Increased levels of CSF soluble CD27 in patients with primary central nervous system lymphoma

The aim of this study is to determine the diagnostic value of cerebrospinal fluid (CSF) soluble CD27 (sCD27) as a tumor marker for primary central nervous system lymphoma (PCNSL). We examined sCD27 levels in CSF obtained from various types of brain tumor patients. Forty-two patients were studied (including 12 PCNSL patients) who had not received any therapy for their tumors. In all PCNSL cases, CSF sCD27 levels were more than 15 U/ml (median 84.5 U/ml, range 17-484 U/ml) and in other brain tumor cases, CSF sCD27 levels were all less than 15 U/ml. Our data suggest that CSF sCD27 levels are useful to distinguish PCNSL from other brain tumors.

Angiotensin I-converting enzyme gene polymorphism in intracranial saccular aneurysm individuals

A polymorphism in the angiotensin I-converting enzyme (ACE) gene has been associated with cerebrovascular diseases as a new potent risk factor. The purpose of this study was to investigate an association of the gene polymorphism with intracranial saccural aneurysmal patients. The study population consisted of 83 aneurysmal patients (age range 41-85 years) (the AN group) and 104 matched control subjects (age range 30-81 years) (the Control group). For detection of the ACE gene polymorphism, the standard PCR method was performed by using genomic DNA isolated from peripheral blood leukocytes. The PCR products were a 490-bp in the presence of the insertion (I) and a 190-bp fragment in the absence of the insertion (D). The ACE gene polymorphism was classified into three genotypes: I/I genotype (a 490-bp band); D/D genotype (a 190-bp band); or I/D genotype (both a 490-bp and a 190-bp band). The number of subjects with I/I, I/D, and D/D genotypes was 38, 40, and 5 in the AN group and 43, 45, and 16 in the Control group, respectively. The frequency of the D/D genotype in the AN group was significantly lower (5/83 = 0.06) than that in the Control group (16/104 = 0.15) (chi 2 = 4.06; p = 0.044). There was no significant difference between the genotype sof hypertensive patients and normotensive patients in the AN group. Thus, this present study suggests that genetic heterogeneity of the ACE gene may be correlated with the etiology of intracranial aneurysms.

Moyamoya disease associated with pulmonary sarcoidosis--case report

A 61-year-old female presented with a unique case of moyamoya disease associated with pulmonary sarcoidosis. She was admitted for sudden onset of left temporalgia with episode of numbness on face, tongue, and upper extremity on the right side. The next morning, she had symptoms of Gerstmann syndrome and her ability to speak was disturbed. Her medical history included radical resection of lung cancer on the right side. She had no symptoms of pulmonary sarcoidosis. Neuroimaging showed an infarction in the left occipital lobe. Angiography showed occlusions of the bilateral internal carotid arteries at the supraclinoid portions. Subsequently, a left superficial temporal artery-middle cerebral artery anastomosis with encephalo-myo-synangiosis was performed. Ninety-three days after admission, she suddenly developed dyspnea which resulted in death 3 hours later. Autopsy findings showed typical epithelioid granulomas of sarcoid type in the lymph nodes of the peribronchus, lung, and liver. Thrombotic emboli were found in the bilateral pulmonary arteries, and marked fibrous intimal thickening in the bilateral internal carotid arteries. Immunological reaction with inflammatory events may cause pathological changes in patients with moyamoya disease or sarcoidosis. The co-incidence in this case suggests that some common inflammatory events may be involved in the pathogenesis of these diseases.

Permeability characteristics of tetragastrins across intestinal membranes using the Caco-2 monolayer system: comparison between acylation and application of protease inhibitors

PURPOSE

Three types of acyl tetragastrin (TG), acetyl-TG (C2-TG), butyryl-TG (C4-TG) and caproyl-TG (C6-TG) were synthesized and their in vitro intestinal permeability characteristics were examined using Caco-2 monolayers.

METHODS

The disappearance of acyl-TGs from the apical side of Caco-2 monolayers was estimated by analyzing degradation and permeation processes in terms of clearance.

RESULTS

The amount of native TG transported to the basolateral side was very low due to its large degradation clearance (CLd) on the apical side. Degradation of TG was reduced by chemical modification with fatty acids, which resulted in an increase in the transport of TG across Caco-2 monolayers. In addition, the permeation clearance (CLp) value of carboxyfluorescein (CF), a paracellular transport and undegradable marker, was increased in the presence of acyl-TGs. Furthermore, we investigated the effects of the protease inhibitors bacitracin and gabexate on the transport of TG across Caco-2 monolayers. In the presence of a low concentration (0.1 mM) of protease inhibitor, the CLd value of TG was reduced, but they did not affect its CLp value. However, a higher concentration (1.0 mM) of bacitracin significantly reduced TG degradation on the apical side, and further increased its CLp value.

CONCLUSIONS

We demonstrated that acylation of TG made it resistant to intestinal proteases and caused it to enhance absorption of drugs, including itself, across Caco-2 monolayers. Further, bacitracin acted as both a protease inhibitor and an absorption enhancer.

Replating potential of colony-forming units of granulocytes/macrophages (CFU-GM) expanded ex vivo by stem cell factor, interleukin (IL)-3, IL-6, granulocyte colony-stimulating factor, erythropoietin with or without thrombopoietin

Ex vivo expansion systems of hematopoietic progenitor cells (HPC) have been extensively studied and their clinical application is under investigation. However, it is not known whether HPC expanded ex vivo will be able to retain their replating potential. CD34+ cells isolated from cord blood were cultured in Iscove's modified Dulbecco's medium supplemented with 10% fetal bovine serum, 1.0% bovine serum albumin, 50 ng/ml stem cell factor, 50 ng/ml interleukin-3 (IL-3), 50 ng/ml IL-6, 100 ng/ml granulocyte colony-stimulating factor, and 3 U/ml erythropoietin for 0, 5, 7, 10, 14, and 21 days. After the expansion cultures, granulocyte/macrophage progenitor cells (CFU-GM) were assayed from each culture by the standard methylcellulose method. After 14 days of culture, CFU-GM-derived colonies were randomly picked up and processed for the replating assay. The fold increase of CFU-GM peaked at day 7 of the expansion culture (29.8 +/- 7.7-fold, n = 5), followed by a decline until day 21. In the replating assay of CFU-GM from freshly isolated CD34+ cells, the mean replating efficiency was 91.2 +/- 4.7%. The replating efficiency decreased gradually with the time of the expansion culture. At day 7 when the fold increase of CFU-GM reached its peak, the replating efficiency had dropped to 47.5 +/- 2.3%, followed by a further decline to 5.3 +/- 3.4% at day 21. Furthermore, the addition of 100 ng/ml thrombopoietin to this expansion system failed to prevent the decline of replating efficiency. These observations suggest that the replating potential of CFU-GM may decrease in the ex vivo expansion system, even when their fold increase reaches its peak. This should be taken into consideration when HPC expanded ex vivo are used in clinical transplantation.

Effect of acute saline infusion on the cardiovascular deconditioning after 20-days head-down tilt bedrest

Recent study showed that dehydration induced by prolonged exercise significantly impaired orthostatic tolerance with tachycardia and hypotension, and subsequent rehydration restored it. As physiological changes during exposure to actual or simulated microgravity can be viewed as dehydration process, we hypothesized that rehydration after prolonged bedrest may be a promising candidate to countermeasure not only fluid volume loss but also autonomic nervous deconditioning. Therefore, the purpose of present study was to determine the effect of acute rehydration by saline infusion on orthostatic cardiovascular deconditioning after bedrest.

A case of biliary cystadenoma with obstructive jaundice

Biliary cystadenoma is a rare cause of obstructive jaundice. We report a case of a 78-year-old Japanese man with biliary cystadenoma presenting repetitive abdominal pain and jaundice. Ultrasound sonography revealed a hyperechoic mass in the left lateral lobe of the liver. Histological examination revealed a biliary cystadenoma. Intracystic hemorrhage was assumed to be the cause of obstruction of the bile ducts.

Effects of physiological salt water injection after 20 days of head down tilt bed rest on maximal aerobic power in young males

There is such a speculation that if the decrease in plasma volume (PV) makes central blood volume (CBV) and stroke volume (SV) reduce during prolonged BR, but if the changes in red cell volume (RCV) is little and a physiological salt water (PSW) volume matched to a body fluid loss is injected, then the increased PV would make CBV increase and the increase would contribute to prevent the decrease of SVmax as well as maximal cardiac output (COmax ). As a result, maximal oxygen uptake (VO2max ) would be come up to the before BR level. In the present study, to investigate the speculation, maximal exercise test immediately following the injection of PSW after prolonged head down tilt bed rest (HDTBR) was performed and compared to the before BR level in young males.

Effects of doxorubicin and/or cilostazol on cancer cells during liver regeneration after two-thirds hepatectomy in rats

A rat model of liver metastases generated by intraportal injection of syngeneic tumor cells after two-thirds hepatectomy to determine the optimal benefit of doxorubicin and/or cilostazol for early hepatic metastases. Four groups of WKA rats had viable tumor cells injected directly into the portal vein after two-thirds hepatectomy. Group A underwent to further treatment. Group B had doxorubicin injected 24 h post-operatively. Group C had cilostazol administered prior to two-thirds hepatectomy. Group D received cilostazol, and doxorubicin injections. The mean survival period in each group was 22.2, 20.0, 28.8, and 22.8 days, respectively. The mean survival was significantly longer in group C than in groups A, B and D (p < 0.05). Based on these findings, we believe that during the phase of liver regeneration adjuvant chemotherapy is not recommended. Cilostazol exerts an important antiproliferative effect on liver metastases after hepatectomy.

Prognosis of hepatocellular carcinoma with diabetes mellitus after hepatic resection

We evaluated the effect of diabetes mellitus on the prognosis of hepatocellular carcinoma after an elective hepatic resection. Of the 342 patients who underwent a hepatic resection between April 1985 and March 1995, 87 (25.4%) were diabetic. Postoperative morbidity was more common among diabetics than among nondiabetics (36.0% vs. 22.5%, P = .0239). The postoperative survival rate and the cancer-free survival rate were also better in patients without diabetes than in those with diabetes (P = .0333, P = .0149). The results of a multivariate analysis show diabetes mellitus to be an independent and prognostic indicator after a hepatic resection with hepatocellular carcinoma. According to the above findings, diabetes mellitus is thus considered to be a risk factor for prognosis after hepatic resection in patients with hepatocellular carcinoma.

Pulsed off-resonance magnetization transfer for brain tumor in patients

We investigated the clinical applicability of pulsed off-resonance magnetization transfer (MT) technique in magnetic resonance (MR) imaging for the estimation of the histological feature of brain tumor. The parameters were optimized using bovine serum albumin (BSA) solutions and gels in 1.5-tesla MR system as follows: TR, 50 msec; TE, 5 msec; flip angle, 30 degree; offset frequency, 1000 Hz. MT effect was evaluated by measuring the MT ratio (MTR) and reconstructing calculated MTR color image. The MTRs of the BSA solutions and gels increased with increasing concentrations of protein, while the MTRs of the gels were remarkably higher than those of the solutions. The optimized sequence was performed in 20 healthy volunteers and 30 patients with brain tumors. In normal brains, the MTRs were significantly higher in white matter than in gray matter (p < 0.05). The MTR in brain tumor was significantly lower than that in normal brain tissue (p < 0.05) and the calculated MTR image produced contrast between brain tumor and normal brain tissue. There was a statistically significant difference in MTR between benign (0.30 +/- 0.05, n = 17) and malignant (0.26 +/- 0.04, n = 13) tumors (p < 0.05). The optimized MT technique is quite sensitive for estimating the degree of intermolecular interaction between macromolecules and water within the central nervous system.

Treatment strategy for patients with cystic lesions mimicking a liver tumor: a recent 10-year surgical experience in Japan

OBJECTIVE

To clarify some of the difficulties in determining the appropriate surgical indications for cystic lesions mimicking a neoplasm in the liver.

DESIGN

A retrospective review of hepatic resections for cystic lesions mimicking a neoplasm in the liver between August 1, 1986, and July 31, 1996.

SETTING

A university hospital with a long history of hepatic resection for cystic lesions mimicking a neoplasm in the liver.

PATIENTS

Ten patients with such cystic lesions in the liver, who underwent a hepatectomy during a recent 10-year period, were included in this study.

MAIN OUTCOME MEASURES

Detailed clinicopathologic data were analyzed, and comparisons were made between the preoperative and postoperative diagnoses.

RESULTS

The postoperative diagnoses consisted of cysts, including cysts complicated by an infection or hemorrhage in 7 patients, localized cystic dilation of the bile duct due to hepatolithiasis in 1, cystadenoma in 1, and mucin-producing cholangiocarcinoma in 1. In only one case was postoperative diagnosis identical to the preoperative diagnosis. In one case, an intraoperative pathological examination showed the tumor to be a mucin-producing cholangiocarcinoma instead of a cystadenocarcinoma. A tumor-marker analysis of the fluid in the cystic lesions also did not contribute to a definite diagnosis. Furthermore, cytological examination of the fluid could not completely exclude malignancy. Neither mortality nor morbidity occurred in any of the patients, and their mean length of hospitalization after hepatectomy was only 13.7 days.

CONCLUSIONS

The accurate diagnosis of cystic lesions mimicking a tumor remains problematic; however, the results of hepatectomy for such cases are normally satisfactory. Such cystic lesions of the liver should be indicated for hepatectomy whenever the possibility of a cancerous neoplasm cannot be completely ruled out.

Pedicle transposition of the greater omentum for sternal osteomyelitis and mediastinitis after cardiac operation

Three patients underwent pedicle transposition of the greater omentum for sternal osteomyelitis and mediastinitis after cardiac operation. These patients were previously operated on with coronary artery bypass grafting, aortic valve replacement and redo Fontan operation in each. This procedure was carried out on 4, 6, 8, and 14th postoperative day. The complications cured within about one month after the procedure in all cases. It is suggested that this maneuver is effective for obtaining healing osteomyelitis and mediastinitis following cardiac operation.

A father and son with Turcot's syndrome: evidence for autosomal dominant inheritance: report of two cases

Typical Turcot's syndrome is characterized by the association of a brain glioma together with multiple colonic polyposis, in which the number of polypoid lesions is small and the association of colonic cancer occurs at a younger age than in familial adenomatous polyposis. We describe a family in which both the father and his son presented with typical Turcot's syndrome without parental consanguinity. This is the first report of a family that is considered to follow an autosomal dominant inheritance. After reviewing 25 documented cases in which the average age of death was 20.3 years old, it was learned that the major cause of death was brain tumor (76 percent) and the minor cause was colon cancer (16 percent). Patients were very young and, therefore, unlikely to have produced a child before their death. These facts seem to support the theory that Turcot's syndrome is an autosomal dominant disorder.

Diversity of myocardial involvement in systemic sclerosis: an 8-year study of 95 Japanese patients

BACKGROUND

Myocardial fibrosis has been reported to be an important complication of systemic sclerosis (SSc). Left ventricular (LV) hypertrophy has also been reported, but its significance is unclear. Correlations between cardiac complications and clinical or serologic subsets of SSc have not been previously evaluated by long-term observational studies.

METHODS

We correlated the findings of echocardiography, electrocardiography, and autopsy with clinical and serologic features in 95 patients with SSc who were monitored for up to 8 years.

RESULTS

Septal thickness determined by echocardiography was significantly greater in patients with anti-nuclear ribonucleoprotein (nRNP) antibodies than in patients with anti-Scl70 or anticentromere antibodies. Fractional shortening was reduced in patients with diffuse cutaneous involvement or anti-Scl70 antibodies. Ten patients had cor pulmonale, which was confirmed by echocardiography. Four of them had diffuse cutaneous involvement and advanced pulmonary fibrosis, whereas four had anti-nRNP antibodies and mild or no fibrosis. Septal hypertrophy was detected in 12 patients, 10 of whom had limited cutaneous involvement and six had anti-nRNP antibodies. Diffuse or regional LV wall hypokinesia was seen in seven patients, of whom six had anti-Scl70 antibodies and five had diffuse cutaneous involvement. Six patients with cor pulmonale, five with abnormal LV wall motion, and three with septal hypertrophy died during the follow-up period. Autopsy revealed LV hypertrophy in three with septal hypertrophy, disarray and irregular hypertrophy of myocytes in one of them, and extensive myocardial fibrosis in one with diffuse LV wall hypokinesia.

CONCLUSIONS

Septal hypertrophy and cor pulmonale caused by pulmonary vasculopathy were associated with limited cutaneous involvement or anti-nRNP antibodies, whereas abnormal LV wall motion and cor pulmonale caused by advanced pulmonary fibrosis were mostly seen in patients with diffuse cutaneous involvement or anti-Scl70 antibodies.

Analysis of blood pressure responses during exercise by logistic function curve in hypertension: effects of age, gender and physical training

During exercise blood pressure fluctuates from minute to minute and does not rise linearly with time. Blood pressure responses were evaluated during exercise by a logistic function curve. Thirty-nine hypertensive patients underwent exercise testing with an ergometer, employing a multistage method (25 watts increment, every 3 min). We plotted the exercise duration on the X-coordinate and systolic blood pressure on the Y-coordinate and blood pressure was assumed to form a logistic curve for exercise duration. The relationship of systolic blood pressure vs. exercise duration was better fitted into a logistic function curve than a linear regression model. The logistic curve was defined by lower plateau, upper plateau, SPX (the X-coordinate at the shift point) and df (SPX), the maximal slope at the shift point. The effects of aging, gender and physical training were then analyzed on the curve. Aging did not affect lower plateau, upper plateau and SPX but augmented df (SPX), indicating greater blood pressure responses in older subjects during exercise. In females the curve was shifted to the left compared to males (SPX: 4.9 vs. 8.3 min, P < 0.05) without changes in plateaux and df (SPX), indicating greater blood pressure responses than males. Physical training for 3 weeks decreased the lower plateau from 157 to 144 mmHg (P < 0.05) and shifted the curve to the right (SPX: 7.1 vs. 8.6 min, P < 0.05), indicating unchanged blood pressure responses after training because of the opposite effects by decreases in the lower plateau vs. the curve shift to the right. In conclusion, blood pressure during exercise is better delineated by a logistic function curve than a linear regression model. The biological or physiological significance of df (SPX) is not clear at present and needs further investigations.

[Sudden death during Holter electrocardiographic monitoring in a patient with hypertrophic cardiomyopathy]

A 56-year-old man visited a doctor because of arrhythmia and a diagnosis of hypertrophic cardiomyopathy was made in 1990. On January 9th, 1997, when aged 63 years old, he visited another doctor because of paroxysmal atrial fibrillation tachycardia. Since his clinical symptoms did not ameliorate, he visited our hospital on April 14th, and Holter electrocardiographic monitoring was started on April 16th. While walking on the street, his heart rate increased up to 107 beat/min when premature ventricular contraction with a long coupling interval of 400 msec occurred, followed by polymorphous ventricular tachycardia, ventricular fibrillation and death. He had no risk factors for sudden death such as early onset of symptoms, history of syncope, family history of sudden death, documented ventricular tachycardia, and congestive heart failure. Although many cases of hypertrophic cardiomyopathy end in sudden death, no electrocardiographic recordings at the time of sudden death have been available. This is the first case of electrocardiographic recording at the time of sudden death in a patient with hypertrophic cardiomyopathy.

A branched chain amino acid-enriched solution does not induce any beneficial effect on the postoperative intestinal functions

BACKGROUND/AIMS

This study was conducted in order to clarify the significance of using a branched chain amino acid-enriched solution on surgical patients, especially regarding the postoperative nitrogen balance as well as such intestinal functions as permeability and immunity.

METHODOLOGY

Eight patients were prospectively and randomly divided into 2 groups. Consisting of a control group (n = 4) who all received conventional postoperative hyperalimentation using the branched chain amino acid-enriched solution; and a high-dose group (n = 4), who received an additional amount of branched chain amino acid-enriched solution immediately after operation up until postoperative day 7. No significant differences were observed in the background variables between the two groups.

RESULTS

The nitrogen balance in the high dose group from postoperative day 1 to day 4 was significantly better for all compared to those of the control group. The ratio of the branched-chain amino acids to aromatic amino acids at postoperative day 3 in the high dose group was significantly higher than that in the control group. The urinary 3-methylhistidine excretion in the high-dose group tended to be lower than that in the control group. However, regarding the intestinal functions, no significant differences between the two groups were observed regarding the lactulose-mannitol test, the rate of positive Candida antigen, and the serum level of secretary immunoglobulin A, or the serum activity of diamine oxidase.

CONCLUSIONS

A high dose branched chain amino acid-enriched solution can improve immediately postoperative nitrogen balance and may also lead to the prevention of a breakdown in the skeletal muscles. However, no beneficial effects were observed in the postoperative intestinal functions, which play an important role in preventing bacterial translocation.

Role of adhesion molecule expression and soluble fractions in hepatic resection

BACKGROUND

Little has so far been documented about the relationship between liver injury and adhesion molecules. The aim of this study is to clarify the role of adhesion molecules in hepatic resection by studying both the expression of such adhesion molecules and the measurement of their soluble fractions in the blood.

STUDY DESIGN

To study adhesion molecule expression in the liver, liver biopsies were obtained before and after hepatectomy in 14 patients. Using frozen sections, immunochemical staining for intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) was then performed. To study the soluble fractions of adhesion molecules in the hepatic venous blood, the serum soluble fractions of ICAM-1 and VCAM-1 from another 17 patients were measured using an enzyme-linked immunosorbent assay. The plasma levels of polymorphonuclear leukocyte (PMN) elastase were also measured using an enzyme immunoassay. Both the preoperative and postoperative values of the serum soluble fractions of ICAM-1, VCAM-1, and PMN elastase were then compared. The correlation between their values and the perioperative variables was also investigated.

RESULTS

Either ICAM-1 or VCAM-1 was stained on the sinusoidal endothelial cells and Kupffer cells or circulating PMNs in the sinusoid. The positive rate of either ICAM-1 or VCAM-1 staining in livers with more than 40 minutes of total ischemic time (80%) was significantly higher than that in livers with less than 40 minutes of total ischemic time (0%; p < 0.05). The incidence of postoperative complications in the ICAM-1 positive staining group tended to be higher than that in the ICAM-1 negative group. Both soluble fractions of ICAM-1 and VCAM-1 in patients with cirrhotic liver disease were also significantly higher than those in patients with a normal liver. The soluble VCAM-1 level in patients with a chronic active hepatitic liver tended to be higher than that in those with a nonactive hepatitic liver. The preoperative level of soluble ICAM-1 correlated with that ofVCAM- 1, PMN elastase, albumin, aspartate aminotransferease (AST), and the indocyanine green dye retention test at 15 minutes (ICG R15), while the preoperative level of VCAM-1 correlated with albumin, the hepaplastin test, AST, and ICG R15. Both the serum soluble ICAM-1 and VCAM-1 levels after hepatectomy were significantly lower than those before hepatectomy. By contrast, the posthepatectomy level of PMN elastase was significantly higher than its prehepatectomy level. The difference between the postoperative and preoperative values of soluble ICAM-1 correlated with the postoperative AST level, postoperative alanine aminotransferase level, and total ischemic time.

CONCLUSIONS

Adhesion molecules were expressed in the liver after hepatic resection, and such expression correlated with a total ischemic time during hepatectomy. In addition, judging from the soluble forms of such molecules, these adhesion molecules play an important role in hepatic resection.

Activation of the protein kinase p38 in the spindle assembly checkpoint and mitotic arrest

The mitogen-activated protein kinase (MAPK) superfamily comprises classical MAPK (also called ERK), c-Jun amino-terminal or stress-activated protein kinase (JNK or SAPK), and p38. Although MAPK is essential for meiotic processes in Xenopus oocytes and the spindle assembly checkpoint in Xenopus egg extracts, the role of members of the MAPK superfamily in M phase or the spindle assembly checkpoint during somatic cell cycles has not been elucidated. The kinase p38, but not MAPK or JNK, was activated in mammalian cultured cells when the cells were arrested in M phase by disruption of the spindle with nocodazole. Addition of activated recombinant p38 to Xenopus cell-free extracts caused arrest of the extracts in M phase, and injection of activated p38 into cleaving embryos induced mitotic arrest. Treatment of NIH 3T3 cells with a specific inhibitor of p38 suppressed activation of the checkpoint by nocodazole. Thus, p38 functions as a component of the spindle assembly checkpoint in somatic cell cycles.

Ultrastructural study of development of hepatic necrosis induced by TNF-alpha and D-galactosamine

Recent studies have suggested an association between tumor necrosis factor-alpha (TNF-alpha) and the development and progression of acute liver failure. To investigate the role of TNF-alpha in the mechanism of massive hepatic necrosis, we studied a mouse model of TNF-alpha and D-galactosamine (GalN) -induced hepatic necrosis by ultrastructural analysis. Administration of GalN caused edema of hepatocellular microvilli and widening of sinusoidal endothelial fenestrae (SEF); administration of TNF-alpha caused only a widening of the SEF. Massive hepatic necrosis with hemorrhage was seen 6 hr after concomitant administration of TNF-alpha and GalN. In the ultrastructural analysis, edema of the hepatocellular microvilli, widening of the SEF, and transmigration of red blood cells (RBC) and platelets to the space of Disse without exfoliation and necrosis of the sinusoidal endothelial cells were observed. Fibrin deposits were seen in areas adjacent to injured hepatocytes. The diameter of the SEF was significantly greater than in the nontreated group and the groups treated with TNF-alpha or GalN alone. These results suggest that as a consequence of the increase in diameter of the SEF, transmigration of RBCs and platelets to the space of Disse may have resulted in massive hepatic necrosis due to occlusion of the microcirculation.

Clinical applicability of functional magnetic resonance imaging and activation study with single photon emission computerized tomography for functional mapping

The purpose of this study is to estimate the clinical applicability of functional magnetic resonance imaging (f-MRI) combined with the activation study using single photon emission computerized tomography (SPECT) with special reference to identification of primary sensorimotor area. Five healthy volunteers and 5 patients with brain tumors located around the sensorimotor cortex were studied by both f-MRI with gradient echo and SPECT with 99mTc-ethyl cysteinate dimer using split-dose and subtraction method. In f-MRI study, the significant activation of the sensorimotor area was observed in all subjects. Various concurrent activation regions such as supplementary motor (2 volunteers vs. 4 patients), premotor (1 vs. 2) and ipsilateral sensorimotor area (1 vs. 2) were also observed. In the cases with the activation of neighboring regions of sensorimotor area, it was difficult to identify the area in f-MRI. In SPECT study, the sensorimotor area was depicted as the most increased area in regional cerebral blood flow in eight cases, the characteristics of which were helpful to diagnose the area, while significant activation of the area with edema could not be detected in two patients. Consequently, the sensorimotor area was cross-validated with both the modalities. This study demonstrated that it would be valuable to use both techniques for the clinical assessment of the sensorimotor area.

Ceramide formation leads to caspase-3 activation during hypoxic PC12 cell death. Inhibitory effects of Bcl-2 on ceramide formation and caspase-3 activation

PC12 cells undergo apoptosis as well as necrosis following exposure to hypoxia. Following a 6-h hypoxic treatment, a time-dependent increase in intracellular ceramide level was observed with a concurrent decrease in sphingomyelin. It was also shown that the hypoxia-induced ceramide accumulation resulted from activation of neutral magnesium-dependent sphingomyelinase. Comparative kinetic analyses of the neutral sphingomyelinase in the cells under normoxia and hypoxia showed that hypoxia increased Vmax but did not affect Km of the enzyme. In PC12 cells overexpressing Bcl-2 which show strong resistance to hypoxia, sphingomyelin hydrolysis was decreased and activation of neutral sphingomyelinase was reduced. Addition of exogenous C2-ceramide induced cell death and activated caspase-3 as markedly as the hypoxia treatment. On the other hand, in PC12 cells overexpressing Bcl-2, significant decreases in cell death and inhibition of caspase-3 activation were observed after exogenous addition of C2-ceramide. The inhibitors of caspase-3 prevented cell death by either hypoxia or C2-ceramide. These results suggest that ceramide generated by activation of neutral magnesium-dependent sphingomyelinase mediates hypoxic cell death and that Bcl-2 has inhibitory effects on ceramide formation and caspase activation.

Significance of the peroral phenolsulfonphthalein test in hepatic resection: a possible predictor of bacterial translocation

BACKGROUND/AIMS

The aim of this study was to evaluate the perioperative changes in intestinal permeability by using the phenolsulfonphthalein (PSP) test and to also to clarify the significance of the peroral PSP test in hepatic resection.

METHODOLOGY

Fifty patients, all of whom underwent hepatic resection, were prospectively studied. Postoperative complications occurred in 16 patients, and 10 of these complications were infectious. A peroral PSP test, which was scheduled before operation and on postoperative days 3, 7, and 14, was performed as follows: after the administration of 30 mg of PSP, a 24-hour urine was collected, and the urinary PSP was measured by colorimetric assay. The correlation between the preoperative PSP value and various clinical variables, such as perioperative changes in urinary PSP excretion, and the relationship between the postoperative PSP value and postoperative complications, were investigated.

RESULTS

Preoperative urinary PSP excretion was found to increase in proportion to the degree of liver dysfunction. In contrast, urinary PSP excretion did not significantly change during the perioperative period. However, urinary PSP excretion on postoperative day 3 in patients with postoperative infectious complications (27.3%) was significantly greater than that in those without infectious complications (17.4%; p < 0.05). Furthermore, PSP excretion on postoperative day 3 in those with infectious complications was also significantly greater as compared to the preoperative level. The patients with a urinary PSP excretion level on postoperative day 3 of greater than 25%, exhibited infectious complications more frequently than patients with a level under 25% (60% versus 10.3%, respectively; p < 0.05).

CONCLUSIONS

The peroral PSP test is thus suggested to be a possible predictor of bacterial translocation after hepatic resection.

Early viral complications following CD34-selected autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma

A patient with non-Hodgkin's lymphoma who received a CD34-selected autologous peripheral blood stem cell transplant (PBSCT) developed cytomegalovirus retinitis, adenovirus-associated haemorrhagic cystitis (HC) and fatal herpes simplex virus pneumonia. Depletion of mature T cells from the graft and a persistent decrease in CD4+ lymphocytes following PBSCT may have predisposed this patient to such viral infections. Infusion of cryopreserved autologous PBSC (containing mature T cells) was effective for adenovirus-associated HC. Immunosuppression and resultant viral infections may affect patients receiving CD34-selected autologous transplantation.