The enhancing mechanism of capric acid (C10) from a suppository on rectal drug absorption through a paracellular pathway

Capric acid (C10) enhanced the absorption of cefoxitin sodium in a concentration-dependent manner following the rectal administration as a suppository in rats. The optimal concentration of C10 was 13%. C10 administered as a suppository also reduced rectal membrane resistance (Rm), showing that the above enhancing effect was induced by widening the paracellular pathway. Both the enhancing effect on the absorption and the reducing effect on Rm were inhibited by W7, an inhibitor of myosin light chain kinase. These results supported that, as shown in the in vitro Caco-2 cell system, the C10 effect on the paracellular pathway is due to activating the contraction of Ca(2+)-calmodulin-dependent actin filament.

Magnetic stimulation of the lumbosacral vertebral column in children: normal values and possible sites of stimulation

We describe a technique of lumbosacral magnetic stimulation (MS) using an 8-shaped coil in 44 normal children and 7 normal adults on the lower limb muscles. In most child subjects and some adult subjects, we observed two peaks in amplitude of the motor evoked potential (MEP) following MS when the coil was moved caudally from Th8 to S2. The rostral peaks of MEP were elicited at L1/2, and the caudal peaks were elicited below L3. Rostral peak amplitudes were considerably higher in younger children than in adolescents and adults. MEP latencies tended to decrease as the coil was moved from Th11 to L4/5, and were almost constant at caudal to L4/5 in most child subjects, especially in younger children. Comparison of MEP latencies with the peripheral motor conduction times by the F technique suggests that the proximal sites of excitation of the nerve root are 0.0-0.6 ms conduction times distal to the motoneuron, while the distal sites of excitation are 2.1-2.9 ms conduction times distal to the motoneuron. We conclude that performing MS using the 8-shaped coil enables us to excite the nerve roots near the motoneuron as well as those near the intervertebral foramen, and that MEPs are elicited more easily in younger children than in adolescents and adults.

A novel neurological disorder with progressive CNS calcification, deafness, renal tubular acidosis, and microcytic anemia

Progressive calcification of the brain and the spinal cord at early infantile onset was observed in two siblings. They showed growth failure, psychomotor deterioration, deafness, vestibular dysfunction, microcytic hypochromic anemia, abnormal ratios of lymphocyte subpopulations, and slightly decreased bicarbonate on blood gas analysis. Distal renal tubular acidosis was demonstrated in one of them. Carbonic anhydrase II activity was normal. This new hereditary disease might have a defect in a molecule that is present in brain, spinal cord, kidney and hematocytes and is involved in H+/HCO3- production or transport.

[Clinical studies of learning disability. Part III: Prevalence of children with suspected learning disabilities]

The prevalence of children with suspected learning disabilities (LD) was investigated. One thousand and eight-hundred-eighty-nine pupils at ordinary elementary classes were evaluated by class teachers. We defined suspected LD as a condition with normal IQ (not less than 70) and low PRS score (not more than 65). Eighteen children (12 boys, 5 girls, and 1 with sex unknown) were considered as suspected LD with this criterion. The prevalence of suspected LD at elementary schools was 0.95%, the lowest figure as compared to those in previous reports. The suspected LD children were studied for the LD type and school grade. Verbal LD was not found, non-verbal LD was found in 6 children, and mixed type in 11. In the study of their school grades, the third grade suspected LD children were the largest. There was a significant decrease in number at higher school grades.

Proximal gastrectomy and jejunal pouch interposition for the treatment of early cancer in the upper third of the stomach: surgical techniques and evaluation of postoperative function

BACKGROUND

Limited surgery for the treatment of early gastric cancer located in the upper third of the stomach should be based on a well-balanced reduction in the extent of lymph node dissection and gastric resection while assuring a favorable quality of life and prognosis after operation.

METHODS

We have used interposition of a double jejunal pouch between the esophagus and the remnant stomach after performing proximal gastrectomy. To assure anastomosis and hemostasis during this operation, we currently use a surgical stapler with a vaginoscope and our new edge clamps. This method has been used in 12 patients to date.

RESULTS

On histopathologic examination the 12 cases comprised 11 early cancers (seven mucosal and four submucosal cancers) and one subserosal cancer. There was no evidence of lymph node metastasis of postoperative complications such as anastomotic leakages or hemorrhage, demonstrating the low-risk nature of this procedure.

CONCLUSIONS

The evaluation of postoperative quality of life, in terms of clinical signs and symptoms and dietary status, yielded favorable results. Thus our method has the important advantage of allowing good organ preservation.

Technical devices in jejunal pouch reconstruction following total gastrectomy, including postoperative results

BACKGROUND/AIMS

Either straight Roux-en-Y anastomosis or jejunal interposition used to be adopted following total gastrectomy. However, dissatisfaction with regard to postoperative quality of life has prompted the development of new techniques. The purpose of this study is to describe and assess the authors' technical devices in jejunal pouch (J-pouch) reconstruction following total gastrectomy and the results of these operations.

PATIENTS AND METHODS

A prospective study of 17 patients with malignant gastric disease (nine with J-pouch interposition, eight with J-pouch Roux-en-Y reconstruction) was performed. To facilitate the side-to-side anastomosis of the jejunal loop, the authors used an autosuture instrument. The anastomosis was then checked for hemostasis using a vaginoscope.

RESULTS

An Endo GIA with a 60-mm long white cartridge (closed height of staples, 1.0 mm) is the instrument of choice to create the J-pouch. This autosuture instrument fires triple staggered staple lines, which minimizes bleeding from the anastomosed site and reduces operative time. No anastomotic leaks were associated with the autosuture instrument. The vaginoscope facilitates a direct observation of the staple lines internally and if necessary, enables secure hemostasis with sutures. Bowel motility was satisfactory for both surgical procedures, as measured by the percentage of radiopaque markers which were expelled from the pouch. There were no serious complications, and all patients have currently survived, a maximum of 5 years and 6 months after surgery, except for one patient who died from recurrent disease.

CONCLUSION

The authors' procedures for J-pouch reconstruction are advantageous due to a favorable postoperative quality of life, with low complication rates.

[Clinical studies of learning disability. Part IV : A prospective study of children with risk factors for learning disability at three year-old screening--clinical examinations in 1995]

We are following children with risk factors for learning disability (LD) at three year-old screening prospectively. In 1995, one child reportedly as normal in 1994 was considered to have a possibility of LD. The complaints of their parents had shifted to underachievement. In several children, their poor social skill in school and family was considered to be more serious in 1995 than in 1994. All children who were clumsy in early childhood showed non-optimal motor co-ordination on minor neurological examinations by Touwen. This suggested that non-temporary neurological impairments led them to LD.

A C57BL/KsJ mouse model of Niemann-Pick disease (spm) belongs to the same complementation group as the major childhood type of Niemann-Pick disease type C

A cell line (SPM-3T3) derived from a C57BL/KsJ mouse model of Niemann-Pick disease type C (NP-C) shows biochemical abnormalities similar to those in fibroblasts derived from NP-C. Somatic cell hybridization analysis of the SPM-3T3 cells and five fibroblast strains derived from NP-C patients (four childhood cases and one adult case) was carried out. The criterion for complementation was the restoration of a normal intracellular fluorescent pattern in multinucleated cells stained with filipin to demonstrate cholesterol accumulation. These cells can be assigned to two complementation groups. The SPM-3T3 cells did not complement cell strains derived from childhood-type NP-C, while they complemented a cell strain derived from an adult patient. Our results suggest that SPM-3T3 represents a genetically authentic model of a major complementation group of NP-C, and that NP-C consists of genetically heterogeneous groups.

Hepatocytes entrapped in collagen gel following 14 days of storage at 4 degrees C: preservation of hybrid artificial liver

Preservation of hepatocytes is a key technical factor toward the successful clinical application of hybrid artificial livers. It was possible to culture hepatocytes that had been preserved with collagen gel for 8 and 14 days in 4 degrees C University of Wisconsin solution. Phase-difference and scanning electron microscopy showed that most of the stored hepatocytes maintained a round-shaped morphology. In the 14 day preservation group, on Days 2 and 8, respectively, ureogenesis was 98.3% and 69.6%, gluconeogenesis was 65.2% and 80.7%, lidocaine clearance was 81.7% and 72.5%, urea synthesis after ammonia load was 47.6% and 57.5% of those in the comparable control group. This implies that preserved hepatocytes maintained adequate functional capability even after 14 days of preservation. We suggest that our preservation method will be valuable for the future application and development of a practical hybrid artificial liver.

Bilateral opercular syndrome caused by perinatal difficulties

Four patients with pseudobulbar palsy, mental retardation and various degrees of speech disturbance associated with perinatal difficulties are described as having an acquired type of opercular syndrome. There were two patients with fetal bradycardia and three with subarachnoid haemorrhage and neonatal convulsion. Magnetic resonance imaging revealed cortical atrophy in the bilateral opercula with some signal abnormalities in the underlying white matter in common. Single photon emission computed tomography (SPECT) also confirmed the presence of hypoperfusion in the regions. Although the opercular syndrome is a clinical entity with a multitude of underlying pathologies, perinatal difficulties could be an important cause of the acquired type.

Endoscopic treatment of early oesophageal or gastric cancer

BACKGROUND AND AIMS

Endoscopic treatment has become increasingly popular in recent years as an alternative to surgical treatment with the hope of offering superior quality of life (QOL) for the patient. The results of endoscopic treatment of mucosal lesions of mostly early oesophageal or gastric cancer performed in 145 patients (155 lesions) over the past eight years were reviewed from the standpoint of QOL.

RESULTS

In 56 patients who underwent radical resection of the oesophageal mucosa, no serious complications and symptoms occurred, with epithelialisation completed within about a month. Patients also showed good results regarding dietary intake and performance status (PS), and all are currently alive without any sign of recurrence. One time fractionated endoscopic resection was carried out in about 40% of the 57 patients who underwent gastric mucosal resection. In these 57 patients, an artificial ulcer measuring 3 cm or more was formed, resulting in a favourable outcome after healing. An overwhelming proportion of these subjects had no symptoms and good PS after the treatment.

CONCLUSIONS

The introduction of this method, endoscopic mucosal resection using a cap fitted panendoscope, is expected to permit additional indications for endoscopic treatment. Endoscopic Nd-YAG laser irradiation was applied mainly to early gastric cancer lesions (32 patients), usually for relative indications for endoscopic treatment. This procedure is safe and advantageous in that it requires no hospitalisation, permits fractionated irradiation, and secures good QOL.

Facilitation of ipsilateral motor pathways during recovery from hemiplegia in two adolescent patients

In two hemiplegic patients with acquired cerebral lesions, transcranial magnetic stimulation (TMS) was carried out to examine the contribution of the ipsilateral motor pathways to recovery from hemiplegia. A 13-year-old girl (patient 1) had acute hemiplegia due to a rupture of an arteriovenous malformation, and a 13-year-old boy (patient 2) had subacute hemiplegia due to a brain tumour. They showed complete upper limb palsy but recovered after therapy; patient 1 had slightly disabled motor function of the arm, and patient 2 recovered completely. Motor evoked potentials (MEPs) were recorded from the biceps brachii muscles on both sides. The MEPs of the paretic biceps were only elicited by TMS of the intact hemisphere at the beginning of recovery from hemiplegia, but not by TMS of the affected hemisphere. The MEP amplitudes increased and cortical representation areas for the paretic biceps by TMS were enlarged temporarily during recovery. They regressed in patient 1 and MEPs were not evoked at all in patient 2 after recovery. Conversely, MEPs were obtained by TMS of the affected hemisphere after recovery in both patients. These data indicate that ipsilateral motor pathways play a role in recovery from hemiplegia, especially at the beginning, and become inactivated when the contralateral motor pathways recover.

Genomic analysis of a new mammalian distal-less gene: Dlx7

We have cloned a new Dlx gene (Dlx7) from human and mouse that may represent the mammalian orthologue of the newt gene NvHBox-5. The homeodomains of these genes are highly similar to all other vertebrate Dlx genes, and regions of similarity also exist between mammalian Dlx7 and a subset of vertebrate Dlx genes downstream of the homeodomain. The sequence divergence between human and mouse Dlx7 in these regions is greater than that predicted from comparisons of other vertebrate Dlx genes, however, and there is little sequence similarity upstream of the homeodomain both between these two genes and with other Dlx genes. We present evidence for alternative splicing of mouse Dlx7 upstream of the homeodomain that may account for some of this divergence. We have mapped human DLX7 distal to the 5' end of the HOXB cluster at an estimated distance of between 1 and 2 Mb by FISH. Both the human and the mouse Dlx7 are shown to be closely linked to Dlx3 in a convergently transcribed orientation. These mapping results support the possibility that vertebrate distal-less genes have been duplicated in concert with the Hox clusters.

Multiple-level compression myelopathy: concomitant asymptomatic cervical compression adversely affects surgical outcome for thoracic compression myelopathy

To determine whether asymptomatic spinal cord compression affects surgical outcome for another compression, we retrospectively reviewed the outcome for thoracic myelopathy due to spinal ligament ossification. Improvement assessed by changes in motor function of the lower extremity using the Japanese Orthopedic Association Classification was significantly less in cases associated with asymptomatic cervical ligament ossification (C+T group, N = 5) than in cases without cervical ligament ossification (T group, N = 13) (p < 0.05, Mann- Whitney U test). The "no disability" recovery rate was 61.5% in the T group and none in the C+T group (p < 0.05, Fisher's exact probability test). There was no significant difference in background parameters between the two groups. This study showed that concomitant spinal cord compression, even if asymptomatic itself, can adversely affect surgical outcome at a separate segment.

[Three-dimensional images of hepatic tumors and hepatic vessels obtained by helical computed tomography]

Helical computed tomography was performed with intravenous contrast material administration in ten patients with hepatic tumors (metastatic tumor, n = 6; hepatocellular carcinoma, n = 4). Maximum intensity projection (MIP) images of intrahepatic portal venous branches and hepatic veins, and shaded surface display (SSD) images of the hepatic tumors were reconstructed for each patient. The MIP image and SSD image were fitted to overlap on a single display to obtain three-dimensional (3-D) images showing both the hepatic vessels and hepatic tumors. Subsegmental localization of the tumors determined from the 3-D images proved to be correct in all of the six patients who received hepatic resection after examination. 3-D images seem to be useful for preoperative assessment of hepatic tumors.

Fishing-rod-type abdominal wall lifter for gasless laparoscopic surgery

We have designed a new abdominal wall lifter for gasless laparoscopic surgery which consists of stainless steel rods and iron lifters. They elevate the abdominal wall up like a dome-type camping tent, which does not disturb any manipulation of scope or X-ray camera. We received a good view of the peritoneal cavity without CO2 gas insufflation in ten patients with cholecystitis. This will be helpful for general laparoscopic surgery or laparoscopic assisted surgery with the use of conventional forceps or extracorporeal suturing through a valveless trocar.

A novel mutation in the mitochondrial tRNA(Thr) gene associated with a mitochondrial encephalomyopathy

A novel G-to-A transition at nucleotide 15915 in mtDNA is described. The patient showed a combination of muscle weakness, hearing loss, mental retardation, and seizures. Muscle biopsy showed RRFs and focal COX deficiency. We sequenced all mtDNA, and found 5 novel nucleotide substitutions. Three of them were synonymous mutations, one was a missense mutation in cytochrome b gene (A-->G at nt 15422), and the last one was the 15915 mutation in tRNA(Thr) gene. We screened for the 15422 and the 15915 mutations with mismatch primers and found that one of 104 normal individuals carried the former one and none of 175 had the latter one. The 15422 mutation existed in homoplasmic states both in the patient and the normal individual, suggesting that this is a polymorphism. In contrast the 15915 mutation resided in heteroplasmic states in muscle, skin fibroblast and blood. The nucleotide substitution at nt 15915 disrupts a highly conserved base pair in anticodon stem of the tRNA(Thr). Our data suggest that the 15915 mutation is an additional mtDNA mutation responsible for mitochondrial encephalomyopathies.

Sensorineural deafness in siblings with adenosine deaminase deficiency

Two siblings with adenosine deaminase deficiency were successfully treated with allogeneic bone marrow transplantation without conditioning. Although the patients were free from infections after immunologic reconstitution, both showed sensorineural deafness at 1 year of age. Because there were no structural abnormalities in the inner and middle ears, no evidence of prenatal infections of rubella, cytomegalovirus or toxoplasma, and no postnatal infection of mumps in the siblings, sensorineural deafness might be one of the neurologic problems associated with adenosine deaminase deficiency.

Human V delta 2+ gamma delta T-cell tolerance to foreign antigens of Toxoplasma gondii

Little is known about the mechanisms involved in human gammadelta T-cell tolerance to self or to foreign antigens. Patients with congenital toxoplasmosis offer a unique opportunity to examine Vdelta2+ gammadelta T-cell tolerance. Analysis of gammadelta T cells in patients with congenital toxoplasmosis revealed evidence for anergy of these cells with or without clonal Vdelta2+ gammadelta T-cell expansion in the acute phase of the Toxoplasma infection. T cells in general were unresponsive and did not proliferate upon exposure to mitogens or to Toxoplasma lysate antigens or in response to live Toxoplasma-infected cells when the congenitally infected infants were 1 month of age, and they exhibited selective anergy to Toxoplasma lysate antigens and live Toxoplasma-infected cells when the infants were aged 5 months. During the chronic phase of congenital toxoplasmosis in the patients who were more than I year of age, the repertoires of the gammadelta T-cell receptors were found to be within normal ranges. In addition, in the chronic phase, the gammadelta T cells proliferated and secreted gamma-interferon in response to exposure to live Toxoplasmia-infected cells. By contrast, alphabeta T cells remained anergic. Vdelta2+ gammadelta T cells have been considered to undergo extrathymic maturation and thus to be subject to development of peripheral tolerance. Our findings indicate that Vdelta2+ gammadelta T-cell tolerance was lost in these infected infants earlier than alphabeta T-cell tolerance. These findings suggest that gammadelta T cells play a role in protection against Toxoplasma gondii in the chronic phase when congenitally infected children are more than 1 year of age, especially in those in whom alphabeta T cells continue to exhibit deficits in specific immune responses to Toxoplasma antigens.

Prenatal diagnosis of congenital myotonic dystrophy in two Japanese families: direct mutation analysis by a non-radioisotope PCR method and haplotype analysis with flanking DNA markers

The prenatal diagnosis of congenital myotonic dystrophy in two Japanese families was reported. The CTG repeat size in the myotonin/protein kinase gene was determined by a nonradioisotope PCR method. Polymorphisms of the DNA markers (ApoCII, X75b-VSSM and KLK-1) flanking the CTG repeat were analyzed from normal Japanese and were used to determine the risk haplotype. Two pregnant women with myotonic dystrophy requested prenatal diagnosis. The first case was diagnosed as having myotonic dystrophy at 36 weeks of pregnancy. The CTG repeat size in the cord blood from the fetus was not expanded and the risk for the disease was judged to be low by haplotype analysis with the X75b-VSSM marker. In the second case, the chorionic villus was sampled in the pregnant mother who had already had two children with congenital myotonic dystrophy. The small expanded allele (36 repeats) from the mother and a normal allele from the father were detected in the chorionic villus. The risk for the disease was not determined by haplotype analysis with ApoCII and X75b-VSSM, only being judged as low by haplotype analysis with KLK-1 in the second case. These babies from two families were born and developed normally. DNA diagnosis for direct CTG repeat expansion combined with haplotype analysis has been useful for pregnant women with myotonic dystrophy who are at high risk of having severely affected babies.