[Re-examination of the criteria for clinical evaluation on bacterial prostatitis--analysis of the data of the clinical study of temafloxacin]

The clinical efficacy of temafloxacin (TMFX) was evaluated in the patients with acute prostatitis (AP: 31 cases) and chronic prostatitis (CP: 75 cases), and the criteria for clinical evaluation on bacterial prostatitis by the Japanese UTI Committee were re-examined. The clinical efficacy of TMFX on prostatitis was examined. The number of the evaluable cases by doctors in charge were 30 and 68 for AP and CP, respectively. The efficacy rates were as high as 96.7% for AP and 80.9% for CP. In the patients whose efficacy could be evaluated by the Committee, the efficacy rates were as high as 100% (15/15) for acute bacterial prostatitis (ABP) and 66.7% (18/27) for chronic bacterial prostatitis (CBP). The bacteriological eradication rates were 100% (15/15) for ABP and 81.5% (22/27) for CBP. Adverse drug reactions were observed in 8 of 100 cases (total evaluable cases) but they clinically did not consist any problems. Abnormal laboratory test findings were observed in 9 of 71 cases (total evaluable cases), whose changes were all slight and did not clinically cause any problem. Therefore, TMFX was concluded to be highly useful in the treatment of ABP and CBP. The criteria for clinical evaluation on bacterial prostatitis were re-examined. Concerning the treatment period, comparison of the evaluation at Day 7 with that at Day 14 in ABP revealed that the efficacy was evaluable at Day 7. In the same way, comparison of the evaluation at Day 14 with that at Day 28 in CBP revealed that the efficacy was evaluable at Day 14. Concerning the pathogens, in ABP, the major pathogens were considered to be GNR as well as E. coli. On the other hand, in CBP, GNR and E. faecalis, that were generally authorized to be pathogens, were detected in less than half of the patients, and CNS were detected in the other patients. Among the CNS cases, there were some cases that showed no relationship between improvement of clinical symptoms and bacterial response. Therefore, it is necessary to perform further studies on this matter. In conclusion, regarding the criteria for clinical evaluation on bacterial prostatitis proposed by the Japanese UTI committee, the treatment period for evaluation of efficacy was appropriate, and it is necessary to perform further studies in order to determine the pathogens in bacterial prostatitis.

[A case of dural arteriovenous malformation in the anterior cranial fossa presenting with intracranial hemorrhage]

We report a case of dural arteriovenous malformation (dAVM) in the anterior cranial fossa presenting with intracranial hemorrhage. The patient was a 60-year-old man who became unconscious shortly after developing an acute headache. Computed tomography performed on admission demonstrated a left frontal intracranial hematoma together with subarachnoid hemorrhage and a subdural hematoma. Cerebral angiography revealed a dAVM in the left anterior cranial fossa supplied by the anterior ethmoidal arteries bilaterally from enlarged ophthalmic arteries and which drained into the superior sagittal sinus via a dilated cortical vein with aneurysmal dilatation. The lesion was successfully resected via a left frontal craniotomy. Although reports of dAVMs in the anterior fossa are rare, a number of new cases have been described recently. The clinical features and angiographic findings in 58 cases are analyzed. The average age at the time the patients presented was 55.8 years, and males predominated (85.0%). Intracranial hemorrhage was the presenting manifestation in most cases (74.1%). Ocular symptoms occurred especially in cases with a posterior venous drainage pattern. Angiographically, the dAVM was most frequently supplied by the anterior ethmoidal artery (94.8%) and drained into a pial vein with vascular sac in almost every case. Rupture of this varicose dilatation often caused intracranial hemorrhage. The main drainage sinus or vein was usually the superior sagittal sinus (86.0%). The nidus was usually in the dura mater, but recently a nidus in the brain parenchyma has also been reported. The pathogenesis of this entity remains unclear, but some impairment of normal embryonic vascular development is the most likely etiology. Surgical resection remains the treatment of choice.

Differentiation between parasystole and extrasystoles. Influence of vagal stimulation on parasystolic impulse formation

Recently, it has been shown that when a sinus impulse falls late in the parasystolic cycle, it usually hastens the next ectopic discharge. Thus, in many cases, the classic criteria for the diagnosis of parasystole (ie, varying coupling intervals and constant shortest interectopic intervals) cannot be used. To differentiate between parasystole and extrasystoles in such cases, the influence of vagal stimulation on parasystolic impulse formation was investigated in seven cases of "true" parasystole in which one or more "pure" ectopic cycles without any intervening nonectopic QRS complexes were found spontaneously. In all cases pure ectopic cycles were found during sinus arrest caused by vagal stimulation; namely, none of the cases showed extreme prolongation of the parasystolic cycle. These results strongly suggest that instead of the classic criteria, vagal stimulation causing temporary sinus arrest is the optimal method for differentiation between parasystole and extrasystoles in cases without spontaneous pure ectopic cycles.

[Effects of sevoflurane on contraction, membrane ionic currents and intracellular cyclic AMP concentration in canine single ventricular cells]

The effects of sevoflurane (SV) on contraction, membrane ionic currents and intracellular cAMP concentration were studied in single canine ventricular cells. The authors demonstrated first that SV depressed contractile response of single ventricular cells in a dose-dependent manner. In electrophysiological studies, SV depressed the plateau height and duration of action potentials. Whole-cell voltage clamp experiments revealed that SV depressed voltage-dependent Ca2+ currents in a dose-dependent manner but SV (1%, 2%) did not change Na+ currents. Further, SV (1%, 2%) did not reduce intracellular cAMP concentrations. We conclude that the decrease of myocardial contractile response in single canine cardiac cells by SV is mainly due to the inhibition of voltage-dependent L-type of Ca2+ channels at the sarcolemma and not through changes in intracellular cAMP levels.

Correlations of C1q- and C3d-bearing circulating immune complexes with immunopathological disease activity in lupus nephritis patients

The serum levels of circulating immune complexes (CIC) measured by three different types of enzyme immunoassay (EIA) using monoclonal anti-C1q and antibodies and C1q as solid phase reagents were compared with clinical disease activity and immunohistological glomerular lesions in 29 SLE patients. Three types of CIC measured by these assays (anti-C1q CIC, anti-C3d CIC and C1q SP CIC) showed significantly higher levels in patients than in controls and were significantly associated with the clinical and serological disease activities. Anti-C1q CIC showed good correlation not only with mesangial IgG depositions (P < 0.01), but also with that of C1q (P < 0.05). C1q SP CIC also showed a weak correlation with mesangial C1q deposition (P < 0.05). Serum levels of anti-C3d CIC increased with the degree of mesangial IgG and complement depositions. Analysis of the clinical course of a patient with active SLE revealed a more rapid decrease of anti-C1q CIC and anti-C3d CIC along with the improvement of disease activity, including the mesangial lesion, than that of C1q SP CIC. According to these results, the CIC detected with assays using monoclonal antibodies against complement fragments, especially the anti-C1q assay, is likely to provide specific information regarding the clinical, serological and immunohistological disease activity in lupus nephritis.

Stimulation of polyomavirus DNA replication by wild-type p53 through the DNA-binding site

The tumor suppressor p53 possesses characteristics of a transcription factor; it binds to specific DNA sequences and activates transcription from various promoters. Here we found that murine wild-type p53 stimulated not only transcription but also polyomavirus (Py) DNA replication in a sequence-dependent manner. Oncogenic mutant p53, lacking the DNA-binding activity, showed no stimulation of Py DNA replication. Deletion of the N-terminal acidic transactivation domain of wild-type p53, which completely eliminated the ability to stimulate transcription, only impaired the function to stimulate Py DNA replication. The replication-stimulating activity of wild-type p53 was impaired by the deletion of the C-terminal oligomerization domain as well, without affecting the ability to stimulate transcription. The region responsible for the sequence-specific DNA-binding activity mapped to the central portion of the p53 molecule has a minimal activity. The results indicate that both the N-terminal and the C-terminal regions significantly contribute to the p53-mediated stimulation of Py DNA replication.

[Autologous vs bovine pericardial valved patch for widening of the right ventricular outflow tract of tetralogy of Fallot]

Autologous or glutaraldehyde treated bovine pericardial valved patch was utilized for widening of the right ventricular outflow tract in 20 patients with tetralogy of Fallot (autologous pericardium group in 10 patients and bovine pericardium group in 10). Pericardial valve function of the both materials was evaluated by postoperative cardiac catheterization performed 1 year after the operation. There were no significant differences in pulmonary arterial and right ventricular pressures, and right ventricular ejection fraction and end-diastolic volume between the 2 groups. Pulmonary angiogram in the autologous pericardium group patients demonstrated the pulmonary regurgitation (PR) of grade 1 in 5 patients, grade 2 in 4 and grade 3 in 1. On the other hand, 1, 3 and 6 patients in the bovine pericardium group demonstrated no-PR, grade 1 PR and grade 2 PR, respectively. It was concluded that there were no significant differences between autologous and glutaraldehyde treated bovine pericardium as a material of valved patch for widening of the right ventricular outflow tract of tetralogy of Fallot.

[Possible roles of airway epithelial cells in the control of airway smooth muscle tone]

While the airway epithelium provides a diffusion barrier to the access of inhaled stimulants, it has recently been considered to have a more active physiological and pharmacological role in the regulation of the airway smooth muscle tone. The initial evidence for this comes from the fact that mechanical removal of the airway epithelium increases the in vitro responsiveness of airway smooth muscle to various spasmogens 3-5 times, although the nature of these regulatory mechanisms on the smooth muscle by the epithelium remains largely unresolved. One of the possible explanations is that the epithelium a generates factor(s) that inhibits the responsiveness of the underlying smooth muscle cells (epithelium-derived inhibitory or relaxing factor EpDIF/EpDRF). Furthermore, recent investigations revealed that airway epithelial cells also release a factor(s) that modulates the vascular smooth muscle tone, excitatory-neuroeffector transmission and resting membrane potential of the airway smooth muscle cells (epithelium-derived hyperpolarizing factor: EpDHF). This review will present and discuss the evidence indicating that the epithelium generates and releases a factor(s) that modulates smooth muscle tone, resting membrane potential of airway smooth muscle cells (EpDHF) and excitatory neuro-effector transmission in the airway.

[The effect of preclotting and collagen coating on endothelializing rate and thrombogenesity of Dacron grafts in the canine thoracic aorta]

Although high porosity knitted Dacron is generally recognized to have superior healing characteristics over woven Dacron, its porosity must be controlled at the clinical operation. This can be achieved with several materials, including geratin, insoluble collagen, albumin, and fibrin. We made atherocollagen coated graft using EX-313 as a new crosslinking agent. The purpose of this study is to compare the endothelializing rate and thrombogenesity of Dacron grafts coated by atherocollagen in the canine thoracic aorta with preclotting grafts with blood or albumin. Five groups were studied: Control group (n = 10), without preclotting; A-P group (n = 8), preclotting with albumin; B-P group (n = 5), preclotting with blood; W-C group (n = 5), atherocollagen coating with low cross-linkage; S-C group (n = 7), atherocollage coating with high cross-linkage. Thoracic aorta was replaced with 8 mm graft in length of 5.0 to 5.5 cm using temporary bypass with anthron tube. Grafts were harvested 3 months following implantation, and the endothelized surface ratio was calculated by microscopic line sampling method. Endothelized surface ratio of Control group, A-P group B-P group, W-C group and S-C group were 85%, 55%, 67%, 93% and 85%, respectively. Endothelized surface ratio of W-C group and S-C group were higher (p < 0.05) than those of A-P group, B-P group. There were thrombus in non-epithelized area. We conclude that atherocollagen coated graft had superior antithrombogenesity compared to albumin or blood preclotting graft.

Significance of hepatocellular proliferation in the development of hepatocellular carcinoma from anti-hepatitis C virus-positive cirrhotic patients

BACKGROUND

There is a hypothesis explaining the pathogenesis of carcinoma that increased proliferation of tissue cells correlates with the development of carcinoma, presumably by increased rate of random mutations and by promotion. In this study, the significance of hepatocellular proliferation in the development of human hepatocellular carcinoma (HCC) from anti-hepatitis C virus (HCV)-positive cirrhotic patients was studied.

METHODS

Twenty-eight Child A cirrhotic patients who were anti-HCV (C-100 antibody) positive were studied. At the beginning of the study, the in vitro uptake of bromodeoxyuridine (BrdU, a thymidine analogue) by hepatocytes in biopsied liver specimens was investigated as labeling indices (LIs), and they were divided into high-DNA synthetic (BrdU LI > or = 1.5%) and low-DNA synthetic (BrdU LI < 1.5%) groups. The patients were then surveyed prospectively with frequent ultrasonography (every 3 months) for the development of HCC for 3 years.

RESULTS

The mean BrdU LI plus or minus standard deviation for 14 cirrhotic patients with high-DNA synthesis activity (BrdU LI > or = 1.5%) was 2.7 +/- 0.8%, and this was significantly (P < 0.001) higher than that for 14 cirrhotic patients with low-DNA synthesis activity (BrdU LI < 1.5%, 0.5 +/- 0.3%). Nine of 14 (64.3%) of the cirrhotic patients with high-DNA synthesis activity developed HCC in the 3-year period, in contrast to only 2 of 14 (14.3%) of the cirrhotic patients with low-DNA synthesis activity P < 0.05).

Structural analysis of the functional gene and pseudogene encoding the murine granulocyte colony-stimulating-factor receptor

Granulocyte colony-stimulating factor is a cytokine which specifically regulates the production of neutrophilic granulocytes. The granulocyte colony-stimulating-factor receptor (GCSFR) is mainly expressed in neutrophils and their precursor cells. In this study, we isolated the chromosomal gene for murine GCSFR and determined its structure. Like the human GCSFR gene homolog, it consists of 17 exons. The exon-intron organization of the murine and human GCSFR-encoding genes are very similar, except that exon 14 and exon 15 in the murine gene are interrupted by a larger intron (greater than 10 kbp) than that found in the human gene (128 bp). This GCSFR-encoding functional gene (Csfgr) was localized to the distal region of murine chromosome 4 by interspecific backcross mapping. A comparison of the 5' flanking sequence of murine and human Csfgr revealed that a sequence of approximately 300 bp upstream from the cap site is highly conserved. Within this region, an 18-nucleotide element conserved in the promoter of the genes for neutrophil-specific enzymes, was found approximately 140 bp upstream from the cap site, suggesting an involvement of this element in the specific expression of GCSFR in neutrophilic granulocytes. In addition to the functional GCSFR-encoding gene, we isolated a pseudogene for GCSFR, which is flanked by a 15-bp direct repeat at the 5' and 3' ends, and lacks all introns, exons 1-3 and exons 7-8 of the functional gene. The processed pseudogene has, in its most 5' region, a sequence of approximately 200 bp that is highly related to the DNA sequence approximately 1.2 kbp upstream of the cap site of the functional gene.

Plasmodium coatneyi-infected rhesus monkeys: a primate model for human cerebral malaria

Although several animal models for human cerebral malaria have been proposed in the past, none have shown pathological findings that are similar to those seen in humans. In order to develop an animal model for human cerebral malaria, we studied the pathology of brains of Plasmodium coatneyi (primate malaria parasite)-infected rhesus monkeys. Our study demonstrated parasitized erythrocyte (PRBC) sequestration and cytoadherence of knobs on PRBC to endothelial cells in cerebral microvessels of these monkeys. This is similar to the findings seen in human cerebral malaria. Cerebral microvessels with sequestered PRBC were shown by immunohistochemistry to possess CD36, TSP and ICAM-1. These proteins were not evident in cerebral microvessels of uninfected control monkeys. Our study indicates, for the first time, that rhesus monkeys infected with P. coatneyi can be used as a primate model to study human cerebral malaria.

Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution

BACKGROUND

In view of the popular acceptance of the adenoma-carcinoma sequence, endoscopic polypectomy is indicated for the removal of colorectal adenomas. Larger or sessile lesions should be removed by an experienced endoscopist, but complications such as hemorrhage and perforation still may occur.

METHODS

To render the removal of sessile lesions feasible by endoscopic polypectomy and to reduce the risk of complications, we attempted local submucosal injection of hypertonic saline-epinephrine solution [(HSE) a mixture of 4.7% sodium chloride and 0.005% epinephrine] before electrosurgical snare excision; 0.5-2 ml HSE were injected into the base and immediate vicinity of polyps to produce mucosal bulging.

RESULTS

Between August 1990 and April 1992, 645 polyps in 403 patients were removed by this method; sessile lesions could be more readily removed. Of these, 17 (2.6%) revealed invasive carcinoma and 19 (3.0%) carcinoma in situ. The largest sessile polyp removed was 40 mm in diameter and 7 mm in height and contained a carcinoma in situ. Even a 6-mm depressed adenoma and two rectal carcinoid tumors could be excised completely. No serious complications were encountered with this method.

CONCLUSION

We conclude that local injection of HSE makes the endoscopic removal of colorectal polyps much easier and safer.

Formulation of inactivated influenza vaccines for providing effective cross-protection by intranasal vaccination in mice

Attempts were made to formulate an inactivated influenza vaccine to provide effective cross-protection by intranasal vaccination in mice. Mice were immunized with a nasal site-restricted volume of various HA vaccines (split-product virus vaccines), prepared from some of the H1N1 subtype viruses which circulated in humans from 1934 to 1986, together with cholera toxin B subunit (CTB) as an adjuvant. Four weeks later, they were challenged intranasally with a lethal dose of the earliest H1N1 virus strain, A/PR/8/34 (PR8) or the latest virus strain, A/Yamagata/120/86 (Yamagata/86). The adjuvant-combined vaccines, prepared from drift H1N1 viruses, A/Kumamoto/37/79 and A/Bangkok/10/83, provided a higher degree of cross-protection against a challenge with Yamagata/86 than with PR8. A booster with another drift virus vaccine given 4 weeks after the primary vaccination increased the protection against Yamagata/86; the effect was higher when mice were vaccinated with a later strain as the second antigen than when boosted with PR8. These results suggest that vaccination with a later virus strain followed by another later strain in a two-dose nasal vaccination regimen gives effective cross-protection against the current epidemic virus strains.

Lipoprotein analysis in transgenic mice expressing human apolipoprotein (apo) A-I and apo C III: use of micromethods in analysis of lipoprotein system in mice

Transgenic animal technology has added a new dimension to the study of lipoprotein physiology. The unique advantage of the technology is that the exact physiological role (s) of a gene and the corresponding protein whose function (s) has been undefined may be revealed in vivo by the expression or inactivation of the expression of the gene. Although mice are most frequently used transgenic animals, the lipoprotein system has not been studies extensively. This report primarily focuses on practical applications of the existing laboratory methods to transgenic mice expressing human apoproteins. Described below is the summary of the results obtained from transgenic mice expressing human apo A-I and apo C III. In one line of transgenic mice expressing human apo A-I, the total plasma apo A-I level (mouse plus human) was higher than that in control (mean +/- SEM, 381 +/- 18 vs. 153 +/- 7 mg/dl, n = 6, respectively, p = 0.0001) with 64% increase in the HDL cholesterol (HDL-C) level (90 +/- 3 vs. 55 +/- 5 mg/dl, p = 0.0001). High fat feeding further increased the apo A-I and HDL-C levels. One line of apo C III transgenic mice with approximately 100 copies of human apo C III gene were severely hypertriglyceridemic compared to negative littermates (mean +/- SEM; 959 +/- 217 vs. 49 +/- 6 mg/dl). In a second line, animals with one to two copies of the human apo C III gene manifested mild hypertriglyceridemia. These experiments revealed for the first time in vivo that overexpression of apo A-I and C III could lead respectively to hyperalphalipoproteinemia and hypertriglyceridemia and may suggest possible etiology for these disorders in human.

Characterization of diazepam-insensitive [3H]Ro 15-4513 binding in rodent brain and cultured cerebellar neuronal cells

Experiments were performed to characterize diazepam-insensitive [3H]Ro 15-4513 binding sites in discrete regions of rodent brain and cultured rat cerebellar granule cells. Scatchard analysis of [3H]Ro 15-4513 binding in the presence of 10 microM diazepam revealed that diazepam-insensitive binding sites in the rat brain were most abundant in the cerebellum, followed by the hippocampus, cerebral cortex and olfactory bulb. Diazepam-insensitive sites represented approximately 80% of the total [3H]Ro 15-4513 binding sites in the membranes of cultured rat cerebellar granule cells. The Bmax values for total [3H]Ro 15-4513 and [35S]TBPS are almost identical, and 5-6 times larger than that for [3H]diazepam in this preparation. Although some annelated [1,5-a]benzodiazepine analogues such as Ro 15-4513, ro 16-6028, flumazenil and Ro 15-3505, and an imidazothieno-diazepine, Ro 19-4603, showed high affinity for cortical and cerebellar diazepam-insensitive sites, all the annelated benzodiazepine compounds tested showed higher affinity for cerebellar diazepam-insensitive sites than cortical ones. In contrast, a pyrazoloquinoline compound, CGS 8216, and beta-carboline analogues such as beta-carboline-3-carboxylate ethyl ester (beta-CCE) and beta-carboline-3-carboxylate methyl ester (beta-CCM) exhibited higher affinity for cortical than cerebellar sites. These results suggest that diazepam-insensitive sites are heterogeneous in brain areas with respect to ligand specificity.

Effects of epithelial cell supernatant on membrane potential and contraction of dog airway smooth muscles

We investigated the effects of cultured epithelial cells and supernatants on resting membrane potential and excitatory neuroeffector transmission in smooth muscle cells of dog trachea and bronchioles. The mean resting membrane potential of the mucosa-free tracheal smooth muscle cells was -59.5 +/- 1.5 mV (+/- SD). Application of cultured epithelial cells (> 2.5 x 10(5) cells/ml) hyperpolarized the membrane, resulting in a potential of -64.5 +/- 1.7 mV. The supernatant of the cultured epithelial cells also increased the resting membrane potential of the mucosa-free tracheal smooth muscle cells by 4 to 9 mV. These hyperpolarizing actions were not modified by indomethacin (10(-5) M), l-NG-nitroarginine (10(-5) M), or oxyhemoglobin (10(-5) M), but were inhibited by glibenclamide (10(-6) M). The supernatants of the cultured epithelial cells completely or partially suppressed the contractile response of epithelium-denuded bronchioles to electrical field stimulations and suppressed the amplitude of excitatory junction potentials of the trachealis evoked by electrical field stimulations. Indomethacin prevented the inhibitory effect of supernatants on the amplitude of twitch contractions and excitatory junction potentials and markedly suppressed supernatant-associated inhibition of the excitatory neuroeffector transmission. Furthermore, indomethacin with AA861, a lipoxygenase inhibitor, completely suppressed this effect. Our findings suggest that cultured airway epithelial cells spontaneously release at least two factors. One factor selectively modulates the resting membrane potential, and the other inhibits the excitatory neuroeffector transmission.

HN proteins of human parainfluenza type 4A virus expressed in cell lines transfected with a cloned cDNA have an ability to induce interferon in mouse spleen cells

Primary monkey kidney cells infected with human parainfluenza type 4A virus (HPIV-4A) were treated with various concentrations of formaldehyde. Formaldehyde (0.275%) treatment completely blocked virus production. However, when mouse spleen cells were cocultured with the fixed virus-infected cells, interferon was produced in the culture fluid. On the other hand, when mouse spleen cells were incubated with the fixed virus-infected cells in the presence of anti-HPIV-4A antiserum or a mixture of anti-HN protein monoclonal antibodies, interferon activity could scarcely be detected in the culture fluid. These findings indicated that the fixed virus-infected cells had an ability to induce interferon in mouse spleen cells and that the HN protein was related to interferon induction. Subsequently, a recombinant plasmid was constructed by inserting the cDNA of the HN gene of HPIV-4A into a pcDL-SR alpha expression vector. Mouse spleen cells produced interferon when cocultured with COS7 cells transfected with the recombinant plasmid, but did not when cocultured with COS7 cells transfected with the vector alone. Furthermore, we established HeLa cells constitutively expressing HPIV-4A HN (HeLa-4aHN cells) or F protein (HeLa-4aF cells). Type I (alpha/beta) interferon was detected in culture fluids of mouse spleen cells with HeLa-4aHN cells, but was not detected in those with HeLa-4aF cells. Therefore, it was concluded that the HN glycoproteins on the cell surface were sufficient for interferon induction to occur.

[Infection in genitourinary cancer patients during cancer chemotherapy]

To examine the frequency and the type of infection during cancer chemotherapy in the urological field, we studied the causes of fever in 67 patients with genitourinary cancer. Twenty-six patients had developed a fever of higher than 38 degrees C. Although fever without proven infection was seen in 11 patients (42.3%), fever caused by pyelonephritis was the most common infection. There was a relationship between fever and the presence of hydronephrosis. Fever was observed more often in patients with a leucocyte count of less than 2,000 white blood cell/mm3. In conclusion, we recommend the interruption of cancer chemotherapy or the use of granulocyte colony-stimulating factor for the prevention of infection, when the leukocyte count is less than 2,000 cell/mm3, especially in patients with hydronephrosis.

Significance of hepatocellular proliferation in the development of hepatocellular carcinoma from anti-hepatitis C virus-positive cirrhotic patients

BACKGROUND

There is a hypothesis explaining the pathogenesis of carcinoma that increased proliferation of tissue cells correlates with the development of carcinoma, presumably by increased rate of random mutations and by promotion. In this study, the significance of hepatocellular proliferation in the development of human hepatocellular carcinoma (HCC) from anti-hepatitis C virus (HCV)-positive cirrhotic patients was studied.

METHODS

Twenty-eight Child A cirrhotic patients who were anti-HCV (C-100 antibody) positive were studied. At the beginning of the study, the in vitro uptake of bromodeoxyuridine (BrdU, a thymidine analogue) by hepatocytes in biopsied liver specimens was investigated as labeling indices (LIs), and they were divided into high-DNA synthetic (BrdU LI > or = 1.5%) and low-DNA synthetic (BrdU LI < 1.5%) groups. The patients were then surveyed prospectively with frequent ultrasonography (every 3 months) for the development of HCC for 3 years.

RESULTS

The mean BrdU LI plus or minus standard deviation for 14 cirrhotic patients with high-DNA synthesis activity (BrdU LI > or = 1.5%) was 2.7 +/- 0.8%, and this was significantly (P < 0.001) higher than that for 14 cirrhotic patients with low-DNA synthesis activity (BrdU LI < 1.5%, 0.5 +/- 0.3%). Nine of 14 (64.3%) of the cirrhotic patients with high-DNA synthesis activity developed HCC in the 3-year period, in contrast to only 2 of 14 (14.3%) of the cirrhotic patients with low-DNA synthesis activity P < 0.05).

Functional innervation of bovine ophthalmic artery

To investigate the functional innervation pattern in smooth muscle of bovine ophthalmic artery, we studied the effect of electrical stimulation and various drugs on the mechanical responses of this muscle using isometric tension recording methods. Electrical stimulation evoked phasic contractions which were abolished by guanethidine and tetrodotoxin (TTX), suggesting that the responses were neurogenic in origin. Phentolamine (10(-5) M) and 10(-5) M timolol did not affect this contractions, but 10(-5) M phentolamine and 10(-6) M prazosin markedly reduced the amplitude of contraction evoked by exogenously applied phenylephrine (10(-5) M). Electrical stimulation applied during sustained contraction evoked by 5-hydroxytryptamine in the presence of guanethidine and atropine evoked relaxation which was markedly suppressed by TTX. These results indicate that bovine ophthalmic artery is innervated by adrenergic nerve fibers, and an unidentified neurotransmitter, other than noradrenaline, may play an important role in the excitatory neuroeffector transmission, and that the tissue is also innervated by non-adrenergic non-cholinergic inhibitory nerve fibers.

Fetal heart rate recorder for long-duration use in active full-term pregnant women

We sought to assess the signal consistency and accuracy of a long-duration fetal heart rate (FHR) recorder (a 1-MHz ultrasonic Doppler transducer composed of six miniprobes and an autocorrelation technique) in active, full-term pregnant women. The FHR data of 15 normal full-term fetuses were obtained every 250 milliseconds in various maternal positions using the new Doppler system or a direct scalp electrocardiographic (ECG) transducer. Differences between simultaneous Doppler and ECG measures were small and within acceptable limits except for short-term variability. Signal loss, assessed in 15 subjects in various positions, was less than 10% except during sitting or walking. The mean (+/- standard deviation) percentages of FHR signals lost over 2 hours in bed, 1 hour out of bed, and 24 hours in and out of bed were 1.2 +/- 2.1, 12.9 +/- 16.2, and 3.8 +/- 4.4, respectively. This system for recording FHR is suitable for clinical research and routine FHR monitoring, and provides data comparable to Holter ECG monitoring in patients with heart disease.

[Common carotid artery thrombosis--clinical and radiological evaluation]

Common carotid artery thrombosis (CCAT) is not common. We studied 4 patients with CCAT to clarify the clinical and radiological features of this disorder. Case 1 had only episodes of TIA. Case 2 was diagnosed by chance as having CCAT at the time of admission due to cerebellar infarction. On the contrary, Cases 3 and 4 were admitted because of disturbance of consciousness and hemiparesis. Case 4 died soon after his stroke because of complications. We evaluated cases 1, 2 and 3 using head CT, head MRI, neck MRI, MR angiography, SPECT and cerebral angiography. Case 4, who was evaluated with head CT and cerebral angiography, was autopsied to confirm the occlusion of the common carotid artery. The clinical severity of CCAT varies from asymptomatic to severe, because each differs in the time taken for complete occlusion of the common carotid artery; the development of collateral circulation; and hemodynamics of the brain. As for the collaterals their contribution is variable; for example, the thyrocervical and other arteries function as the bypass. We can diagnose CCAT easily and noninvasively using MR angiography and neck MRI based on disappearance of the flow void in the common carotid artery or internal carotid artery. On physical examination, it is important to detect faded pulsation of the superficial temporal artery that is ipsilateral to the occluded common carotid artery.

The character of endogenous retrovirus in pancreatic beta-cells of NOD mice

The character of retrovirus type C in NOD mouse pancreatic-beta-cells was investigated. First, the in vitro response of retrovirus type C to glucose stimulation was examined. When the pancreatic islets of control NON mice were observed with an electron microscopy retrovirus types C could not be detected in the beta-cells with or without glucose stimulation. Retrovirus type C particles and intracisternal type A particles (IAPs) in NOD mouse pancreatic beta-cells increased by glucose stimulation, but the increase in retrovirus type C differed from that of IAPs. The clusters of retrovirus type C were found in some beta-cells, whereas IAPs were scattered in beta-cells. Next, we investigated the expression of retrovirus type C transcript in NOD mouse pancreatic islets. From polymerase chain reaction analysis using two primers of retrovirus type C designed from a conserved U3 region, a major product was found to be endogenous polytropic retrovirus (Pmv). The subcloned PCR probe and oligonucleotide probes specific for Pmv and modified polytropic retrovirus were used for Northern blot analysis. Pancreatic islets from NOD and NON mice (control mice) contained 8.4-kb and 3.0-kb Pmv transcripts. The quantity of transcripts of Pmv in NOD mouse pancreatic beta-cells were the same as that in NON mice. The transcript level of islets was much higher than those of thymus and liver. The appearance of retrovirus type C particles in beta-cells of NOD mice may involve the mechanisms by which diabetes is generated in NOD mice.