[The value of hepatic arterial infusion chemotherapy for liver metastases--discussion from viewpoints of prevention of hepatic death and QOL]

The value of hepatic arterial infusion chemotherapy for liver metastases was discussed from the viewpoints of the prevention of hepatic death and the negative effect on QOL, based on the results of repeated hepatic arterial infusion chemotherapy for 128 patients with unresectable liver metastases employing implantable catheter and port system. In 70% of patients, hepatic death due to metastases was prevented by this therapy, and the negative effect on QOL by this therapy was limited. Thus, in spite of the limited effects on the prolongation of survival compared with systemic chemotherapy, there is a reasonable basis for the use of hepatic arterial infusion chemotherapy as a treatment for unresectable liver metastases.

A novel hypothyroid 'growth-retarded' mouse derived from Snell's dwarf mouse

This paper describes a novel mutant mouse that has been spontaneously derived from the Snell's dwarf (DW/J) mouse. It was named the 'growth-retarded mouse' because of a characteristic growth pause followed by the delayed onset of pubertal growth. The onset of the increase in pituitary GH content that normally occurs concomitant with pubertal growth was also delayed in the growth-retarded mice. The serum concentration of thyroxine was very low in these mice from the neonatal period through adulthood, and a supplement of tri-iodothyronine was effective in shortening the growth pause and commencing the suppressed pubertal growth. Histological and immunohistochemical studies revealed that the anterior pituitary gland of the growth-retarded mouse contains clustered unusual chromophobic cells which are not reactive to various antisera against anterior pituitary hormones and the gland becomes enlarged with age. Breeding data indicated that these characteristics of the mice show an autosomal recessive inheritance and the gene responsible was designated as 'grm'. Partial linkage analysis utilizing microsatellite polymorphism demonstrated that the grm gene does not identify with the lit or hyt genes. Based on comparison of the hormonal status and growth pattern between growth-retarded, dwarf and normal mice, we have suggested the existence of a mutual interaction, possibly positive feedback regulation, between the pituitary and thyroid glands, that develops or matures the hormonal network which is responsible for rapid somatic growth and metabolic changes at puberty in mice.

PCR localization of C-type natriuretic peptide and B-type receptor mRNAs in rat nephron segments

The present study was undertaken to investigate the presence of C-type natriuretic peptide (CNP) mRNA and its receptor, natriuretic peptide B-type receptor (ANPR-B) mRNA, in rat renal structures. The microlocalization of mRNAs coding for CNP and ANPR-B was carried out in the rat kidney, using an assay of reverse transcription and polymerase chain reaction (RT-PCR) in individual microdissected renal tubule segments, glomeruli, vasa recta bundle, and arcuate arteries. The PCR signal for CNP was detected in glomerulus, vasa recta bundle, and arcuate artery. The PCR product of ANPR-B was widely present in renal structures. Relatively large amounts of ANPR-B PCR product were detected in glomerulus, vasa recta bundle, arcuate artery, and distal nephron segments. A relatively high concentration of CNP (10(-7) M) stimulated guanosine 3',5'-cyclic monophosphate accumulation in glomerulus, medullary thick ascending limb, cortical collecting duct, and inner medullary collecting duct. Our data demonstrate that CNP can be produced locally in the glomerulus and renal vascular system and that ANPR-B is widely distributed in renal structures. Thus CNP may influence renal function and act in autocrine and paracrine fashions in the kidney.

Anterior decompression and fusion for cervical myeloradiculopathy secondary to ossification of the posterior ligament

The authors reviewed 85 patients who had undergone anterior decompression and cervical fusion for myeloradiculopathy due to ossification of the posterior longitudinal ligament. There were 72 males and 13 females; the average follow up was for 8.3 years. Sixteen patients (group I) underwent one vertebra subtotal spondylectomy with fusion, 58 (group II) two vertebra subtotal spondylectomy, and 11 (group III) three vertebra subtotal spondylectomy. Neurological recovery was assessed on the grading system of the Japanese Orthopaedic Association. The patients in group I had an average improvement of 75%, in group II 72% and in group III 23%. The severity of compromise of the spinal cord did not affect the postoperative improvement. Duration of disease, previous injury and advanced neurological symptoms all affected neurological recovery. Spondylectomy of at most two vertebrae, with fusion, is recommended for ossification of the posterior longitudinal ligament. If there is more extensive involvement laminoplasty may be indicated.

Differences related to the production of arachidonic acid between collagen- and thrombin-stimulated human platelets

The effects of collagen and thrombin on the liberation of free arachidonic acid were investigated in human platelets by fluorometric high-performance liquid chromatography. Collagen induced a concentration-dependent increase in the extent of platelet aggregation, as well as an accumulation of arachidonic acid in human platelets. By contrast, thrombin effectively provoked a potent aggregation at relatively low concentration without any accumulation of free arachidonic acid, although the accumulation of arachidonic acid was detected at a high concentration of thrombin (> 0.1 U/ml) that induced full aggregation. The selective liberation of arachidonic acid was found in thrombin-stimulated platelets. Non-selective liberation of fatty acids occurred in platelets that had been stimulated with a high concentration of collagen (10 micrograms/ml), as well as in platelets stimulated with A23187. The net amount of free arachidonic acid in collagen-stimulated platelets was estimated by use of eicosatetraenoic acid (ETYA), which is an inhibitor of both cyclooxygenase and lipoxygenase. ETYA markedly potentiated the accumulation of free arachidonic acid in collagen-stimulated platelets without changing the amounts of other fatty acids in the cell.

Distribution of kallikrein-binding protein mRNA in kidneys and difference between SHR and WKY rats

We investigated kallikrein-binding protein (KBP) mRNA distribution in the kidney of Sprague-Dawley (SD) rats, spontaneously hypertensive rats (SHR), and Wistar-Kyoto strain (WKY) rats. Northern blot analysis revealed that KBP mRNA was located mainly in the medulla and with lower amounts in SHR than in WKY rats. KBP mRNA in microdissected nephron segments was detected by reverse transcription and polymerase chain reaction (RT-PCR) followed by Southern blot analysis. In SD rats, the most abundant signals were consistently found in inner medullary collecting duct (IMCD), with small amounts in outer medullary collecting duct, proximal convoluted tubule, and glomerulus. No signals were found in connecting tubule and cortical collecting duct. The nephron distribution of KBP mRNA was similar in WKY and SD rats. Only a small amount of signal was found, however, in IMCD of SHR. In conclusion, 1) KBP mRNA was predominantly distributed in the medullary segments of the distal nephron, downstream from the known kallikrein activity site in the collecting duct, and 2) KBP mRNA expression was significantly decreased in the kidney of SHR.

Crystal structure of RNase T1 complexed with the product nucleotide 3'-GMP. Structural evidence for direct interaction of histidine 40 and glutamic acid 58 with the 2'-hydroxyl group of the ribose

The crystal structure of RNase T1 complexed with 3'-GMP has been determined. The glycosyl conformation of 3'-GMP is in the syn conformation, and the ribose adopts the O4'-endo pucker. This observed pucker is different from that in any complex structures of RNase T1. In the present complex, this energetically unfavorable conformation is stabilized by the water molecule with the bridged hydrogen bonds between the O2' and the O3' atoms of the ribose. The guanine base is recognized in the same manner as observed in the complex of 2'-GMP. The 2'-hydroxyl group of the ribose shows a tight hydrogen bond to both His-40 and Glu-58 with the suitable geometry for the proton transfer. These hydrogen bonds suggest that the two residues can participate directly in the proton transfer. His-92 is hydrogen bonded to two the proton transfer. His-92 is hydrogen bonded to two oxygen atoms of the phosphate group. Based on the geometry in the active site, the O1P atom may correspond to the O5' atom of the leaving nucleotide in the phosphoryl transfer or a water molecule as a nucleophile in the hydrolysis reaction. In the present complex, the conformations of the 3'-GMP molecule and the side chains of the catalytic residues would be represented as the conformation before the phosphoryl transfer reaction and/or after the hydrolysis reaction.

[Anesthetic management of a patient with mild hypothyroidism]

A patient with mild hypothyroidism underwent a repair of abdominal aortic aneurysm. Although the serum TSH level of this patient was very high and T4, free T4 levels were low, T3 level remained within normal ranges. Inhalation anesthesia with continuous epidural block was selected and there was no complication such as hypotension or hypothermia during perioperative period. Recently, several reports demonstrate that the preoperative supplemental therapy of the thyroid hormone should not be necessary in the case of mild hypothyroidism. Moreover, the biological potency of T3 is higher than that of T4. Thus, in patients whose T3 level is kept within normal ranges even if serum T4 level is low and serum TSH level is high, we may say that they are in euthyroid state. We think these patients can be anesthetized safely.

Intermittent priapism associated with lumbar spinal stenosis

Nine patients with intermittent priapism associated with lumbar spinal stenosis are described. They had severe intermittent claudication and priapism when walking, and 7 had sensory disturbances affecting the lumbosacral nerve roots at rest. Radiographs showed degenerative central stenosis in 6, and degenerative spondylolisthesis in 3. Seven were treated by surgical decompression and 2 refused operation. Six of the 7 had improvement in their priapism, but symptoms recurred in one as a result of spondylolisthesis developing after operation.

Effects of hyperosmolality on ANP-stimulated cGMP generation in rat inner medullary collecting duct

The inner medullary collecting duct (IMCD) is a major target site of atrial natriuretic peptide (ANP) for diuresis and natriuresis, and it is in a hypertonic condition made by the renal countercurrent multiplication system. We investigated the effects of hyperosmolality on ANP-stimulated cGMP generation in IMCD and glomerulus. Hypertonic solutions (490 and 690 mOsm/kg.H2O) were made by adding NaCl or urea to isotonic solution (290 mOsm/kg.H2O). Hypertonicity of 490 mOsm/kg.H2O using NaCl reduced both ANP-stimulated guanylate cyclase activity (from 7.7 +/- 1.1 to 4.1 +/- 0.5 fmol/mm/5 min) and cGMP generation (from 1.35 +/- 0.18 to 0.48 +/- 0.20 fmol/mm/3 min) in IMCD. Hypertonicity of 690 mOsm/kg.H2O using NaCl did not further reduce ANP-stimulated cGMP generation in IMCD. Hypertonicity using urea also inhibited ANP-stimulated guanylate cyclase activity and cGMP generation in IMCD. On the other hand, hypertonicity using NaCl stimulated AVP-stimulated cAMP generation in IMCD, while hypertonicity using urea reduced it. In glomeruli, hyperosmolality of 490 mOsm/kg.H2O using NaCl also reduced ANP-stimulated cGMP generation, and hypertonicity of 690 mOsm/kg.H2O using NaCl further reduced it. In summary, hyperosmolality using NaCl and urea inhibited ANP-sensitive guanylate cyclase activity and cGMP generation both in IMCD and glomeruli. However, the mechanisms at work may be different between NaCl and urea.

Localization of cyclophilin A and cyclophilin C mRNA in murine kidney using RT-PCR

Cyclosporin A (CsA), which is widely used as an immunosuppressant, has a nephrotoxic side effect. The mechanism of this nephrotoxicity is not well understood; however, recent studies suggest that cyclophilin (cyp) is responsible for mediating the immunosuppressive action of CsA through the interaction with the Ca(2+)- and calmodulin-dependent phosphatase, calcineurin. While cyp A mRNA is expressed ubiquitously, cyp C mRNA has been shown to be topically expressed, including in the kidney. We examined: (1) distribution of cyp A and cyp C mRNA in microdissected murine nephron segments, using a combination of reverse transcription and polymerase chain reaction (RT-PCR) techniques, and (2) the effect of CsA administration on cyp C mRNA expression in proximal convoluted tubule. Among the nephron segments examined, large signals for cyp C PCR product were detected in proximal convoluted tubule and proximal straight tubule. Our data showed that the distribution of cyp C mRNA was uneven, and it mainly existed in segments that are relatively sensitive to CsA toxicity. In contrast, cyp A mRNA was found to be distributed almost equally along the nephron segments examined. By CsA administration, the signal for cyp C mRNA PCR product was increased. These results suggest that cyp C may play some role in the renal tubular disorder observed in CsA nephrotoxicity.

Expression of adult and fetal natural killer cell markers in sinonasal lymphomas

The majority of sinonasal non-Hodgkin's lymphomas (NHLs) are thought to originate from T-cell lineage. However, they often express natural killer (NK)-cell markers so that their origin still remains obscure. In this study, cell type of sinonasal NHLs were characterized by immunohistochemical and Southern blot analyses. We examined nine patients with sinonasal NHL. Six patients with tonsillar or pharyngeal non-B-cell lymphomas served as a control group. Immunohistochemical study showed that all nine cases of sinonasal NHL were CD56+CD2+, whereas controls were CD56-CD2+. According to the rearrangement of T-cell receptors (TCRs) and expression of CD3 markers, the sinonasal NHL cases were classified into three groups: TCR-CD56(Leu-19)+CD3(Leu4)- NHL (three patients), TCR-CD56+CD3+ NHL (five patients), and TCR+CD56+CD3+ NHL (one patient). In contrast, control patients' NHLs were TCR+CD56-CD3+. These results imply that eight cases of TCR-CD56+ sinonasal NHL are of NK-cell lineage. Among these eight cases, TCR-CD56+CD3+ cases (five of eight patients) were rather similar to the phenotype of fetal NK cells. From these results, the majority of sinonasal NHLs seem to originate from varying maturation stages of NK-cell lineage.

[Influence of Lactobacillus casei on rat bladder carcinogenesis]

The inhibitory effect of Lactobacillus casei (L. casei) in superficial bladder tumors was investigated in an experimental study using N-butyl-N (4-hydroxybutyl) nitrosamine (BBN)-induced rat bladder cancer as an experimental system. The study consisted of two experiments; in a short-term experiment, the inhibitory effect of 6-week treatment with L. casei was assessed in vitro in terms of the capacity for agglutination by concanavalin A (Con A) of bladder epithelial cells in their incipient stage of malignant transformation induced by 1-week exposure to BBN. As a result, the number of bladder epithelial cell aggregates caused by Con A was significantly smaller in the L. casei-treated group than in the non-L. casei-treated group (p < 0.001). In a long-term experiment, treatment with L. casei of varying duration was investigated for effectiveness against bladder tumors induced by 7-weeks exposure to BBN that arose 22 weeks. The results indicate that both bladder weight and tumor volume per organ were significantly lower in the L. casei-treated than non-L. casei-treated group (p < 0.05). The inhibitory effect on these parameters was more pronounced with treatment with L. casei of longer duration. While there was no significant difference among the treatment groups in the degree of extension of induced malignancy, tumors with a high degree of extension (T1b, T2) developed only in the non-L. casei-treated group. The degree of malignancy of induced tumors was significantly lower in those groups receiving L. casei while BBN was being administered as compared to the non-L. casei-treated group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Intraspinal epidermoid after lumbar puncture

An intraspinal epidermoid tumour developed six years after a lumbar puncture in a woman aged 30 years. This rare complication possibly arose from implanted cutaneous tissue.

Human alpha-galactosidase gene expression: significance of two peptide regions encoded by exons 1-2 and 6

Two proteins with alpha-galactosidase activity, alpha-galactosidase A (alpha-GalA) and alpha-galactosidase B (alpha-GalB, or alpha-N-acetylgalactosaminidase; alpha-NAGA) have a high homology of amino-acid sequence. Point mutations of the alpha-GalA gene have been reported only in the exons 1, 2 or 6. In this study, the exon 1-2 and/or 6 sequences of alpha-GalA cDNA were partly substituted by the corresponding regions of alpha-GalB cDNA, and three chimeric proteins were prepared by the baculovirus expression system: CMB12 with substitution at the exon 1-2 region, CMB6 at the exon 6 region, and CMB126 at both regions. They all preserved alpha-GalA antigenicity. Their kinetic properties toward 4-methylumbelliferyl alpha-galactopyranoside were compared with those of alpha-GalA. The catalytic activity was slightly low in CMB12, decreased to 1/10 in CMB6, and restored to a significant degree in CMB126. Km was more than 4-fold higher for CMB6 and CMB126 than for alpha-GalA. The pH optimum was 4.0 for both CMB12 and alpha-GalA, 4.8 for CMB6, and 4.6 for CMB126 and alpha-GalB. The catalytic activity was inhibited most by galactosamine in CMB6, and less in alpha-GalB, CMB126, alpha-GalA and CMB12 in decreasing order. The 50% inhibition concentrations of melibiose (Gal alpha 1-6Glc) and methyl alpha-galactopyranoside were 2.5- to 3-fold higher for CMB126 than for alpha-GalA. These results indicate that the low affinity of CMB126 to the substrate was caused by a reduced affinity to terminal alpha-linked galactose. We conclude that (1) the two regions encoded by exons 1-2 and 6 contribute to the alpha-galactosidic cleavage, and (2) an increase in Km of CMB6 or CMB126, with chimeric substitutions at the exon 6 region, was caused by a loss of affinity toward terminal alpha-linked galactose.

Laminoplasty following anterior cervical fusion for spondylotic myeloradiculopathy

Eighteen patients with spondylotic myeloradiculopathy who had undergone expansive laminoplasty after anterior cervical fusion were reviewed. The average period from the initial to the second operation was 7.8 years. Excellent neurological improvement occurred in 4 patients, good in 6, fair in 4 and poor in 4. Radiographs at the time of the second operation showed spinal canal stenosis in 11, and 12 showed dynamic spinal canal stenosis immediately above the fused area. A narrow spinal canal adds to the risk of recurrence. When spinal stenosis is treated by anterior cervical fusion, additional laminoplasty should be carried out to prevent structural compromise occurring adjacent to the fused vertebrae.

Endothelin (ET)-3 stimulates cyclic guanosine 3',5'-monophosphate production via ETB receptor by producing nitric oxide in isolated rat glomerulus, and in cultured rat mesangial cells

We investigated the effects of endothelins on receptor-mediated cyclic nucleotide metabolism in rat glomerulus, inner medullary collecting duct (IMCD), and also in cultured rat glomerular mesangial cells. Endothelin (ET)-3 dose-dependently stimulated cGMP accumulation in glomerulus, which was higher than that of ET-1 or ET-2. ETB receptor agonist IRL 1620 produced cGMP in a dose-dependent manner, mimicking the effect of ET-3. ETA receptor antagonist BQ123-Na did not inhibit ET-3- or IRL 1620-stimulated cGMP generation. NG-monomethyl-L-arginine (L-NMMA) significantly inhibited ET-3- or IRL 1620-induced cGMP production, suggesting that ET-3- or IRL 1620-stimulated cGMP generation was mediated through nitric oxide (NO). Intracellular Ca chelator BAPTA/AM and calmodulin antagonist W-7, but not Ca channel blocker nicardipine, significantly inhibited ET-3- or IRL 1620-induced cGMP generation. In cultured rat mesangial cells, ET-3 stimulated cGMP generation through NO in the presence of fetal calf serum, which was not inhibited by addition of BQ123-Na. In IMCD, ET-3 had no stimulative effect on cGMP generation. We conclude that ET-3 stimulates NO-induced cGMP generation through ETB receptor in glomerulus. This effect seems to be mediated through intracellular Ca/calmodulin, but not through Ca influx via L-type Ca channel. Mesangial cells can be a source of NO coupled to ETB receptor activation in glomerulus. From these results, mesangial ETB receptor may work to counteract the vasoconstrictive effect of endothelin caused via ETA receptor in glomerulus.

Simultaneous occurrence of lung adenocarcinoma and fibular osteosarcoma in a 13-year-old girl

Bronchogenic cancer in the pediatric age group is extremely rare and less than 100 cases have been reported in the world literature. We report a 13-year-old girl with simultaneous occurrence of lung adenocarcinoma and osteosarcoma. The patient was admitted with lower leg pain, and an abnormal shadow in the right fibula was noted on X-ray examination. Further examination of the fibular lesion including tumor biopsy revealed an osteosarcoma. Following completion of the first course of preoperative chemotherapy, multiple lung shadows were found on chest X-ray films. After five courses of preoperative chemotherapy, however, all lung shadows except one in the right lower lobe disappeared. The fibular tumor was then resected. Postoperatively, an additional six courses of chemotherapy was given. However, the lung shadow in the right lower lobe was still present. Exploratory thoracotomy was performed. Pathologically, the lung tumor measured 0.8 cm in diameter with an ill-defined border, and histological examination revealed a well differentiated papillary adenocarcinoma. To our knowledge, only a few cases of pediatric lung cancers have been reported to be associated with congenital cystic malformation of the lung. However, this combination of pediatric lung adenocarcinoma and osteosarcoma has not been previously reported.

Enzyme-linked immunosorbent assay of carbamoylphosphate synthetase I: plasma enzyme in rat experimental hepatitis and its clearance

Carbamoylphosphate synthetase I (CPS I), a urea cycle enzyme, is located almost exclusively in the mitochondria of hepatocytes. The enzyme is unique in that it constitutes about 2-6% of total liver protein and is composed of a large subunit of 160 kD. We developed a sensitive enzyme-linked immunosorbent assay (ELISA) for measurement of the enzyme in plasma using an antibody against the rat enzyme. In galactosamine-induced rat acute hepatitis, plasma concentration of CPS I that was 1-2 micrograms/ml blood before the treatment, increased up to 125 micrograms/ml blood in 24 h after the treatment and decreased to a near control level in 72 h. Plasma concentration of ornithine carbamoyl-transferase (OCT), another urea cycle enzyme, reached a maximum in 24 h and then decreased a little more rapidly than that of CPS I. On the other hand, alanine aminotransferase activity reached a maximum in 36 h and decreased to a normal level in 96 h. In immunoblot analysis, the native CPS I polypeptide of 160 kD and its fragments of 140 and 125 kD were detected 24-48 h after the treatment. When purified rat CPS I and bovine OCT were injected intravenously into rats, the enzymes disappeared from blood roughly exponentially with apparent half-lives of about 67 and 18 min, respectively. Development of an ELISA for human CPS I and determination of the serum enzyme in various liver diseases remain to be performed.

Total en bloc spondylectomy and circumspinal decompression for solitary spinal metastasis

We have developed a new surgical technique, 'total en bloc spondylectomy' (TES), to treat a solitary metastasis in the thoracic or lumbar vertebra. This operation is designed as a local cure for the metastatic site and involves the radical resection of the affected vertebra with a wide margin. The spondylectomy consists of two steps: en bloc laminectomy with posterior spinal instruments for stabilisation (first step) and en bloc corporectomy and replacement using a vertebral prosthesis (second step). TES makes it possible to remove the affected vertebra extracompartmentally with its tumour barrier and accomplishes circumferential decompression of the spinal cord. Before clinical practice, we constructed experimental models using cats to examine spinal cord blood flow (SCBF) after ligation of the nerve roots and circumspinal decompression. The changes of SCBF were negligible, so it was proved that TES on one vertebra has little effect on spinal cord circulation. This method was used in 24 patients. Fourteen of the 18 patients with neurological deficits improved remarkably, and the 23 evaluable cases experienced pain relief. Impending paralysis was prevented in all six patients by this surgical intervention. There has been no recurrence of the local tumour after surgery. After a median follow up period of 14.1 months, 12 patients have survived. These data suggest that TES may have a significant clinical value in the treatment of spinal metastasis.

Rhabdomyoblastic differentiation after chemotherapy in malignant triton tumor - a case-report

A case of malignant Triton tumor which consists of a malignant schwannoma accompanied by rhabdomyo-sarcomatous elements is reported. Only a small number is known in literature. The patient survived for four years without any sign of local recurrence or metastasis although an extremely poor prognosis for this neoplasm is reported. The therapy consisted of wide resection, irradiation and pre-and postoperative combination chemotherapy. The effect of multi-agent antineoplastic drugs on the differentiation of rhabdomyosarcoma cells and the relevant literature is discussed.

Fingertip replantation: pre-osteosynthesis vein graft technique

Since 1985 we have been performing replantation of amputated fingertips using a pre-osteosynthesis vein graft technique. First, we locate an artery and vein at the distal part of the fingertip and perform a vein graft. After this, we perform osteosynthesis. Since there is sufficient vessel length, the anastomosis technique becomes easier than with the method previously used. In our department, between 1985 and 1990 we performed 11 Zone I replantations. Ten fingers survived and one failed. There were good results in seven cases and three had fair results. The pre-osteosynthesis vein graft technique is a reliable technique for amputated fingertip replantation.