Medial femoral head border is a reliable and reproducible reference for axis determination for femoral component of unicompartmental knee arthroplasty

PURPOSE

The femoral component should be implanted parallel to the mechanical axis in unicompartmental knee arthroplasty. It was hypothesised that a line between medial femoral condyle centres and medial border of femoral head will be parallel to the mechanical axis; this study set out to examine this hypothesis.

METHODS

One hundred X-rays in fifty patients were included for this study. Long-leg standing X-rays including hip and ankle with patellae facing forwards were obtained. On these films, we measured the angle, α, between mechanical axis and the line between the femoral head centre and knee centre (medial mechanical axis), and the angle, β, between the medial mechanical axis and a line between medial femoral condyle and femoral head centre.

RESULTS

The average value of α was 0.1 ± 0.5° and the average value of β 3.0° ± 0.3°. These data indicate that mechanical axis and medial mechanical axis are virtually parallel to each other.

CONCLUSION

As medial femoral head border is easily identified fluoroscopically, it is a reliable landmark for orientating the femoral component of medial UKA.

Activation of fibroblast growth factor receptor 3 and oncogene-induced senescence in skin tumours

BACKGROUND

The activation of oncogenes is an important step in tumorigenesis, and recently, oncogene-induced senescence (OIS) was proposed as a critical barrier against malignant transformation in normal primary cells.

OBJECTIVES

The aim of this study was to examine the activation of fibroblast growth factor receptor 3 (FGFR3) as an oncogene product and OIS in human skin tumours.

METHODS

We investigated the activation of FGFR3 and OIS by mutation and immunohistochemical analysis in skin tumours, including seborrhoeic keratosis, actinic keratosis (AK), Bowen's disease (BD), basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

RESULTS

Activated point mutations of FGFR3 were identified in four of 22 cases (18%) of seborrhoeic keratosis, but no mutation was detected in the other skin tumours. Twenty-seven of 31 cases (87%) of seborrhoeic keratosis showed moderately to strongly positive expression of the FGFR3 protein, but almost all the other skin tumours were negative. On the other hand, almost all the seborrhoeic keratoses showed negative immunoreactivity for antiphoshohistone H2AX (gamma-H2AX) as a marker of OIS, but 17 of 22 cases (77%) of AK were moderately to strongly positive. Immunoreactivity for gamma-H2AX was significantly greater in AK than in seborrhoeic keratosis, BD, BCC and SCC.

CONCLUSIONS

The activation of FGFR3 might be a common feature in the tumorigenesis in seborrhoeic keratosis, although the activation does not induce a typical oncogenic signal in keratinocytes. In addition, OIS due to some oncogenic signals rather than activation of FGFR3 might be involved in the early skin carcinogenesis related to chronic ultraviolet radiation exposure.

Quantitative unspun-urine microscopy as a quick, reliable examination for bacteriuria

The diagnosis and treatment of urinary infection are often delayed, causing renal damage, largely because of the unavailability of quick, accurate, diagnostic examinations. Three hundred and twenty-five urine samples from 130 patients were examined for significant bacteriuria using the standard culture method. The urine samples were also examined using the Gram-stain method and quantitative unspun-urine microscopy. When particles could not be distinguished definitely as bacilli by quantitative microscopy, the unspun urine was examined on a slide glass using oil-immersion microscopy at x 1000 magnification. Significant bacteriuria in 37 urine samples was detected by bacterial culture. Using quantitative microscopy, rods were found in 30, cocci in a chain in 3, and indefinite particles in 44 samples. In the 44 indefinite samples, oil-immersion microscopy was able to distinguish rods in one, cocci in a chain in one, cocci in a cluster in two, and negative in 40, which were confirmed by culture as rods, streptococci, staphylococci, and negative, respectively. The quantitative microscopy method was similarly reliable (94.6% sensitivity, 99.3% specificity) for diagnosis of significant bacteriuria when compared with the Gram-stain method (89.2% sensitivity, 98.6% specificity). Quantitative unspun-urine microscopy, confirmed by oil-immersion, is a quick, reliable method for diagnosis of significant bacteriuria, and is considered to be useful for early diagnosis of urinary infection.

Fusion of HIV-1 Tat protein transduction domain to poly-lysine as a new DNA delivery tool

Effective gene therapy depends on the efficient transfer of therapeutic genes to target cells. None of the current technologies, however, satisfy all of the requirements necessary for gene therapy, because the plasma and nuclear membranes of mammalian cells are tight barriers against gene transfer using synthetic delivery systems. The protein transduction domain (PTD) of human immunodeficiency virus type 1 (HIV-1) Tat protein greatly facilitates protein transfer via membrane destabilisation. We synthesised polylysine peptides containing Tat PTD (TAT-pK), or other sequences, and investigated their potential as agents for gene transfer. The synthesised polypeptide TAT-pK retains DNA binding function and mediates delivery of a reporter gene to cultured cells. RGD motif binds with low affinity to alpha integrins which induce cell activation. Two control polypeptides, GGG-pK and RGD-pK, were synthesised and tested, but their gene transfer abilities were weaker than those of TAT-pK. TAT-pK-mediated gene transfer was enhanced in the presence of chloroquine or ammonium chloride, to a greater extent than that of cationic lipid-mediated gene transfer in most cancer cell lines tested. These data suggest that TAT-pK may be a potent candidate delivery vehicle that promotes gene transfer, dependent on the endocytic pathway. We conclude that the TAT-pK/DNA complex is useful as a minimal unit to package therapeutic genes and to transduce them into mammalian cells.

Clinical significance of immune cell infiltration within gallbladder cancer

To investigate the pathophysiological significance of infiltrating antitumour immune cells, we evaluated the quantity of immune cell intratumoral infiltration in 110 surgically resected gallbladder specimens by immunohistochemistry. We examined 45 cases of gallbladder cancer and 65 cases of benign gallbladder diseases for CD4⁺ T cells, CD8⁺ T cells, natural killer cells (NKCs), and dendritic cells (DCs). High levels of CD4⁺ T cell, CD8⁺ T cell, NKC, and DC infiltration were recognised in 51.1% (23 out of 45), 37.8% (17 out of 45), 33.3% (15 out of 45), and 48.9% (22 out of 45) of cancer specimens, respectively. High numbers of infiltrating CD4⁺ and CD8⁺ T cells correlated with decreasing tumour invasion, and high numbers of infiltrating DCs correlated with decreasing lymph-node tumour metastasis. Furthermore, increased infiltration of CD4⁺ and CD8⁺ T cells and DCs exhibited a significant correlation with prolonged survival. NKC infiltration, however, did not correlate with any of the clinicopathological factors examined. Additionally, high levels of infiltration were not identified in specimens from benign diseases, consistent with the cancer-specific activity of CD4⁺ and CD8⁺ T cells and DCs. In this study, we demonstrate that CD4⁺ and CD8⁺ tumour-infiltrating lymphocyte and DCs, but not NKCs, are important factors in the accurate prognosis of survival after surgical removal of gallbladder adenocarcinoma.

Overexpression of hypoxia-inducible-factor 1alpha(HIF-1alpha) in oesophageal squamous cell carcinoma correlates with lymph node metastasis and pathologic stage

The purpose of this study is to investigate the clinical and histopathologic significance of hypoxia-inducible-factor 1alpha (HIF-1alpha) expression in oesophageal squamous cell carcinoma. One hundred and thirty surgically resected specimens of OSCC were immunohistochemically assessed for HIF-1alpha expression with monoclonal antibody. High HIF-1alpha immunostaining was detected in 40 specimens. The percentage of high HIF-1alpha expression cases increased with tumour stage according to pTNM system. High HIF-1alpha expression correlated with pTNM stage, depth of tumour invasion, lymph node metastasis, distant metastasis, lymphatic invasion and positive surgical margin. The overall survival rate was worse in patients with high HIF-1alpha pattern than in patients with low-expression pattern. Univariate analyses identified high HIF-1alpha positivity, depth of tumour invasion, lymph node metastasis, distant metastasis, lymphatic invasion, and a positive surgical margin as risk factors. Multivariate analyses indicated that depth of tumour invasion, lymph node metastasis and positive surgical margin, but not HIF-1alpha, were independent prognostic factors. Survival in patients with a high HIF-1alpha expression was significantly worse than in those with low expression in patient treated with adjuvant therapy.

Caveolin-I overexpression is a favourable prognostic factor for patients with extrahepatic bile duct carcinoma

Extrahepatic bile duct carcinoma (EBDC) is a malignancy well known for its poor prognosis. Some clinicopathological prognostic markers have been proposed, but genetic factors have not been well investigated. We have examined expression patterns of caveolin-1, which has been shown to function as a tumour suppressor in vitro, in EBDC using immunohistochemistry. Normal tissues adjacent to the tumour cells did not show immunoreactivity for caveolin-1. A total of 22 of the 60-carcinoma tissue samples (36.7%) studied were positive for caveolin-1. Caveolin-1 immunostaining negatively correlated with the patient's age and pathological T factor (pT) in a statistically significant manner. Multivariate analysis using Cox's proportional hazards model identified caveolin-1 expression as an independent positive prognostic factor. Thus, our study suggests that caveolin-1 expression may be a useful prognostic marker for EBDC.

Identification of reddish alcoholic beverages by GC/MS using aroma components as indicators

A method to identify reddish alcoholic beverages used for dissolving stimulant drugs was devised using aroma components as indicators. Thirteen brands of beverages including red wines, blueberry liquors, raspberry liquors, strawberry liquor, a mixture of red wine and blueberry juice and a mixture of red wine and grape juice were examined. Aroma components in each sample were effectively concentrated with a porous polymer beads column (Porapak Q) and were analyzed by gas chromatography/mass spectrometry (GC/MS). Specific aroma components were detected in each beverage and reddish alcoholic beverages were successfully classified into five groups using five aroma components as indicators. The present method should prove to be useful in criminal investigations.

RCAS1 as a tumour progression marker: an independent negative prognostic factor in gallbladder cancer

Receptor-binding cancer antigen expressed on SiSo cells (RCAS1) induces apoptosis in immune cells bearing the RCAS1 receptor. We sought to determine RCAS1 involvement in the origin and progression of gallbladder cancer, and also implications of RCAS1 for patient survival. RCAS1 expression was examined immunohistochemically in 110 surgically resected gallbladder specimens. The gallbladders represented 20 cases of cholecystitis with no associated pancreaticobiliary maljunction; 23 cases of cholecystitis with pancreaticobiliary maljunction; 14 cases of adenomyomatosis; 7 adenomas; and 46 cancers. High expression of RCAS1 (immunoreactivity in over 25% of cells) was observed in 32 of the 46 cancers (70%), but not in other diseases, including pre-cancerous conditions. RCAS1 immunoreactivity was associated with depth of tumour invasion (P = 0.0180), lymph node metastasis (P = 0.0033), lymphatic involvement (P = 0.0104), venous involvement (P = 0.0224), perineural involvement (P = 0.0351) and stage by the tumour, nodes and metastases (TNM) classification (P = 0.0026). Thus, RCAS1 expression may be a relatively late event in gallbladder carcinogenesis, possibly promoting tumour progression. Cox regression multivariate analysis demonstrated RCAS1 positivity to be an independent negative predictor for survival (P = 0.0337; risk ratio, 12.690; 95% confidence interval, 1.216-132.423). High expression of RCAS1 significantly correlated with tumour progression and predicted poor outcome in gallbladder cancer.

Comparison of nutrient budgets between three forested mountain watersheds on granite bedrock

The budgets of nutrients and major ions between the input flux from atmospheric deposition and the output flux to streams were measured on three forested small mountain watersheds, Aburahi-N (23.8 ha), Aburahi-S (3.8 ha, 2 km south from Aburahi-N) and Myokoji (1.77 ha, 28 km northwest from Aburahi-N), located at 34-35 N and 136 E around the central part of Japan. The bedrock of the watersheds is granite. The main vegetation of Aburahi-N and Aburahi-S was planted with Japanese cypress (Chamaecyparis obtusa Sieb. et Zucc), and Myokoji was a secondary forest growing deciduous broadleaf trees and Japanese red pine. The chemical analysis of the stream waters was carried out once a week at Aburahi-N from 1987 to 1991, at Aburahi-S from 1995 to 1998, and at Myokoji from 1991 to 1993. Wet and dry depositions were collected every month at Aburahi-N. The annual mean concentrations of total nitrogen (TN) of the stream water of Aburahi-N, Aburahi-S and Myokoji were 0.408, 0.614 and 0.349 mg/l, respectively, total phosphorus (TP) contents were 0.0074, 0.0046 and 0.0096 mg/l, and the potassium ion (K+) contents were 0.83, 0.49 and 0.77 mg/l. The average annual output fluxes of TN from the watersheds of Aburahi-N, Aburahi-S and Myokoji were calculated to be 5.85, 4.10 and 12.7 kg/ha/y, TP 0.131, 0.045 and 0.280 kg/ha/y, K+ 9.63, 3.23 and 9.70 kg/ha/y, and discharge 1062, 508 and 1265 mm/y, respectively. The annual outputs tended to increase as the annual precipitation increased. The average annual input fluxes of TN, TP and K+ for six years from 1990-1998 were 12.5, 1.31 and 7.64 kg/ha/y, respectively, and the precipitation averaged 1449 (1019-1947) mm/y.

New method for jejunal pouch interposition reconstruction after distal gastrectomy

BACKGROUND/AIMS

Recently pouch reconstruction has been reported to improve quality of life and functional results after surgery for gastric cancer. Although jejunal pouch reconstruction after distal gastrectomy has favorable results for patients' quality of life, it is complicated and takes a long time to complete. We developed a new technique using a linear stapling device to avoid this problem.

METHODOLOGY

The duodenum and the jejunum are simultaneously divided with a 100-mm linear stapler 0.5 cm distal to the pyrolus ring and 20 cm distal to the ligament of Treitz, respectively. A 100-mm linear stapler is introduced into two approximated segments of the jejunum through two small stab wounds 10 cm and 15 cm distal to the stump, respectively, and side-to-side anastomosis is performed along the antimesenteric borders. The anterior wall of the pouch is cut along the prospective line of anastomosis with the gastric remnant. The anterior wall of the stomach is cut along the planned suture line having a length similar to that of the pouch. The posterior walls of the stomach and the jejunal pouch are placed back-to-back on the planned anastomotic line. End-to-end posterior anastomosis between the gastric remnant and the jejunal pouch is simultaneously performed with gastrectomy using a 100-mm linear stapler. End-to-end anterior anastomosis is created by hand.

RESULTS

This technique has been used in 4 patients, and there have been no complications related to the pouch or anastomoses. Mean operative time was 255 +/- 37 min (range: 205-290 min).

CONCLUSIONS

Shortening of operative time can be attributed to adoption of end-to-end posterior anastomosis between the stomach and the jejunal pouch using the linear stapling device simultaneously with gastrectomy.

A novel PTEN mutation in a Japanese patient with Cowden disease

Cowden disease (CD) is an autosomal dominant syndrome characterized by multiple hamartomatous lesions and an increased risk for malignancies. Recent evidence has indicated that the PTEN gene, encoding a protein tyrosine phosphatase, is the CD susceptibility gene. However, another line of evidence has suggested that CD might be genetically heterogeneous. Clinical features of CD are variable, and there are interfamilial differences in the expression of skin lesions. Therefore, information on PTEN mutations in CD patients should be accumulated to clarify the genotype-phenotype correlation. In the present study, we found heterozygous germline mutations of PTEN in all of three Japanese patients with CD examined, indicating no genetic heterogeneity among our patients. The mutations included two non-sense mutations of R335X and R130X, and a mis-sense mutation of C136R. To the best of our knowledge, the C136R mutation has not previously been reported in CD patients. This novel mutation was located outside the core motif of the phosphatase domain of PTEN protein, where most of the missense mutations previously reported in CD patients were clustered. Mucocutaneous manifestations were far fewer in the patient with this mutation than in the patients with nonsense mutations. Whether the phenotypic difference in mucocutaneous features was due to the different mutations remains unclear.

Carotenoids and retinoids as suppressors on adipocyte differentiation via nuclear receptors

The adipocyte differentiation program is regulated by the sequential expression of transcriptional activators, mainly peroxisome proliferator activated receptor (PPAR) families. In the present study, we have decided to systematically examine the effects of vitamin A and its precursors, carotenoids and retinoids, on terminal differentiation from preadipocytes to adipocytes on the cellular and molecular aspects. The effects of active form of vitamin A, retinoic acid (RA), are believed to be mediated by specific nuclear receptor proteins [retinoic acid receptor (RAR)] which are members of the steroid and thyroid/retinoid receptor superfamily of ligand dependent transcriptional regulators, RARalpha, RARgamma, RXRalpha, and RXRbeta mRNA were abundant in adipose tissue and 3T3-L1 adipose cells. The autoregulated amplification of RARgamma mRNA was observed by these own ligands in 3T3-L1 cells. And, RA inhibited PPARgamma2 expression more effectively and caused concomitantly a greater inhibition of adipocyte differentiation. These results suggest that the inhibitory action of adipocyte differentiation by carotenoids and retinoids are exhibited through the RAR up-regulation and the suppression of PPARgamma2. The nature of the cross talk of vitamin A actions between the RARs, RXRs and PPARs via co-activator in adipose tissue will likely prove to be important for understanding the process of adipogenesis.

Dominant-negative mutations of the tumor suppressor p53 relating to early onset of glioblastoma multiforme

Previous experiments have suggested that some mutant forms of p53 are able to inactivate the endogenous wild-type p53 protein in a dominant-negative fashion. However, it remains unknown whether tumors with such dominant-negative (transdominant) p53 mutants have a biological significance that is different from that of recessive p53 mutants. In this study, we examined the dominant-negative potential of various p53 mutants using a yeast-based assay in which both wild-type and mutant p53 were efficiently expressed. We tested a total of 106 p53 mutants, which were identified in brain tumors, glioblastoma multiforme-derived cell lines, breast cancers, or premalignant lesions and squamous cell carcinomas of oral epithelium or were otherwise created by mutagenesis. In agreement with the previous studies, our results demonstrated that transdominant mutations affected amino acid residues that are essential for the stabilization of the DNA-binding surface in the p53 core domain and for the direct interaction of p53 with its DNA-binding sequence. Among 40 patients with sporadic glioblastomas, the average age at diagnosis was significantly younger in the patients with tumors harboring dominant-negative mutations (30.4 +/- 14.7 years, n = 7) than it was in those with recessive mutations (55.2 +/- 18.6 years, n = 9, P < 0.012) and in those without mutations (54.7 +/- 17.1 years, n = 24, P < 0.003). Our data suggest that dominant-negative p53 mutants accelerate development and/or growth of glioblastoma anlagen.

Ultrasonography evaluation of abdominal fat in live rats

We have developed a new noninvasive method of estimating abdominal fat volume in live rats using ultrasonography. By this method, cross sections of perirenal (retroperitoneal) fat tissue, which is an abdominal fat, at the renal vein level could be identified and the area determined. The perirenal fat in Wistar rats (wide body weight range, 111.4 to 497.3 g; limited range, 300.1 to 337.9 g) measured by ultrasonography was compared with the actual fat tissue weight. The cross-sectional area of perirenal fat tissue was significantly correlated to the actual whole tissue weight. Using this procedure, we examined the changes of perirenal fat stores during fasting. Consequently, the cross-sectional area of perirenal fat and its actual weight decreased in parallel. Total body electrical conductivity (TOBEC) is currently used to measure fat-free mass (FFM) and indirectly predicts total body fat mass of live laboratory animals. The body fat distribution, that is, the location of adipose tissue in the abdominal region, is closely associated with obesity-related diseases. Therefore, it is important to focus not only on the accumulation of total body fat, but also on that of abdominal fat. The present ultrasonographic method is considered to be useful for repeated noninvasive measurement of abdominal fat in the live rat.

A case of pseudosarcoma associated with type 3 squamous cell carcinoma of the esophagus: report of a case

A case of a primary esophageal pseudosarcoma associated with an independent type 3 tumor is described herein. A 60-year-old male presented with dysphagia and chest discomfort. A clinical evaluation revealed a type 3 tumor in the middle of the esophagus, which was diagnosed after a biopsy to be squamous cell carcinoma (SCC). A subsequent gross examination of the subtotally removed esophagus revealed a polypoid tumor adjacent to the type 3 tumor. Histologically, the polypoid mass was composed of SCC and mesenchymal components without a transitional zone. The tumor was thus classified as a pseudosarcoma of the esophagus, and was unique in that this appeared to have developed independently from the SCC.

Identification of an alcoholic beverage in which methamphetamine was dissolved

A man was arrested for violating the Stimulant Control Law. Twelve small plastic containers each containing 1-3 ml of reddish purple alcoholic beverage in which methamphetamine had been dissolved, and a bottle of blueberry liquor of a similar colour, were found in his house. He admitted that the blueberry liquor belonged to him, but strongly insisted that he had been asked to keep the containers by another person and that he had no knowledge of their contents. The alcoholic beverage and the blueberry liquor were analyzed in order to test whether he had dissolved methamphetamine in the blueberry liquor. The aroma components found in the alcoholic beverage in each of the plastic containers were identical, but differed from those found in the blueberry liquor. Based on these results and further police investigations, the suspect's allegation was supported and he was not prosecuted.

Dietary taurine enhances cholesterol degradation and reduces serum and liver cholesterol concentrations in rats fed a high-cholesterol diet

The effect of taurine on hypercholesterolemia induced by feeding a high-cholesterol (HC) diet (10g/kg) to rats was examined. When various amounts of taurine (0.25, 0.5, 1, 2.5, 5, 10, 20, 30, 40 or 50 g/kg diet) were supplemented to HC for 2 wk, serum total cholesterol gradually and significantly decreased in a dose-dependent manner and normalized at the dose of 10 g taurine/kg, compared with the control (cholesterol free) diet group. By contrast, serum HDL-cholesterol was elevated by taurine supplementation. The HC diet caused a significant decrease in the concentration of taurine in serum, liver and heart compared to that in the control group, and the effective dose of supplemental taurine to improve its reduction was 2.5 g/kg diet. In the hypercholesterolemic rats fed the HC diet, the excretion of fecal bile acids and hepatic cholesterol 7 alpha-hydroxylase (CYP7A1) activity and its mRNA level increased significantly, and the supplementation of taurine further enhanced these indexes, indicating an increase in cholesterol degradation. The abundance of mRNA for Apo A-I, one of the main components of HDL, was reduced by HC and recovered by taurine supplementation. Agarose gel electrophoresis revealed that, in hypercholesterolemic rats fed the HC diet, the serum level of the heavier VLDL increased significantly, but taurine repressed this increase and normalized this pattern. Significant correlations were observed between the time- and dose-dependent increases of CYP7A1 gene expression and the decrease of blood cholesterol concentration in rats fed the HC diet supplemented with taurine (time, r = -0.538, P < 0.01, n = 32; dose, r = -0.738, P < 0.001, n = 20). These results suggest that the hypocholesterolemic effects of taurine observed in the hypocholesterolemic rats fed the HC diet were mainly due to the enhancement of cholesterol degradation and the excretion of bile acid.

Clinical significance of hepatocyte growth factor and c-Met expression in extrahepatic biliary tract cancers

Hepatocyte growth factor (HGF)/c-Met expression is known to be correlated with poor prognosis in several cancers. We investigated HGF/c-Met immunoreactivity and its correlation with clinical features in 51 patients with curatively resected extrahepatic biliary tract carcinoma. c-Met showed significant correlations with tumor location, T category, stage, perineural invasion and local recurrence. Overall survival in patients with HGF and c-Met immunopositivity was significantly worse than in those who were negative. Our findings suggest that HGF/c-Met play some roles in tumor development and that HGF/c-Met immunoreactivity could be a predictor of the mode of recurrence and poor prognosis.

[Emergency coronary artery bypass grafting in dialysis patients]

Emergency coronary artery bypass surgery was performed in nineteen patients including five chronic hemodialysis patients. In fourteen patients (non-dialysis patients), ten patients required preoperative IABP and four required PCPS for cardiogenic shock. Four patients died (29%); three from LOS and one from sudden death. Most of them (3/4) were preoperative cardiogenic shock. In other five patients (dialysis patients), four patients had conventional CABG, while one received off-pump bypass surgery for calcified aorta and brain complication. All five patients received arterial in situ conduit and continuous hemofiltration in the early postoperative period for controlling water and electrolyte. Two patients died (40%); one from arrhythmia and one from deterioration of original disease (SLE encephalopathy) but no one died from LOS. These methods of surgical modification and perioperative management for chronic hemodialysis patients are considered very useful.

Laparoscopic treatment of cholecystocolonic fistula: report of a case preoperatively diagnosed by barium enema

The authors present a case of cholecystocolonic fistula with no specific symptoms, such as severe diarrhea or pneumobilia, preoperatively diagnosed and treated by the laparoscopic approach. A preoperative barium enema demonstrated a cholecystocolonic fistula. The fistula was divided by the laparoscopic stapling technique. Important features in the management of this case are (1) preoperative diagnosis of the fistula by barium enema carried out for screening colorectal cancer, (2) dissection of the gallbladder from its bed before division of the fistula, and (3) use of the laparoscopic stapling technique to divide the fistula while preventing fecal soilage.

Vascular endothelial growth factor expression is an independent negative predictor in extrahepatic biliary tract carcinomas

BACKGROUND

Vascular endothelial growth factor (VEGF) is one of the most important factors for angiogenesis in various tumors. However, its clinical significance in extrahepatic biliary tract carcinoma remains unclear.

MATERIALS AND METHODS

To clarify the association of VEGF expression with the clinicopathological features of the disease, surgical specimens from 51 patients were examined for VEGF expression by immunohistochemistry.

RESULTS

Sixteen of 51 (31.4%) cases were positive for VEGF. VEGF immunoreactivity showed a tendency toward association with lymph node metastasis, M category and peritoneal recurrence (p = 0.059, 0.086 and 0.069, respectively). Overall survival in patients with VEGF positivity was significantly worse than in those with negativity (p = 0.033 by log-rank test). Multivariate Cox regression analysis revealed that VEGF expression was an independent negative predictor (p = 0.025).

CONCLUSION

VEGF immunoreactivity is an independent negative predictor in extrahepatic biliary tract carcinomas.

Lack of somatic mutation in the PTEN gene in squamous cell carcinomas of human skin

The tumor suppressor gene PTEN is deleted and/or mutated in a variety of tumors and the susceptibility gene for Cowden disease. Loss of heterozygosity of chromosome 10q23, where PTEN resides, in squamous cell carcinomas (SCCs) of human skin and the association of SCC with Cowden disease were reported previously. In the present study, we screened for mutations of PTEN in SCCs by polymerase chain reaction single strand conformation polymorphism analysis to examine whether PTEN is involved in the carcinogenesis of SCC. None of 21 SCCs showed somatic mutations in the coding regions of PTEM. Instead the same allelic variation was detected in two cases without any clinical features of Cowden disease. Our results indicate that inactivation of PTEN does not play an important role in the carcinogenesis of SCC.

Counteraction of retinoic acid and 1,25-dihydroxyvitamin D3 on up-regulation of adipocyte differentiation with PPARgamma ligand, an antidiabetic thiazolidinedione, in 3T3-L1 cells

Retinoic acid (RA) and 1,25-dihydroxyvitamin D3 (1,25 (OH)2 D3) inhibited adipocyte differentiation of 3T3-L1 preadipocytes in the presence of thiazolidinedione, a specific ligand for peroxisome proliferator-activated receptory (PPARgamma). These fat-soluble vitamins repressed the up-regulated protein expression of PPARgamma2 during the first 40 hours of initiation of 3T3-L1 preadipocyte differentiation. Compared with RA, 1,25 (OH)2 D3 inhibited PPARgamma2 expression more effectively and caused concomitantly a greater inhibition of adipocyte differentiation. These results suggest that the inhibitory action of adipocyte differentiation by RA or 1,25 (OH)2 D3 is exhibited through direct repression of the expression of PPARgamma2 protein, even in the presence of its ligand. They also raise the intriguing possibility that attenuation or amplification of the pharmacological effects of thiazolidinedione that are dependent on PPARgamma in adipose cells is caused by alteration of the levels of these fat-soluble vitamins.

Identification of beverages and beverage stains by GC/MS using aroma components as indicators

A method to identify brown coloured beverages or beverage stains for criminological purposes was devised using aroma components as indicators. The examined beverages comprised three brands each of beer, coffee, cola and black tea, two brands of oolong tea, and four brands of green tea. Aroma components in each sample were efficiently concentrated with a porous polymer beads column (Porapak Q) and were analyzed by gas chromatography/mass spectrometry (GC/MS) using n-octyl alcohol as the internal standard. Specific aroma components were found in each beverage and beverage stain, for example cis-terpin hydrate in cola, and thus identification of beverages or beverage stains became feasible through the detection of these specific components. The present method was applied efficiently to two practical criminological cases.

Moisture-induced drift in thermo-optic phase shifters composed of deuterated and fluorinated methacrylate polymer waveguides

Using deuterated and fluorinated methacrylate polymer waveguides, we fabricated thermo-optic phase shifters that require a small electric power of 10 mW to cause a pi phase shift. The phase shifters had a phase drift that was greater at higher humidity and that was saturated in approximately 10 min. This phenomenon is ascribed to the moisture desorption-sorption of the waveguide polymers caused by heating-cooling on the basis of experimental results on the relationships among waveguide temperature increase, relative humidity, and moisture sorption of the waveguide polymers. This conclusion is supported by the calculation of temperature and moisture distribution in the waveguide when the thin-film heater is heated.

Genetic analysis of Pseudomonas aeruginosa by pulsed field gel electrophoresis

We identified the serotypes and genomes patterns of 100 strains of Pseudomonas aeruginosa (P. aeruginosa) that had been isolated from patients who were admitted to the hospital of the Fukui Medical School between 1992 and 1995. A monoclonal diagnostic kit was used to identify the serotypes. Genome patterns were determined by pulsed field gel electrophoresis (PFGE). Serotypes A, B, C, D, E, F, G and I exhibited distinct genome patterns. Differences in genome patterns were also observed in strains of serotypes E and G, depending on the types of clinical samples collected and/or the area of the hospital from which they were isolated. Many of the multiple antibiotic-resistant strains of P. aeruginosa exhibited serotype E. The genome pattern differed between strains that were susceptible vs. resistant to multiple antibiotics. The latter strains exhibited similar genome patterns regardless of their origin. These findings suggest that analysis of genome patterns is important for identifying the origin of nosocomial infection caused by P. aeruginosa, serotype E.

Value of intraoperative intrathoracic ultrasonography during video-assisted thoracoscopic pulmonary resection

Recent advances in endoscopic surgical equipment, video monitoring, and endoscopic surgical techniques have expanded the application of thoracoscopic surgery to pulmonary resection. One of the major limitations of this technique is the difficulty in identifying invisible pulmonary nodules in which manual palpation is not possible. To resolve this problem, we employed intraoperative intrathoracic ultrasonography during video-assisted thoracoscopic pulmonary resection. We conclude that intraoperative ultrasonography during thoracoscopic pulmonary resection is useful to identify pulmonary nodules, except inflammatory lesions.

[The clinical significance of glitter-cells in the urine during urinary tract infection]

To clarify the relationship between glitter-cells and urine osmotic pressure, neutrophils were isolated from venous blood of 4 normal volunteers and incubated in urine specimens with different osmotic pressures. Glitter-cells were detected in the urine with 100-400 mOsm/l. The rate of glitter-cells in neutrophils incubated for 4 hours were significantly less than those incubated for 0 minute (p < 0.05). We clinically investigated the relationship between the presence of glitter-cells in fresh urine and the site of urinary tract infection (UTI) or organisms isolated from urine. Fresh urine samples were obtained from 95 patients (55 male and 40 female). Urine samples were examined for bacteriuria by the quantitative culture method, and significant bacteriuria was defined as more than 10(5)/ml of bacilli for midstream urine or as more than 10(4)/ml for urine collected by catheterization. Leukocytes and glitter-cells in the unspun and unstained urine were counted on a disposable slide using a counting chamber. Patients with upper UTI showed a significantly higher incidence of glitter-cells than patients with lower UTI (p < 0.05). Patients with glitter-cells had a significantly higher incidence of polymicrobial infections than those without glitter-cell (p < 0.05). These findings suggest that patients with glitter-cells in the urine show upper UTI (pyelonephritis) and polymicrobial infections.

[Quantitative urine microscopic examination using disposable counting chamber for diagnosis of urinary tract infection]

Routine urinalysis is performed as a screening test for urinary tract infection (UTI) in out-patients or in-patients. We assessed the usefulness of microscopic examination of unspun and unstained urine using a disposable slide with counting chambers (Kova Slide 10 grid, Miles-Sankyo) for diagnosis of significant bacteriuria. 173 fresh urine samples were obtained from 173 subjects (89 male and 84 (female), including 117 inpatients, aged from 0 to 96 years. Urine samples were examined for bacteriuria by the standard culture method and counting chamber method. Significant bacteriuria was defined as 10(5)/ml or more of bacilli for midstream urine and urine collected by bags and 10(4)/ml or more for urine collected by catheterization and from indwelling catheters. Urine leukocytes were also counted on disposable slide. The rapid dipstick test (N-multistix-SG-10, Miles-Sankyo) of leukocyte esterase activity and nitrite were measured in the urine specimens read by a photometer (Clinitek-10, Miles-Sankyo). Significant bacteriuria was diagnosed by standard culture method in 67 urine samples. Close correlation was obtained between bacterial counts determined by the bacterial culture and counting chamber method (Spearman's correlation coefficient p < 0.001). Sensitivity and negative predictive value for significant bacteriuria were 94.0 and 95.1%, respectively, when bacteriuria or pyuria was present in the counting chamber. Dipstick test had a sensitivity and negative predictive value of 86.6 and 89.9%, respectively, when either leukocyte esterase activity of + or more, or nitrite of + was found. In out-patients, both sensitivity and negative predictive value were as high as 100% in counting chamber method. Thus, we can conclude that urine microscopy on disposable counting chambers is a very sensitive, simple, time-saving and lost-effective method for diagnosis of UTI.

Urine microscopy on a counting chamber for diagnosis of urinary infection

Several quantitative methods of urine microscopic examination for bacteriuria and pyuria on a blood cell counting-chamber have been found reliable for the diagnosis of urinary tract infection (UTI). However, no one technique has become popular or widely used because of laborious procedures associated with the method. We investigated the usefulness of microscopic examination of uncentrifuged urine on disposable counting-chambers. A total of 89 urine samples were obtained from 53 children (24 male and 29 female). Urine samples were examined for bacteriuria and pyuria using a disposable counting chamber and its reliability was analyzed in predicting significant bacteriuria defined by routine urine culture. Significant bacteriuria was diagnosed in 23 of 89 urine samples by urine culture. Microscopic urine examination on disposable counting-chambers was very easy without the need to set up or wash chambers and provided immediate information. Urine bacterial concentration determined by the counting-chamber method was closely correlated to that determined by bacterial culture. The counting-chamber method identified bacteriuria correctly in 21 of 23 urine samples diagnosed as significant bacteriuria (sensitivity = 91%) and also gave a correct diagnosis of 64 of 66 urine samples with non-significant bacteriuria (specificity = 98%). Nineteen of the 23 urine samples with significant bacteriuria also had pyuria. The positive predictive value of concomitant bacteriuria and pyuria was 100%. When neither bacteriuria nor pyuria was found, the negative predictive value was 100%. It was concluded that urine microscopy using disposable counting chambers was very easy, inexpensive, quick and reliable and thus an extremely useful method for diagnosing UTI.

Rapid dipstick test for diagnosis of urinary tract infection

The rapid dipstick test of urine leukocyte esterase (LE) activity and nitrite has not been studied fully in pediatric clinical situations. We investigated the usefulness of the dipstick LE and nitrite test in the screening of urinary tract infection (UTI) in pediatric patients. Ninety-two fresh urine samples were obtained from children suspected of having UTI. Leukocyte esterase activity and nitrite were measured in the urine specimens read by a photometer. Leukocytes were also counted on a disposable slide. Urine samples were examined for bacteriuria by the standard culture method. The results of the urine dipstick test of LE showed a close relationship with leukocyte counts on a counting chamber. Leukocyte esterase (-) indicated leukocyte counts of less than 10/uL with a probability of 97% (58/60). Of the 22 urine samples with significant bacteriuria diagnosed by standard urine culture, the nitrite test did not detect bacteriuria in 10. While the sensitivities of the dipstick tests of nitrite (+) and LE +/- or more for the diagnosis of significant bacteriuria were 55% (12/22) and 86% (19/22), respectively, the sensitivity and negative predictive value of the combined test were 100%. These results suggest that use of the dipstick test of LE and nitrite can avoid a large part of the cost incurred by urine culture and is useful for screening UTI in children.

Diagnosis of urinary tract infection by urine microscopy using a disposable counting chamber

Routine urinalysis is performed as a screening test for urinary tract infection (UTI), but is not very reliable. We assessed the usefulness of microscopic examination of unspun urine using a disposable slide with counting chambers for the diagnosis of UTI caused by a variety of species of bacilli. One hundred and seventy-two urine samples were obtained from 113 subjects (60 male and 53 female), including 84 inpatients, aged 20-96 years. The urine samples were examined for bacteriuria and pyuria using a counting chamber, and the reliability of this method in predicting significant bacteriuria defined by routine urine culture and Gram stain of urine smears was analyzed. Significant bacteriuria was diagnosed in 68 urine samples, including 34 from indwelling catheters, from 52 patients mostly having underlying diseases. Only 12 of the positive urine samples contained E. coli, with a variety of other bacilli including cocci found in the rest. The counting chamber method detected bacteriuria in 64 of these 68 positive samples (sensitivity = 94%). Specificity was 88%. While the sensitivity and specificity of pyuria (WBC > 10 microliters-1) were 79 and 71%, respectively, both sensitivity and negative predictive value were as high as 97% when bacteriuria or pyuria was present. We demonstrated that urine microscopy on a disposable counting chamber is a simple, sensitive and time- and cost-saving method for the diagnosis of UTI caused by a variety of bacterial species including cocci.

Formation of p-hydroxycocaine from cocaine by hepatic microsomes of animals and its pharmacological effects in mice

The hepatic microsomal metabolism of cocaine and the pharmacological effects of some metabolites were studied in experimental animals. Hepatic microsomes from mice, rats and guinea pigs catalyzed the oxidation of cocaine to m- and p-hydroxycocaines. Only trace amounts of m-hydroxycocaine were detected in the extract of the incubation mixture with rabbit hepatic microsomes. The total amount of the two hydroxycocaines was less than 12% that of norcocaine which was the most predominant microsomal metabolite in all the animals species examined. The administration of p-hydroxycocaine (20 mg/kg i.p.) to mice significantly increased locomotor activity (total distance and number of rearing movements). The effect of p-hydroxycocaine was more active or comparable with that of cocaine, indicating that this metabolite is an active metabolite of cocaine.

Interaction of rat lecithin-cholesterol acyltransferase with rat apolipoprotein A-I and with lecithin-cholesterol vesicles

The interaction of rat plasma lecithin-cholesterol acyltransferase with lecithin-cholesterol vesicles and with rat apo-A-I was studied in comparison with that of human plasma lecithin-cholesterol acyltransferase to clarify the reaction mechanism of rat plasma lecithin-cholesterol acyltransferase. The interaction of both human and rat lecithin-cholesterol acyltransferase with lecithin-cholesterol vesicles was investigated by gel permeation chromatography on Superose 12. Both enzymes had almost the same affinity to the vesicles. The affinity of rat enzyme to rat apo-A-I was stronger than that of human enzyme to human apo-A-I when estimated on the apo-A-I-Sepharose 4B column. When human apo-A-I was added to the human enzyme/vesicle mixture which contained the enzyme-vesicle complex, the enzyme was effectively dissociated from the complex. But when rat apo-A-I was added to the rat enzyme/vesicle mixture, apo-A-I-enzyme-vesicle complex was still recognized by its elution pattern on gel permeation chromatography. This suggests that the mixture of rat enzyme, rat apo-A-I, and vesicles, which are the major components in the rat lecithin-cholesterol acyltransferase reaction, forms a stronger complex than do the components of the human reaction.

[Relationship between immediate hypersensitive reactions by buckwheat ingestion and specific IgE for rice in subject with positive IgE-RAST for buckwheat]

IgE-mediated mechanisms are important in immediate hypersensitive reactions (IHR) to buckwheat. However, a part of subjects with high IgE for buckwheat show no IHR to buckwheat ingestion. Inspite of cross-allergenicity between buckwheat and rice, rice ingestion rarely induces IHR even in subjects with high IgE for rice unlike buckwheat-induced IHR. We speculated that there were some relationships between the presence of IHR to buckwheat and recognition of cross-allergenic determinants on buckwheat components with rice components. We examined IgE-RAST for rice in 58 subjects with positive IgE-RAST for buckwheat. IgE-RAST for Dermatophagoides pteronyssinus (Dp), egg white and cow's milk as unrelated antigens with rice were also assessed for a comparison. Subjects (n = 33) without IHR to buckwheat showed higher IgE-RAST values for rice than those (n = 25) with IHR, whereas there were no differences in IgE-RAST values for Dp, egg white and cow's milk between two groups with and without IHR. IgE-RAST values for buckwheat showed significant close correlations to those for rice in subjects without IHR to buckwheat but not in those with IHR. There were no significant correlations between IgE-RAST values for buckwheat and for Dp, egg white or cow's milk in both groups with and without IHR. These results suggested that the IgE from subjects without IHR to buckwheat recognized cross-allergenic determinants with rice on the buckwheat components.

Forensic analysis of triazolam in human tissues using capillary gas chromatography

A reliable and sensitive method has been developed to assess the concentrations of the hypnotic drug triazolam in human tissues, including putrefied tissues. The method involves a 3-step solvent extraction, clean-up on a silica gel column and gas chromatography using a nitrogen phosphorus detector and a capillary column. Estazolam was used as an internal standard. The calibration curve was linear over the concentration range 1 ng/g-1 microgram/g and the lower limit of detection was 0.5 ng/g. A forensic study was performed on the toxicological effects of triazolam using putrefied tissues.

Demonstration of immunoglobulin G in normal human epidermis by peroxidase-labeled antibody

Cytoplasmic immunoglobulin G (IgG) in normal human epidermis was defined by a peroxidase-labeled antibody method. A correlation between cytoplasmic staining and the serum level of IgG was found. Epidermal cells containing IgG were not present when the serum level of IgG was less than 1000 microgram/ml.