Factors associated with nodal metastasis in nasopharyngeal cancer: an approach to reduce the radiation field in selected patients

OBJECTIVES

The purpose of this study was to investigate factors associated with lymph node (LN) metastasis to identify which nasopharyngeal cancer (NPC) patients can undergo a reduction in the prophylactic radiation field. MRI of biopsy-proven NPC patients was evaluated to determine primary tumour extension and the existence of LN metastasis.

METHODS

Sex, age, pathological type, T stage, primary tumour size, existence beyond the midline of the nasopharynx at the primary site and parapharyngeal extension of the primary tumour were assessed regarding their impact on the laterality of LN metastasis using the χ(2) test.

RESULTS

Of the 167 patients, 149 (89%) showed nodal involvement. The existence beyond the midline of the nasopharynx was significantly associated with the laterality of LN metastasis (p<0.0001). Most patients (82%) with primary tumour presence within the midline showed only ipsilateral LN metastasis or no LN metastasis. In addition, contralateral LN metastases were seen only at Level II and the retropharyngeal LN among most of other patients.

CONCLUSION

These results suggest that LN areas other than Level II and the retropharyngeal LN on the contralateral side could be omitted in patients with primary tumour presence within the midline and without the contralateral Level II or the retropharyngeal LN. Whether disease control is compromised by reducing the radiation field for subclinical diseases is a problem that should be solved in the future by prospective study.

Role of alpha adrenoceptors in the nucleus accumbens in the control of accumbal noradrenaline efflux: a microdialysis study with freely moving rats

Microdialysis technique was used to study the effects of the locally applied alpha adrenoceptor agonist phenylephrine and antagonist phentolamine on the basal noradrenaline efflux as well as on the noradrenaline uptake inhibitor desipramine-elicited noradrenaline efflux in the nucleus accumbens (NAc) of freely moving rats. Tetrodotoxin reduced basal noradrenaline efflux by 72%, whereas desipramine increased it by 204%. Phenylephrine reduced the basal noradrenaline efflux by 32% and phentolamine blocked this effect. Phentolamine elevated the basal noradrenaline efflux by 150% and phenylephrine counteracted this effect. The desipramine-elicited noradrenaline efflux was not affected by phenylephrine, but enhanced by phentolamine. Desipramine counteracted the effects of phenylephrine and potentiated those of phentolamine. These results indicate that the accumbal noradrenaline efflux is under inhibitory control of alpha adrenoceptors that are suggested to be presynaptically located on adrenergic nerve terminals in the NAc. Furthermore, this study suggests that the conformational state of alpha adrenoceptors varies across the available amount of noradrenaline. The clinical impact of these data is discussed.

Betaine and homocysteine concentrations in infant formulae and breast milk

BACKGROUND

Early diagnosis and treatment of homocystinuria with methionine-free or low methionine formulae significantly improve prognosis in children found by newborn screening and treated soon after birth. Betaine (Bet) supplementation is also an effective strategy for dietary treatment of homocystinuria. However, previous reports on diet therapy have only examined methionine and cysteine concentrations but not those of Bet and homocysteine (Hcy) in infant diets.

METHODS

We measured Bet and Hcy concentrations in three methionine-free formulae, five infant starter formulae, and 33 samples of human breast milk from 10 mothers.

RESULTS

In methionine-free formulae, Hcy but not Bet was isolated. However, in human breast milk and infant starter formulae, both Bet and Hcy were detected. However, the Bet concentration was not sufficient for the treatment.

CONCLUSIONS

Our study suggests that methionine-free formulae should have Hcy eliminated and be fortified with Bet to the concentration of 150 mg/dL for the treatment of homocystinuria.

Manganese elevations in blood of children with congenital portosystemic shunts

Magnetic response imaging has demonstrated increased signal intensities within the basal ganglia in patients with hepatic encephalopathy; the densities are considered to represent manganese deposition. We measured whole blood manganese concentrations in nine children with congenital portosystemic venous shunts detected by screening tests for galactosaemia. Beyond 1 year of age, these patients showed significantly higher manganese concentrations than controls (2.40 +/- 0.43 versus 1.48 +/- 0.38 micrograms/dl; P = 0.0001). Four of the nine patients were studied by magnetic response imaging. T1-weighted images showed increased signal intensities in the basal ganglia of those four patients, suggesting manganese accumulation.

CONCLUSION

Children with congenital portosystemic venous shunts showed manganese elevations in blood and magnetic response imaging changes in the basal ganglia. These children should avoid excessive manganese intake.

Congenital porto-left renal venous shunt as a cause of galactosaemia

Congenital porto left renal venous (PRV) shunt was found to be the cause of galactosaemia in four galactosaemic neonates detected by mass screening (Paigen method). The patients did not have hereditary galactosaemias and were diagnosed as having galactosaemia of unknown cause, because porto-systemic venous (PS) shunts had not been recognized. At the time of diagnosis, hypergalactosaemia was not severe (0.44-0.55 mmol/L; 8-10 mg/dl) and plasma concentration of total bile acids (TBA) did not suggest a PS shunt (46-50 micromol/L). However, slightly but consistently increased concentrations of galactose and TBA strongly suggested the presence of a PS shunt, and careful ultrasonographic investigation revealed PRV shunt. We conclude that PRV shunt should be suspected in patients with hypergalactosaemia of unknown cause.

Neurological features in Gaucher's disease during enzyme replacement therapy

This report describes two patients with Gaucher's disease who had unusual clinical symptoms during enzyme replacement therapy. One patient was a female with type 3 Gaucher's disease. She developed a pericardial effusion at 7 y of age, which contained many Gaucher cells despite enzyme replacement therapy. She died from neurological deterioration during enzyme replacement therapy, despite an improvement in her visceral manifestations. The other patient is a male with type 2 Gaucher's disease, who has achieved long-term survival after being supported by mechanical ventilation and enzyme replacement therapy. While on enzyme replacement therapy at the age of 4 y, he suffered a generalized cutaneous disease which was clinically diagnosed as ichthyosis.

CONCLUSION

These cases suggest that ordinary enzyme replacement therapy is insufficient for some of the non-neurological manifestations of severe types of Gaucher's disease.

Galactose metabolites in blood from neonates with and without hypergalactosaemia detected by mass screening

Concentrations of galactose (Gal) in plasma and galactose metabolites in red blood cells (RBC) were determined in 18 normal neonates and 249 others with hypergalactosaemia according to the Paigen method. Normal neonatal values for plasma Gal, RBC galactose-1-phosphate (Gal-1-P), RBC uridine diphosphate glucose (UDP-Glc), and RBC uridine diphosphate galactose (UDP-Gal) were 0.96 +/- 0.71 mg/dl, 1.69 +/- 1.45 mg/dl of packed RBC, 1.00 +/- 0.45 mg/dl of packed RBC, and 1.44 +/- 0.45 mg/dl of packed RBC, respectively. The UDP-Gal concentration was higher and the UDP-Glc concentration lower than previously reported in normal children. Of the 249 cases with excessive Gal in whole blood, 23 showed high Gal concentrations in plasma; among these, four portacaval shunts and one case of congenital biliary atresia were diagnosed. In subjects homozygous or heterozygous for UDP-Gal-4 epimerase deficiency, concentrations of UDP-Gal and Gal-1-P were elevated only in RBC, corresponding to restriction of the metabolic abnormality to these cells. Most cases of hypergalactosaemia detected by the Paigen method have large excesses of Gal-1-P in RBC. Although a specific diagnosis based solely on blood Gal metabolites is difficult, individual concentrations reflect underlying conditions to some extent.

CONCLUSION

In neonates, uridine diphosphate galactose concentrations were higher and uridine diphosphate glucose concentrations were lower than previously reported paediatric values. Patients with high plasma galactose concentrations should be investigated by hepatic imaging.

Potential interaction between ritonavir and carbamazepine

Ritonavir (RTV), a protease inhibitor, and carbamazepine (CBZ), an anticonvulsant, were administered concurrently to a patient who had human immunodeficiency virus infection and epilepsy. The combination resulted in elevated serum concentrations of CBZ, with accompanying vomiting, vertigo, and transient liver dysfunction. After discontinuing RTV and reducing the dosage of CBZ, the serum concentration of CBZ returned to the optimal range, symptoms subsided, and liver function returned to baseline. Carbamazepine is metabolized in the liver to a large extent by the cytochrome P450 (CYP) system, especially CYP3A4, 2C8, and 1A2, whereas RTV is metabolized primarily by CYP3A and is a potent inhibitor of this enzyme. Careful clinical monitoring may help prevent adverse drug interactions when these drugs are administered concurrently.

Delay of liver maturation as a cause of transient neonatal galactosemia

BACKGROUND

Because a large amount of serum alpha-fetoprotein (alpha-FP) is synthesized in the liver of the fetus or premature newborn, high concentrations or delayed degradation of serum alpha-FP during the neonatal period may reflect hepatic immaturity.

METHODS

In order to evaluate the relationship between transient neonatal galactosemia and delay of liver maturation, the concentration and half-life of serum alpha-FP during the neonatal period were measured in patients with transient galactosemia and in normal neonates.

RESULTS

No significant differences were observed in the serum concentration of alpha-FP between normal and galactosemic patients less than 1 month of age. However, the half-life of serum alpha-FP was significantly longer in galactosemic patients between 15 and 60 days of age compared with age-matched normal neonates.

CONCLUSION

Based on these results, we hypothesize that delay of liver maturation during the neonatal period, especially during the first 2 months after birth, can be a cause of transient neonatal galactosemia.

Extracapsular cataract extraction with a sutureless incision for dense cataracts

PURPOSE

To evaluate the use of extracapsular cataract extraction (ECCE) via a sutureless incision for dense cataracts.

SETTING

Nagata Eye Clinic, Nara, Japan.

METHODS

This retrospective study comprised 51 eyes of 45 consecutive patients with dense cataracts who had ECCE with a sutureless incision between January 1996 and April 1998. A scleral incision from 6.0 to 8.5 mm was made at 12 o'clock or between 9 and 12 o'clock (oblique incision). Measures of outcome included postoperative visual acuity, surgically induced astigmatism (polar value method and vector analysis), complications, and changes in corneal endothelial cell density and morphology.

RESULTS

Self-sealing was achieved in 45 eyes (88.2%), but additional sutures were required in 6 (11.8%). Intraoperative complications included posterior capsule rupture in 3 eyes (5.9%) and iris prolapse in 2 (3.9%). Corneal flattening against the preoperative steep meridian was observed in the 12 o'clock incision group (0.24 diopter [D] +/- 1.23 [SD]) and in the oblique incision group (0.17 +/- 0.89 D). By vector analysis, the surgically induced vector was 1.41 +/- 0.72 D in the 12 o'clock incision group and 1.02 +/- 0.66 D in the oblique incision group. After surgery, the mean cell loss was 8.2% +/- 12.5%. There were no significant differences, however, between other preoperative and postoperative morphometric indexes.

CONCLUSION

This fast, safe, and inexpensive technique may be a viable treatment for dense cataracts with large, hard nuclei.

Transient galactosemia detected by neonatal mass screening

BACKGROUND

The Paigen method has detected not only persistently galactosemic patients, but also many children with transient galactosemia during the neonatal period. The diagnosis and clinical course of 389 patients with transient galactosemia detected by neonatal mass-screening from 1986 to 1996 in the Hiroshima prefecture were evaluated.

METHODS

Enzyme assays for galactose metabolism, measurement of blood galactose levels, erythrocyte galactose-1-phosphate levels, serum total bile acid (TBA) levels and liver function tests were performed at the first visit by patients to our hospital. Liver function and the mental and physical development of patients were evaluated during the follow-up period (approximately 1 year).

RESULTS

The diagnoses were classified as follows: 253 patients with unknown cause, 128 heterozygotes and two homozygotes for galactose enzyme deficiency (galactose-1-phosphate uridyltransferase, galactokinase, UDP-galactose 4-epimerase) and six heterozygotes for Duarte variant. Twelve patients showed high serum levels of TBA (> 80 mumol/L), which suggests the presence of portal-systemic shunts during the neonatal period causing galactosemia. Most patients showed normal mental and physical development during infancy. However, of 25 patients with mild to moderate abnormal liver function tests of unknown etiology after the neonatal period, five showed poor weight gain coincident with liver dysfunction. In almost all patients, levels of transferase decreased to the normal range by 1 year of age.

CONCLUSION

We found that the prognosis of transient galactosemia was almost always favorable. However, patients should be followed for at least 1 year, because late liver dysfunction, which might cause poor weight gain, occurred in 6% of our patients.

Spontaneous disappearance of a middle cranial fossa arachnoid cyst after suppurative meningitis

BACKGROUND

Spontaneous disappearance of an arachnoid cyst is very rare, particularly after suppurative meningitis.

CASE REPORT

A 2-month-old boy with a high fever was diagnosed with suppurative meningitis by cerebrospinal fluid examination. Computed tomography disclosed a large arachnoid cyst in the left middle cranial fossa. Two months later, the meningitis was cured. The arachnoid cyst disappeared with long-term antibiotic therapy alone.

CONCLUSION

Although an infected arachnoid cyst may disappear with antibiotic treatment alone, careful observation and individualized patient management are essential.

Protective protein/cathepsin A loss in cultured cells derived from an early-infantile form of galactosialidosis patients homozygous for the A1184-G transition (Y395C mutation)

Galactosialidosis is a human autosomal recessive lysosomal storage disease caused by a genetic defect of protective protein/cathepsin A (PPCA). The patients in a Japanese family with the severe early-infantile form of galactosialidosis were revealed to be homozygous for the A1184-G transition in the PPCA gene in both alleles, which leads to the Y395C substitution. The acid carboxypeptidase (cathepsin A) and lysosomal neuraminidase activities were markedly decreased in cultured fibroblasts and chorionic villus cells derived from the patients, although the decrease in beta-galactosidase activity was less. Immunoblot and immunocytochemical analyses showed that neither the precursor nor the mature form of the PPCA gene product was present in the cultured cells. The Y395C mutation was revealed to cause the loss of the translated product, that determines the severity of the clinical phenotype.

Clinical features and outcome of eight infants with intrahepatic porto-venous shunts detected in neonatal screening for galactosaemia

Of 18 newborn infants found to have persistent galactosaemia and without enzyme deficiencies, intrahepatic porto-venous (P-V) shunts were the cause in 8 cases. We retrospectively analysed the clinical and biochemical features of the eight infants. Four patients received prednisolone, one of whom with heart failure owing to arteriovenous shunts also underwent hepatic arterial embolization. The other four patients were merely observed without receiving drug therapy. Regardless of treatment, the P-V shunts disappeared in five infants before the age of 1 y and persisted in three others. All infants showed mild or moderate abnormalities in liver function tests. None exhibited hyperammonemia or neuropsychiatric symptoms related to the shunts. The data indicated that the prognosis of infants with intrahepatic P-V shunts is generally good. In the absence of complications related to the P-V shunts, no treatment other than galactose elimination diet is indicated.

Heterologous expression, purification, and properties of diol dehydratase, an adenosylcobalamin-dependent enzyme of Klebsiella oxytoca

Recombinant adenosylcobalamin-dependent diol dehydratase of Klebsiella oxytoca overexpressed in Escherichia coli was purified to homogeneity. The enzyme has a low solubility and was extracted from the crude membrane fraction with 1% Brij 35 in a high recovery. Subsequent chromatography on DEAE-cellulose resulted in 4.9-fold purification of the enzyme in an overall yield of 65%. The enzyme thus obtained showed specific activity comparable to that of the wild-type enzyme of K. oxytoca. The apparent molecular weight determined by nondenaturing gel electrophoresis on a gradient gel was 220,000. The enzyme consists of equimolar amounts of the three subunits with apparent Mr of 60,000 (alpha), 30,000 (beta), and 19,000 (gamma). Therefore, the subunit structure of the enzyme is most likely alpha2beta2gamma2. The recombinant enzyme was also separated into components F and S upon DEAE-cellulose chromatography in the absence of substrate. Components F and S were identified as the beta subunit and alpha2gamma2 complex, respectively. Apparent Km for adenosylcobalamin, 1,2-propanediol, glycerol, and 1,2-ethanediol were 0.83 microM, 0.08 mM, 0.73 mM, and 0.56 mM, respectively. The three genes encoding the subunits of diol dehydratase were overexpressed individually or in various combinations in Escherichia coli. The alpha and gamma subunits mutually required each other for correct folding forming the soluble, active alpha2gamma2 complex (component S). Expression of the beta subunit in a soluble, active form (component F) was promoted by coexpression with both the alpha and gamma subunits, probably by coexistence with component S. These lines of evidence indicate that each subunit mutually affects the folding of the others in this heterooligomer enzyme.

Fetal diagnosis of galactosialidosis (protective protein/cathepsin A deficiency)

The fetal diagnosis of galactosialidosis is performed by measuring carboxypeptidase (cathepsin A) activity in cultured villous cells and by immunofluorescence analysis with an antibody against an oligopeptide corresponding to the N-terminal domain of the human mature protective protein. Neither carboxypeptidase activity nor immunofluorescence was detected in cultured villous cells derived from an at-risk fetus or in cultured fibroblasts derived from the sister with galactosialidosis. Neuraminidase and beta-galactosidase activities were also confirmed to be deficient or low. A direct assay system for protective protein/cathepsin A is useful for the accurate prenatal diagnosis of galactosialidosis.

Elevated plasma bile acids in hypergalactosaemic neonates: a diagnostic clue to portosystemic shunts

To determine whether plasma levels of total bile acids may provide a useful index for hypergalactosaemia due to porto-systemic shunts, these levels were determined in hypergalactosaemic neonates. Increased levels were found in all cases with portohepatic venous or portocaval shunts. The levels of both total bile acids and galactose were normalized when the shunts disappeared on the echograms. Both bile acids and galactose are almost completely absorbed by the liver via the first portal blood passage. Portosystemic shunts contribute to elevated levels of bile acids and galactose.

CONCLUSION

Increased plasma levels of total bile acids serve as a diagnostic clue to the presence of portosystemic shunts in neonates with hypergalactosaemia.

Primary intrathoracic extrapulmonary hemangiopericytoma. CT and MR findings

We report the imaging features of a rare case of primary intrathoracic extrapulmonary hemangiopericytoma. Radiography, computed tomography, magnetic resonance imaging, and angiography, were used to evaluate this rapidly growing extrapleural tumor originating from the chest wall. The studies demonstrated smooth margins, hypervascularity, and intermediate signal on T1-weighted images and increased signal on T2-weighted images.

Serologically defined genotypes of hepatitis C virus among Japanese patients with chronic hepatitis C

Recently, Tsukiyama-Kohara et al. (1993) reported that most hepatitis C viruses (HCVs) in Japan can be classified into two types, type 1 and type 2, on the basis of the NS4 region nucleotide sequence. They developed a new assay in which antibodies against group-specific recombinant proteins of the NS4 region were measured by ELISA (serologically defined genotype, serotype). In the present study, we examined 306 patients with chronic liver disease due to HCV infection. The sensitivity of this assay was 98.7% (302/306). The serotype distribution of HCV was 230/306 (75.2%) for type 1, 65/306 (21.2%) for type 2, 7/306 (2.3%) for mixed, both being positive, and 4/306 (1.3%) indeterminate. The frequency of type 1 was significantly higher than that of type 2 (P < 0.01). There were no significant differences in clinical characteristics among the mixed and the indeterminate serotypes. Among the mixed-serotype patients, 4/7 (57.1%) showed seroconversion to a single serotype at 6 and 9 months later, although the serotypes of the indeterminate-serotype patients were also indeterminate at 6 and 9 months later. Using aliquots of the same serum samples, HCV genotyping was carried out by the reverse transcription polymerase chain reaction (RT-PCR) method using type-specific primers derived from the NS5 region of HCV to verify the specificity of this serotyping. The sensitivity of genotyping by RT-PCR was 167/183 (91.3%). The HCV genotypes determined by both methods were consistent in 161/183 (88.0%) of the cases, and there were no contradictory results for any sample between the two methods. These findings indicate that serological genotyping might be useful in determining the HCV genotype among Japanese patients with HCV infection.

Cystic lymphangioma of the gall-bladder: a case report

Intra-abdominal cystic lymphangiomas are rare lesions that can be difficult to diagnose. We present a report of a patient with a giant multilocular cystic lesion in the abdomen. Ultrasonography and computed tomography scans of the abdomen revealed that the cyst had originated in the gall-bladder fossa. There was some calcification and thickening of the cyst wall. Endoscopic retrograde cholangiopancreatography demonstrated a medially deviated common bile duct, an elongated cystic duct and an inferior compressed gallbladder. There was no apparent communication between the cyst and the biliary tract; however, an abdominal angiogram revealed that the lesion was supplied by a branch of the cystic artery. Histological findings obtained intra-operatively were consistent with a cystic lymphangioma. Its characteristic histology was observed in the subserous layer of the gall-bladder. This case is a rare instance of a cystic lymphangioma originating in the gall-bladder.

Confirmation of hepatitis C virus transmission through needlestick accidents by molecular evolutionary analysis

To document the transmission of hepatitis C virus (HCV) through needlestick accidents, 3 health workers who acquired HCV through such accidents and their HCV donor patients were studied using molecular evolutionary analysis based on the HCV E2 region. At least six clones were sequenced from each subject. Nucleotide substitutions were estimated by the six-parameter method, and a phylogenetic tree was constructed by the neighbor-joining method. HCV isolates from the donor patient and the recipient were nested in one monophyletic cluster; this clustering was confirmed to be statistically significant by bootstrap analysis. The nucleotide divergence among the isolates from the recipient was always smaller than that from the donor, supporting the notion that the direction of transmission was from the donor to the recipient. These findings provide evidence, at a molecular evolutionary level, that HCV was transmitted through needlestick accidents.

Nucleotide sequence of the core region of hepatitis C virus in Pakistan and Bangladesh and the geographic characterisation of hepatitis C virus in south Asia

A large number of complete and partial hepatitis C virus (HCV) sequences have been reported and classified into several genotypes, although none have been reported from South Asia. We have determined and evaluated partial sequences in the core region of HCV obtained from patients with chronic hepatitis in Pakistan and Bangladesh. Nucleotide sequences from these viruses show significant homology with the Japanese HCV-TR isolate (91.7%-97.9%) and low homology with other Japanese, American, and UK isolates including HCV-1, HC-J4, HC-J6, HC-J8, and E-b1 (79.3%-86.2%). The homologies of their deduced amino acids sequence with HCV-1, HC-J4, HC-J6, HC-J8, E-b1, and HCV-TR were 84.3%-89.8%, 85.0-87.9%, 84.1%-86.9%, 84.3%-87.0%, 90.2%-93.1%, and 89.8%-93.5%, respectively. These results suggest that our clones might be classified into the same genotype as HCV-TR. Further analysis using molecular evolutionary methods strongly supported the classification of these sequences with the HCV-TR genotype. Moreover, we could not detect any isolates which were closely related to our clones or HCV-TR in countries outside the South Asian area. These data further support the association of HCV genotypes with distinct geographic regions.

[Significance of serological genotyping of hepatitis C virus in Japanese patients with chronic liver disease due to hepatitis C]

Recently, T-Kohara et al. reported that most hepatitis C virus (HCV) in Japan can be classified into two groups, group 1 (G-1) and group 2 (G-2), on the basis of the NS4 region nucleotide sequence. Using a genetic engineering method, they developed a new assay in which antibodies against group specific recombinant proteins of the NS4 region were measured by ELISA (Serological Genotype, Serotype). In the present study, we examined 100 patients with chronic liver disease due to hepatitis C. The sensitivity of this assay was 98.0% (98/100). The HCV serotype distribution was 74/100 (74.0%) for serotype G-1, 22/100 (22.0%) for serotype G-2, 2/100 (2.0%) for both being positive and 2/100 (2.0%) for indeterminate. The distribution of G-1 was significantly higher than that of G-2 (p < 0.05), however, we found no difference between the distribution of G-1 and that of G-2 in age, sex, history of blood transfusion or type of liver disease. In the same serum samples, we performed HCV genotyping by reverse transcription polymerase chain reaction (RT-PCR) using type specific primers derived from the NS5 region of HCV to verify the specificity of such serotyping. The sensitivity of genotyping by RT-PCR was 88.0% (88/100). The HCV genotypes determined by both methods were consistent in 86.0% (86/100) of cases, and were not contradictory in any sample. These data indicated that serological genotyping was more sensitive and was consistent with genotyping by RT-PCR. Therefore, we consider the method useful for epidemiologic studies of HCV in Japan.

Hepatitis C virus serotype II responds more favorably to interferon-alpha therapy

To determine whether serological typing of hepatitis C virus correlated with the response to interferon-alpha therapy, hepatitis C virus serotypes were determined by subtype-specific antibody to NS4 polypeptide by enzyme-linked immunosorbent assay in 55 Japanese patients with chronic active hepatitis C who subsequently received recombinant interferon-alpha 2a therapy. Response to interferon-alpha was defined as complete and sustained (n = 12), complete response followed by relapse (n = 26), and no response (n = 17). There was no difference in the clinical biochemical parameters between these patients groups. However, a higher proportion (50.0%) of patients with hepatitis C virus serotype II showed complete and sustained response to interferon-alpha, compared to serotype I (11.1%, p < 0.01). These data indicate that this simple hepatitis C virus serotyping assay is a useful predictor of response to interferon-alpha therapy in patients with chronic hepatitis C virus infection.

Erythrocyte galactokinase assay with high performance liquid chromatography

An assay for erythtocyte galactokinase based on high performance liquid chromatographic determination of galactose 1-phosphate (Gal-1-P) is described. The determination of Gal-1-P was applied to a post-column fluorometric detection of reducing sugars using arginine. This method is as sensitive and accurate as conventional radioisotopic methods, but needs no radioisotopic facilities. It requires only a small blood sample and is suitable as a follow-up test in neonatal screening.

Development of serum Dermatophagoides farinae-, ovalbumin- and lactalbumin-specific IgG, IgG1, IgG4, IgA and IgM in children with bronchial asthma/allergic rhinitis or atopic dermatitis

Dermatophagoides farinae-, ovalbumin- and lactalbumin-specific IgG, IgG1, IgG4, IgA and IgM were evaluated in 161 healthy children [Group 1], 84 children with bronchial asthma and/or allergic rhinitis but without atopic dermatitis [Group 2], and 54 children with atopic dermatitis but without bronchial asthma and allergic rhinitis [Group 3]. We also studied D. farinae-, egg-white-, and milk-specific IgE of children with allergic diseases. D. farinae-specific IgG, IgG1, IgG4 and IgA in Groups 2 and 3 increased until 5 years of age and thereafter they remained constant. After 2 years of age, D. farinae-specific IgG, IgG1, IgG4 and IgA in Group 2 were higher than those in Groups 1 and 3. Ovalbumin- and lactalbumin-specific IgG, IgG1, IgG4 and IgA in Groups 2 and 3 increased until 1 year of age and thereafter decreased. Until 1 year of age, ovalbumin- and lactalbumin-specific IgG, IgG1 and IgG4 in Groups 3 were higher than those in Groups 1 and 2. D. farinae-, ovalbumin- and lactalbumin-specific IgM were constant in all ages of all groups. These results suggest that atopic dermatitis in young children is related to food-specific immunoglobulins and that respiratory allergic diseases in older children is related to D. farinae-specific immunoglobulins.

Scimitar syndrome associated with diaphragmatic herniation of the liver

A rare case of scimitar syndrome associated with diaphragmatic herniation of the liver is reported. The upper lobe blood of this case drained abnormally to the inferior vena cava. Pulmonary angiography and radionuclide scintigraphy were useful in the diagnosis of the abnormal vessels and herniated liver.

[Gastrointestinal complications caused by high-dose-rate intracavitary irradiation of carcinoma of the uterine cervix]

We treated 64 patients with carcinoma of the uterine cervix with high-dose-rate intracavitary irradiation between 1978 and 1984. Of the 52 patients who were followed for more than two years, gastrointestinal complications occurred in 11 (21%): six grade I patients (12%), two grade II patients (4%) and three grade III patients (6%). The patients were graded according to the severity of the complications. The three patients with grade III complications underwent emergency surgery because of ileus or perforation of the gastrointestinal tract. It is suggested that these severe complications are liable to occur in patients given more than seven fractions of intracavitary irradiation in a fraction dose of 6 Gy to point A or previously operated on in the pelvic cavity. Accurate center shield in relation to tandem sources is also emphasized.

Determination of cystathionine in rat tissues using isotachophoresis

A method for measurement of cystathionine in biological samples has been developed by using an isotachophoretic analyzer. The determination of the amount of cystathionine was carried out by measuring a zone length of cystathionine in isotachophoresis. The amount of cystathionine in brains of normal rats determined by using this method was 0.084 +/- 0.023 mumol/g. This value agreed well with earlier reports. The amount of cystathionine in rats with experimental cystathioninuria was determined in several tissues. The results determined by using this method for the determination of cystathionine in the rat tissues agreed well with the results obtained by using an amino acid analyzer.