Serum retinol levels are associated with brain volume loss in patients with multiple sclerosis

Background

Although predicting future brain volume loss (BVL) in patients with multiple sclerosis (MS) is important, studies have shown only a few biomarkers that can predict BVL.

Objectives

The aim of this study is to elucidate the association between longitudinal BVL and serum biomarker candidates.

Methods

This single-center, retrospective, observational study intended to cover MS patients during January 2008 to March 2016. Patients who underwent brain MRI two times at intervals of >24 months and had a blood test to measure biomarker candidates at the time or within three months of the MRI scan were included. Evaluation of brain volume was performed by using SIENAX and SIENA in the FMRIB software library.

Results

Twenty-three patients with MS were included in this study. We found that serum retinol binding protein (RBP) levels were significantly correlated with percentage brain volume change (PBVC) (p = 0.0079). Furthermore, best subset selection of multiple linear regression models identified baseline normalized brain volume and serum RBP as the best predictors of PBVC.

Conclusions

Our study shows that lower serum retinol levels are associated with greater longitudinal BVL and that serum RBP and can be a predictor of BVL.

Percutaneous Transluminal Angioplasty for Intracranial Arteriosclerotic Lesions

Recent developments of the interventional neuroradiological technique made percutaneous transluminal angioplasty (PTA) possible even for intracranial arteries1.

We report our experiences of 17 cases treated by PTA including 9 intracranial internal carotid (ICA), 4 middle cerebral (MCA) and 4 vertebro-basilar arterial (VBA) stenoses and discuss the problems of the procedure.

All patients had cerebral ischemic symptoms and stenoses more than 60% calculated angiographically. Three of them were treated by PTA for residual stenoses after thrombolytic therapy for acute occlusion. We used PTA balloon catheters 2.0 mm to 3.5 mm in diameter (Stealth, Target therapeutics) for all PTA procedures. A PTA balloon was inflated for 1 min at 6 atm as a rule. All were successfully dilated (stenosis less than 50%) except one treated by PTA for residual MCA stenosis after thrombolytic therapy.

The patient died from massive infarction due to MCA re-occlusion caused by MCA dissection. Restenosis appeared in 4 of 16 patients. Repeated PTA was successfuly carried out for the 4 patients.

However, restenosis appeared in one of them but the patient is now on follow-up because of asymptomatic course.

PTA for intracranial arteries is an effective treatment but its indication should be determined strictly because of potential risk such as acute occlusion derived from dissection.

The Strategy of Dural Arteriovenous Fistula with Isolated Sinus

We treated 7 cases of dural arteriovenous fistulas (dAVF) with isolated sinus by transvenous direct embolization.

The fistulas located in the transverse-sigmoid sinus in 5 cases, superior sagittal sinus in 1 case and transverse-sigmoid and superior sagittal sinus in 1 case.

The initial symptoms were generalized convulsion in 2 cases, disturbed consciousness in 1 case, tinnitus in 2 cases and transient ischemic attack in 2 cases. We performed sinus packing with coils in all cases following transarterial embolization.

All patients improved neurologically after the treatments and AVFs completely disappeared in all cases.

Endovascular Treatment for Internal Carotid Stenoses

Seventy four cases of internal carotid stenoses greater than 60% were treated by PTA and/or stenting 86 times. Sixty one cases of cervical ICA stenosis were treated 71 times. 11 cases of high cervical - intracranial ICA stenosis were treated 13 times. Two cases of ICA dissection were treated by stent deployment.

Stenotic ratio reduced from 79% to 29% in cervical ICA stenosis and 71 % to 32% in high cervical to intracranial ICA stenosis in average. Morbidity related to PTA and/or stenting was 2/74 (2.7%) and mortality was 0%. One was an ischemic complication and the other was a hemorrhagic complication due to hyperperfusion. Restenosis (stenosis greater than 70%) rate was 32%. Asymptomatic cerebral embolism were found in three cases (4.2%) on angiogram immediately after PTA and/or stenting. The complication rate related to PTA and/stenting was low but asymptomatic emboli were found in three cases.

Considering these results, the indication for PTA and/stenting should be restricted to patients with high risk group, such as cases with high medical risks or difficult CEA cases, if appropriate protective systems for cerebral emboli were not available.

Spinal cord ring enhancement in patients with neuromyelitis optica

OBJECTIVES

Clinical and pathological significance of gadolinium (Gd)-enhancing pattern on magnetic resonance imaging (MRI), including ring enhancement (RE), is well documented in multiple sclerosis but not in neuromyelitis optica (NMO), especially in the spinal cord. The purpose of this study is to examine the prevalence of spinal cord RE in NMO and to determine the association between clinical characteristics and spinal cord RE.

MATERIALS AND METHODS

We retrospectively examined Gd-enhanced spinal cord MRI scans, during the acute phase, in patients with anti-aquaporin 4-positive NMO, including NMO spectrum disorder. We then analysed their clinical features and MRI imaging characteristics of spinal cord lesions.

RESULTS

Of the 30 patients with NMO, we enrolled 12 patients with 16 Gd-enhanced spinal cord MRI scans in this study. Five scans revealed RE (31.2%). Male ratio, as well as myelin basic protein (MBP) levels, in the cerebrospinal fluid (CSF) of patients with RE was significantly higher than those of patients without RE (P = 0.018, P = 0.026, respectively).

CONCLUSIONS

Spinal cord RE is common in patients with NMO. Higher MBP levels in the CSF of patients with RE can be associated with a higher degree of myelin damage.

Acute multiple brain infarction in large-artery atherosclerosis is associated with hyperhomocyst(e)inemia

OBJECTIVES

Although hyperhomocyst(e)inemia had been proven to be a potent risk factor for ischemic stroke, it is still controversial which subtype of stroke is associated with hyperhomocyst(e)inemia. The aim of this study was to clarify the association between plasma homocyst(e)ine (Hcy) levels and stroke subtypes according to TOAST classifications based on MRI findings.

METHODS

We prospectively recruited 124 consecutive first-ever ischemic stroke patients hospitalized in Toride Kyodo General Hospital. Each patient underwent brain MRI including diffusion-weighted imaging (DWI) and was evaluated for total plasma Hcy levels in addition to routine laboratory tests.

RESULTS

Of the 93 patients enrolled in this study, 19 were subtyped with large-artery atherosclerosis with acute multiple brain infarction [LA-AMBI(+)], 13 with LA-AMBI(-). Patients with LA-AMBI(+) showed significantly higher plasma Hcy levels than those with LA-AMBI(-). Moreover, for LA-AMBI, the plasma Hcy level was associated with an OR of 1.3 (95% CI 1.06-1.71, P=0.017) per 1 mumol increase in concentration, and 1.4 (95% CI 1.04-1.77, P=0.025) after adjustment for age, sex and serum cholesterol levels.

CONCLUSION

In the subset of patients with LA strokes, those with high Hcy levels are more likely to have AMBI than those without elevated Hcy levels possibly due to plaque instability.

Three-dimensional rotation venography using the digital subtraction angiography unit with a flat-panel detector: usefulness for the transtemporal/transtentorial approaches

We obtained the venograms using the two-dimensional digital subtraction angiography (2D DSA) images and three dimensional rotation venography (3D RV) images and investigated the potential usefulness of the 3D RV compared with venograms of 2D DSA using the newly developed three-dimensional rotation angiography unit with a flat-panel detector (FPD). This study included 26 sides (11 left, 15 right) in 20 cases (4 males and 16 females) who underwent radiographic examination for management of intracranial tumors and vascular diseases between May 2003 and December 2003. Each patient underwent diagnostic angiography performed on a DSA unit with a FPD. In all patients, the 2D DSA images, including anteroposterior view and lateral view of the carotid artery, were obtained in two stereoscopic views. The 3D RV was used to produce volume-rendered images. Two neuroradiologists investigated the venous configuration of 3D RV compared with that of 2D DSA about the relationship of the venous drainage system on the temporal lobe according to Guppy et al.'s classification. Twenty-four sides of the 26 sides enabled the precious visualization on 3D RV images. In investigation of 2D DSA, 9 sides (37.5%) were classified into type A, 13 (54.2%) into type B, two (8.3%) into type C, and no sides into types D, E, and F. In investigation of 3D RV images, 10 sides (41.7%) were classified into type A, 9 (37.5%) into type B, 1 (4.2%) into type C, 2 (8.3%) into type E, and 2 (8.3%) into type F. Seven of 24 sides demonstrated discrepancy in results between 2D DSA and 3D RV. The 3D RV could be performed by setting the adequate delay in between the injection of the contrast material and starting time of third rotation to acquire the opacified images. In Guppy et al.'s classification, the 3D RV images could demonstrate the precious venous drainage including the venous lakes with use of multiple views and variable reconstruction compared with 2D DSA. Our DSA system with FPD could provide good 3D RV images. These images are very useful for the skull-base surgery because we can understand the three-dimensional vascular anatomy preoperatively.

Endovascular treatment for vertebral dissecting aneurysm presenting with subarachnoid hemorrhage

We report results and problems of the endovascular treatment in 12 cases of intradural vertebral dissecting aneurysm presenting with subarachnoid hemorrhage. There were four complications related to interventional procedure and conventional angiography. In three patients (25%), VDAs ruptured immediately after injection of contrast media or hypertension during the interventional procedure, which caused respiratory arrest. In a case of bilateral VA dissection (8%), after proximal VA occlusion had been performed for unilateral VDA, contralateral dissection extended to the basilar artery resulting in brain stem infarct. We suggest that the incidence of rebleeding of VDA during angiography and embolization is higher than that of usual saccular aneurysms. Careful injection of contrast media and strict blood pressure control seems to be more important to prevent rebleeding in VDAs than intracranial saccular aneurysms. Since unilateral VA occlusion may extend contralateral dissection in a case of bilateral VA dissection, it is necessary to check contralateral VA dissection before VA occlusion.

Clinical results and complications of endovascular treatment for intracranial aneurysms

SUMMARY

Thirty-two patients with intracranial aneurysm were treated via the endovascular approach and clinical results and complications were accessed. The aneurysms were on the anterior circulation, posterior circulation and feeding artery of AVM in 17, 12 and three patients respectively. In 17 (anterior circulation aneurysm), 12 patients underwent parent artery occlusion. There were two complications: cerebral embolism due to premature detachment of balloons and cerebral infarct due to parent artery occlusion. In 12 (posterior circuration aneurysm), four patients had complications: three infarcts due to parent artery occlusion and one aneurysmal bleeding at the interventional procedure. Coil compactions occurred in four cases. There were no complications in cases associated with AVM. Use of detachable balloons for intra-aneurysmal occlusion and intra-aneurysmal embolisation for partially thrombosed giant aneurysm tends to result in ischemic lesions where patient outcome is poor. We must pay attention to avoid these complications even though intra-aneurysmal embolisation using microcoils is currently performed safely.

[MR hydrography of the abdomen: technical consideration of data acquisition and future prospects for clinical applications]

Recent advances in MR hydrography have enabled various clinical applications in the areas of abdominal and pelvic disorders, for example, MR cholangiopancreatography (MRCP), MR urography(MRU), and MR hydrography of the fetus. Although the two-dimensional(2D) single-slice method provides excellent information as to the global relationship between lesions and various anatomical structures, small lesions or detailed anatomical characteristics may not be visualized owing to the partial volume effect. Source images of the 2D multislice method are most suitable for the detection of small lesions and detailed evaluation of anatomical structures as "tomographic imaging", while the three-dimensional(3D) method is useful in obtaining data sets for 3D imaging. MR hydrography is a promising method for the noninvasive evaluation of various abdominal disorders, and it has the potential to play new roles in various anatomical regions. However, knowledge of the proper indications is essential for successful clinical application.

Promotion of survival and regeneration of nigral dopamine neurons in a rat model of Parkinson's disease after implantation of embryonal carcinoma-derived neurons genetically engineered to produce glial cell line-derived neurotrophic factor

OBJECT

The P19 embryonal carcinoma-derived cell line consists of undifferentiated multipotential cells, which irreversibly differentiate into mature neurons after exposure to retinoic acid (RA). In the present study, the authors genetically engineered P19 cells to produce glial cell line-derived neurotrophic factor (GDNF), and grafted the cells in a rat model that had been rendered parkinsonian.

METHODS

Undifferentiated P19 cells were grown in vitro and transduced with GDNF complementary DNA. The level of GDNF released from the transduced cells was measured using an enzyme-linked immunosorbent assay, and its neurotrophic activities were assessed by testing the effects on rat embryonic dopamine (DA) neurons in culture. After having been exposed to RA for 48 hours and allowed to differentiate into postmitotic neurons, the GDNF gene-transduced cells were implanted into the midbrain of immunosuppressed rats. A unilateral nigrostriatal lesion was then induced by intrastriatal infusions of 6-hydroxydopamine. Immunohistochemical analyses performed 4 weeks postgrafting revealed that the GDNF-producing cells expressed several neuronal markers without evidence of overgrowth. The grafts expressed GDNF protein and prevented the death of nigral DA neurons. Furthermore, the GDNF-producing cells implanted 4 weeks after nigrostriatal lesions restored the expression of tyrosine hydroxylase in injured DA neurons and induced their dendritic sprouting.

CONCLUSIONS

The results indicate that the P19 cell line transduced with the GDNF gene can stably secrete functional levels of GDNF, even after being converted to postmitotic neurons. Because it is has been established that GDNF exerts trophic effects on DA neurons, the means currently used to deliver GDNF into the brain could be a viable strategy to prevent the death of nigral DA neurons in cases of Parkinson's disease.

Treatment of restenosis after percutaneous transluminal angioplasty for internal carotid artery stenosis

The efficacy of repeated percutaneous transluminal angioplasty (PTA) and carotid endarterectomy (CEA) was examined in patients with restenosis after PTA for carotid stenosis. After percutaneous transluminal angioplasty (PTA) for 63 cases of internal carotid stenoses 13 cases of restenosis appeared. They were treated by PTA or carotid endarterectomy. The treatment was chosen by the patient after explanation of each treatment. We initially treated seven patients by repeat PTA and six by carotid endarterectomy. The degree of stenosis improved from 82% to 30% on average after repeated PTA. However, one patient in the PTA group had restenosis, and carotid endarterectomy was then performed. The other cases also had restenosis and were treated by PTA. The six cases treated by carotid endarterectomy were successfully treated without difficulty. The success rate of PTA was 5/7 (71%) in the restenosis cases. Patients with a greater residual stenosis after initial PTA had significantly more frequent restenosis. Repeat PTA and CEA both appeared effective treatment for restenosis after initial PTA, although PTA had a restenosis rate similar to that of initial PTA.

Dephosphorylation-induced decrease of anti-apoptotic function of Bcl-2 in neuronally differentiated P19 cells following ischemic insults

It is known that Bcl-2 has a protective effect against neuronal ischemia. Some reports speculate anti-apoptotic function of Bcl-2 depends not on the expression level but on the phosphorylation state. We found induction of apoptosis and CPP32 activation by energy impairment (3-nitropropionic acid (3-NP)-treatment or glucose-deprivation) in the neuronally differentiated P19 cells. Time course study of cell viability following ischemic insults showed that the number of viable cells decreased along with the increase in the amount of dephosphorylated Bcl-2 without obvious quantitative alteration of the protein. Then, we generated differentiated P19 cells overexpressing wild-type Bcl-2 (P19/wt. Bcl-2) or phosphorylation-negative Bcl-2 mutant (P19/mut.Bcl-2), in which alanine was substituted for serine 70. When the cell viability was examined within 24 h, P19/mut.Bcl-2 was more vulnerable to energy impairment as compared with P19/wt.Bcl-2. In addition, overexpression of wild-type Bcl-2 inhibited DNA laddering and CPP32 activation induced by the insults, while that of mutant Bcl-2 did not. These findings suggest that the phosphorylation state, as well as the expression level, of Bcl-2 plays an important role to modulate its protective effect against ischemic insults.

Presumed intraventricular meningioma treated by embolisation and the gamma knife

A 58-year-old woman with a presumed incidentally discovered meningioma in the left lateral ventricle was treated by superselective embolisation and gamma knife therapy. The diameter of the tumour was 40 mm, and its main feeding artery was the left lateral posterior choroidal artery. This vessel was embolised with microcoils. At 8 months following embolisation, the diameter of the tumour had decreased and was stable. The gamma knife was chosen as an adjuvant therapy for the further control 13 months after embolisation. Embolisation and gamma knife therapy may be an alternative treatment for meningiomas where surgical resection appears difficult.

Enhancement of cisplatin sensitivity in high mobility group 2 cDNA-transfected human lung cancer cells

To elucidate the role of high mobility group 2 protein (HMG2) in cis-diamminedichloroplatinum (II) (cisplatin, CDDP) sensitivity, we constructed a human HMG2-transfected human non-small cell lung cancer cell line, PC-14/HMG2. The HMG2 mRNA expression level was approximately twice those of parental PC-14 and mock-transfected PC-14/CMV. Gel mobility shift assay revealed a CDDP-treated DNA-protein complex in the nuclear extract of PC-14/HMG2, which was not found in the extracts of PC-14 and PC-14/CMV. This complex formation was subject to competition by CDDP-treated non-specific salmon sperm DNA, indicating that ectopic HMG2 recognizes CDDP-damaged DNA. PC-14/HMG2 showed more than 3-fold higher sensitivity to CDDP than PC-14 and PC-14/CMV. The intracellular platinum content of PC-14/HMG2 after exposure to 300 microM CDDP was 1.1 and 1.5 times that of PC-14 and PC-14/CMV, respectively. Cellular glutathione levels were not different in these cell lines. Repair of DNA interstrand cross-links determined by alkaline elution assay was decreased in PC-14/HMG2. These results suggest that HMG2 may enhance the CDDP sensitivity of cells by inhibiting repair of the DNA lesion induced by CDDP.

The C-terminal domain of p53 catalyzes DNA-renaturation and strand exchange toward annealing between intact ssDNAs and toward eliminating damaged ssDNA from duplex formation through preferential recognition of damaged DNA by a duocarmycin

The C-terminal domain of p53 may bind single-stranded (ss) DNA ends and catalyze renaturation of ss complementary DNA molecules, suggesting a possible direct role for p53 in DNA repair (Proc. Natl. Acad. Sci. USA, 92, 9455-9459, 1995). We found that DU-86, a duocarmycin derivative which alkylates DNA, bound ssDNA and enhanced the DNA binding activity of the p53 C-terminus. DU-86 weakened p53-mediated catalysis of complementary ssDNA renaturation. p53 C-terminus catalyzed DNA strand transfer toward annealing between intact ssDNAs and toward eliminating DU-86-damaged ssDNA from duplex formation. These results suggest that p53, via the C-terminal domain, may play a direct role in DNA repair by preferential recognization and elimination of damaged DNA.

Vertebral arteriovenous fistula treated by embolization technique. Report of three cases

SUMMARY

Three patients with vertebral arteriovenous fistulae are described. Transarterial embolization by microcoils and balloons was used in each case and the fistula was completely occluded in one case immediately after embolization. Another two cases with partial obliteration of the fistula were followed and showed complete occlusion of the fistula after a one year follow-up. After embolization of the fistula, each patient improved in clinical signs and symptoms and showed no complications. Transarterial embolization for vertebral arteriovenous fistula is a safe and effective treatment.

Treatment of Restenosis after PTA for Internal Carotid Stenosis

SUMMARY

Thirteen cases of restenosis occurred after percutaneous transluminal angioplasty (PTA) in 63 cases of internal carotid stenoses. They were treated by PTA or carotid endarterectomy. The patients were sufficiently informed of each treatment. Seven of them were initially treated by repeated PTA. The stenosis ratio improved from 82% to 30% after repeated PTA on average. However, one case in the PTA treated group resulted in restenosis and then carotid endarterectomy was performed. The other case also caused restenosis and was treated by PTA. Six cases were initially treated by carotid endarterectomy and all cases were successfully treated without difficulty. The success rate of the PTA was 2/7 (29%) in restenosis cases. One case causing re-restenosis had severe calcification in the arterial wall. PTA was thought to be effective for the restenosis cases after initial PTA if the arterial calcification was not severe.

Clinical Results and Problems in Embolization for Intracranial Aneurysms using Electrically Detachable Coils

SUMMARY

Nineteen patients with intracranial aneurysm were treated using electrically detachable coils (GDC or IEDC) and angiographic results and complications were assessed. In 18 aneurysms treated by endosaccular occlusion, 11 (61%), 3 (17%) and 4 (22%) resulted in complete occlusion, neck remnant and dome filling, respectively. Neither haemorrhagic nor thromboembolic complications occurred in 19 patients. Embolization using electrically detachable coils seemed to be a safe and useful procedure without complications, but we should give attention to avoiding complications and incomplete occlusion in particular in a case of 1) wide-necked, 2) small (< 3 mm) or 3) complex- shaped aneurysms.

Percutaneous transluminal angioplasty for intracranial arteriosclerotic lesions

We report 17 cases of intracranial arterial stenosis treated by percutaneous transluminal angioplasty (PTA), including 9 on the intracranial internal carotid (ICA), 4 on the middle cerebral (MCA), and 4 on vertebrobasilar artery (VBA) system. All patients had ischaemic brain symptoms and stenoses of more than 60% (calculated angiographically). We treated four patients by PTA for residual stenoses after thrombolysis for acute occlusion. We used PTA balloon catheters 2.0-3.5 mm in diameter for all procedures. As a rule, the balloon was inflated for 1 min at 6 atm. All arteries were successfully dilated (stenosis less than 50%) except for one treated by PTA for residual MCA stenosis after thrombolysis. The patient died of a massive infarct due to MCA reocclusion caused by arterial dissection. Stenosis recurred in 4 of 16 patients. Repeat PTA was successfully carried out in these cases. However, stenosis recurred in one of these patients 3 months after PTA, but the patient is being followed because he is asymptomatic. PTA of intracranial arteries is effective, but its indications should be based strictly on potential risks, such as acute occlusion derived from arterial dissection.

Carotid endarterectomy and simultaneous percutaneous transluminal angioplasty for tandem internal carotid stenoses

We treated three patients with tandem internal carotid stenoses in single procedures including carotid endarterectomy (CEA) for the proximal stenosis and percutaneous transluminal angioplasty (PTA) for the distal stenosis. We devised a Y-shaped shunt tube for the CEA, through which a balloon catheter was introduced to perform PTA guided by mobile digital subtraction angiography. No cerebrovascular events occurred during follow-up. Our approach avoids the risk of a second procedure while effectively treating tandem stenoses.

Percutaneous Transluminal Angioplasty for Bilateral ICA Occlusive Lesions

SUMMARY

We performed Percutaneous Transluminal Angioplasty (PTA) in 50 patients with internal carotid artery (ICA) stenosis. Fifteen of these patients also showed signs of contralateral ICA occlusive lesions. Various neurological symptoms, such as hemiparesis or convulsions, frequently appeared in these patients with contralateral lesions during PTA. The balloon inflation time was restricted in 2 patients who experienced convulsions during PTA, resulting in an unsuccessful dilatation in one case. No permanent neurological deficits appeared as a result of PTA in these cases. The treatment for these cases is discussed in this report.

Endovascular Treatment for Tandem Internal Carotid Stenosis. Development of a New Shunt Tube for PTA

SUMMARY

Three patients with tandem internal carotid stenoses were treated in one operation including carotid endarterectomy (CEA) for the proximal stenosis and percutaneous transluminal angioplasty (PTA) for the distal stenosis. We devised a Y-shaped shunt tube which we used for CEA, while a PTA balloon catheter was introduced via the tube to perform PTA guided by portable digital subtraction angiography (DSA). No cerebrovascular events occurred during follow-up. Our approach avoids the risk of a second procedure while effectively treating tandem stenoses.

p16INK4 expression is associated with the increased sensitivity of human non-small cell lung cancer cells to DNA topoisomerase I inhibitors

Inactivation of p16INK4, an inhibitor of cyclin-dependent kinases 4 (CDK4) and 6 (CDK6), may be essential for oncogenesis in non-small cell lung cancer (NSCLC). We examined the sensitivity of two clones of p16INK4-transfected NSCLC cell line with homozygous deletion of p16INK4, A549/p16-1 and 2, to DNA topoisomerase I (topo I) inhibitors. A549/p16-1 and -2 showed 7.7- and 9.1-fold increases in sensitivity to CPT-11 (11,7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin ), respectively, compared with A549 cells. Ectopic p16INK4-expressing cells also showed approximately 4.0-fold increase in sensitivity to SN-38 (7-ethyl-10-hydroxycamptothecin), the active metabolite of CPT-11, compared to the parent cells. The topo I-mediated DNA relaxation activities of ectopic p16INK4-expressing cells were approximately 5 times higher than those of the parent cells. Northern and western blot analyses indicate that these increased topo I activities of ectopic p16INK4-expressing cells were due to an elevated topo I mRNA level and an increase in topo I protein. The chemosensitivity to topo I inhibitors, topo I mRNA level, protein content and activity of a p16INK4 revertant, lacking functional p16INK4, tended to be restored toward those of the parental phenotype to some extent. These results suggest that p16INK4 expression is closely associated with the increased sensitivity of ectopic p16INK4-expressing NSCLC cells to topo I inhibitors. The up-regulation of topo I mRNA level, protein content and activity may be responsible for this hypersensitivity.

Circumvention of glutathione-mediated mitomycin C resistance by a novel mitomycin C analogue, KW-2149

A novel antitumor antibiotic 7-N-[2-[[2-(gamma-L-glutamylamino)ethyl]dithio]ethyl] mitomycin C (KW-2149), an analogue of mitomycin C (MMC), is activated by thiol molecules, such as glutathione (GSH). To clarify the relationship between cellular GSH levels and the cytotoxicity of KW-2149, a murine fibroblast cell line (NIH/3T3) was transfected with human gamma-glutamylcysteine synthetase (gamma-GCS) cDNA, which codes a rate-limiting enzyme of GSH synthesis. Transfected cells (3T3/GCS) displayed increased gamma-GCS mRNA levels, gamma-GCS activity and GSH content, compared with NIH/3T3 cells. 3T3/GCS cells exhibited a 4.4-fold resistance to MMC, but not to KW-2149 (x 0.69), using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, suggesting that the increased cellular GSH levels did not affect the growth-inhibitory effect of KW-2149. KW-2149 exerted a greater growth-inhibitory effect than MMC on cisplatin- and doxorubicin-resistant cells with cross-resistance to MMC. KW-2149 exhibited a greater growth inhibitory effect than MMC not only on cells with GSH-mediated MMC resistance but also on cells with acquired resistance. We thus conclude that KW-2149 might be a clinically useful drug.

Subdural and meaningful involvement related to Wegener's granulomatosis: case report

OBJECTIVE AND IMPORTANCE

The first case of Wegener's granulomatosis associated with subdural empyema is presented.

CLINICAL PRESENTATION

A 37-year-old man was admitted to our hospital for treatment of bilateral subdural masses. Magnetic resonance imaging demonstrated strong bilateral subdural and meningeal enhancement. The patient was treated with subdural drainage, based on the diagnosis of bilateral subdural hematoma or empyema as revealed by magnetic resonance imaging. Even after surgery, he developed systemic symptoms that are typical for Wegener's granulomatosis, including hemosputum, papules, peripheral nervous disorders, hematuria, myalgia, and joint pain. A diagnosis of Wegener's granulomatosis was confirmed by positive circulating antineutrophil cytoplasmic antibodies and histological findings from the skin and nasal mucosa. We diagnosed the subdural masses as Wegener's granulomatosis from the laboratory and neuroimaging studies, retrospectively.

INTERVENTION

Pus-like fluid containing hematoma with negative micro-organism was evacuated by surgery.

CONCLUSION

Wegener's granulomatosis should be suspected in young patients with pulmonary symptoms and subdural hematoma without head injury. This is the first case of Wegener's granulomatosis associated with subdural masses.

Effect of glutathione depletion on cisplatin resistance in cancer cells transfected with the gamma-glutamylcysteine synthetase gene

Overexpression of the human gamma-glutamylcysteine (gamma-GCS) gene resulted in cisplatin resistance with an increased glutathione (GSH) content, increased ATP-dependent glutathione S-conjugate export pump (GS-X pump) activity and decreased platinum accumulation in human lung cancer cells transfected with a gamma-GCS cDNA expression vector, as we previously reported. In this study, we examined the effects of buthionine sulfoximine (BSO), a specific inhibitor of gamma-GCS, to determine whether GSH depletion alters cisplatin resistance in a gamma-GCS-transfected cell line, SBC-3/GCS. In the presence of 10 microM BSO for 4 days, SBC-3/GCS still showed resistance to cisplatin, although it was partially reversed. Under these conditions, GS-X pump activity remained up-regulated in spite of low GSH content, and the platinum content was decreased. These data suggest that the GS-X pump itself influences cisplatin resistance, as well as cellular GSH content.

The effect of endovascular therapy for cerebral arterial spasm, its limitation and pitfalls

PURPOSE

The effect of endovascular treatment for vasospasm was investigated by analysing the results of patients treated in Wakayama City in 1994.

MATERIALS AND METHODS

Ninety nine patients with ruptured cerebral aneurysms, who survived more than one week and were treated in Wakayama City in 1994, were studied. Twenty five patients caused symptomatic vasospasm and 25 were treated by endovascular therapy, percutaneous transluminal angioplasty (PTA) and/or intra-arterial papaverine infusion (IAP). PTA was performed for proximal vasospasm which located in the main arterial trunk, such as ICA, M1, BA (n = 3). IAP was chosen for distal vasospasm which located mainly in the M2, A1, A2 (n = 12). PTA and/or IAP was performed for diffuse vasospasm which located in proximal and distal arteries (n = 10).

RESULTS

In the proximal vasospasm group, all patients were good to moderately disabled on the Glasgow outcome scale (GOS). In the distal vasospasm group, 8 patients were good to moderately disabled, and 4 patients were severely disabled. The overall results were as follows: 17 (68%), good to moderately disabled, 4 (16%), severely disabled, 4 (16%), dead. The morbidity and mortality rate was 8/25 (32%) in symptomatic spasm group.

CONCLUSION

PTA was very effective especially for proximal vasospasm, but IAP was not always effective for distal or diffuse vasospasm. Diffuse vasospasm revealed a high mortality rate in spite of the endovascular therapy.

Antitumor effects of butyrolactone I, a selective cdc2 kinase inhibitor, on human lung cancer cell lines

Butyrolactone I, which is a naturally occurring specific inhibitor of the cdc2 kinase family, showed antitumor effects on several non-small- and small-cell-lung cancer cell lines with IC50 values the order of 50 micrograms/ml on the former. No cross-resistance of several drug-resistant cell lines, including those with the multidrug-resistant phenotype and five cisplatin-resistant cell lines to butyrolactone I was observed. The cdc2 kinase activity of PC-14 cells was inhibited by treatment with 20 micrograms/ml butyrolactone I, a concentration comparable to the IC50 value, for 2 hours. Longer exposure to butyrolactone I (> 24 hours) reduced the cdc2 kinase protein level. Butyrolactone I arrested the cells at the G2/M phase in a concentration dependent manner. These results suggest that butyrolactone I actually acts on cdc2 kinase, rather than other cdk kinases, in PC-14 cells. Inhibition of DNA synthesis, determined by measuring thymidine uptake, occurred earlier (2 hours) after initiating exposure than the decrease in the cdc2 protein level and was concentration dependent, suggesting that butyrolactone I inhibited DN4 synthesis. Cell permeabilization by digitonin enhanced DN4 synthesis inhibition by butyrolactone I, suggesting that the permeability of the membrane to this agent was the limiting factor for its growth inhibitory effect. Many anticancer agents, such as alkylating agents and cisplatin, cause cells to accumulate at the G2/M phase of the cell cycle. We investigated whether butyrolactone I had any modulatory effect on the antitumor effects of several anticancer drugs in vitro. Butyrolactone I showed no modulatory effects on vindesine, paclitaxel, or etoposide, but exposure of PC-9 and PC-14 cells to butyrolactone I together with or prior to treatment with cisplatin reduced the cytotoxicity of the latter. Thin-layer chromatographic analysis revealed that butyrolactone I bound to cisplatin, which was a possible cause of the reduced cisplatin cytotoxicity in the presence of bytyrolactone I.

Clinical use of mechanical detachable coils for dural arteriovenous fistula

Seven dural arteriovenous fistulas were successfully embolized with mechanical detachable coils. Two lesions were located in the transverse-sigmoid sinus, four in the cavernous sinus, and one in the marginal sinus. All lesions were completely occluded on postembolization angiography. No recurrent symptoms appeared during a mean follow-up period of 11 months. Owing to the length and retrievability of the mechanical detachable coils, embolization was quicker and safer, and coils were packed more densely, than is possible with conventional coils. Coil migration was avoided because coils of the appropriate size were chosen before they were placed.

Transluminal angioplasty for arteriosclerotic disease of the distal vertebral and basilar arteries

OBJECTIVE

Percutaneous transluminal angioplasty (PTA) for the distal vertebral and basilar artery is now being performed in selected patients with haemodynamically significant lesions of the posterior cerebral circulation. Its effect and overall results were examined.

PATIENTS AND METHODS

A balloon dilatation catheter specifically developed for these procedures, with a 2.0-3.5 mm balloon diameter, at 6 atmospheres of pressure, was used. Angioplasty was performed in 12 patients (including six whose initial results have been reported) with angiographically documented stenotic lesions involving either the intracranial vertebral artery (C1-C2 portion) or the basilar artery, and satisfying the following criteria: (1) clinical symptoms suggestive or consistent with a transient ischaemic attack refractory to medical treatment, or small infarction of the posterior circulation; and (2) angiographically documented stenosis greater than 70%. Two of 12 patients had complete thrombosis of the distal vertebral and basilar artery and PTA was performed after successful intra-arterial thrombolysis.

RESULTS

Successful results, without complications, were obtained in eight patients, with complete resolution of vertebrobasilar ischaemic symptoms. Immediate complications occurred in four patients including two with vessel dissection, and two with thromboembolism. The two patients with acute arterial dissection were reoperated but developed small infarctions with permanent neurological deficits. The two patients with thromboembolic complication showed transient neurological deficit. The overall stenosis ratio decreased from a mean of 84% pretreatment to 44% after the angioplasty procedure. Restenosis occurred in two patients. Long term clinical follow up in 11 patients who survived more than six months showed resolution of ischaemic symptoms after PTA in all except for one with a restenosis who had recurrent transient ischaemic attacks.

CONCLUSION

Transluminal angioplasty may be an effective procedure to treat vertebrobasilar ischaemia secondary to high grade arteriosclerotic disease affecting either the distal vertebral or basilar artery regions that do not respond to medical treatment.

Preoperative embolization of meningiomas fed by ophthalmic branch arteries

BACKGROUND

The efficacy of preoperative embolization for hypervascular meningiomas mainly fed by the branches of the ophthalmic arteries was examined.

CASES AND METHODS

Five hypervascular meningiomas mainly fed by the branches of the ophthalmic arteries, four posterior ethmoidal arteries, one anterior falx artery, and one recurrent middle meningeal artery were embolized with Gel-foam powder, polyvinyl alcohol (PVA) particles, and/or microcoils as a preoperative treatment using a microcatheter.

RESULTS

Catheterization of the ophthalmic and tumor feeding artery was possible and feeding arteries and lesion embolization were effective to reduce the bleeding during surgery in all cases. In three cases, visual acuity and visual field were preserved. However, in one case, visual acuity and visual field defect appeared due to the migration of Gelfoam powder (Upjohn, Kalamazoo, MI) into the retinal artery. In another case, the retinal artery was embolized with the feeding arteries since the patient was already blind.

CONCLUSION

Embolization of hypervascular meningioma feeding vessels arising from the ophthalmic artery is possible and effective with preservation of vision, if embolic agents are injected gently enough not to reflux into the central retinal artery.

[The effect on higher cortical dysfunction of percutaneous transluminal angioplasty for internal carotid artery stenosis]

Seven patients with internal carotid artery (ICA) stenosis with higher cortical dysfunction due to hemodynamic ischemia were treated by percutaneous transluminal angioplasty (PTA). The patients ranged from 49 to 71 years of age, and included five males and two females. Neuropsychological tests were evaluated before and after PTA. Higher cortical dysfunction improved in all cases after PTA. It is concluded that PTA is effective to improve higher cortical dysfunction in patients who have ICA stenosis associated with hemodynamic compromise, if the ICA is satisfactorily dilated.

Stenotic kinking of the cavernous internal carotid artery with a giant intra-cavernous aneurysm: case report

We report a giant aneurysm of the cavernous internal carotid artery with proximal internal carotid stenosis. The stenosis showed two typical features: a kink at the stenosis and location at the exit from the carotid canal. We believe that the cavernous portion of the internal carotid artery is compressed medially by the giant aneurysm and a kink occurs at the point where the artery leaves the bony carotid canal.

Tissue plasminogen activator thrombolysis and transluminal angioplasty in the treatment of basilar artery thrombosis: case report

A 61-year-old man with basilar artery thrombotic occlusion was successfully treated by a combination of local infusion of tissue plasminogen activator (t-PA) followed by percutaneous transluminal angioplasty (PTA). t-PA superselective infusion combined with the mechanical destruction of the clot by the guide wire was effective for recanalization. A Stealth dilation catheter, with a 2.5-mm balloon diameter and 10-mm length, was used for PTA. A balloon inflation time of 60 seconds with 4 atmospheres of pressure was delivered for successful dilation of the basilar artery. It was confirmed to be widely patent on follow-up angiography 40 days after the combined procedure with no further ischemic attacks apparent on clinical examination at 6 months.

[Newly developed blocking balloon catheter for PTA of internal carotid artery]

We have developed a new blocking balloon system for percutaneous transluminal angioplasty (PTA) of the internal carotid artery (ICA). A latex balloon (BALT) is attached on the top of a Superselector infusion-type catheter (TORAY) which is used as a blocking balloon catheter. It can be navigated into the distal part of the ICA under torque control as well as flow control by withdrawing the core wire. Our PTA procedure is as follows, 1) insert the sheath catheter 8-9 F in size, 2) insert the PTA balloon catheter (Accent balloon, Cook) with a blocking balloon catheter through the sheath catheter, 3) navigate the blocking balloon into the distal part of the ICA, 4) introduce the PTA balloon to the stenotic portion after occlusion of the distal ICA by the blocking balloon, 5) PTA, 6) wash the lumen of the ICA with saline, 7) deflate the blocking balloon and withdraw the system. We performed PTA for 5 ICA lesions in 4 cases and got successful dilatations for all of them without complications. Our blocking balloon system is useful for performing the PTA of the ICA safely.

Complex occipital arteriovenous fistula associated with neurofibromatosis treated by embolization and surgery. Case report

It is well known that neurofibromatosis is associated with various types of arteriovenous fistulas (AVF), but association with an occipital AVF has not been reported. We are reporting this case which was successfully treated with a combination of embolization and surgery. Superselective angiography defines the anatomic details of the fistula and intraoperative digital subtraction angiography (DSA) facilitates the surgery to cure the fistula. It is important to identify the best therapeutic options using angiographic information to treat a complex arteriovenous fistula.

Autotransplantation of peripheral cholinergic neurons into the brains of Alzheimer model rats

Current hypotheses regarding Alzheimer's disease implicate cholinergic function. In this study, peripheral cholinergic neurons in the vagal nodosal ganglion were transplanted into the brains of Alzheimer model rats. Eighteen Sprague-Dawley strain rats were divided into three groups: 1) unoperated control rats, 2) rats that had undergone bilateral destruction of the nucleus basalis of Meynert (NBM) (Alzheimer model), and 3) the transplantation group in which the vagal nodosal ganglion was transplanted into the cerebral neocortex one week after the bilateral destruction of the Meynert nucleus. Seven weeks after the transplantation rat behaviour was assessed using psychological tests (spontaneous activity, passive avoidance response and the Hebb-Williams maze test). The Alzheimer model rats had a statistically significant increase in spontaneous activity in comparison with controls (P less than 0.01). The transplant rats showed some amelioration of this abnormal increase in spontaneous activity observed in the Alzheimer model rats. All of the control rats showed conditioned passive avoidance responses, while only one Alzheimer model rat retained is shocked-conditions behaviour before 24 hours (P less than 0.01). Three of the six transplanted rats showed complete improvement in the passive avoidance response test. In the Hebb-Williams maze test, the rats with NMB lesions made more errors than the control rats. The transplanted rats had a lower number of errors than NBM-lesioned rats but still more than the controls. Histological examination revealed many cholinergic cells in the transplanted tissue, especially in the area adjacent to the cerebral cortical surface. The present results indicate that autotransplantation of peripheral cholinergic cells ameliorates abnormal behaviour in Alzheimer model rats.

Meningeal melanocytoma: magnetic resonance imaging characteristics and pathological features. Case report

A case of meningeal melanocytoma at the foramen magnum is reported in a 62-year-old man. Magnetic resonance (MR) imaging revealed characteristic signal patterns: homogeneous high intensity on the T1-weighted image and low intensity on the T2-weighted image. Light microscopy showed a histological appearance similar to that of melanotic meningioma. The ultrastructural features of the neoplastic cells were compatible with those of melanocytes, but they contained no features of arachnoidal cells. Immunohistochemical bromodeoxyuridine study revealed low proliferative activity among the neoplastic cells. The MR appearance and pathological features in this rare case of meningeal melanocytoma are demonstrated and discussed.

A possible involvement of central atrial natriuretic peptide in cerebral cortical microcirculation

The possible involvement of atrial natriuretic peptide (ANP) in cerebral cortical microcirculation was investigated in rats by means of laser-Doppler flowmetry and immunohistochemistry. In the laser-Doppler study, local cerebral blood flow (LCBF) changes after the administration of 10(-6) to 10(-8) mol/LANP solution or vehicle (saline solution) as an intracortical injection for 5 minutes were continuously monitored throughout the 30 minutes of the study and were expressed as percentages of preinjection values represented as 0%. The administration of 10(-6) to 10(-8) mol/LANP caused a significant decrease in LCBF; the onset of LCBF responses occurred within a few minutes after the start of the injection and the decrease in LCBF reached the maximum level within 7 to 10 minutes after the completion of the administration, after which LCBF gradually recovered. In the immunohistochemical study, no specific ANP immunoreactivity was found associated with the intraparenchymal blood vessels; however, ANP-immunoreactive neurons were observed primarily in the hypothalamus and septum, in which high concentrations of ANP-containing neurons have been identified. The data from the laser-Doppler study suggest that central ANP may produce a vasoconstriction of the intraparenchymal blood vessels, regardless of whether through direct action on these vessels or through the mediation by some system in the central nervous system. Because there is no evidence for ANP-containing nerves around these vessels, the role of central ANP in the cerebral circulation must await identification of the source of perivascular ANP.

[Selective vulnerability of peptide-containing neurons in cerebral ischemia; immunohistochemical study]

Histochemical changes in peptidergic and catecholaminergic neurons during ischemia were investigated in the cerebral neocortex of the gerbil. Catecholaminergic fibers were observed by catecholamine histofluorescence with glyoxylic acid solution, and peptidergic neuron systems such as vasoactive intestinal polypeptide (VIP), somatostatin (SOM), and neuropeptide Y (NPY) were observed by immunohistochemistry. Two hours after unilateral occlusion of the internal carotid artery, catecholaminergic fibers disappeared in the neocortex on the occlusion side, while peptidergic nerve fibers except for NPY fibers were intact after 2 hours of ischemia. NPY fibers had decreased in number on the occlusion side 2 hours after ischemia. VIP-, SOM-, and NPY-immunoreactive neurons showed a decrease of 60% six hours after ischemia, and these neurons completely disappeared in the cerebral neocortex 24 hours after ischemia. These results suggest that catecholaminergic neuron system is more vulnerable than the peptidergic one in ischemic event.

[Dynamics of extracellular acetylcholine of the gerbil striatum during cerebral ischemia monitored by intracerebral microdialysis]

Neurons in the hippocampus and striatum are vulnerable to the ischemic insult. In the present study we focused on the vulnerability of acetylcholine (ACh)-containing neurons in the striatum. To determine the change of ACh content in the striatum, we employed a simple sensitive brain microdialysis method with high performance liquid chromatography electrochemical detection. Morphological change of cholinergic neurons was studied by ACh-esterase staining during ischemic insult. After bilateral carotid artery occlusion, local cerebral flow decreased less than 5 ml/min/100 g in the striatum. Ach content in dialysate for 20 min after the occlusion was elevated to 135% of the control. ACh content decreased to 15% of the control 2hs after the ischemia. Density of Cholinergic fibers and cell bodies was reduced 10 min after the ischemia and further decreased 20 min after the occlusion. Our study suggests that the transient elevation of ACh content was probably due to diffusion of ACh from destruction cholinergic terminals after the ischemic insult. The increase of ACh immediately after arterial occlusion may affect severity of ischemic damage in the brain by its excitatory effect.

Effect of atrial natriuretic peptide on ischemic brain edema: changes in brain water and electrolytes

The effects of intraventricularly administered atrial natriuretic peptide (ANP) on the brain water, sodium, and potassium contents in ischemic brain edema were investigated. By use of a three-vessel occlusion model, ischemic brain edema was produced in the rat brain by 15 minutes of global ischemia followed by recirculation. Water content was measured by means of a drying/weighing method; sodium and potassium contents were measured by means of flame photometry. The effects of intraventricular administration of ANP were evaluated by a comparison between the groups given 2 and 5 micrograms of atriopeptin II (treated) and those given 0.9% NaCl (sham-treated). The treated groups showed significant decreases in brain water (P less than 0.02) and sodium (P less than 0.01) contents at 15 and 30 minutes after recirculation, whereas the brain potassium contents remained unaltered. Before ischemia and immediately after 15 minutes of ischemia, intraventricularly administered ANP did not significantly change the brain water, sodium, or potassium contents. There was no significant difference in the effect on the amount of brain water and sodium between the two doses (2 and 5 micrograms). These effects of ANP were thought not to be mediated by primary changes in serum osmolality and sodium and potassium concentrations, because intraventricular administration of ANP did not change them significantly. The present results reveal that, in ischemic brain edema, ANP may act directly on the central nervous system to inhibit brain water and sodium accumulation.