Use of latissimus dorsi flap for reconstruction with prostheses after tumor resection

Five latissimus dorsi musculocutaneous flaps (LD flap) were used for reconstruction with prostheses after resection of tumors between 1984 and 1991 in our hospital. Bony structures were reconstructed with prostheses and in three cases autoclaved autobone grafts were also needed. The prostheses and adjacent grafts were then wrapped by the LD flaps. Tumor sites included one humerus, two thighs, and two knees. All but one case healed primarily. The sole case of infection was successfully treated with debridement and irrigation. Due to the LD flaps' plentiful blood supply, we believe infection of the prosthetics can be avoided and good clinical results can be achieved using the flap with autoclaved autograft prosthetic composite reconstruction.

[Interaction of trichloroethylene and isopropyl alcohol in the perfused rat liver]

The interaction of trichloroethylene (TCEL) and isopropyl alcohol (IPA) was studied in the perfused rat liver. Experiments consisted of four parts; TCEL administration with or without IPA, chloral hydrate (CH) administration with or without IPA, IPA administration with or without CH, IPA administration with or without trichloroethanol (TCE). The chemicals were administered into the perfusate of Krebs-Henseleit buffer saturated with 95%O2/5%CO2 in a non-recirculating circuit. Concentrations of the following three metabolites in the effluent were continuously measured by gas chromatograph and chemical methods: TCE and trichloroacetate (TCA) (metabolites of TCEL and CH), and acetone (a metabolite of IPA). Fluorescence from intracellular reduced pyridine nucleotides (NADH, NADPH) was monitored by surface fluorometry. The results showed that IPA changed the TCA/TCE ratio in the TCEL metabolism because of an increase in NADH production, and IPA oxidation was suppressed by CH because of an inhibitory effect of TCE on alcohol dehydrogenase. It was concluded that IPA and TCEL, both ubiquitous agents, interacted with each other in their metabolic pathways in the perfused rat liver, suggesting a new feature of a combined effect of these chemicals when they coexist.

Crystal structure of RNase T1(Y45W) complexed with 3'AMP and GflpA

We have previously reported the crystallization of a mutant RNase T1(Y45W) with a synthetic modified trinucleotide ApGflpA [Hakoshima, T. et al. (1990) J. Biochem. 108, 695-698]. In the present report, we describe the crystal structure refined at 2.4 A resolution. During the refinement process, we found that the ApGflpA molecule was cleaved at the phosphodiester bond between the 5'-terminal adenosine and the subsequent 2'-fluoroguanosine. At the end of the refinement (R = 17.1%), it was supposed that the resulting molecules, i.e., 3'AMP and GflpA, were separately bound to the enzyme. In the complex structure, the binding-site of the enzyme was occupied by the guanine base of GflpA via a similar interaction to that of the enzyme complexed with 2'GMP, while the phosphate group of GflpA was not bound to the active site. The guanosine adopted the anti orientation on the glycosyl torsion angle with a C2'-endo-C3'-exo sugar pucker. This conformation resulted in the phosphate group protruding from the active site. The phosphate group of 3'AMP was bound to the active site of the enzyme and oriented itself toward the solvent region. This orientation was different from that of 2'AMP bound to the RNase T1(Y45W).

Expression of endothelin-3 mRNA along rat nephron segments using polymerase chain reaction

Endothelin (ET) is now known to be a family of three distinct peptides. Although many reports have studied the renal action of ET-1, comparatively little is known concerning ET-3. We previously reported that ET-1 mRNA is expressed in glomerulus (Glm) and inner medullary collecting duct (IMCD). In this study, microlocalization of mRNA coding ET-3 was carried out in the rat kidney using a reverse transcription and polymerase chain reaction (RT-PCR) assay of individual microdissected renal tubule segments along the nephron, Glm, vasa recta bundle, and arcuate arteries. Large signals for ET-3 PCR product were detected in proximal convoluted and straight tubules, cortical collecting duct, and outer medullary collecting duct. Glm, IMCD, and vasa recta bundle also expressed relatively large amounts of ET-3 mRNA. Small signals were found in medullary thick ascending limb, inner medullary thin limb, and arcuate artery. We detected ET-3 protein in tubule suspensions from cortex, outer medulla, and inner medulla of rat kidney. Furthermore, incubation with TGF-beta did not change ET-3 PCR signal, whereas ET-1 PCR signal was increased significantly by exposure to TGF-beta in Glm and IMCD. Thus, ET-3 and ET-1 are distributed differently along the nephron and are regulated in different manners. This suggests that ET-3 and ET-1 may affect kidney functions in different ways.

Chemotherapeutic effect on osteosarcoma on basis of collagen analysis: a proposal of the induction of osteosarcoma differentiation

The authors studied effect of chemotherapy on osteosarcoma by collagen analysis. As a result of this case study we propose the induction of osteosarcoma differentiation by chemotherapy. Treatment of a conventional osteosarcoma with two intra-arterial infusions of cisplatin and the T-12 protocol of Rosen resulted in sclerotic changes and good margination accompanied by the disappearance of the soft-tissue component from the X-rays. More than 90% tumour destruction was histologically demonstrated; tumour bone and osteoid increased after the chemotherapy, and the viable area of the tumour resembled an osteoblastoma. Before the chemotherapy, immunolocalization determined collagen types I and V to be diffusely present in the bone and osteoid. After the chemotherapy, the antibody to type I collagen was diffusely present, but the antibody to type V collagen occurred only on the surface of the increased bone and osteoid as in normal bone. When osteosarcoma cells were treated in vitro with methotrexate or cisplatin, collagen production increased significantly. It is thus believed that tumour cells were directly stimulated with these chemotherapeutic agents to produce collagen. The findings suggested that some anticancer agents might not only be cytotoxic to but also differentiate osteosarcoma cells.

Synthesis of 3-episiastatin B analogues having anti-influenza virus activity

Two epimers of siastatin B, 3-episiastatin B (3) and 3,4-diepisiastatin B (4), were obtained by the chemical modification of siastatin B. Compound 3 showed marked inhibitory activity against influenza virus neuraminidases and significant inhibition of influenza virus infection in vitro.

New antiviral antibiotics, kistamicins A and B. I. Taxonomy, production, isolation, physico-chemical properties and biological activities

A new strain of Microtetraspora parvosata subsp. kistnae subsp. nov. (ATCC 55076) was found to produce new antiviral antibiotics, designated kistamicins A and B. These antibiotics exhibited activity against influenza virus type A and moderate activity against Gram-positive bacteria.

Anterior spinal artery syndrome

Three patients with symptoms due to the anterior spinal artery syndrome were treated by direct perfusion of dexamethasone sodium phosphate and urokinase into the artery of Adamkiewicz. Their symptoms were paraparesis with dissociated sensory loss and sphincter dysfunction, and there was no evidence of the possible cause. In the early phase of the disease, three consecutive injections were carried out with an interval of a week between each. All the patients made a good recovery.

Calcium crystal deposition in the ligamentum flavum of the cervical spine

This article reports eight patients who underwent posterior decompressive surgery for myeloradiculopathy caused by calcium crystal deposition in the ligamentum flavum of the cervical spine. All were women with an average age of 72 years and showed neurologic improvement postoperatively. Four patients had diabetes mellitus, and knee meniscus calcification on radiographs were noted in four patients. The ligamentum flavum of C5-6 and C6-7 were sites frequently involved. Crystallographic examination confirmed resected deposits as calcium pyrophosphate dihydrate crystal in all patients and additional hydroxyapatite crystal in two. Histology confirmed marked degeneration in elastic fibers about the calcium deposits. This pathologic condition is possibly spinal manifestation of systemic calcium crystal deposition disease.

[Analysis of differential cell counts of sputa induced by inhalation of ultrasonically nebulized hypertonic saline or distilled water in asthmatic patients]

Bronchial asthma is an inflammatory disease of the airways, and a simple method of evaluating inflammation, safer than BALF or bronchial mucosal biopsy, has long been sought after. The induction of sputa by the inhalation of an appropriate solution and the examination of the induced sputa may provide such a method. We compared the safety of two sputum induction methods, ultrasonically nebulized hypertonic saline inhalation and distilled water inhalation, and examined the usefulness of differential cell counts of the induced sputa. The safety of these methods was ascertained by determining lung functions (FEV1.0, PEFR) and urinary leukotriene E4 before and after inhalation of these solutions, and the usefulness of differential cell counts of induced sputa by examining the uniformity/reproducibility. Only after the inhalation of distilled water did the lung function reveal a statistically significant decrease when the data were compared with the control values for each of the two methods (p < 0.01), and when the data obtained with distilled water inhalation and hypertonic saline inhalation were compared (p < 0.05). The urinary leukotriene E4 levels obtained were not very different between the two methods; however, in two patients, urinary leukotriene E4 levels were increased markedly only after inhalation of distilled water. The uniformity of the sputum differential cell counts in the same specimen (evaluated by intraclass correlation coefficient) and inter-specimens (evaluated by Friedman test) was satisfactory for both methods, except for basophils. Hypertonic saline inhalation at 24-hour intervals gave a better reproducibility in differential cell counts of the induced sputa (evaluated by interclass correlation coefficient), when compared with distilled water inhalation. These results suggest that hypertonic saline inhalation is safer and more useful than distilled water inhalation for induction of sputum in a uniform and reproducible way, and that the induction of sputum by hypertonic saline inhalation will be clinically useful in asthmatic patients who cannot expectorate sputa spontaneously.

Different localization and regulation of two types of vasopressin receptor messenger RNA in microdissected rat nephron segments using reverse transcription polymerase chain reaction

Recent studies have revealed that arginine vasopressin (AVP) has at least two types of receptors in the kidney: V1a receptor and V2 receptor. In this study, microlocalization of mRNA coding for V1a and V2 receptors was carried out in the rat kidney using a reverse transcription and polymerase chain reaction. Large signals for V1a receptor PCR product were detected in the glomerulus, initial cortical collecting duct, cortical collecting duct, outer medullary collecting duct, inner medullary collecting duct, and arcuate artery. Small but detectable signals were found in proximal convoluted and straight tubules, inner medullary thin limbs, and medullary thick ascending limbs. Large signals for V2 receptor mRNA were detected in the cortical collecting duct, outer medullary collecting duct, and inner medullary collecting duct. Small signals for V2 receptor were found in the inner medullary thick limbs, medullary thick ascending limbs, and initial cortical collecting duct. Next, we investigated V1a and V2 receptor mRNA regulation in the dehydrated state. During a 72-h water restriction state, the plasma AVP level increased and V2 receptor mRNA decreased in collecting ducts. In contrast, V1a receptor mRNA did not change significantly. Thus, the two AVP receptor subtypes are distributed differently along the nephron, and these mRNAs are regulated differently in the dehydrated state.

Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy

A retrospective study was performed to evaluate the radiographic changes that occurred at spinal levels adjacent to fused vertebrae after anterior cervical fusion. One hundred six patients with cervical spondylotic myeloradiculopathy (88 men, 18 women) were followed for an average of 8.5 years. The average age at follow-up was 64 years. Forty-two patients underwent a single-level fusion, 52 had a two-level fusion, and 12 had three levels fused. Seventeen patients who underwent additional surgery after anterior fusion also were reviewed, with an average follow-up period of 2.9 years. Postoperatively, cervical flexion-extension resulted in significantly increased movement about the vertebral interspace at the upper adjacent level. An increment of posterior slip of the vertebra immediately above the fusion level, with associated spinal canal compromise of less than 12 mm, significantly affected neurologic results. Patients with multilevel fusions notably exhibited these radiographic abnormalities at adjacent levels. Spinal canal stenosis, when associated with dynamic spinal canal stenosis in the vertebra above the fusion level, affected late neurologic results. Results of salvage laminoplasty were not satisfactory. Unnecessarily extended longer fusion must be avoided.

[An application of dynamic CT for diagnosis of abnormal external ocular muscle movement]

To evaluate the movements of retrobulbar structures radiologically, we have developed a new technique called "external ocular muscle movement CT" (EOM CT), in which dynamic CT scanning is performed while the patient performs controlled eye movements. This new technique was applied in one volunteer and 72 patients with external ophthalmoplegia due to orbital mass lesion, hyperthyroid ophthalmopathy, blowout fracture, and other retrobulbar lesions. EOM CT permits the assessment of extraocular muscle contraction in cases of blowout fracture, the evaluation of muscular contraction in hypertrophy of the extraocular muscles, and the diagnosis of adhesions between the extraocular muscles and intraorbital masses. Radiation dose to the lens from EOM CT was measured using a phantom and TLD, and was compared with that of conventional CT scanning with a 5 mm slice thickness. The dose to the lens from EOM CT was three times higher than that for conventional CT in axial scanning, but in the coronal section of the retrobulbar region, the dose to the lens from EOM CT decreases to one twelfth that of conventional CT. EOM CT promises to be a powerful modality for functional evaluation of the extraocular muscles and other retrobulbar structures.

[Chemotherapy for Ewing's sarcoma, malignant fibrous histiocytoma and malignant lymphoma]

Recent advances in adjuvant chemotherapy for malignant bone tumor have been improving the survival rate and making limb-salvage surgery a reliable technique. Ewing's sarcoma is treated by multiple agent chemotherapy. We treat Ewing's sarcoma by Rosen's T-11 protocol (CYT.ADM.MTX.VCR.ACT-D.BLM). This protocol is very effective, but results are poorer than for osteosarcoma. Newly developed protocols such as EICESS (European Intergroup Cooperative Ewing's Sarcoma Study)-92, including new drugs, should be investigated. The results with malignant fibrous histiocytoma are comparable to those for osteosarcoma. We have performed an original chemotherapy protocol, called "K-1 protocol." Patients were treated with three courses of intraarterial infusion of cisplatin (120 mg/m2) and caffeine (1.0-1.5 mg/m2/day for three days continuously) at two-week intervals. If the effect was insufficient, ADM (30 mg/m2/day for two days continuously) is added to this protocol. We treat malignant lymphoma in collaboration with a hematologist and radiologist. The 5-year survival rate of non-Hodgkin's lymphoma in our series was 56% in clinical stage III and 34% in clinical stage IV. We are trying third-generation chemotherapy to improve the survival rate.

Overexpression of HLA class I antigen reduces insulin secretion in pancreatic beta cells (RINM5F): evidence for a non-immune mechanism

Our recent observation indicated that overexpression of HLA-class I antigen on pancreatic beta cells is one of the features of insulin-dependent diabetes mellitus (IDDM). To analyze the effect of class I antigen overexpression, we have introduced human HLA class I (HLA-Cw3) gene into rat pancreatic beta cell lines, RINm5F. Several stable transformants with various levels of surface expression of class I antigens have been cloned. The insulin secretion of these transfectants was analyzed to evaluate the functions of beta cells. Highly negative correlation between the level of insulin secretion and that of class I expression (correlation coefficiency: r = 0.89) has been observed. These data suggest that the overexpression of HLA class I antigen itself may impair pancreatic beta cells through a nonimmune mechanism.

Primary mucinous carcinoma of the skin

BACKGROUND

Primary mucinous carcinoma is a rare primary adnexal neoplasm of the skin with a high recurrence rate.

OBJECTIVE

To improve the recognition of this clinical entity and aid in establishing the origin of this tumor.

METHODS

Two cases of this tumor were reported and investigated histopathologically and histochemically. Furthermore, some mucinous carcinomas arising from the breast or gastrointestinal tract were compared with this tumor.

RESULTS

Both cases showed no evidence of primary neoplasms as a source of metastasis and had characteristic findings of primary mucinous carcinoma of elongated cords and small lobules of epithelial cells floating in lakes of sialomucin. The origin of this tumor seemed to be an eccrine sweat gland.

CONCLUSION

This tumor should be resected widely and, at least, the breasts and gastrointestinal tract should be investigated for primary lesions.

Borderline chondrosarcoma of long and flat bones

We reviewed histological and clinical findings of six cases of borderline chondrosarcoma and examined the expression of collagen types I, II, III, V, and VI by immunohistochemical analysis of these tumors. Borderline chondrosarcoma is defined as a cartilaginous tumor of bone resembling enchondroma on the basis of histomorphology. Clinically the tumor causes intermittent vague pain unrelated to physical activities. On radiographs borderline chondrosarcoma is characterized by evidence of endosteal erosion. We observed local recurrences in two cases treated by intralesional excision and marginal excision, and one of those cases died of inoperable local tumor recurrence. In our histological analysis based on tissue patterns, there were enchondromatous patterns in five cases, and chondrosarcomatous patterns in four cases. In the second recurrent tumor in one case, a chondrosarcomatous pattern was newly observed, and the recurrent tumor was found to be a low-grade chondrosarcoma cytologically in the other case. In the tumor matrix immunoreactivity for collagen types II and VI was predominant, with collagen types I, III, and V showing heterogeneous expression in some cases. In all cases rimming of tumor lobules with collagen types I and V was absent. Immunoreactivity for collagen type II in the cytoplasm of tumor cells was found in four cases and all three recurrent tumors. Borderline chondrosarcoma, as defined by histology, clinical symptoms and radiological appearance, shows a collagen distribution pattern similar to that of low-grade chondrosarcoma. These findings are in accordance with the clinical outcome of borderline chondrosarcoma which parallels that of low-grade chondrosarcoma. Thus borderline chondrosarcoma may be best treated by wide en-bloc excision rather than curettage.

[Therapeutic effect of hemodialysis on gouty arthritis and tophi in 2 patients with chronic renal failure]

Therapeutic effect of hemodialysis on gouty arthritis and tophi in 2 patients with chronic renal failure (CRF) is described. One patient was 74-year-old man with CRF due to benign nephrosclerosis, and had severe secondary gout. There were many tophi in metatarsophalangeal joints of the fingers and toes. Another patient was 44-year-old man with CRF probably due to familial gout. He had many tophi in elbows, knees, wrists, fingers and toes. In both cases initiation of hemodialysis treatment, at first temporally exacerbated gouty arthritis, but thereafter gradually eliminated the tophi. From these results, dialysis treatment is considered to be quite efficient method of treatment for gouty arthritis and tophi in patient with CRF. Gouty arthritis in CRF patient, which does not respond to the conservative therapy, should be considered to be one of the indices for commencement of hemodialysis.

Verucopeptin, a new antitumor antibiotic active against B16 melanoma. I. Taxonomy, production, isolation, physico-chemical properties and biological activity

A new antitumor antibiotic verucopeptin was isolated from the culture broth of Actinomadura verrucosospora Q886-2. It should potent cytotoxicity and specific in vivo activity against B16 melanoma. Maximum T/C value (162%) was obtained by Q1D x 1 treatment schedule.

PCR localization of angiotensin II receptor and angiotensinogen mRNAs in rat kidney

Recent studies revealed that angiotensin II (Ang II) interacts with two pharmacologically different subtypes of cell surface receptors. Type I Ang II (AT1) receptor is characterized by signal transduction mediated through G protein and phospholipase C. In this study, the micro-localization of mRNAs coding for AT1 receptor and angiotensinogen 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 along the nephron, glomeruli, vasa recta bundle, and arcuate arteries. Large signals for AT1 receptor were detected in the glomerulus, proximal convoluted tubule (PCT), proximal straight tubule (PST), cortical collecting duct, and vascular system. Small signals were also seen in medullary thick ascending limb, outer medullary collecting duct, and inner medullary collecting duct (IMCD). Angiotensinogen mRNA is expressed largely in PCT, PST, and a small amount in glomerulus and vasa recta. Our data demonstrate that Ang II could be produced locally in proximal tubule and vasa recta bundle, and that the AT1 receptor was widely distributed not only in the glomerulus and vessels but also in tubules from PCT to IMCD.

5-Hydroxyanthranilic acid derivatives as potent 5-lipoxygenase inhibitors

Three new 5-lipoxygenase inhibitors, designated as BU-4601 A, B and C, were found in the fermentation broth of Streptomyces sp. strain No. AA2807. Their structures were identified as isodecyl, isoundecyl and isolauryl esters of 5-hydroxyanthranilic acid, respectively. Based on their structures, five related esters were synthesized and evaluated for biological activity as inhibitors of 5-lipoxygenase. Both naturally-occurring and chemically-synthesized compounds exhibited almost equal levels of 5-lipoxygenase inhibitory activities in vitro.

Two cases of dorsal defect of the patella with arthroscopically visible cartilage surface perforations

Dorsal defect of the patella is an approximately 1-cm, circular, radiolucent, well-marginated benign lesion invariably located in the superlateral aspect of the patella. Only approximately 50 cases have been described in the world literature, of which < 10 cases have been studied histologically. We report two patients with bilateral, virtually symmetrical, dorsal defects of the patella and describe the arthroscopic and histologic findings. Case 1 was a 14-year-old girl and case 2 was a 35-year-old man. Cartilage perforations were seen via arthroscopy on the cartilage surface of both knees. The pathophysiology of this disorder remains to be clarified, although van Holsbeeck et al. proposed that vastus lateralis traction injury in the ossification process of the patella may be involved, as in the case of bipartite patella. The present arthroscopic and histological findings support this hypothesis.