[An acute epidural hematoma soon after nose blowing: a case report]

We reported a very rare case of an epidural hematoma soon after nose blowing. A 22-year-old male visited our hospital complaining of severe headache and nausea soon after he blew his nose. Thirteen years ago, he had a ventriculo-peritoneal (V-P) shunt operation for a pineal region tumor which had not recurred after irradiation. His left auditory tube had been patent. He hit his head about 3 months ago. On his arrival, his consciousness was almost clear but we observed slight right hemiparesis. Computed tomography of his head obtained on the first day showed the air in the hematoma in the left parietal epidural space which penetrated his petrosal bone from the mastoid air cells. Removal of his epidural hematoma was performed the next day and there was no abnormality of his parietal bone, dura and meningeal arteries. We supposed that nose blowing was what triggered his epidural hematoma. From pressure of nose blowing, the air of his nasopharyngeal space passed through his patent auditory tube into the tympanic cavity, and entered into the epidural space penetrating a microfracture or dissociation in the petrosal bone. In addition to this, V-P shunt system and the looser adhesion of dura to the skull in the young promoted entrance of air. Associated with formation of epidural hematoma in this case were four factors, "patency of auditory tube", "defect or microfracture of petrosal bone", "V-P shunt", "younger age" and triggered by nose blowing.

Development of surface photochemical modification method for micropatterning of cultured cells

This article reports the development of micropatterning technology of cultured cells by precise surface regional modification via photochemical fixation of phenyl azido-derivatized polymers on polymer surfaces. Photoreactive polymers prepared in this study included poly(N,N-dimethylacrylamide-co-3-azidostyrene), bis-4-azidobenzamide-polyethylene glycol, and poly(styrene-co-3-azidostyrene). The photochemical fixation of these photoreactive polymers consisted of three steps: 1) coating of a photoreactive polymer on a material surface, 2) ultraviolet irradiation through a photomask, and 3) removal of nonreacted polymer by a solvent. Electron spectroscopy for chemical analysis and water contact angle measurement were employed for surface characterization. Two different types of regionally modified surfaces were prepared; one was a hydrophilic polymer regionally fixed on a tissue culture dish and the other was a hydrophobic polymer regionally fixed on poly(vinyl alcohol) (PVA). Photochemical surface microfabrication permits mu-order dimensional precision, which was verified by the micropatterned tissue formation of bovine aorta endothelial cells (ECs) when ECs were seeded on these surfaces. ECs adhered, spread, and confluently proliferated only on uncoated tissue culture dish surfaces or hydrophobic regions on PVA. Thus, the regionally differentiated cell adhesional regions were created by photochemically driven surface microprocessing.

Different effect of cyclosporin A on arthritides induced by a muramyl dipeptide analogue or the complete adjuvant in rats

Muramyl dipeptide-Lys(L18) given by daily subcutaneous injection for 14 days induced arthritis in male Lewis, Fischer and nude rats, to a lesser degree in the last two than in the first strain. On the other hand, a single intradermal administration of Freund's complete adjuvant induced arthritis in Lewis and Fischer but not nude rats. Cyclosporin A (CsA) co-administered for 14 days markedly exacerbated the muramyl dipeptide-Lys(L18) induced arthritis (MIA) in rats of all three strains, but completely blocked the development of the adjuvant induced arthritis (AIA) in Lewis rats. Furthermore, AIA was transferred to recipient Lewis rats through spleen cells obtained from the donors with AIA, whereas MIA was not. Antibodies against type II collagen and DNA were not detected in sera from MIA or AIA rats. These data show a clear difference between MIA and AIA in the pattern of development of arthritis and suggest that delayed hypersensitivity reactions may be involved in the pathogenetic mechanisms of AIA, but not in MIA.

[Triple primary intracranial tumors of different cell types: a case report]

We report a case of triple intracranial tumors of different cell types without phacomatosis. The patient was a 77-year-old female who was hospitalized with left hemiparesis and vomiting. Computed tomography (CT) scans revealed a large tumor mass in the right frontal lobe and relatively small tumor masses in the medial right frontal and parietal lobes. Other tumors were also detected in the sella turcica, left sphenoidal wing, left anterior clinoidal process and left cerebellar convexity. This case was considered to be one of metastatic brain tumors, and surgery was performed for the right frontal tumor because of its mass effect. The tumor was so highly vascular that it could not be totally removed. Postoperatively, the mass effect showed a gradual increase on CT scans because of intratumoral hemorrhage and peritumoral edema. The patient's consciousness level gradually fell, and she died of pneumonia and cardiac insufficiency 1 month after the operation. The surgical specimen of the tumor was diagnosed as glioblastoma multiforme by histological examination. At autopsy, the small tumors in the medial frontal lobe and parietal lobe were found to be clearly separated from the large right frontal tumor and were diagnosed as multicentric glioblastoma multiforme. The sellar tumor revealed chromophobe pituitary adenoma and was diagnosed as a prolactinoma by immunohistochemical examination. The tumors in the left sphenoidal wing and left cerebellar convexity were diagnosed as transitional meningiomas. Multiple primary intracranial tumors of different cell types without phacomatosis are relatively rare, but almost 100 reported cases could be found in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Human steroidogenic acute regulatory protein: functional activity in COS-1 cells, tissue-specific expression, and mapping of the structural gene to 8p11.2 and a pseudogene to chromosome 13

Steroidogenic acute regulatory protein (StAR) appears to mediate the rapid increase in pregnenolone synthesis stimulated by tropic hormones. cDNAs encoding StAR were isolated from a human adrenal cortex library. Human StAR, coexpressed in COS-1 cells with cytochrome P450scc and adrenodoxin, increased pregnenolone synthesis > 4-fold. A major StAR transcript of 1.6 kb and less abundant transcripts of 4.4 and 7.5 kb were detected in ovary and testis. Kidney had a lower amount of the 1.6-kb message. StAR mRNA was not detected in other tissues including placenta. Treatment of granulosa cells with 8-bromo-adenosine 3',5'-cyclic monophosphate for 24 hr increased StAR mRNA 3-fold or more. The structural gene encoding StAR was mapped using somatic cell hybrid mapping panels to chromosome 8p. Fluorescence in situ hybridization placed the StAR locus in the region 8p11.2. A StAR pseudogene was mapped to chromosome 13. We conclude that StAR expression is restricted to tissues that carry out mitochondrial sterol oxidations subject to acute regulation by cAMP and that StAR mRNA levels are regulated by cAMP.

Separation of neutrophils from blood in human and laboratory animals and comparison of the chemotaxis

We separated neutrophils from the peripheral blood of the human, monkey, dog, rabbit, rat, hamster, and mouse and investigated their responses to several chemotactic factors to evaluate the species-dependent difference in responsiveness. Heparinized blood was obtained by venipuncture from human, monkey, dog, and rabbit. In the rat, hamster, and mouse, the hetastarch exchange transfusion method was used to increase the neutrophil recovery. After sedimentation of red blood cells, a leukocyte suspension was layered on 5-step discontinuous Percoll gradients of densities from 1.081 to 1.097. We could routinely obtain the fractions containing neutrophils at more than 90% in all of the seven species tested. Chemotaxis assay was performed using a 48-well modified Boyden chamber. Dog neutrophils did not migrate to N-formylmethionyl-leucyl-phenylalamine (fMLP), and dog and rat neutrophil responses to leukotriene B4 (LTB4) were remarkably modest. However, neutrophils from other species showed a high reactivity to fMLP and LTB4. Although neutrophils of all species responded to human recombinant interleukin 8 (hrIL-8), the sensitivity of human and monkey neutrophils to hrIL-8 were higher as compared with other species. Human, dog, and rat neutrophils reacted most to homologous zymosan-activated serum derived respectively from human, dog, and rat serum. The present results show species-dependent differences of neutrophils in chemotactic responses.

A novel translocation involving chromosomes 2, 9, 14, and 22 in chronic myeloid leukemia

A 46-year-old man with chronic myelogenous leukemia was found to have a new complex translocation. In chronic phase, all of the bone marrow cells had a rearrangement of a t(2;9;14;22) (p21;q34;q32;q11). Southern blot analysis of leukocyte DNA revealed rearrangement of the breakpoint cluster region (bcr) within the 5.8-Kb bcr. The patient eventually died in blast crisis 28 months later. The cytogenetic findings of bone marrow cells showed a 46,XY,t(2;9;14;22)(p21;q34;q32;q11),add(1p),del(3q) karyotype in blast crisis.

Role of steroidogenic acute regulatory protein in adrenal and gonadal steroidogenesis

Congenital lipoid adrenal hyperplasia is an autosomal recessive disorder that is characterized by impaired synthesis of all adrenal and gonadal steroid hormones. In three unrelated individuals with this disorder, steroidogenic acute regulatory protein, which enhances the mitochondrial conversion of cholesterol into pregnenolone, was mutated and nonfunctional, providing genetic evidence that this protein is indispensable normal adrenal and gonadal steroidogenesis.

[A case of primary signet ring cell carcinoma of urinary bladder]

A 72-year-old female patient presented to our clinic with the chief complaint of gross hematuria and urinary frequency on September 6, 1990. Cystoscopic examination revealed a thumb's head size nonpapillary tumor. The tumor was located adjacent to the orifice of the left ureter. Histological findings of the tumor by transurethral resection (TUR) indicated transitional cell carcinoma with partial signet ring cell carcinoma. No other malignant findings in any other organs including the gastrointestinal tract were noted. Total cystectomy was performed and Indiana pouch was constructed. Histopathological staging was pT1 N0 M0. The patient died of multiple metastasis of the signet ring cell carcinoma on June 22, 1992. This is the thirty-second case of signet ring cell carcinoma of urinary bladder reported in the medical literature in Japan. We investigated 19 alive or unknown cases as follow up and briefly discussed the treatment and outcome of the primary signet ring cell carcinoma of the urinary bladder. The outcome appeared to be somewhat better than previous reports. Total cystectomies were performed in 18 of the 32 cases (56.3%). As noted in past reports, the treatment of our patient consisted of total cystectomy. Twenty-two patients died of signet ring cell carcinoma. Recurrence to the pelvic area was observed in 18 of the 22 (81.8%) patients who died. Because of this high rate of recurrence, we recommend a thorough assessment of the pelvic area of the patients diagnosed with signet ring cell carcinoma of urinary bladder.

Extended wear soft contact lenses induce corneal epithelial changes

The purpose of this study was to determine the corneal epithelial alterations induced by various types of contact lenses. By employing the specular microscope, the corneal epithelia of 60 patients who had worn contact lenses for more than 1 year were re-examined along with 15 myopic controls. The morphological changes in aphakic patients who changed from extended wear soft to extended wear rigid gas permeable lenses were also studied. The mean cell area of the corneal epithelium was 621.5 (SD 92.5) microns 2 for daily wear rigid gas permeable lenses (n = 15), 645.8 (98.1) microns 2 for daily wear soft lenses (n = 15), and 634.7 (88.6) microns 2 for extended wear rigid gas permeable lenses (n = 15), none of which differed significantly from the control value of 610.5 (98.1) microns 2. Only the extended wear soft lens group (n = 15) showed significantly enlarged epithelia (806.1 (50.1) microns 2, p < 0.01 versus the other groups). The epithelium partially returned to normal after changing from extended wear soft lenses to extended wear rigid gas permeable ones. The corneal epithelium showed increased cell area only with extended wear soft contact lenses which are known to pose a risk for corneal infection.

[A case report of angina pectoris associated with hypereosinophilia in a patient on continuous ambulatory peritoneal dialysis (CAPD)]

We report a case of hypereosinophilia which was associated with the onset of anginal attacks. A 64-year-old man progressed to end-stage renal failure due to diabetic nephropathy, and was treated with continuous ambulatory peritoneal dialysis (CAPD). He had no past history of angina pectoris nor hypereosinophilia. Three weeks after the initiation of CAPD, the eosinophil count in peripheral blood increased (up to 4093/mm3). Two weeks later, he suffered from an anterior chest pain attack, and angina pectoris was diagnosed. As a result of treatment with isosorbide dinitrate and prednisolone, hypereosinophilia disappeared rapidly and repeated episodes of anginal attacks also disappeared. After an interval of 3 months, however, hypereosinophilia (up to 15190/mm3) and anginal attacks recurred. He underwent coronary angiography, in which no stenotic change was observed. The administration of prednisolone was effective in the treatment of these episodes. Although a close relationship between hypereosinophilia and anginal attack has been reported, it has not been known in CAPD patients as described here. Attention should be paid to these relationships in CAPD patients, because hypereosinophilia is frequently observed in maintenance peritoneal dialysis patients.

Serum levels of steroid sulfatase protein in gynecologic carcinomas

Steroid sulfatase (STS) desulfates a number of 3 beta-hydroxysteroid sulfates, converting inactive steroid hormone to the active form. We have established an enzyme-linked immunosorbent assay (ELISA) of STS by using polyclonal antibody against STS purified from human placenta to measure the amount of the enzyme protein in sera. ELISA was performed by a 'Sandwich' method using a peroxidase conjugated anti-STS IgG Fab' fragment. A range of STS of 10-1,500 ng/ml in serum was assayed by this method. When the serum STS from the patients with gynecologic carcinomas was assayed by the ELISA, the level was significantly elevated in endometrial carcinoma (P < 0.05) and ovarian carcinoma (P < 0.01), respectively, as compared with that of normal healthy women.

[Accelerated hyperfractionation in the treatment of malignant glioma]

A retrospective evaluation was performed to determine whether accelerated hyperfractionation (AHF) improves the survival rate of patients with malignant gliomas. One hundred and seven patients with malignant gliomas, including glioblastoma multiforme, who had received radical radiotherapy were evaluated. Of the patients, 36 were treated by conventional fractionation (CF), and 71 by AHF. The treatment results of the two regimens were compared with regard to survival rate after therapy. Treatment by AHF was conducted at 10-15 F/W (1.5 Gy/F); the mean total dose was 61 Gy over an average of 27 days. Treatment by CF was conducted at 5 F/week (1.8-2 Gy/F); the mean total dose was 59 Gy over 51 days. Multivariate analysis using Cox's proportional hazard model revealed that AHF significantly increased survival rate. Besides pointing to the selection of the AHF method as a treatment regimen, multivariate analysis showed the following factors to be indicators of favorable prognosis: a histopathological diagnosis other than glioblastoma multiforme, age below 40 years, and supratentorial location of the tumor.

Effect of growth temperature on maintenance of virulent Rhodococcus equi

Repeated passage of virulent Rhodococcus equi ATCC 33701 and L1 at 38 degrees C resulted in attenuation of the strains as a result of curing the virulence plasmid; at 30 degrees C, repeated passage had no such effect. At a temperature of 38 degrees C the plasmid-bearing cells replicated more slowly than their plasmid-cured derivatives and so were gradually replaced by cells lacking plasmids. In contrast, at a temperature of 30 degrees C the growth rate of either strain was not affected by the presence or absence of the plasmid. No plasmid-cured derivative was recovered from mouse organs at 48 h after inoculation of a mixture of equal numbers of bacteria with and without plasmids. It is concluded that under nonselective conditions growth temperature is an important factor in maintaining the virulence of R. equi.

Inhibitory effects of caffeine on secretagogue-induced catecholamine secretion from adrenal chromaffin cells of the guinea-pig

1. The inhibitory action of caffeine on catecholamine secretion induced by secretagogues was investigated in perfused adrenal glands and dispersed chromaffin cells of the guinea-pig. 2. Caffeine (10 mM) caused a reversible inhibition of catecholamine secretion evoked by acetylcholine (ACh, 50 microM), KCl (56 mM, high K+) and veratridine (100 microM) and that induced by muscarinic receptor activation in the absence of extracellular Ca2+ in perfused adrenal glands. 3. In dispersed chromaffin cells, caffeine caused a dose-dependent inhibition of the secretory responses to 100 microM ACh and veratridine. Forskolin (30 microM), dibutyryl cyclic AMP (1 mM) and 8-bromo cyclic AMP (1 mM) did not mimic the action of caffeine. 4. In the voltage-clamp, whole-cell recording mode (at a holding potential of -60 mV or -70 mV), ACh (100 microM) evoked an inward current, and depolarizing pulses elicited inward Na+, Ca2+ and outward K+ currents. All these responses were partially inhibited by caffeine (20 mM). 5. ACh rapidly increased the intracellular concentration of Ca2+ ([Ca2+]i) in fura-2-loaded cells in either the presence or the absence of external Ca2+, though its magnitude was decreased by about 50% in Ca(2+)-free conditions. Caffeine (20 mM) inhibited these ACh-induced increases in [Ca2+]i. 6. In permeabilized chromaffin cells, caffeine (20 mM) caused an inhibition of catecholamine secretion evoked by Ca2+ (10 microM). 7. These results suggest that caffeine inhibits evoked catecholamine secretion through mechanisms such as the blockade of voltage-dependent Na+ and Ca2+ currents and ACh receptor current, and reduction of the release of intracellularly stored Ca2+ and/or Ca(2+)-sensitivity of the secretory apparatus.

Single dose toxicity study of the new cognition-enhancing agent nefiracetam in mice, rats and dogs

Single oral dose toxicity of nefiracetam (N-(2,6-dimethylphenyl)-2-(2-oxo- 1-pyrrolidinyl) acetamide, DM-9384, CAS 77191-36-7), a new cognition-enhancing agent, was examined in ddY mice, SD rats and beagle dogs. The LD50 values of nefiracetam were 2005 mg/kg for male mice and 1940 mg/kg for female mice, 1182 mg/kg for male rats and 1408 mg/kg for female rats and more than 500 mg/kg for beagle dogs. Common toxic signs in all species were a decrease in locomotor activity, lying on the side or back and loss of righting reflex, considered to be caused by depression of the central nervous system. Pathologically, no remarkable change associated with nefiracetam administration was observed in any species. In addition, toxicities of the decomposition product (D-2) and by-products (Bis, 3-Me and 4-Me) of nefiracetam were examined by oral administration, and of the metabolites (M-3 and M-11) by intravenous injection in male ddY mice. LD50 values of the 3-Me and 4-Me forms were 1399 and 1534 mg/kg, respectively. Clinical signs in mice treated with these by-products were similar to those caused by nefiracetam. The other compounds induced no toxic signs or death up to the highest dose (2000 mg/kg) used.

Tissue-targeting ability of saccharide-poly(L-lysine) conjugates

To evaluate the effect of introducing a saccharide moiety to poly(amino acids) on tissue distribution, several glycoconjugates of epsilon-(2-methoxyethoxyacetyl)-poly(L-lysine) of three molecular weights were synthesized using an octylene spacer between the sugar and polymer chain. Methoxyethoxyacetylation of the epsilon-amino group of the lysine unit in poly(L-lysine) was useful for avoiding nonspecific distribution to many tissues as the result of cationic charges. The tissue-targeting ability of each saccharide moiety was considered as the actual amount changed in each tissue caused by saccharide modification. Galactose terminated saccharides such as galactose, lactose and N-acetylgalactosamine accumulated exclusively in the liver, probably by the hepatic receptor. These conjugates could therefore be good carriers for a drug delivery system to the liver. On the other hand, the mannosyl and fucosyl conjugates were preferentially delivered to the reticuloendothelial systems such as those in the liver, spleen and bone marrow. In particular, fucosyl conjugates accumulated more in the bone marrow than in the spleen. Xylosyl conjugates accumulated mostly in the liver and lung. Generally, the accumulated amount in the target tissue increased with increasing molecular weight and an increased number of saccharides on one molecule of polymer.

[A clinical study on lymph node metastasis of renal pelvic and ureteral cancers]

A clinical study was performed on 38 patients with renal pelvic and ureteral cancers who were treated in our hospital between 1977 and 1992. Nine patients (23.7%) had lymph node metastasis. The risk factors of lymph node metastasis were high grade, high stage and class IV or V or urine cytology. None of the patients with G1 or under pT1 had lymph node metastasis. The 5-year survival rate of the patients without [lymph node metastasis was 76.7% and that of the patients with lymph node metastasis was 11.1%. Although 6 of the 9 patients with G1 or G2 and under pT1 did not have adjuvant therapy, none of them died of the cancer. We concluded that lymph node metastasis in renal pelvic and ureteral cancers was the most important prognostic factor and that regional lymphadenectomy might be useful for the decision of adjuvant therapy.

Thirteen-week oral toxicity study of the new cognition-enhancing agent nefiracetam in dogs

The 13-week oral toxicity of nefiracetam (N-(2,6-dimethylphenyl)-2-(2-oxo- 1-pyrrolidinyl) acetamide, DM-9384, CAS 77191-36-7), a new cognition-enhancing agent, was investigated in Beagle dogs of both sexes. No change was observed in the 20 mg/kg group. Hypospermatogenesis and slightly increased deposition of hemosiderin in the spleen were seen in male dogs treated with 60 mg/kg or more. Dosing at 180 mg/kg induced a decrease in food consumption, increases in urinary volume and urinary protein, and renal papillary necrosis in both male and female dogs. The non-toxic dose was 20 mg/kg under these experimental conditions.

Expression of laminin, type IV procollagen and 230 kDa bullous pemphigoid antigen genes by keratinocytes and fibroblasts in culture: application of the polymerase chain reaction for detection of small amounts of messenger RNA

In order to clarify whether keratinocytes and/or fibroblasts express genes encoding basement membrane zone macromolecules, we examined laminin, type IV collagen and 230 kDa bullous pemphigoid antigen (BPAG1) gene expression in keratinocytes and fibroblasts in culture. Northern transfer analysis revealed the presence of specific mRNA transcripts for alpha 1(IV) and alpha 2(IV) chains of type IV collagen as well as B1 and B2 chains of laminin in both fibroblast and keratinocyte RNA. Laminin A mRNA, however, was detected in fibroblasts but not in keratinocytes. In contrast, BPAG1 mRNA was detected in keratinocytes but not in fibroblasts using the same RNA preparations. A polymerase chain reaction (PCR) using laminin A and BPAG1-specific primers produced amplified DNAs with the predicted sizes in reverse-transcripted cDNA derived from keratinocyte and fibroblast RNA, respectively. These results provide evidence that normal human skin keratinocytes and fibroblasts express genes encoding laminin A, B1, B2, alpha 1(IV), and BPAG1 at a steady-state level. Moreover, the PCR for detecting small amounts of mRNA suggested that both keratinocytes and fibroblasts can be utilized for the analysis of DNA mutations in inherited skin diseases affecting the basement membrane zone, such as epidermolysis bullosa.

A case of myelodysplastic syndrome progressing to acute myelocytic leukemia in which adult-onset Still's disease had occurred 6 years before

A patient with adult-onset Still's disease who presented with myelodysplastic syndrome (MDS) after a course of 6 years is reported. To our knowledge, this is the first such reported case. The patient died of acute myelocytic leukemia. The possibility that cyclosporine contributed to the onset of MDS is discussed.