Self-expanding metal stents for palliative treatment of malignant biliary and duodenal stenoses

Patients with malignant biliary stenosis due to pancreatic head cancer often have the associated problem of duodenal obstruction. We report here the case of a 78-year-old woman with this clinical situation, who was treated with self-expanding Gianturco metal stents placed in the distal common bile duct and, nine months later, placed in the descending duodenum. The patient's frequent vomiting resolved, and she was able to tolerate peroral solid food; jaundice also decreased (bilirubin pre-stenting: 7.8; post-stenting: 1.2). Self-expanding metal stents therefore appear to be effective for the palliative treatment of malignant duodenal stenosis as well as biliary stenosis.

A highly enhanced thrombopoietic activity by monomethoxy polyethylene glycol-modified recombinant human interleukin-6

Interleukin-6 (IL-6) is a novel cytokine with activities that can affect hematopoietic cells including those of the megakaryocytic lineage. We have examined the effects of monomethoxy polyethylene glycol-modified recombinant human interleukin-6 (Peg-IL-6) on thrombopoiesis in vivo. To compare the thrombopoietic activity between Peg-IL-6 and unmodified IL-6, each was administered subcutaneously to mice every 24 hours at various doses. A dose-response experiment showed that Peg-IL-6 and IL-6 increased platelet counts in a dose-dependent fashion at a plateau stimulation level of 0.5 micrograms/day and 10 micrograms/day, respectively. This dose of Peg-IL-6 and IL-6 induced the elevated platelet counts by approximately 140% to 160% and 50% to 60%, respectively. Peg-IL-6 treatment (0.5 micrograms/day) for x-ray (6.0 Gy) irradiated mice induced an increase in the rate of platelet recovery, and a higher dosage (5 micrograms/day) completely blocked the induction of thrombocytopenia in this model. In contrast, IL-6 (10 micrograms/day) could not protect the animals from platelet nadir but reduced the period of thrombocytopenia after x-ray irradiation. Furthermore, when administered to 5-fluorouracil-treated mice, 5 micrograms/day of Peg-IL-6 diminished the platelet nadir and increased platelet counts on individual days during the recovery phase. The potent thrombopoietic activity of Peg-IL-6 were due to prolongation of circulating IL-6 levels that were reverted from Peg-IL-6 in vivo. These findings indicate that reduction of total body clearance of IL-6 induces potent thrombopoiesis and that Peg-IL-6 may be a useful thrombopoietic agent.

[Effect of mesalazine microgranules on experimental colitis]

Mesalazine microgranules are an ethylcellulose-coated formulation from which mesalazine is released throughout the intestinal tract and are expected to be effective for idiopathic inflammatory bowel disease, ulcerative colitis and Crohn's disease. Mesalazine microgranules were administered orally to investigate the distribution of mesalazine throughout the intestinal tract in rats. Mesalazine microgranules distributed sufficient amounts of mesalazine and its metabolite, N-acetyl-mesalazine, to the intestinal tissues, while pure mesalazine delivered lower amounts of both. In acetic acid-induced colitis in rats, mesalazine microgranules administered orally reduced the damage score significantly (P < 0.05) at a dose of 50 mg/kg as assessed by macroscopic observation and at 100 mg/kg as assessed by histological evaluation. The number of ulcers in carrageenan-induced colitis in guinea pigs was inhibited at doses of 50, 100, 200 mg/kg, p.o. The colonic wet weight of rats in 2,4,6-trinitrobenzenesulfonic acid (TNB)-induced colitis was reduced significantly (P < 0.05) at a dose of 50 mg/kg, p.o. Mesalazine microgranules showed the ability to distribute mesalazine efficiently throughout the intestinal tract and showed effectiveness against acetic acid-, carrageenan- and TNB-induced colitis. These studies strongly suggest that mesalazine microgranules are effective for idiopathic inflammatory bowel disease.

[A case of surgical treatment of sever constrictive pericarditis with biventricular failure]

A 68-year-old woman had been pointed out a calcification of pericardium on chest X-ray ten years ago. She admitted to our hospital associated with generalized edema. RA pressure.pulmonary capillary wedge pressure.RVEDP.LVEDP increased markedly and low cardiac output coexisted (C.I. = 1.77 l/min/m2). On September 9, 1992, she underwent a total pericardiectomy through mediansternotomy without cardiopulmonary bypass. She complicated a prolonged biventricular heart failure despite total pericardiectomy postoperatively. It was considered that delayed clinical improvement had based on myocardial degeneration or atrophy in long-term morbidity. We recommend a early operative intervention at the clinical hemodynamic deterioration.

Action of a diffusible target-derived chemoattractant on cortical axon branch induction and directed growth

Cortical axons innervate their brainstem target, the basilar pons, by the initiation and extension of collateral branches interstitially along their length. To address whether a diffusible pons-derived chemoattractant controls these events, we used cocultures in collagen matrices and time-lapse microscopy. Pontine explants enhanced by 5-fold the de novo initiation of transient branches along cortical axons; most branches were directed toward pons. Of the branches extended toward pons, 2%-3% were stabilized; those extended away were not. Pontine explants also enhanced the stable bifurcation of growth cones and prompted directional changes by growth cone turning and collateral extension. These effects were distance dependent and mimicked by pons-conditioned medium. This evidence indicates that the pons activity promotes branch initiation interstitially along cortical axons, a novel property for a chemoattractant, and provides a directional cue for their growth. These findings suggest that the pons chemoattractant serves as a diffusible target-recognition molecule.

Inhibition of the growth of cariogenic bacteria in vitro by plant flavanones

Phytoalexins, defensive compounds produced by plants against microbial infections, were purified from Sophora exigua (Leguminosae) and their growth inhibitory effects on oral cariogenic bacteria were determined in vitro. Among three isolated compounds, 5,7,2',4'-tetrahydroxy-8-lavandulylflavanone completely inhibited the growth of oral bacteria including primary cariogenic mutans streptococci, other oral streptococci, actinomycetes, and lactobacilli, at concentrations of 1.56 to 6.25 micrograms/ml.

Identification of a cis-acting element that is responsible for cadmium-mediated induction of the human heme oxygenase gene

Heme oxygenase is an essential enzyme in heme catabolism and is inducible by various environmental derangements such as cadmium. The activity and mRNA levels of heme oxygenase were remarkably increased in HeLa cells by the treatment with cadmium. As a first step in studying the molecular mechanisms of this induction, we performed transient expression assays in four human cell lines including HeLa to analyze the cadmium-mediated inducibility of the fusion genes, containing the firefly luciferase gene as a reporter under the human heme oxygenase gene promoter. By determining the luciferase activity expressed in the transfected cells, we found the region between about 4.5 and 4 kilobase pairs upstream from the transcriptional initiation site of the heme oxygenase gene which confers cadmium-mediated inducibility on the fusion gene. The region was then subjected to further functional analysis in HeLa cells, which allowed us to localize the cadmium-responsive element to 20 base pairs. Gel mobility shift assays demonstrated that this 20-base pair element is specifically bound by nuclear protein(s) of HeLa cells, the binding activities of which were however unchanged by the treatment with cadmium. Using the synthetic cadmium-responsive elements containing various base changes, we have identified a 10-base pair sequence, TGCTAGATTT, required for the cadmium-mediated inducibility and in vitro protein binding. We thus suggest that this binding protein(s) is involved in the cadmium-mediated activation of the heme oxygenase gene. Incidentally, the consensus sequence of AP-1 binding site, TGAGTCA, is present downstream of this cadmium-responsive element. However, we provide evidence that AP-1 is not directly involved in the cadmium-mediated induction of the human heme oxygenase gene.

Inhibition of DNA topoisomerase II by ICRF-193 induces polyploidization by uncoupling chromosome dynamics from other cell cycle events

ICRF-193, a novel noncleavable, complex-stabilizing type topoisomerase (topo) II inhibitor, has been shown to target topo II in mammalian cells (Ishida, R., T. Miki, T. Narita, R. Yui, S. Sato, K. R. Utsumi, K. Tanabe, and T. Andoh. 1991. Cancer Res. 51:4909-4916). With the aim of elucidating the roles of topo II in mammalian cells, we examined the effects of ICRF-193 on the transition through the S phase, when the genome is replicated, and through the M phase, when the replicated genome is condensed and segregated. Replication of the genome did not appear to be affected by the drug because the scheduled synthesis of DNA and activation of cdc2 kinase followed by increase in mitotic index occurred normally, while VP-16, a cleavable, complex-stabilizing type topo II inhibitor, inhibited all these processes. In the M phase, however, late stages of chromosome condensation and segregation were clearly blocked by ICRF-193. Inhibition at the stage of compaction of 300-nm diameter chromatin fibers to 600-nm diameter chromatids was demonstrated using the drug during premature chromosome condensation (PCC) induced in tsBN2 baby hamster kidney cells in early S and G2 phases. In spite of interference with M phase chromosome dynamics, other mitotic events such as activation of cdc2 kinase, spindle apparatus reorganization and disassembly and reassembly of nuclear envelopes occurred, and the cells traversed an unusual M phase termed "absence of chromosome segregation" (ACS)-M phase. Cells then continued through further cell cycle rounds, becoming polyploid and losing viability. This effect of ICRF-193 on the cell cycle was shown to parallel that of inactivation of topo II on the cell cycle of the ts top2 mutant yeast. The results strongly suggest that the essential roles of topo II are confined to the M phase, when the enzyme decatenates intertwined replicated chromosomes. In other phases of the cycle, including the S phase, topo II may thus play a complementary role with topo I in controlling the torsional strain accumulated in various genetic processes.

Pulmonary hypertension in systemic lupus erythematosus: a report of an autopsied case

An autopsied case of systemic lupus erythematosus with pulmonary hypertension is reported. A 29-year-old woman with a seven-year history of polyarthralgia, butterfly rash, nephrotic syndrome and Raynaud's phenomenon was admitted because of progressive dyspnea on exertion. Tests for antinuclear antibody, anti-cardiolipin antibody and lupus anticoagulant were positive. Echocardiographic examination revealed right ventricular hypertrophy and a moderate pericardial effusion. Estimated systolic pulmonary arterial pressure was 53 mmHg. Despite treatment with corticosteroids including pulse methylprednisolone therapy, lipo-PGE1 and warfarin, she died of progressive congestive heart failure. Postmortem examination of the pulmonary vasculature revealed findings consistent with plexogenic pulmonary arteriopathy, without evidence of vasculitis, fibrinoid necrosis, or thromboemboli.

Structure-activity studies of the s-echistatin inhibition of bone resorption

Synthetic Arg-Gly-Asp (RGD)-containing peptides were examined in bone resorption or attachment and detachment assays with isolated mammalian osteoclasts in an effort to elucidate the mechanistic and structural basis for the inhibition of bone resorption by s-echistatin. Bone resorption was the process most sensitive to inhibition by s-echistatin, with IC50 = 0.3 nM; inhibition of attachment to bone or detachment (lamellipodial retraction) was 30- to 70-fold less sensitive, with IC50 = 10 or 20 nM, respectively. Single amino acid substitutions within the 49-residue sequence of s-echistatin showed that although the efficacy of s-echistatin is dependent on the Arg24-Gly25-Asp26 sequence, additional residues, including Asp27, Met28, and Cys39, are also critical for potent inhibition of the resorbing activity of isolated rat osteoclasts. Because of the identification of the av beta 3 as the primary integrin on rat osteoclasts interacting the RGD peptides (Helfrich et al.), we examined the possibility of modeling bone resorption with other beta 3-mediated processes. Specifically, av beta 3 endothelial cell (human or rat) attachment to vitronectin and aIIb beta 3 platelet aggregation were compared with bone resorption for sensitivity to s-echistatin analogs, linear RGD peptides, and cyclic RGD peptides. Essentially no similarity in sensitivity to RGD peptides were observed between bone resorption, platelet aggregation, or endothelial cell attachment. Because rat osteoclasts and human giant cell tumors (osteoclastomas) shared similar sensitivity to s-echistatin and rat and human endothelial cells showed a similar sensitivity profile to RGD peptides, the dissimilarity of bone resorption to other beta 3-mediated processes cannot be explained in terms of species differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Remote subarachnoid haemorrhage in the posterior fossa following supratentorial surgery. Clinical observation of 6 cases

Haemorrhage in regions remote from the site of following intracranial operations is rare, but they do occur. We performed supratentorial craniotomy on 639 patients between the time of introduction of computed tomography (CT) for clinical use in 1983 and June 1992; subarachnoid haemorrhage (SAH) in the posterior fossa occurred postoperatively in six of these cases. These included four patients with tumours in the sellar region, one with an arteriovenous malformation (AVM) and one who underwent superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The ages of the six patients ranged from 17-72 years. Haemorrhage occurred on the day of operation in one case and was detected on CT examination on the day following surgery in the remaining five cases. Of three patients with disturbance of consciousness, two underwent suboccipital craniectomy for reduction of intracranial pressure, while one received barbiturate therapy and later underwent cerebrospinal fluid (CSF) shunt surgery. No special treatment was necessary for the remaining three patients with less serious lesions. Five of the six patients ultimately recovered their pre-operative neurological status apart from the primary diseases. Factors inducing such haemorrhages seem likely to include displacement of the cerebellum by reduced CSF pressure during and after operations, and stretching and tearing of the veins and venules in the sulci of the tentorial surface of the cerebellum. Consideration should therefore be given to the maintenance of an appropriate CSF pressure during operation; this is particularly important in elderly patients and those with an atrophied cerebral cortex.

Cerebrospinal fluid leakage from the nipple after ventriculoperitoneal shunt: case report

A case of ventriculoperitoneal shunt malfunction is presented, in which cerebrospinal fluid was discharged from the nipple. A pseudocyst was found at the end of peritoneal catheter in the right subphrenic abdominal cavity. In addition, a fibrous tract was formed around the peritoneal catheter and communicated with the lactiferous duct probably injured incidentally during the subcutaneous insertion of catheter. Consequently, cerebrospinal fluid accumulated in the pseudocyst in the abdominal cavity and then flowed backward in the fibrous tract to the lactiferous duct during the respiration to discharge from the nipple.

Involvement of 4F2 antigen expressed on the MHC-negative target cells in the recognition of murine CD3+CD4-CD8- alpha beta (V alpha 4/V beta 2) T cells

T cells of an unique phenotype (CD3+CD4-CD8- alpha beta TCR+) develop in vitro from the hematopoietic progenitors, the majority of which carry homologous alpha beta TCR (V alpha 4J alpha 28/V beta 2D beta 1.1J beta 2.6). In the present study, antigen corresponding to the particular alpha beta TCR was investigated, taking advantage of the fact that growth of T cell hybridomas was arrested by their TCR stimulation. Results indicated that both syngeneic and allogeneic thymocytes, particularly from newborn mice, could specifically inhibit the proliferation of a T cell hybridoma with the V alpha 4/V beta 2 TCR (15H1.2). Proliferation of neither TCR-missing hybridoma subclones nor those with unrelated alpha beta TCRs was affected at all. It was also found that embryonal carcinoma (EC) cells without classical MHC antigens could specifically inhibit the proliferation of 15H1.2 cells. We then raised a mAb, 14.37, against an EC line, OTF9, that could interfere with the ability of them to inhibit the growth of 15H1.2. Pretreatment of 15H1.2 cells with anti-V beta 2 and OTF9 cells with 14.37 mAb respectively completely abrogated the growth inhibition of 15H1.2 by OTF9. The 14.37 antigen was a 120 kDa heterodimer glycoprotein consisting of 85 and 36 kDa proteins. In normal lymphoid tissues, the expression of 14.37 antigen exhibited an apparently inverse relationship with that of class I MHC antigens. Thus, ontogenically it was strongly expressed in fetal and newborn mice, rather rapidly declined thereafter, and remained at very low levels in adult organs. In a given stage, the distribution of 14.37 antigen and class I MHC was rather exclusive to each other.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of AETT-induced neuronal ceroid lipofuscinosis on learning ability in rats

The behavioral effects of ceroid-lipofuscin accumulation, induced by intraperitoneal administration of acetyl-ethyl-tetramethyl-tetralin (AETT) in Wistar rats for 3 months, were examined in the present studies. A significant increase in neuronal ceroidlipofuscin was demonstrated neuropathologically as well as morphometrically. Although the AETT-intoxicated rats showed neither alteration of locomotor activity nor shock sensitivity, a significant impairment of learning ability, especially an acquisition trial in passive avoidance tests, was observed. Results of the present studies indicate the possibility that a diffuse lipofuscin accumulation causes a learning impairment in rats. The results also imply the possibility of a significant role of age-related lipofuscin accumulation in the dementing processes of human especially in the elderly.

Ethylene production by strains of the plant-pathogenic bacterium Pseudomonas syringae depends upon the presence of indigenous plasmids carrying homologous genes for the ethylene-forming enzyme

The molecular characteristics of the ethylene-forming enzymes of strains of Pseudomonas syringae were tested. The ethylene-producing activities of the nine strains as measured in vivo and in vitro were similar, except for that of P. syringae pv. mori M5. A polyclonal antibody and a DNA probe for the ethylene-forming enzyme from P. syringae pv. phaseolicola PK2 were prepared to investigate homologies among the proteins and genes for the ethylene-forming enzymes. With the exception of P. syringae pv. mori M5, eight strains tested expressed the same antigen as the ethylene-forming enzyme from P. syringae pv. phaseolicola PK2 and were homologous to DNA sequences on indigenous plasmids. Molecular masses of antigenic proteins from all ethylene-producing strains were 40 kDa. The N-terminal amino acid sequence of the purified ethylene-forming enzyme from P. syringae pv. glycinea KN130 was identical to that of the enzyme from P. syringae pv. phaseolicola PK2. These results show that the ethylene-forming enzymes encoded by the indigenous plasmid(s) in the pathogenic bacteria examined were similar.

Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma

BACKGROUND

The authors have used percutaneous microwave coagulation therapy (PMCT) as a new percutaneous local treatment for single unresectable hepatocellular carcinoma (HCC) measuring 2 cm or less in greatest dimension (small HCC). PMCT was used to attempt a cure of the disease. In this study, the efficacy of this treatment was assessed.

METHODS

PMCT was performed on 18 patients with single small HCC. A microwave electrode (custom-made, 30-cm long by 1.6-mm thick) was inserted percutaneously into the tumor area under ultrasonic guidance. Microwaves at 60 W for 120 seconds were used to irradiate the tumor and surrounding area.

RESULTS

After PMCT was administered, various image findings were correlated with tissue necrosis. At the tumor and surrounding area, ultrasonography showed echogenic change, contrast enhancement disappeared on contrast enhanced computed tomography, and magnetic resonance imaging (T2-weighted image) showed decreased intensity in all cases after treatment. Complete necrosis of the tumor area in a specimen obtained from one patient who underwent hepatectomy after PMCT also was confirmed. The treatment reduced levels of the tumor marker, alpha-fetoprotein, which had been high in some patients. Although the follow-up period was short (11-33 months), 17 patients remain alive. Local recurrence in the treated area has not been detected, and no serious side effects or complications have been encountered.

CONCLUSIONS

PMCT may be an effective and safe treatment for small HCCs.

Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma

BACKGROUND

The authors have used percutaneous microwave coagulation therapy (PMCT) as a new percutaneous local treatment for single unresectable hepatocellular carcinoma (HCC) measuring 2 cm or less in greatest dimension (small HCC). PMCT was used to attempt a cure of the disease. In this study, the efficacy of this treatment was assessed.

METHODS

PMCT was performed on 18 patients with single small HCC. A microwave electrode (custom-made, 30-cm long by 1.6-mm thick) was inserted percutaneously into the tumor area under ultrasonic guidance. Microwaves at 60 W for 120 seconds were used to irradiate the tumor and surrounding area.

RESULTS

After PMCT was administered, various image findings were correlated with tissue necrosis. At the tumor and surrounding area, ultrasonography showed echogenic change, contrast enhancement disappeared on contrast enhanced computed tomography, and magnetic resonance imaging (T2-weighted image) showed decreased intensity in all cases after treatment. Complete necrosis of the tumor area in a specimen obtained from one patient who underwent hepatectomy after PMCT also was confirmed. The treatment reduced levels of the tumor marker, alpha-fetoprotein, which had been high in some patients. Although the follow-up period was short (11-33 months), 17 patients remain alive. Local recurrence in the treated area has not been detected, and no serious side effects or complications have been encountered.

CONCLUSIONS

PMCT may be an effective and safe treatment for small HCCs.

Neurotensin transcription is oppositely regulated during development and regeneration

Our previous work demonstrated that neurotensin mRNA expression was transiently up-regulated during development in the hypoglossal motoneurone. The present study was carried out to examine how neurotensin mRNA expression changes during nerve regeneration. Following either unilateral resection or crushing of the hypoglossal nerve, mRNA expression was detected by non-radioactive in situ hybridization histochemistry using an alkaline phosphatase-labelled oligonucleotide probe. A reduction in neurotensin mRNA was observed on the operated side after the nerve injury. It took around 2 months for NT mRNA levels to return to normal. Similar down-regulation was observed following crushing, but recovery was more rapid than that observed with sectioning, probably due to the extent of nerve damage. This finding indicates that neurotensin transcription is up-regulated during development but, on the contrary, down-regulated during regeneration.

Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma

BACKGROUND

The authors have used percutaneous microwave coagulation therapy (PMCT) as a new percutaneous local treatment for single unresectable hepatocellular carcinoma (HCC) measuring 2 cm or less in greatest dimension (small HCC). PMCT was used to attempt a cure of the disease. In this study, the efficacy of this treatment was assessed.

METHODS

PMCT was performed on 18 patients with single small HCC. A microwave electrode (custom-made, 30-cm long by 1.6-mm thick) was inserted percutaneously into the tumor area under ultrasonic guidance. Microwaves at 60 W for 120 seconds were used to irradiate the tumor and surrounding area.

RESULTS

After PMCT was administered, various image findings were correlated with tissue necrosis. At the tumor and surrounding area, ultrasonography showed echogenic change, contrast enhancement disappeared on contrast enhanced computed tomography, and magnetic resonance imaging (T2-weighted image) showed decreased intensity in all cases after treatment. Complete necrosis of the tumor area in a specimen obtained from one patient who underwent hepatectomy after PMCT also was confirmed. The treatment reduced levels of the tumor marker, alpha-fetoprotein, which had been high in some patients. Although the follow-up period was short (11-33 months), 17 patients remain alive. Local recurrence in the treated area has not been detected, and no serious side effects or complications have been encountered.

CONCLUSIONS

PMCT may be an effective and safe treatment for small HCCs.

[Follow-up study of MRI imaging in a case of traumatic pulmonary hematoma]

A 29-year-old male was suffered from traumatic pulmonary hematoma by blunt chest trauma. We examined chest roentogenograms, chest CT, and MR imaging of the thorax periodically. Those revealed that: 1) Traumatic pulmonary hematoma produce an intense signal and is not influenced by blood stream in the MR imaging. 2) Like other methods, in MRI, pulmonary hematoma gradually decreased its volume. However, as hematoma is visualized solitarily in MRI, small hematoma can be distinguished easily.

Enzymatic sulfation of glycosides and their corresponding aglycones by arylsulfate sulfotransferase from a human intestinal bacterium

A novel type of arylsulfate sulfotransferase (ASST) from a predominant human intestinal bacterium catalyzes the stoichiometric transfer of a sulfate group from phenolic sulfate esters to phenols. We clarified that polyphenols were better substrates of this enzyme than the corresponding glycosides. Additionally, a coumarin derivative, esculetin, was sulfated by ASST at the 6-position to give 6-monosulfate. Therefore, ASST is more useful for the preparation of sulfated polyphenols at their specific hydroxyl groups and would play an important role in the metabolism of phenolic compounds in vegetable food and traditional medicines.