytes was investigated. When pericytes were cultured with AGE-bovine serum albumin (BSA), pericyte growth was significantly retarded in a dose-dependent manner. They also exhibited an immediate toxicity to pericytes. However, MRC-5 human fibroblasts were totally resistant to AGE-BSA. Moreover, antisense oligonucleotides complementary to mRNA coding for AGE receptor were found to reverse the AGE-induced decrease in viable pericyte number, although the mRNA level was about one order of magnitude lower in pericytes than in the fibroblasts. These results indicate that pericytes may possess a peculiar sensitivity to AGE, and that AGE ligand-receptor interactions may play an important role in the pathogenesis of pericyte loss, the principal change in diabetic microangiopathies.