Inferring phenotypic causal structures among meat quality traits and the application of a structural equation model in Japanese Black cattle

Meat quality is one of the most important traits determining carcass price in the Japanese beef market. Optimized breeding goals and management practices for the improvement of meat quality traits requires knowledge regarding any potential functional relationships between them. In this context, the objective of this research was to infer phenotypic causal networks involving beef marbling score (BMS), beef color score (BCL), firmness of beef (FIR), texture of beef (TEX), beef fat color score (BFS), and the ratio of MUFA to SFA (MUS) from 11,855 Japanese Black cattle. The inductive causation (IC) algorithm was implemented to search for causal links among these traits and was conditionally applied to their joint distribution on genetic effects. This information was obtained from the posterior distribution of the residual (co)variance matrix of a standard Bayesian multiple trait model (MTM). Apart from BFS, the IC algorithm implemented with 95% highest posterior density (HPD) intervals detected only undirected links among the traits. However, as a result of the application of 80% HPD intervals, more links were recovered and the undirected links were changed into directed ones, except between FIR and TEX. Therefore, 2 competing causal networks resulting from the IC algorithm, with either the arrow FIR → TEX or the arrow FIR ← TEX, were fitted using a structural equation model () to infer causal structure coefficients between the selected traits. Results indicated similar genetic and residual variances as well as genetic correlation estimates from both structural equation models. The genetic variances in BMS, FIR, and TEX from the structural equation models were smaller than those obtained from the MTM. In contrast, the variances in BCL, BFS, and MUS, which were not conditioned on any of the other traits in the causal structures, had no significant differences between the structural equation model and MTM. The structural coefficient for the path from MUS (BCL) to BMS showed that a 1-unit improvement in MUS (BCL) resulted in an increase of 0.85 or 1.45 (an decrease of 0.52 or 0.54) in BMS in the causal structures. The analysis revealed some interesting functional relationships, direct genetic effects, and the magnitude of the causal effects between these traits, for example, indicating that BMS would be affected by interventions on MUS and BCL. In addition, if interventions existed in this scenario, a breeding strategy based only on the MTM would lead to a mistaken selection for BMS.

Theoretical study on the need for laser iridotomy in an implantable collamer lens with a hole using computational fluid dynamics

PurposeAlthough one of the advantages of the Hole-ICL implantation is that laser iridotomy (LI) is unnecessary, the evidence have not been reported from the viewpoint of aqueous humor circulation. We investigated the effect of laser iridotomy (LI) on the fluid dynamics of aqueous humor in an implantable collamer lens (ICL) with a central hole, that is, a Hole-ICL using computational fluid dynamics.MethodsA fluid dynamics simulation was performed using the thermal-hydraulic analysis software FloEFD (Mentor Graphics Corp.). For the simulation, three-dimensional eye models with a conventional ICL (Model ICM, STAAR SURGICAL) and a Hole-ICL were used. The LI diameters were 250 and 500 μm. The flow distribution between the anterior surface of the crystalline lens and the posterior surface of the ICL was also calculated.ResultsThe flow velocity 0.25 mm in front of the center of the crystalline lens in the Hole-ICL without LI, with LI of 250 μm, and with LI of 500 μm was 1.48 × 10^-1, 1.20 × 10^-1, and 4.52 × 10^-2 mm/s, respectively. The flow velocity in the conventional ICL without LI, with LI of 250 μm, and with LI of 500 μm was 1.21 × 10^-5, 3.60 × 10^-4, and 6.33 × 10^-4 mm/s, respectively.ConclusionsThese results suggest that there is less need for LI in a posterior chamber phakic intraocular lens with a central hole from the viewpoint of aqueous humor circulation, although the results can be considered only in an ideal condition and further studies are needed to clarify the effect of LI in clinical practice.

Maternal Separation Induces Orofacial Mechanical Allodynia in Adulthood

It is well known that exposure to maternal separation (MS) in early life causes plastic changes in the nervous system in adulthood, occasionally resulting in ubiquitous chronic pain. However, the pathogenic mechanisms of pain hypersensitivity remain unclear. Here, the authors examined the involvement of corticosterone in orofacial mechanical hypersensitivity induced by MS. To establish a rat model of MS, pups were placed in isolated cages 180 min/d and kept in a temperature-controlled environment at 22 ± 2 °C for 14 d. Mechanical allodynia in the whisker pad skin in adulthood was induced by MS and was significantly suppressed by successive postnatal subcutaneous administration of the glucocorticoid receptor antagonist mifepristone. Corticosterone levels were increased in the serum of MS rats, and successive postnatal administration of subcutaneous corticosterone to naive rats induced mechanical allodynia in the whisker pad skin. The number of P2X3 receptor-immunoreactive (P2X3R-IR) trigeminal ganglion (TG) neurons innervating the whisker pad skin was significantly increased in MS rats and decreased following subcutaneous administration of mifepristone. The number of P2X3R-IR TG neurons innervating the whisker pad skin was also significantly increased following successive postnatal administration of subcutaneous corticosterone in naive rats. Moreover, the mechanical allodynia was suppressed 30 min after administration of the P2X3R antagonist A317491 to the whisker pad skin in MS rats. These findings suggest that the increase in P2X3R-IR TG neurons innervating the whisker pad skin via enhanced neonatal corticosterone signaling by MS plays an important role in orofacial mechanical allodynia in adulthood.

Expression of umami-taste-related genes in the tongue: a pilot study for genetic taste diagnosis

OBJECTIVE

Expression of taste-related genes in the tongue was analysed to develop a technique for genetic diagnosis of umami taste disorders.

MATERIALS AND METHODS

Tissue samples were collected from healthy volunteers by scraping the foliate papillae of the tongue. Immunocytochemistry staining of gustducin, a taste-cell-specific G protein, and gene expression analysis by real-time polymerase chain reaction of β-actin, gustducin (GNAT3) and umami receptors (T1R1, T1R3 and mGluR1) were performed. Changes in umami receptor expression following application of umami substances onto the tongue were analysed.

RESULTS

Gustducin-positive cells were observed in the samples, indicating the presence of taste cells. Gene expression of β-actin, GNAT3, T1R1 and T1R3 was detected in all seven samples tested, while that of mGluR1 was detected in four samples. Sequence analysis by NCBI Blast showed that each polymerase chain reaction product had a 99% rate of identification of its target sequence. Stimulation of the tongue with monosodium glutamate significantly upregulated the gene expression levels of T1R1 and T1R3, indicating that this method can detect alterations in umami-related gene expression.

CONCLUSION

Evaluation of the expression of the umami receptor genes, T1R1 and T1R3, in the tongue may be clinically useful for objective genetic diagnosis of umami taste disorders.

Whole-genome association study for fatty acid composition of oleic acid in Japanese Black cattle

Fatty acid composition, especially oleic acid (C18:1), plays an important role in the eating quality of meat in Japanese Black cattle. Therefore, the objective of this study was to identify loci associated with C18:1 in the intramuscular fat of the trapezius muscles in Japanese Black cattle using the Illumina BovineSNP50 BeadChip whole genome single nucleotide polymorphism (SNP) assay. We also evaluated the relationship between C18:1 and three fatty acid synthesis genes, fatty acid synthase (FASN), stearoyl-CoA desaturase and sterol regulatory element-binding protein-1. In this experiment, we applied a mixed model and Genomic Control approach using selective genotyping to perform a genome-wide association study. A total of 160 animals (80 animals with higher values and 80 animals with lower values), selected from 3356 animals based on corrected phenotype, were genotyped using the Illumina BovineSNP50 BeadChip and three fatty acid synthesis genes, and the quality of these SNPs was assessed. In this study, a total of 38 955 SNPs, which included SNPs in the three fatty acid synthesis genes, were used, and the estimated inflation factor was 1.06. In the studied population, a total of 32 SNPs, including the FASN gene, had significant effects, and in particular 30 SNPs of all significant SNPs were located between 49 and 55 Mbp on chromosome 19. This study is one of the first genome-wide association studies for fatty acid composition in a cattle population using the recently released Illumina BovineSNP50 BeadChip.

Genomic prediction in Japanese Black cattle: application of a single-step approach to beef cattle

The implementation of genomic selection for Japanese Black cattle, known for rich marbling of their meat, is now being explored. Although multiple-step methods are often adopted for dairy cattle, they present shortcomings such as bias and loss of information in addition to operational complexity. These can be avoided using single-step genomic BLUP (ssGBLUP) based on the relationship matrix H, which is constructed from the numerator relationship matrix (A) augmented by the genomic relationship matrix (G). This study assessed the use of ssGBLUP for 3 economically important traits in Japanese Black cattle. Three aspects of ssGBLUP that are important for practical use were examined specifically: the mixing proportions of blending G with A, selection of subsets of genotyped animals used for constructing H, and prediction ability for ungenotyped animals. Different mixing proportions were tested to assess the influence of these proportions on variance component estimation and prediction accuracy. For all traits, the highest or nearly highest accuracy was obtained when the adopted mixing proportion provided heritability closest to that inferred based on A. However, the accuracy did not increase greatly under adjustment of the mixing proportion, thereby suggesting that the influence of the mixing proportion on the accuracy was limited. Genotype data of influential bulls showed a greater contribution to accuracy than that of bulls that were less influential. Genotyping animals with phenotypic records increased the accuracy. It can be prioritized over genotyping bulls that are not influential on the population. These results are expected to present good guides to the future expansion of genotyped populations. Even for animals without genotype data but with genotyped sires, ssGBLUP provided more accurate prediction than BLUP did. For both phenotype and breeding value prediction, ssGBLUP provides more accurate prediction than BLUP, suggesting its usefulness in genomic selection in Japanese Black cattle.

Atypical retardation pattern in measurements of scanning laser polarimetry and its relating factors

PURPOSE

To assess the prevalence of atypical retardation pattern (ARP) in scanning laser polarimetry (SLP) with variable corneal compensation (VCC) and enhanced corneal compensation (ECC), and to evaluate the factors relating to typical scan score (TSS).

METHODS

Measurements of SLP-VCC, SLP-ECC, and the Humphrey field analyzer (HFA) were performed in 105 normal subjects and 82 open-angle glaucoma (OAG) patients. ARP was defined as an SLP image with TSS<80.

RESULTS

Prevalence of ARP with SLP-VCC was 13.3 and 14.6% in normal and OAG eyes, respectively, and that with SLP-ECC (2.9% and 1.2%) was lower than SLP-VCC (P<0.009). TSS with SLP-VCC was significantly correlated with age (partial correlation coefficient (PCC)=-0.22, P=0.003) and refractive error (PCC=0.26, P<0.001) after adjusting for each other. TSS with SLP-ECC was significantly correlated with neither age nor refractive error (PCC=-0.02, P=0.788; PCC=0.10, P=0.177, respectively). In OAG eyes, mean deviation (MD) of HFA was significantly correlated with TSS with SLP-VCC and SLP-ECC (PCC=0.35, P=0.001; PCC=0.23, P=0.039, respectively). In SLP-VCC, MD was significantly correlated with retinal nerve fibre layer (RNFL) thickness only after excluding eyes with ARP (P<0.001).

CONCLUSIONS

ARP in SLP-VCC measurements was found in more than 10% of normal or glaucomatous eyes, and TSS was significantly lower in older subjects, more myopic eyes, or eyes with more advanced glaucomatous damage. The presence of ARP disturbs the accuracy of RNFL thickness measurement by SLP-VCC. In SLP-ECC measurements, prevalence of ARP was considerably lower and TSS was not affected by age or refractive error, suggesting the advantages of ECC in clinical practices.

A simple, yet accurate method for detecting and quantifying secretions from human minor salivary glands using the iodine-starch reaction

The lack of published information about the minor salivary glands is due in part to the difficulties experienced in collecting and quantifying their secretions. In fact, no method exists for measuring their secretions that is both simple and accurate. This investigation examined the accuracy of our newly developed method (which simply employs the iodine-starch reaction) in 10 healthy non-medicated adults. A strip painted with a solution of iodine in absolute alcohol then with a fine starch powder mixed with castor oil was placed at a designated location on the lower-lip mucosa for 2 min to collect saliva. Black-stained spots of various sizes corresponding to the individual glands could be accurately visualized. After removal of the strip, the total stained area (mm2) was calculated by digitizing the spot areas using a computer system. The correlation coefficient (r) between known volumes of saliva and stain size was 0.995, indicating a close correlation. The correlation coefficient (r) between area values obtained in the first trial in each subject (Y) and the second (X; 10 min later) was 0.963, and the simple regression equation was close to Y=X, indicating good reproducibility. The mean flow rate microl/cm2 per min) obtained by converting mean total area to volume and thence to flow rate was 0.49+/-0.26, in good agreement with published values obtained by others. These results suggest that our newly developed method allows both the distribution and secretion rate of the minor salivary glands to be observed, and that it should be of practical value due to its simplicity, accuracy, and reproducibility.

Centrally mediated reflex vasodilation in the gingiva induced by painful tooth-pulp stimulation in sympathectomized human subjects

This study was designed to determine whether painful electrical stimulation of the tooth pulp induces centrally mediated reflex vasomotor changes in human gingiva and whether the sympathetic nervous system is involved in the vasomotor responses. Dynamic changes in maxillary gingival blood flow (GBF) following painful electrical stimulation of the mandibular lateral incisor were investigated, by means of laser-Doppler flowmetry, in both healthy volunteers and patients undergoing sympathetic blockade for hyperhidrosis. Increases in GBF were observed in both healthy volunteers and patients on the ipsilateral side without an increase in systemic blood pressure, but the evoked GBF increase disappeared when pain sensation was abolished by local anesthetization with 2% xylocaine solution. The vasodilator responses did not differ in amplitude between before and after the sympathectomy. These results suggest that painful tooth stimulation evokes centrally mediated reflex vasodilation, presumably via parasympathetic efferent fibers, in the human gingiva and that sympathetic vasomotor mechanisms are not involved in these responses.

Dependence of pulpal blood-flow responses on baseline blood-flow in the cat

It has been shown earlier that electrical stimulation of the distal cut end of the inferior alveolar nerve (IAN) in the cat evokes three different patterns of pulpal blood-flow (PBF) response in the ipsilateral mandibular canine tooth (a decrease, a biphasic response, or an increase). The response to a given stimulus sometimes changed to another pattern even in one and the same experimental animal during the course of the experiment. It is known that the evoked decrease is due to activation of the sympathetics and that the increase is due to antidromic activation of sensory fibres; but, it is unknown why the response varies so much. It is hypothesised that the baseline blood-flow (BBF) modulates vasomotor responses in the dental pulp. To test this hypothesis, the effects of BBF on PBF responses elicited by the IAN stimulation mentioned above were investigated. Dynamic changes in PBF in cat mandibular canine teeth were elicited by electrical stimulation of the distal cut end of the IAN, at various BBF, with blood-flow monitored by laser Doppler flowmetry. The amplitude of the PBF vasodilator response increased as BBF was adjusted downwards (by cooling the tooth). In contrast, the amplitude of the PBF vasoconstrictor response increased as the BBF rose. Vasodilator responses could be transformed into vasoconstrictor responses, and vice versa, by alterations in the BBF. No systemic blood-pressure changes were elicited throughout the experiment. These results indicate that a consideration of baseline vascular tone is important, whenever the size of PBF responses to various stimuli is discussed or calculated.

Re-evaluation of refractory anemia with excess blasts in transformation

The category 'refractory anemia with excess blasts in transformation (RAEBt)' consists of two sub-sets; one group is categorized based on the percentage of blasts in the marrow (> or =20%) and other is based on the percentage of blasts in the peripheral blood (> or =5%). We separated RAEBt patients based on these two criteria and compared hematologic and clinical relevance to assess the reasonable basis for the new classification. All RAEBt patients showing peripheral blood (PB) blasts of > or =5% were re-classified as RAEB by the WHO classification. This subset of RAEBt patients had lower percentages of bone marrow (BM) blasts, and notably they showed frequent complex cytogenetic abnormalities, including -5/5q- and/or -7/7q-. Moreover, the RAEBt patients of this group had shorter survivals compared to RAEBt patients with BM blasts between 20 and 30%. We next assessed hematologic and clinical relevance between refractory anemia with excess blasts (RAEB) and RAEBt patients with PB blasts of > or =5%. Except for the percentage of blasts in the PB (P=0.0037) and BM (P=0.0073), there was no significant difference in hematologic or clinical features between RAEB patients with BM blasts of > or =11% and RAEBt patients with PB blasts of > or =5%. When MDS patients with PB blasts of > or =5% (RAEBt by the FAB classification) were included as RAEB-II based on the "MDS 2000 classification', there was a high frequency of patients with complex chromosome changes, involving 5q and 7q, with significant poorer outcome compared to those with RAEB-I. Although it is still controversial whether MDS patients with BM blasts 20% or more should be considered as acute leukemia, the utilization of the 'MDS 2000 classification' might be useful to designate MDS patients diagnosed based on the percentage of blasts in the peripheral blood.

[Underestimation of intraocular pressure after laser in situ keratomileusis]

PURPOSE

We reviewed 115 eyes of 65 patients regarding the intraocular pressure(IOP) following laser in situ keratomileusis(LASIK).

PATIENTS AND METHODS

The ages averaged 31.2 +/- 10.5(mean +/- standard deviation) years. The preoperative spherical equivalent averaged -6.85 +/- 2.54 (mean +/- standard deviation) D. A noncontact pneumatic tonometer and Goldmann applanation tonometer were used in measuring the IOP.

RESULTS

The IOP difference before and after surgery was statistically significant(Mann-Whitney U test). The IOP was significantly corrected with the corrected diopter value, corneal thickness, and corneal curvature(Spearman coefficient by rank).

CONCLUSION

The findings show that postoperative IOP may be underestimated due to decreased corneal thickness and curvature. Due attention has to be paid to this feature in evaluating IOP after LASIK.

Evaluation of pulse sequences used for magnetic resonance sialography

OBJECTIVES

To determine the most appropriate sequences for the visualization of small parotid ducts in MR sialography.

METHODS

MR images of a phantom consisting of distilled water in polyethylene tubes were obtained with turbo-spin echo (TSE), single-shot turbo-spin echo (SSTSE), half-fourier acquisition, single-shot turbo-spin echo (HASTE) and turbo gradient-spin echo (TGSE) pulse sequences and compared visually and quantitatively. MR sialograms obtained from healthy volunteers and patients with Sjögren's syndrome (SS) were obtained using the same four sequences.

RESULTS

In the phantom, TSE images were best and the contrast-noise ratio (CNR) highest. In the volunteers, the main ducts were especially clearly visualized with TSE and in SSTSE; however, the majority of secondary and/or tertiary parotid ducts were not depicted by any of the sequences used. In SS patients, images of small main ducts and small pseudocysts were clearer using TSE. However, TSE could not depict the narrow main ducts or peripheral ducts or very small pseudocysts.

CONCLUSIONS

TSE is considered the most suitable MR sequence for assessing small parotid gland ducts. However, further improvement is needed since it does not always visualize them sufficiently.

Early onset Pneumocystis carinii pneumonia after allogeneic peripheral blood stem cell transplantation

Pneumocystis carinii (P. carinii) is one of the major opportunistic pathogens responsible for hematopoietic stem cell transplantation (HSCT)-related pneumonias. Although trimethoprim-sulfamethoxazol (TMP/SMX) prophylaxis has been shown to prevent almost all P. carinii infections, 1%-2% of patients may still experience this complication. P. carinii pneumonia (PCP) is usually a late complication in patients receiving TMP/SMX prophylaxis, with most cases occurring later than 2 months post-transplant. We report a patient who developed early onset PCP after allogeneic peripheral blood stem cell transplantation (PBSCT) from an HLA-identical sibling donor. On day 12, the patient complained of dyspnea and cough. A chest X ray showed infiltrates in right upper lobe with bilateral pleural effusion. By the findings of Grocott stain on bronchoalveolar lavage fluid obtained on day 14, he was diagnosed as having PCP. Intravenous TMP/SMX failed to improve the lesion. This is the earliest onset PCP in the literature after HSCT despite the prophylactic administration of TMP/SMX before transplant.

Pre-emptive therapy against cytomegalovirus (CMV) disease guided by CMV antigenemia assay after allogeneic hematopoietic stem cell transplantation: a single-center experience in Japan

From April 1998 to March 2000, a cytomegalovirus (CMV) antigenemia-guided pre-emptive approach for CMV disease was evaluated in 77 adult patients who received allogeneic hematopoietic stem cell transplantation at the National Cancer Center Hospital. A CMV antigenemia assay was performed at least once a week after engraftment. High-level antigenemia was defined as a positive result with 10 or more positive cells per 50 000 cells and low-level antigenemia was defined as less than 10 positive cells. Among the 74 patients with initial engraftment, 51 developed positive antigenemia. Transplantation from alternative donors and the development of grade II-IV GVHD were independent risk factors for positive antigenemia. Ganciclovir was administered as pre-emptive therapy in 39 patients in a risk-adapted manner. None of the nine low-risk patients with low-level antigenemia as their initial positive result developed high-level antigenemia even though ganciclovir was withheld. Only one patient developed early CMV disease (hepatitis) during the study period. CMV antigenemia resolved in all but two cases, in whom ganciclovir was replaced with foscarnet. In eight patients, however, the neutrophil count decreased to 0.5 x 10(9)/l or less after starting ganciclovir, including three with documented infections and two with subsequent secondary graft failure. The total amount of ganciclovir and possibly the duration of high-dose ganciclovir might affect the incidence of neutropenia. We concluded that antigenemia-guided pre-emptive therapy with a decreased dose of ganciclovir and response-oriented dose adjustment might be appropriate to decrease the toxicity of ganciclovir without increasing the risk of CMV disease.

Decline in antibiotic enzyme activity of neutrophils is a prognostic factor for infections in patients with myelodysplastic syndrome

We used flow cytometry to measure the activities of cathepsin G and elastase. The activity of elastase in neutrophils from patients with myelodysplastic syndrome (MDS) was significantly lower than that in neutrophils from the control group (P<.001). Patients with low elastase activity were significantly susceptible to infection (P<. 05). Our study suggests that analyzing antibacterial enzymes is useful in evaluating the prognosis of patients with MDS.

Use of real-time PCR to monitor human herpesvirus 6 reactivation after allogeneic bone marrow transplantation

Reactivation of human herpesvirus 6 (HHV-6) is common following allogeneic marrow transplantation, however, little is known about the immune control and pathogenic potential of HHV-6 infection after transplantation. In order to determine whether reactivation of HHV-6 plays an important role in the development of complications in patients undergoing allogeneic bone marrow transplantation or not, we developed a very rapid quantification of viral DNA using a LightCycler. The amount of viral DNA was determined using a supernatant of a chronically infected cell line [TaY(OK)] which contains a known amount of viral DNA. Peripheral blood cells were collected from 5 patients undergoing allogeneic bone marrow transplantation once before transplant and once per week after transplant for 8-24 weeks. The real-time PCR system revealed that there was a linear correlation in the range of 101 to 105 molecules of reference. Using this system, we have found the presence of non-diagnosed HHV-6 reactivation as well as symptomatic infection, indicating the potential for routine implementation of this technology for laboratory diagnosis of HHV-6 infection. Our study shows that this method of rapid quantification of HHV-6 genomes by the real-time PCR using a LightCycler may be useful not only to understand the reconstitution of the immune system following marrow transplantation but also to manage the care of patients.

Acute onset of coagulopathy in a patient with Kasabach-Merritt syndrome following transurethral resection of bladder tumor

We report an unusual case of Kasabach-Merritt syndrome in a 62 year-old woman with bladder tumor who suffered from acute consumption coagulopathy that increased the fibrinolytic activity due to the presence of a huge hemangioma in the upper and lower extremities. Two days after the transurethral resection of the solitary bladder tumor, serious hematuria and life-threatening disseminated intravascular coagulation developed. Following treatments with heparin and subsequent steroid treatment, hemorrhage and abnormal hemostatic values improved. It is suggested that extensive investigation of the coagulation system should be done in patients with giant hemangioma, particularly before a surgical procedure.

Retroperitoneoscopic partial adrenalectomy using an endoscopic stapling device in patients with adrenal tumor

We performed 15 retroperitoneoscopic partial adrenalectomies using an endoscopic stapling device to divide the normal adrenal tissue and adenoma. The mean operating time and mean blood loss were 162 (129-210) min and 12 (5-67) ml, respectively. In 1 patient (6.7%), a pneumothorax occurred at the end of the procedure due to injury of the medial crus of the diaphragm. However, the procedure was not subsequently converted to open surgery. These facts suggest that posterior retroperitoneoscopic partial adrenalectomy is a valuable addition to adrenal gland surgery.

[Non-myeloablative stem cell transplant]

Myeloablation and immunosuppression were considered to be the two major roles of the conditioning regimens for allogeneic stem cell transplantation to facilitate engraftment. It has turned out, however, that immunosuppression is more important and myeloablation is not necessary for engraftment. At the same time, it is considered that the major anti-tumor effect of allogeneic stem cell transplantation depends on the graft-versus-leukemia effect, not on the conditioning regimen itself. In patients with CML who relapsed after allogeneic transplantation, for example, infusion of donor lymphocytes can induce a second complete remission. Non-myeloablative stem cell transplantation (NST) was developed in the late 90s based on these theories. Low-dose, less toxic, so-called "non-myeloablative" preparative regimens have been designed not to eradicate the malignancies, but to provide sufficient immunosuppression to allow donor cells to engraft, while the graft-versus-malignancy effects eradicate the tumor. This strategy permits allogeneic transplantation to be used in patients who are not eligible for conventional, often myeloablative, transplantation because of advanced age or organ dysfunction. Non-myeloablative preparative regimens contain purine analogs, such as fludarabine or cladribine. The NST regimen being used at the National Cancer Center Hospital, Tokyo, Japan, consists of cladribine (0.11 mg/kg x 6 days), busulfan (4 mg/kg x 2 days) and rabbit anti-thymocyte globulin (2.5 mg/kg x 4 days). We enrolled 6 patients in this NST protocol so far: 1 with severe aplastic anemia (sibling-PBSCT), 2 with MDS-RA (1 for sibling-PBSCT and 1 for matched uBMT), 1 with AML-CR2 (matched uBMT), 1 with AML-CR3 (sibling-PBSCT), and 1 with relapsed AML (mismatched related PBSCT). All patients achieved engraftment within 14 days with complete donor chimerism. In addition to leukemias, a graft-versus-malignancy effect was also reported in allogeneic NST of solid tumors, such as renal cell carcinoma and malignant melanoma. The long-term efficacy of NST remains to be determined, and further clinical trials are warranted.

Comparative multi-color flow cytometric analysis of cell surface antigens in bone marrow hematopoietic progenitors between refractory anemia and aplastic anemia

Refractory anemia (RA) in myelodysplastic syndrome (MDS) without prominent dysplasia closely resemble the mild type of aplastic anemia (AA) in their hematological features. This sometimes makes it difficult to distinguish clearly between the two diseases. Using the multi-color flow cytometric technique, we compared cell surface antigen expression patterns on bone marrow hematopoietic progenitor cells which were isolated as a CD34 positive- CD45 dull positive with low side scatter intensity (CD34(+)CD45(dull+)SSC(low)) population in flow cytogram between RA (n=12) and AA (n=11). The antigens analyzed in CD34(+)CD45(dull+)SSC(low) mononuclear cells were: CD38 and CD71 for cell growth-related antigens, CD 33 and CD13 for myeloid and monocytoid lineage-associated antigens, CD7 and CD19 for lymphoid lineage, and CD14 for a monocytic lineage specific antigen. The percentages of CD34(+)CD45(dull+)SSC(low) cells in bone marrow non-erythroid mononuclear cells, and the expression frequencies of CD38, CD71, CD33 and CD13 antigens in CD34(+)CD45(dull+)SSC(low) progenitors were all significantly decreased in AA compared to normal bone marrows (n=7) (P<0.005). In contrast, in RA bone marrows the percentages of CD34(+)CD45(dull+)SSC(low) cells showed wide distribution and the cell surface antigen expression patterns varied among each case: some cases showed low frequencies of CD38 and CD71 expression as well as AA, whereas the others showed high expression frequency of specific antigen(s) which may reflect the clonal expansion of an abnormal clone in bone marrow. An MDS patient who had progressed from RA to RAEB showed further projecting pattern of expression of CD38 and CD33 in CD34(+)CD45(dull+)SSC(low) population in accordance with the disease progression. These data suggest that analysis of cell surface antigen expression patterns of CD34(+)CD45(dull+)SSC(low) progenitor cells by multi-color flow cytometry appears to be a useful method for qualitative and quantitative assessment of marrow progenitor states in AA and RA, therefore this method could be helpful for early detection of clonal evolution in MDS.

Influence of carbon dioxide on respiratory function during posterior retroperitoneoscopic adrenalectomy in prone position

OBJECTIVE

To evaluate the influences of CO(2) insufflation on changes in blood gas analysis and end tidal CO(2) tension (PetCO(2)) during posterior retroperitoneoscopic adrenalectomy in the prone position.

METHODS

Arterial blood gas analysis and measurements of PetCO(2) were carried out during CO(2) insufflation in 16 patients who underwent posterior retroperitoneoscopic adrenalectomy in the prone position (PRA group). The results were compared to 10 patients who underwent open posterior adrenalectomy (OPA group). Ventilation was artificially controlled during the study period in all cases.

RESULTS

Arterial pH, PaCO(2), PetCO(2) and PaO(2) were not significantly different between the PRA and OPA groups. However, the PaCO(2)-PetCO(2) gradient in the PRA group was significantly higher than that in the OPA group (p < 0.01).

CONCLUSION

Transperitoneal absorption of CO(2) occurs in patients undergoing retroperitoneoscopy in the prone position. The alveolo-arterial CO(2) gradient may be the only parameter which indicates the absorption of CO(2) during PRA.

Effects of endothelin receptor antagonists on anterior chamber inflammation induced by intravitreal injection of endothelin-1

To investigate the role of endothelin receptors (ET(A) and ET(B)) in the inflammatory reaction induced by endothelin-1 (ET-1), the time course of changes in aqueous protein concentration (APC) after the intravitreal injection of ET-1 (10(-4), 10(-5) M) was measured using a laser flare-cell meter in pigmented rabbit eyes. The effects of pre-treatment with specific ET(A) receptor antagonist (97-139) (10(-1), 10(-2), 10(-3), 10(-4) M), specific ET(B) receptor antagonist (BQ-788) (1.6 x 10(-3) M), and vehicle solution were assessed. The influence of ET(A)receptor antagonist pre-treatment on aqueous prostaglandin E(2) and leukotriene B(4) concentrations was also evaluated. As a result, pre-treatment with ET(A) receptor antagonist blocked the APC increase induced by 10(-4) M ET-1 in a dose dependent fashion, while BQ-788 did not suppress the inflammatory reaction. The injection of ET-1 increased aqueous prostaglandin E(2) concentration, which was inhibited by pre-treatment with ET(A) receptor antagonist. Aqueous leukotriene B(4) concentration was not affected by ET-1 nor ET(A) receptor antagonist. In conclusion, ET(A) receptor mediates the increases in aqueous protein and prostaglandin E(2) concentration induced by ET-1 injection, and this inflammatory reaction occurs via the cyclooxygenase pathway of arachidonic acid cascade.

Pulmonary function after posterior retroperitoneoscopic surgery

Pulmonary function tests were performed in 12 patients who underwent posterior retroperitoneoscopic surgery, before and on the 3rd and 7th days after operation. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FCV, vital capacity (VC), total lung capacity (TLC), residual volume (RV) and functional residual capacity (FRC) were not significantly different between before and after surgery. It is assumed that posterior retroperitoneoscopic surgery could be performed without impairment of pulmonary function after surgery.

Microscopic analysis of enzyme activity, mitochondrial distribution and hydrogen peroxide in two-cell rat embryos

A developmental block is induced by phosphate in rat embryos at the late two-cell stage. The present study was designed to examine the energy metabolism of rat two-cell blocked and non-blocked embryos. Enzyme activity was measured in individual embryos by histochemical techniques. The activities of malate dehydrogenase, isocitrate dehydrogenase, lactate dehydrogenase, pyruvate dehydrogenase, glyceraldehyde-3-phosphate dehydrogenase, glutamate dehydrogenase, glucose-6-phosphate dehydrogenase, glucose-6-phosphatase, and phosphorylase did not differ among non-blocked and blocked embryos. However, the activity of succinate dehydrogenase was significantly decreased in blocked embryos compared with non-blocked embryos. In blocked embryos, cytochrome oxidase activity was distributed homogeneously, but was located at the perinuclear region in non-blocked embryos. Active mitochondrial organization was visualized using the fluorescent probe rhodamine 123 and laser scanning confocal microscopy. In both non-blocked and blocked embryos, mitochondria were distributed homogeneously. The concentration of H2O2 measured fluorometrically in embryos cultured without phosphate did not change significantly during the culture period, but decreased in embryos cultured with phosphate. The timing corresponded to the occurrence of the two-cell block. In summary, these results suggest that the developmental block in rat two-cell embryos is induced by disturbance of mitochondrial energy metabolism.

Microtubule and microfilament dynamics in rat embryos during the two-cell block in vitro

Developmental block of rat embryo is induced by phosphate at the late two-cell stage. The present study uses immunocytochemistry and laser scanning confocal microscopy to examine microtubule and microfilament dynamics in blocked and nonblocked two-cell-stage rat embryos. Thin fibrous microtubules were distributed homogeneously in the cytoplasm in nonblocked embryos during the interphase of the two-cell stage and then translocated into mitotic spindles at the M-phase. In embryos blocked at the two-cell stage, much thicker fibrous microtubules were formed and distributed as rude meshwork structures in the cytoplasm. Microfilaments were distributed adjacent to nuclei and along the inside of the plasma membrane in nonblocked embryos during the two-cell stage, at M-phase, and at cleavage to the four-cell stage. In embryos blocked at the two-cell stage, however, microfilaments formed granules and dispersed in the cytoplasm. The distribution of microtubules and microfilaments changed relative to the occurrence of two-cell block. In summary, these results indicate that both microtubules and microfilaments are closely involved in the developmental block in two-cell rat embryos.

Inflammatory reaction via arachidonic acid cascade after intravitreal injection of endothelin-1

PURPOSE

To investigate the characteristics of anterior chamber inflammatory reaction induced by intravitreal injection of endothelin-1 (ET-1).

METHODS

The time course of changes in aqueous protein concentration (APC) after intravitreal injection of 10(-4), 10(-5), 10(-6) and 10(-7) M ET-1 into rabbit eyes was measured with a laser flare-cell meter. The influence of a topical diclofenac sodium (DFNa) pre- and post-treatment was assessed. Aqueous prostaglandin E2 and leukotriene B4 concentration was quantified using a radioimmunoassay technique.

RESULTS

Intravitreal injection of 10(-4) and 10(-5) M ET-1 significantly increased APC, while 10(-6) and 10(-7) M ET-1 did not induce anterior chamber inflammation. After 10(-5) M ET-1 injection, APC reached a maximum at 4 h post-treatment and returned to a normal level 48 h after injection. Eyes treated with 10(-4) M ET-1 displayed a bi-phasic time course, with peak values observed 4 to 8 h as well as 48 h after administration. Pre- and post-treatment with topical DFNa completely suppressed the APC increase in the 10(-5) M ET-1 preparation, and considerably inhibited it in the 10(-4) M ET-1 preparation. After ET-1 injection, aqueous prostaglandin E2 concentration increased significantly, followed by an increase in APC. There were no changes in leukotriene B4 concentration.

CONCLUSIONS

ET-1 induces anterior chamber inflammation via the cyclooxygenase pathway of the arachidonic acid cascade. The lipoxygenase pathway is not involved in this reaction.

[Improvement of respiratory burst by individual neutrophils from a patient with chronic granulomatous disease, type X91- under treatment by granulocyte colony-stimulating factor for multiple liver abscess]

A 20-year-old male with chronic granulomatous disease (CGD) was admitted with multiple liver abscesses. He had already been diagnosed as CGD, type X91-, when he was 10 years old. He was successfully treated with antibiotics and granulocyte colony-stimulating factor (G-CSF) combined with continuous drainage of abscess. Employing flow cytometry, respiratory burst by individual neutrophils was measured using 2', 7'-dichlorofluorescein. The fluorescence intensity in all individual neutrophils from the patient under G-CSF treatment was higher than the one without G-CSF. G-CSF can be one of effective therapies for infection in some patients with CGD such as X91-.

Endothelin-1 and intraocular inflammation in pigmented rabbit eyes

We assessed the function of Endothelin-1 (ET-1) in the development of anterior chamber inflammation in pigmented rabbit eyes. After the injection of ET-1 solution (10(-13), 10(-11), 10(-9), or 10(-7) M, diluted with 300 microL of artificial aqueous humor) into the anterior chamber, the aqueous protein concentration (APC) increased significantly in a dose-dependent fashion. Peak effects were observed 1-2 hours posttreatment. The APC returned to normal 12 hours after the injection. Pretreatment with antiprostaglandin agents, topical indomethacin, or intravenous diclofenac sodium suppressed the increase in APC. In an endotoxin-induced experimental uveitis model, the ET-1 concentration in the aqueous humor was significantly higher than in normal controls, as was the plasma ET-1 level. These results suggest that ET-1 is an important mediator in ocular inflammatory reactions via arachidonic acid cascade.

[Anterior chamber inflammation after the injection of endothelin-1 into the vitreous and the effect of ETA receptor antagonist]

To assess the receptors which mediate the inflammatory reaction induced by endothelin-1 (ET-1), we investigated the influence of pre-treatment with an ETA receptor antagonist (97-139) on the increase of aqueous protein concentration (APC) after the injection of ET-1 (10(-4), 10(-5)M) into the vitreous cavity of pigmented rabbits. The concentration of prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) in the aqueous humor after the injection of 10(-4)M ET-1 with or without pre-treatment with 97-139 (10(-1), 10(-2), 10(-3)M) was also studied. Pre-treatment with 10(-2)M and 10(-1)M 97-139 completely prevented the APC increase induced by 10(-5)M and 10(-4)M ET-1, respectively. Increases in aqueous PGE2 concentration were observed after the injection of ET-1, which was inhibited by pre-treatment with 97-139. Aqueous LTB4 concentration was not changed significantly by ET-1. These results indicate that the effects of ET-1 on APC are at least partially mediated by the cyclooxygenase pathway of arachidonic acid cascade, and that ETA receptors play an important role in these reactions.

Possible application of transmitted laser light for the assessment of human pulpal vitality

The purpose of this study was to determine whether use of transmitted laser light would enable a better assessment of human pulpal vitality than back-scattered light does (LDF: laser Doppler flowmetry). The experiments were carried out on ten upper central incisors in six subjects aged 23-28 years; five of the teeth were vital with no restoration, and five were non-vital. For use with transmitted laser light, the fibers within the probe of a conventional LDF apparatus were used, one for transmitting light onto the buccal surface, the other for receiving it at the palatal surface of the same tooth. For LDF, the probe was fixed at the buccal surface. Blood flow was measured at three different locations on each experimental tooth: the incisal third, the center and the cervical third of the tooth crown. In non-vital teeth, 1) output signals with transmitted laser light all registered zero, and no oscillation could be seen in recordings from any location on the tooth, but 2) LDF signals were above zero, there were regular oscillations related to heart rate, and passive increases in blood flow (corresponding to blood pressure increases) were recorded from both the center and the cervical third of the tooth, indicating that LDF registered blood flow of non-pulpal origin. In vital teeth, LDF signals were significantly higher than in non-vital teeth at each location on the tooth. At the central site on vital teeth, the output signals for transmitted laser light were about twice those seen with LDF, and passive blood flow changes corresponding to blood pressure increases were more clearly observed. These results indicated that transmitted laser light would be useful for the assessment of tooth pulp vitality both because the blood flow signals did not include flow of non-pulpal origin, and because its output signals and response to blood flow changes were clear and could easily be monitored.

[Anterior chamber inflammation after the injection of endothelin-1 into the vitreous and the effect of an anti-prostaglandin agent]

We measured the time course of aqueous protein concentration (APC) with a laser flare-cell meter after the injection of endothelin-1 (ET-1) into the vitreous cavity of pigmented rabbits and investigated the influence of pre- or post-treatment with an anti-prostaglandin agent on these effects of ET-1. Injection of ET-1 significantly increased APC in a dose-dependent fashion. After 10(-5)M ET-1 injection, APC reached maximum at 4 hours after treatment and returned to the normal level 24 hours after the injection. On the other hand, the 10(-4)M ET-1 model displayed a bi-phase time course, with a peak value observed at 4 approximately 8 hours and 48 hours post-treatment, and APC did not return to normal even 7 days after treatment. Treatment with anti-prostaglandin agents before and after the injection blocked APC increase completely in the 10(-5)M ET-1 model, and partially in the 10(-4)M ET-1 model. These results indicate that ET-1 effects on APC are at least partially mediated by the cyclooxygenase pathway of the arachidonic acid cascade.

Direct evidence of parasympathetic vasodilatation in cat periodontal ligament

Sympathetic regulation of periodontal ligament blood flow (PLBF) is well-attested; however, vasodilator responses mediated by parasympathetic nerve fibers have yet to be conclusively demonstrated in the periodontal ligament (PL). The present study was designed to determine whether parasympathetic vasodilator mechanisms do or do not exist in the cat PL. In our cats, the cervical sympathetic trunks were sectioned bilaterally prior to any stimulation in order to eliminate sympathetic effects on the vascular beds under study. Dynamic changes in PLBF, with mandibular lip blood flow (LBF) recorded for comparison, were investigated in cat mandibular canine teeth using laser Doppler flowmetry. The peripheral cut ends of the facial and glossopharyngeal nerve roots, which have been reported to contain parasympathetic nerve fibers to the oral tissues, were electrically stimulated intracranially. Such stimulation caused blood flow to increase in the ipsilateral PL and lip, without an increase in systemic blood pressure. These vasodilator responses in the PL and lip were sensitive to ganglion blockade (with hexamethonium), indicating vasodilation via activation of parasympathetic vasodilator fibers. In contrast, although intracranial stimulation of the trigeminal nerve root also induced increases in both PLBF and LBF, these were unaffected by hexamethonium, but reduced by tripelennamine, indicating antidromic vasodilatation via the trigeminal sensory nerve. These results suggest that parasympathetic vasodilator mechanisms do exist in feline PL.

Clinical evaluation of a 5.5 mm three-zone refractive multifocal intraocular lens

PURPOSE

To evaluate the results of implanting the P359-TUV 5.5 mm three-zone refractive multifocal intraocular lens (IOL).

SETTING

Musashino Red Cross Hospital, Tokyo, Japan.

METHODS

The lens was implanted in 29 eyes of 19 patients who were followed for a mean of 13.5 months. Distance visual acuity (DVA), near visual acuity (NVA), and contrast sensitivity were measured postoperatively.

RESULTS

Ninety-three percent of eyes obtained 20/20 or better DVA with correction and J1 or better NVA with correction. Seventy-nine percent obtained J1 or better NVA with distance correction and 93% obtained J3 or better. Postoperative astigmatism was easier to control than with the former large model multifocal IOL. In almost all cases, good DVA and NVA could be obtained without correction and the cases that did not need spectacle correction increased. In unilaterally implanted cases, contrast sensitivity was slightly less in eyes with multifocal IOLs than in eyes with monofocal IOLs. In bilaterally implanted cases, there was no significant difference in contrast sensitivity between the multifocal and monofocal eyes.

CONCLUSION

The small model P359-TUV lens is an effective multifocal lens, especially when implanted bilaterally.

Bilateral reflex vasodilation in the palatal mucosa evoked by unilateral tooth-pulp stimulation in the cat

In a previous study in cats, we found that electrical stimulation of the tooth pulp caused blood flow increases at various sites in the ipsilateral oral mucosa (upper and lower gingivae, lower lip, buccal mucosa and tongue, and, notably, bilaterally in the palatal mucosa). Tooth-pulp stimulation is well-known to induce severe pain and to evoke autonomic reflex responses in other organs and tissues. The purpose of this study was: to confirm that tooth-pulp stimulation may indeed induce autonomically mediated vasodilator responses in the feline oral mucosa away from the stimulated tooth, and to test our hypothesis that the reflex pathway involves parasympathetic vasodilator fibers as efferents. Dynamic changes in palatal mucosal blood flow (PMBF), with lower lip blood flow (LBF) as a control, were investigated in anesthetized, cervically sympathectomized cats by means of Laser Doppler Flowmetry. Unilateral electrical stimulation of the maxillary canine tooth pulp produced hexamethonium-sensitive bilateral increases in PMBF in a stimulus-intensity-dependent manner, without an increase in systemic blood pressure; LBF increased only ipsilaterally. Bilateral section of the glossopharyngeal nerve roots had no effect on the vasodilator responses, while unilateral section of the facial nerve root or lesion of the pterygopalatine ganglion (PPG) abolished the response on that side. Intracranial electrical stimulation of the peripheral cut ends of the facial or glossopharyngeal nerve roots caused an increase in ipsilateral PMBF. These results indicate that unilateral tooth-pulp stimulation induces a bilateral reflex vasodilator response in the palatal mucosa mediated via parasympathetic vasodilator fibers that emerge from the brain stem with the facial nerve and reach the blood vessels via PPG. Although there is a dual innervation of the cat palatal mucosa by parasympathetic vasodilator fibers running via the facial and glossopharyngeal nerve roots, the latter are not involved in the bilateral reflex responses.

[Investigation of retention time of intravesical instillation therapy with pirarubicin (THP)]

The effective and less side effect retention time of intravesical instillation therapy with Pirarubicin (THP) was investigated for the treatment of urinary bladder tumor. Fifty-seven cases of urinary bladder tumor were treated by intravesical instillation therapy with THP (20 mg/40 ml) a total of 6 times, with the first instillation at the time of surgery and the other 5 at a rate of three times a week thereafter. The retention time was 30 minutes, and it was allowed to last 10 or 60 minutes for comparison in some cases. Tumor and normal tissue were examined in the first instillation, and normal tissue in the sixth instillation. Infiltration to the bladder wall of THP was observed under fluorescence microscopy. Although the amount of tumor uptake was larger than normal tissue in the first instillation, no satisfactory infiltration was obtained. Repeated administration of THP with the retention time of 30 minutes enhanced the uptake and increased the infiltration in many cases, and side effects were scarcely noted. Retention time of 10 minutes was unsatisfactory, while the retention time of 60 minutes was discontinued in the early stage of treatment due to severe irritative bladder symptoms. Therefore, a retention time of 30 minutes is adequate in the case of repeated administration of THP in a short period.

Absence of parasympathetic vasodilatation in cat dental pulp

The existence and nature of parasympathetic nerve fibers in the dental pulp have long been a subject for discussion; indeed, vasodilator responses mediated by such nerve fibers have yet to be conclusively demonstrated in the dental pulp. This study was designed to determine whether parasympathetic vasodilator mechanisms do or do not exist in the cat dental pulp. Dynamic changes in pulpal blood flow (PBF), with mandibular lip blood flow (LBF) recorded as a control, were investigated in cat mandibular canine teeth by means of laser Doppler velocimetry. Peripheral trigeminal afferents (see below) were stimulated electrically to confirm that somato-parasympathetic reflex vasodilatation could be induced. The peripheral cut ends of the facial and glossopharyngeal nerve roots, which have been reported to contain parasympathetic nerve fibers to the oral tissues, were then stimulated intracranially. Electrical stimulation of trigeminal afferents (in the infraorbital nerve or the maxillary buccal gingiva) caused no change in PBF but did increase ipsilateral LBF. Neither facial nor glossopharyngeal nerve root stimulation caused a PBF increase, though both elicited increases in ipsilateral LBF. The vasodilator responses in the lip were sensitive to ganglion blockade (with hexamethonium), indicating vasodilatation via activation of parasympathetic vasodilator fibers. In contrast, intracranial stimulation of the trigeminal nerve root induced increases in both PBF and LBF which were reduced by pre-treatment with tripelennamine, indicating antidromic vasodilatation via the trigeminal sensory nerve. These results suggest that a parasympathetic vasodilator mechanism is not present in feline dental pulp.

[Endothelin-1 and intraocular inflammation in pigmented rabbit eyes]

We assessed the role of endothelin-1 (ET-1) in the development of anterior chamber inflammation in pigmented rabbit eyes. After the injection of ET-1 (10(-13), 10(-11), 10(-9) or 10(-7) M) into the anterior chamber, aqueous protein concentration increased significantly in a dose-dependent fashion, with a peak at 1 to 2 hours after treatment, and it returned to the normal level 8 hours after the injection. Pupillary diameter was significantly reduced when 10(-9) M or 10(-7) M ET-1 solution was injected. These effects were blocked by pretreatment with anti-prostaglandin agents, i.e., topical indomethacin or venous diclofenac sodium. In the endotoxin-induced experimental uveitis model, ET-1 concentration in the aqueous humor was significantly higher than that of normal controls as well as the plasma ET-1 level. These results suggest that ET-1 is an important mediator in the ocular inflammatory reactions through the arachidonic acid cascade.

A case of microscopic testicular tumour

A 34-year-old male was referred to us for further examination of gynaecomastia. Serum tests revealed high levels of alpha-foeto protein, human chorionic gonadotropin, oestradiol and prolactin. He had a history of testicular pain and mass, and had been under a local physician's care. With the physician's record of the course of regression we made a diagnosis of microscopic testicular tumour. Serial histopathological sections of the testis revealed a 0.8 mm lesion of chorionic and embryonal carcinoma. We discuss the course of spontaneous regression with a review of the literature.