Histopathological aspects of dural arteriovenous fistulas in the transverse-sigmoid sinus region in nine patients

OBJECTIVE

In recent years, dural arteriovenous fistulas (DAVFs) have been primarily thought to be acquired lesions, formed after sinus thrombosis. The pathogenesis of DAVF, however, is still controversial. We have studied histopathological aspects of DAVFs in resected specimens obtained from nine patients, to obtain clues to the pathogenesis of DAVFs.

METHODS

Histological comparison was made among nine DAVF cases and five control cases without venous sinus disease. In addition, the relationship between the clinical course and histological aspects was investigated.

RESULTS

The essential abnormality found was a connection between the dural arteries and the dural veins within the venous sinus wall, through small vessels averaging approximately 30 microns in diameter. By using several staining methods, we confirmed that the vessels were part of the venous system; we named these dilated venules "crack-like vessels."

CONCLUSIONS

The development of abnormal communications between dural arteries and dural veins (crack-like vessels) is regarded as the essential part of the pathogenesis of DAVFs, and sinus thrombus is not thought to be an essential lesion of DAVFs. It might be postulated that sinus hypertension caused by stenocclusive disease of the venous sinuses triggers the development of fistulous connections between arteries and veins in the dural wall, which may result in increasingly dilated venules and the formation of DAVFs.

Tissue-specific and glucose-dependent expression of receptor genes for glucagon and glucagon-like peptide-1 (GLP-1)

Both glucagon and glucagon-like peptide-1 (GLP-1) play an important role in the regulation of nutrient homeostasis. In this study, the tissue distributions of the expression of receptor genes for glucagon and GLP-1 were examined. Expression of glucagon receptor gene was detected in liver, kidney, ileum and pancreatic islets but not in brain. In contrast, expression of GLP-1 receptor gene was detected in brain, pancreas and pancreatic islets but not in liver, kidney, or ileum. To investigate the existence and characteristics of glucagon and GLP-1 receptors on pancreatic beta cells, expression of the receptor genes and translational regulation of the expression of the receptor genes by glucose were analyzed in a mouse pancreatic beta cell line, MIN6 cells. In the cDNA pool of MIN6 cells, both glucagon and GLP-1 receptor genes were identified and showed higher expression level in MIN6 cells cultured under high glucose condition than in those cultured under low glucose condition. These results suggest that glucagon and GLP-1 receptor genes are expressed in pancreatic beta cells and their expression is upregulated by glucose.

Pyloroduodenal duplication cyst: case report

A 6-day-old female presented with vomiting and an abdominal mass. At laparotomy, a pyloroduodenal duplication cyst was enucleated from the pyloric region. Of the diagnostic studies performed, IV cholangiography with spiral computed tomography and an upper gastrointestinal barium study were useful in the preoperative differential diagnosis.

Diabetic neuropathy in sucrose-fed Otsuka Long-Evans Tokushima fatty rats: effect of an aldose reductase inhibitor, TAT

In an animal model of human non-insulin dependent diabetes mellitus (NIDDM), Otsuka Long-Evans Tokushima Fatty (OLETF) rats were fed with sucrose for 8 weeks to obtain severe hyperglycemia. The effects of sucrose administration on peripheral nerve functions, motor nerve conduction velocity (MNCV) and coefficient of variance of R-R interval (CVR-R), were investigated with concomitant measuring of sciatic nerve blood flow (SNBF), ADP-induced platelet aggregation and polyol content in the sciatic nerves. The effects of an aldose reductase inhibitor, TAT, on these parameters were also studied. Administration of sucrose to OLETF rats caused significant body weight reduction and remarkable hyperglycemia. Sucrose-fed OLETF rats demonstrated significantly delayed MNCV, decreased CVR-R, reduced SNBF and increased platelet aggregation activity to ADP. Sorbitol and fructose accumulation, and myo-inositol depletion in sciatic nerves were observed only in sucrose-fed OLETF rats. These abnormalities were all ameliorated by the treatment with TAT. These observations suggest that the sucrose-fed OLETF rat is a useful animal model for studying the pathogenesis of diabetic neuropathy in human NIDDM, and that an aldose reductase inhibitor is a useful therapeutic agent for the treatment of diabetic neuropathy.

Trp64Arg mutation of beta3-adrenergic receptor in essential hypertension: insulin resistance and the adrenergic system

A putative pathogenic mutation in the beta3-adrenergic receptor gene (Trp64Arg) has been reported to be associated with higher diastolic blood pressure as well as clinical features of the insulin resistance syndrome and an earlier onset of non-insulin-dependent diabetes mellitus (NIDDM) in Pima Indians and Finns. Because essential hypertension is reported to be associated with insulin resistance, we studied the mutation in Japanese patients with essential hypertension to clarify associations of this mutation with hypertension, insulin resistance, and basal adrenergic state in hypertensive subjects. The allele frequency of the mutation (Arg) in patients with essential hypertension was similar to that in control subjects (35 of 202 alleles [17.3%] v 27 of 146 [18.5%], respectively, P > .7). Insulin sensitivity measured by hyperinsulinemic euglycemic glucose clamp and plasma norepinephrine and epinephrine levels were also similar in hypertensive subjects with and without the mutation. These data suggest that Trp64Arg mutation in the beta3-adrenergic receptor gene does not play a major role in susceptibility to essential hypertension or in insulin resistance and basal adrenergic state in hypertension.

Leser-Trélat sign with anaplastic ependymoma--an autopsy case

A 36-year-old Japanese male, who 7 years previously had been diagnosed as having an ependymoma in the left parietal region, had received surgery, chemotherapy and radiotherapy. He later developed a rapid growth of multiple skin lesions on his back and extremities, which coincided with a regrowth of the tumor. Postmortem examination revealed that the ependymoma showed anaplastic transformation and necrosis; however, no malignancy was observed in the extracranial organs. The skin lesions were histologically diagnosed as seborrheic keratoses. We have, therefore, diagnosed the patient as having Leser-Trélat sign associated with anaplastic ependymoma.

Insulin-dependent diabetes mellitus associated with autoimmune thyroiditis and rheumatoid arthritis

A case associated with insulin-dependent diabetes mellitus (IDDM), rheumatoid arthritis (RA), and autoimmune thyroid disease (AITD) was reported. A high titer of anti-glutamic acid decarboxylase antibody (GAD) and a positive islet cell antigen were observed. The patient's human leukocyte antibody (HLA) haplotype was a homozygote of DQA1*0301, DQB1*0401, and DRB1*0405. Because this haplotype was in linkage disequilibrium with DPB1*0501, an allele associated with AITD in Japanese patients, the patient was homozygous for alleles susceptible to IDDM, RA, and AITD. A specific HLA haplotype susceptible to several autoimmune disease may result in the development of IDDM, RA, and AITD.

4-Hydroxy-2-nonenal hardly affects glycolysis

4-Hydroxy-2-nonenal (HNE), one of the major products of lipid peroxidation, inactivated the rate-limiting enzymes (from animal sources) of the glycolytic pathway and the pentose phosphate pathway when incubated at 37 degrees C for 1 h in the absence of glutathione (GSH). The HNE concentration for half-maximal inactivation of 6-phosphofructokinase (PFK) and glyceraldehyde-3-phosphate dehydrogenase was 3-10 microM; and that value for pyruvate kinase, glucose-6-phosphate dehydrogenase, and hexokinases I and II was 0.15-0.6 mM. In the presence of 5 mM GSH, however, only PFK, irrespective of the source (muscle, liver, or erythrocyte), was inactivated by 40-50% when incubated with 0.1 mM HNE for 1 h. Even PFK was not inactivated in the presence of both GSH and its substrate, ATP (2 mM). Glycolysis in human erythrocytes was not affected by treatment of cells with 0.1 mM HNE at 37 degrees C for 30 min. The results suggest that HNE, at concentrations observable under physiological and pathological conditions, hardly affects glycolysis in cells.

Sensory response properties of cortical neurons in the anterior ectosylvian sulcus of cats: intracellular recording and labeling

Visual and auditory sensory responses of cortical neurons in the caudal half of the anterior ectosylvian sulcus (AES) of cats were examined under alpha-chloralose anesthesia, using intracellular recording and labeling techniques. Stable intracellular recordings were obtained from 155 neurons, and 141 neurons exhibited responses to sensory stimuli. Of 141 sensory neurons, 74 (52%) were bimodal neurons that responded to both visual and auditory stimuli, and 67 (48%) were unimodal showing sensory responses only to visual (25) or auditory stimulation (42). Forty-five neurons (35 pyramidal neurons, 5 non-pyramidal neurons, 5 not classified) responsive to sensory stimuli were labeled with biocytin. The percentage of bimodal neurons of the biocytin-labeled neurons was 40% (4/10) in layer II, 50% (10/20) in layer III-IV, 70% (7/10) in layer V and 60% (3/5) in layer VI. Thus the convergence of visual and auditory inputs on single neurons was most intense in layer V. Auditory response latencies were in a narrow range from 10 to 40 ms, whereas visual response latencies were in a wide range from 15 to 100 ms. Late visual responses (> 60 ms) were more commonly elicited in biomodal neurons than in visual unimodal neurons. Visual responses in layer II were all elicited over 40 ms, whereas early visual responses within 40 ms were observed in the other cortical layers. A subgroup of neurons (22/141) had a propensity to exhibit a burst discharge, a train of three to seven action potentials on a depolarizing envelope in response to sensory stimuli. Their specific distribution in cortical tissue was suggested by the result that six out of nine biocytin-labeled neurons (seven pyramidal neurons, two non-pyramidal neurons) showing burst discharges to sensory stimuli were observed in layer V. These results are considered to signify some aspects of intracortical organization related to the cross-modal integration of sensory inputs.

Isolation of a novel chick homolog of Serrate and its coexpression with C-Notch-1 in chick development

Intercellular signaling mediated by the transmembrane proteins, Notch as receptor and its ligands, Delta and Serrate, plays essential roles in the developmental fate decision of many cell types in Drosophila. The Notch genes are highly conserved both in invertebrates and in vertebrates, suggesting that Notch pathway regulates cell fate decisions during vertebrates development. Notch, Delta and Serrate homologs in chicken have been cloned (Henrique et al., Nature 375: 787-790, 1995; Myat et al., Dev. Biol. 174: 233-247, 1996). We isolated a novel chick homolog of Drosophila Serrate, named C-Serrate-2, and examined its expression patterns during the early chick development using whole-mount in situ hybridization. C-Serrate-2 transcripts were detected in several tissues including the forebrain, the myotome and the apical ectodermal ridge (AER) of the limb bud of a 4-day-old chick embryo. In most of the regions where C-Serrate-2 was expressed, C-Notch-1 was also expressed. Our observations suggest that Serrate-2-Notch-1 signaling plays a role in a variety of morphogeneses during the chick development.

Rapid formation of advanced glycation end products by intermediate metabolites of glycolytic pathway and polyol pathway

To clarify roles of intermediate metabolites of the glycolytic pathway and the polyol pathway in nonenzymatic glycation under physiological conditions, we incubated bovine serum albumin with intermediates of both pathways in the micromolar range as well as with 20 mmol/l glucose, and observed the formation of advanced glycation end products (AGEs). We found that triose phosphates, glyceraldehyde, and a novel polyol pathway-related metabolite, fructose 3-phosphate along with its breakdown product, 3-deoxyglucosone were extremely potent glycating agents that at nearly physiological concentrations on incubation with albumin produced substantial amounts of AGEs as early as 24 hours, while 20 mmol/l glucose afforded trace amounts of AGEs after two week incubation. The results along with the previous evidence of the increased level of intermediates in diabetic states may suggest that the intermediate metabolites rather than glucose contribute to enhanced glycation in diabetic tissues, inspite of the much lower concentrations compared with glucose.

A novel microsatellite polymorphism in the human OB gene: a highly polymorphic marker for linkage analysis

The mouse ob gene and its human homologue OB have recently been cloned. The mutations in the ob gene are known to be associated with extreme obesity. The relationship between the human OB gene and disease, however, is largely unknown due to the lack of suitable markers within or adjacent to the OB gene. To obtain informative markers, we searched for simple tandem repeat polymorphisms in the genomic sequence of the human OB gene and identified a novel tetranucleotide repeat in the 3' flanking region. Fifteen alleles were detected in this marker with a heterozygosity of 0.85 and polymorphism information content of 0.83, indicating a highly informative nature of this marker. Two-point linkage mapping in two Centre Etude Polymorphisme Humaine (CEPH) reference families suggested that this marker is located in the interval between D7S514 and D7S530, the same interval where the OB gene is located (recombination fractions with D7S514 and D7S530 were 0.026 and 0.034, respectively). Although allele frequency distributions of this marker did not differ between 84 control subjects and 69 NIDDM patients, there was a tendency to higher body weight in control subjects with class I/class I genotype than in those without this genotype (68.8 +/- 11.1 vs 60.8 +/- 10.3 kg, p = 0.05). The highly polymorphic nature of this marker and its location in the OB gene makes this marker useful for linkage studies of the OB gene with a number of phenotypes, such as obesity, non-insulin-dependent diabetes mellitus, hypertension and the insulin resistance syndrome.

Functional conservation of mouse Notch receptor family members

All the known members of the mouse Notch receptor family were examined for their biochemical function by interaction with a DNA binding protein RBP-Jkappa. mNotch2, mNotch3 and int3 (= mNotch4) were shown to interact with RBP-Jkappa by the GST-fusion pull down assay and dominant negative competition with Epstein Barr virus nuclear antigen 2. Furthermore the intracellular region of int3 was shown to transactivate the Epstein Barr virus TP1 promoter. These results indicate that all mouse Notch family members have biochemical functions similar to mNotch1, which transduces proliferative signal by direct interaction with the DNA binding protein RBP-Jkappa.

Nerve function and blood flow in Otsuka Long-Evans Tokushima Fatty rats with sucrose feeding: effect of an anticoagulant

To investigate the pathogenesis of diabetic neuropathy in non-insulin-dependent diabetes mellitus, Otsuka Long-Evans Tokushima Fatty rats, an animal model of non-insulin-dependent diabetes mellitus, and non-diabetic Long-Evans Tokushima Otsuka rats were fed with or without sucrose and/or cilostazol, an anticoagulant, for 8 weeks. Sucrose-fed diabetic rats showed a delayed motor nerve conduction velocity, decreased R-R interval variability of electrocardiogram, reduced sciatic nerve blood flow, increased platelet aggregability and a decreased erythrocyte 2,3-diphosphoglycerate concentration compared with non-sucrose-fed diabetic rats and non-diabetic rats. These abnormalities were significantly prevented by treatment with cilostazol without changes in the nerve tissue levels of polyols. These findings indicate that sucrose-fed Otsuka Long-Evans Tokushima Fatty rats may be a useful animal model of neuropathy in non-insulin-dependent diabetes mellitus, and that cilostazol may prevent the development of diabetic neuropathy by modifying vascular factors.

The 'functional connection' of neurones in relation to behavioural states in rats

In order to investigate whether dynamics of neuronal networks change during differing behavioural states, the 'functional connection' between neurones in the rat vibrissal sensorimotor system during two different behavioural states (active vs passive whiskering) were revealed using time-dependent scatter diagrams. The functional connection between neurones in the vibrissal motor (MCx) and sensory (SCx) cortices and the superior colliculus (SC) changed depending on the behavioural state. In the rat vibrissal system, the pattern of correlated activities among neurones in the MCx, SCx and SC may play an important role in determining behaviour.

Advanced glycosylation end-products and heat shock proteins accumulate in the basophilic degeneration of the myocardium and the corpora amylacea of the glia

Using monospecific antibody for the advanced glycosylation end-products (AGEP), it was revealed that the AGEP localized in the basophilic degeneration of the myocardium and the corpora amylacea of the glia. The stability of the proteins that constitute those degenerative deposits suggests that they would be ideal substrates for non-enzymatic glycation, a process that occurs over a long time under a high glucose content, and ultimately results in the formation of the AGEP. Such deposits also exhibited evidence of stress reactions: the accumulation of HSP72, heme oxygenase-1 and ubiquitin. As recent studies have shown that AGEP-modified proteins aggregate and that they generate reactive oxygen intermediates, the accumulation of such heat shock proteins may reflect the oxidative stress concomitant with AGEP accumulation, and thereby promote their cellular dysfunction. Hereby, it is proposed that the age-related increase in the AGEP, that is, a fundamental aging process, is involved in the formation of the basophilic degeneration in the myocardium and the corpora amylacea of the glia.

Hemifacial degloving approach to tumours in the infratemporal and pterygopalatine fossae: a preliminary report

A new approach to tumours in the infratemporal or pterygopalatine fossa is presented. Through a midline skin incision, one side of the face from the forehead to the neck is completely degloved. Zygomatic and mandibular osteotomies improve access. All mimic muscles and the facial nerve are included in the elevated flap. This approach provides a widely exposed field from the temporal fossa to the neck without damage to major vessels or nerves other than the supra- and infraorbital nerves. Direct access to tumours in the infratemporal or pterygopalatine fossa is facilitated, thus making tumour resection easier, safer and more reliable. Details of this approach are described.

Effects of lecithinized superoxide dismutase on rat spinal cord injury

Although superoxide dismutase (SOD) has been reported to promote functional recovery in ischemic spinal cord injury, it presents many difficulties in practical use primarily due to its short half-life in vivo and low tissue affinity. In this study, we investigated the effects of a new type of SOD, a lecithinized superoxide dismutase (PC-SOD), on motor disturbances, spinal cord edema, levels of myeloperoxidase (MPO), and spinal cord blood flow (SCBF) after spinal cord injury (SCI) in rats. PC-SOD is reported to show a delayed plasma disappearance in vivo in rats and has a higher affinity for vascular endothelium cells, neutrophils, and other cells than unmodified SOD. PC-SOD (4000 units/kg), unmodified SOD (4000 units/kg), or vehicle was injected intravenously 30 min after SCI. Four hours after SCI, SOD activities in spinal cord tissue and plasma were significantly higher in the PC-SOD group than in the unmodified SOD group. In the PC-SOD-treated rats, motor function was significantly better than in the other 2 groups of rats. PC-SOD significantly suppressed MPO activity, an indicator of neutrophils infiltration, in the spinal cord, at 4, 8, and 24 h after SCI, and spinal cord edema at 24 h after SCI. Moreover, the decrease of SCBF after SCI was less marked in the PC-SOD group. The present results suggest that lecithinization can improve the drug delivery of SOD to the spinal cord and PC-SOD may be an alternative pharmacological treatment for SCI.

Anorectal stenosis in a neonate: report of a case and review of the Japanese literature

We report herein the case of an infant with anorectal stenosis successfully treated by staged surgery. At 1 day of age, the anal orifice showed circumferential stenosis located 5 mm from the anal verge and extending into the anal canal for approximately 1 cm; however, no hypertrophic raphe or bucket handle appearance were observed, and no associated anomalies such as a presacral mass or sacral dysgenesis were found. At 2 days of age, the infant underwent a sigmoid colostomy under the diagnosis of low anorectal stenosis, followed by a successful anorectoplasty, performed through a sacroperineal approach when he was 8 months old. An analysis of 13 other cases of anorectal stenosis from the Japanese literature indicates that this type of malformation should be treated by staged surgery, as an initial colostomy in the neonatal period, followed by anorectoplasty through a sacroperineal approach during infancy.

Induction and its spread of apoptosis in rat spinal cord after mechanical trauma

This study was undertaken to examine the spinal cord of rats after trauma for the induction of apoptosis. DNA ladder formation was demonstrated by gel electrophoresis of the DNA obtained from the spinal cord at the site of injury after trauma from 12 h to 8 days and was most significant on Days 3 and 4. As for the longitudinal spread of the injury in the spinal cord, the ladder formation was observed in the two segments adjacent to the site of trauma 3 days after trauma. Histological examination using in situ end labeling also demonstrated the appearance of apoptosis. These results provide the evidence for the induction of apoptosis in the spinal cord after trauma in rats.

Effect of propionyl-L-carnitine on oscillatory potentials in electroretinogram in streptozotocin-diabetic rats

The effect of propionyl-L-carnitine, an analogue of L-carnitine, and insulin on the oscillatory potentials of the electroretinogram was determined in rats with streptozotocin-induced diabetes. Propionyl-L-carnitine was administered at a daily dose of 0.5 g/kg by gavage for 4 weeks, while other rats were treated with subcutaneous injections of insulin (8-10 U/day). Both treatments shortened the peak latencies of the oscillatory potentials in the electroretinogram, which were significantly prolonged in untreated diabetic rats (O1, O2 and O3, and sigma (O1 + O2 + O3)) (P < 0.0001 vs. untreated normal rats). A significant decrease in the erythrocyte free carnitine level in diabetic rats was prevented by both treatments. Insulin produced a significant reduction of retinal glucose, sorbitol and fructose levels in diabetic rats, while propionyl-L-carnitine failed to do so. However, both treatments markedly reduced serum lipids levels in the diabetic rats. These findings provide information on the pathogenesis of diabetic retinopathy as well as suggesting the potential therapeutic value of propionyl-L-carnitine for retinopathy.