Pineal germinoma with widespread extracranial metastases

A case of primary pineal germinoma with widespread extracranial metastasis in a 36-year-old man is presented. A clinical work-up revealed bilateral pleural effusions, ascites, and metastatic lesions involving the lung. Cytology and electron microscopic study of the pleural and ascitic fluid and of the fine needle aspiration material revealed metastatic germinoma. Although the cytologic features were not distinct from those of anaplastic carcinoma, they were distinguishable from those of glial neoplasms, lymphoma, and sarcoma. The computed tomography findings, elevated human chorionic gonadotropin level, and electron microscopic features contributed significantly to the diagnosis of extracranial metastasis of the pineal germinoma. Metastatic spread most likely occurred via the ventriculoperitoneal shunt.

In vitro luteinizing hormone-releasing hormone release from superfused rat hypothalami: site of action of progesterone and effect of estrogen priming

The study examined the effect of estrogen priming on progesterone (P4)-induced LHRH release, the tissue site of action of P4, and the effect of 5 alpha-dihydroxyprogesterone (5 alpha-DHP) on LHRH release from hypothalamic fragments superfused in vitro. Immature female rats were ovariectomized (OVX) and, at 28 days of age, Silastic capsules containing estradiol (E2) were implanted. Two days later, animals were killed and hypothalamic fragments were removed and transferred to superfusion chambers. The hypothalamic units received P4 or 5 alpha-DHP delivered in an intermittent mode (10-min on, 20-min off). LHRH was determined in perfusates by RIA. After the input characteristics of different infusion modes (single pulses, intermittent, and continuous) of P4 infused into superfusion chambers were assessed, an intermittent infusion mode (10-min on, 20-min off) was selected for further examinations. In the mediobasal hypothalamic-anterior hypothalamic-preoptic area (MBH-AHA-POA) tissue preparations, we observed: 1) an infusion of 5 alpha-DHP was ineffective in stimulating LHRH release; 2) the release pattern of LHRH in response to three different P4 doses (10, 20, and 50 ng/ml) was similar in terms of percent changes (202% to 219% over control values); and 3) E2 priming was absolutely required for P4-stimulated LHRH release, and this requirement appeared to be dose dependent. Upon an examination of three hypothalamic tissue boundaries [the MBH, the POA-suprachiasmatic nuclei (POA-SCN), and the median eminence (ME)] to better delineate the in vitro site of action of P4 on LHRH release, it was demonstrated that the MBH responded upon P4 infusion, whereas the POA-SCN was unable to do so. The ME also responded upon P4 infusion, and LHRH release followed closely the pulsatile administration of P4 since upon each challenge of the steroid at the concentration of 10 or 20 ng/ml, a significant rise in LHRH release occurred. However, the temporal patterns of LHRH release from the ME appears to be different from those obtained from the MBH as well as the MBH-AHA-POA. These observations demonstrate that an intermittent infusion of P4, but not 5 alpha-DHP, is effective in activating the neural LHRH apparatus. Estrogen is an obligatory requirement for this P4-stimulated LHRH release, and the neural site of action of P4 resides within the MBH. However, this steroid also can act directly upon the ME nerve terminals to release LHRH.

Caffeine-induced reorganization of DNA replicating system occurs on or near nuclear matrix in HeLa cells

Since caffeine reorganizes the DNA replicating system, with several consequences, we studied the effect of caffeine on the DNA replication which normally occurs on or near the nuclear matrix in a variety of eukaryotic cells. When HeLa cells, treated with or without the DNA-damaging agent, neocarzinostatin, were postincubated in the presence or absence of caffeine and then pulse-labeled with [3H]thymidine, the DNA remaining tightly associated with the matrix was enriched in the newly synthesized DNA at the same level as that seen in untreated cells. The nuclear matrix-bound DNA polymerase alpha activity was also the same in these cells. Therefore, in the presence of caffeine, DNA replication, with or without DNA damage, also occurs on or near the nuclear matrix, as is the case in normal DNA replication.

Novel system for recognizing and eliminating foreign DNA in Pseudomonas putida

Derivatives of pQSR49 (R1162::Tn1) containing cloned fragments of Escherichia coli chromosomal DNA are stable in E. coli but unstable in Pseudomonas putida. Similar derivatives containing P. putida chromosomal DNA are stable in both species. Instability is a consequence of plasmid loss during growth and is not due to death or inhibition of growth of plasmid-containing cells. Average copy numbers per cell of the unstable hybrid plasmids are similar to that of pQSR49, indicating that instability is not the result of reduced replication of plasmid DNA. A plasmid unrelated to pQSR49, RK2, becomes unstable in the presence of the unstable hybrids but only when it also contains foreign DNA. The data suggest an inducible mechanism in P. putida active in the elimination of plasmid-borne foreign DNA from the cell.

Enhanced immune response in the urinary tract of the rat following vaginal immunization

The immune response in the rat urinary tract was assessed by an enzyme-linked immunosorbent assay for immunoglobulins following vaginal immunization and subsequent intravesical challenge with live E. coli 06. Vaginally immunized rats showed a strong and rapid bladder immune response following intravesical challenge, in contrast to nonimmunized control rats. The immune response was localized to the urinary tract in that antibody to E. coli 06 was not detected in serum, saliva and vaginal washes from immunized rats.

Pre- and postoperative hemodynamic assessments and survival rates in patients with postinfarction ventricular septal perforation

Pre- and postoperative hemodynamics were assessed in 14 consecutive patients who developed ventricular septal perforation (VSP) following acute myocardial infarction (AMI). Results were correlated with the surgical outcome and with postoperative clinical improvements. The patients were divided into 3 groups according to the time intervals between the onset of AMI and the operation; acute (within 2 weeks after AMI), subacute (between 2 and 4 weeks) and chronic (after 4 weeks). In the above groups, 6, 2 and 6 patients were included, respectively. Eleven patients had anteroseptal infarction and 3 patients sustained inferior infarction. The survival rates were 33, 50 and 100% in the acute, subacute and chronic groups, respectively with an overall survival rate of 64%. Hemodynamic comparisons between survivors and non-survivors revealed that the systolic aortic pressure and left ventricular stroke volume index were significantly higher and the right ventricular end-diastolic pressure was significantly lower in survivors than in non-survivors (p less than 0.05). Although no statistical significance was obtained, left ventricular end-diastolic volumes and ejection fractions were higher in survivors. No difference was present between survivors and non-survivors in either Qp/Qs, Pp/Ps, Rp/Rs, systolic pulmonary pressure, left ventricular end-diastolic pressure or cardiac index. Patients with low arterial pressure and high right ventricular end-diastolic pressure under intensive medical regimens, indicating the presence of cardiogenic shock and/or associated right ventricular infarction or severe failure, had a high mortality and should be considered for emergency operation. Postoperative hemodynamics improved significantly in all variables measured (p less than 0.05-0.01). Patients with a VSP should all be considered for surgery unless a definite contraindication exists.

In vitro and in vivo neutralizing activity of human colostrum and milk against purified toxins A and B of Clostridium difficile

The neutralizing activity (NA) of supernates of colostral samples collected postpartum from 55 women and tested against a 50% cytopathic dose of purified toxins A and B of Clostridium difficile was evaluated in Y1 adrenal cells. Thirty-one (56%) of the samples had NA against one or both toxins. Samples of breast milk were collected postpartum from five women-three had colostral NA and two did not. All milk specimens from the three women with colostral NA had NA titers of 1:1-1:4 throughout the study (609 days in one case). Samples from the two women without colostral NA did not exhibit NA during a 60-day follow-up period. In suckling mice either toxin plus human milk with in vitro NA elicited significantly less fluid accumulation than did toxin plus diluent or toxin plus milk without in vitro NA (P less than .025 to P less than .05). Twelve (63%) of 19 milk samples with in vitro NA against toxin A and 15 (65%) of 23 with in vitro NA against toxin B inhibited fluid accumulation caused by the corresponding toxin. In vitro NA against toxin A appeared to reside in the secretory IgA fraction of one milk sample assessed by immune precipitation. The results suggest that human milk may protect newborn infants against toxins A and B of C. difficile.

Idiopathic aldosteronism. A possible disease of the intermediate lobe of the pituitary

A 37-year-old woman with documented primary aldosteronism died of a cerebral hemorrhage. At postmortem examination she was found to have bilateral, adrenal hyperplasia and nodular basophilic hyperplasia of the anterior and intermediate lobe of the pituitary. Based on these findings and experimental evidence suggesting the existence of a pituitary factor that stimulates aldosterone secretion, we postulate that idiopathic aldosteronism is caused by an abnormality of the intermediate lobe of the pituitary gland leading to overproduction of non-adrenocorticotropic hormone peptides derived from pro-opiomelanocortin that increase aldosterone production and cause hyperplasia of the adrenal glands.

Primary myelolipoma of mediastinum

Myelolipoma is a benign nonepithelial neoplasm composed of mature marrow elements and fat cells. This rare neoplasm is usually discovered by pathologists incidentally at autopsy, and, with rare exceptions, usually occurs in the adrenal glands. One of these exceptional anatomic sites is the mediastinum, and only three cases of primary mediastinal myelolipomas have been documented in the English-language literature (1-3). We are presenting a primary myelolipoma involving the posterior mediastinum that was discovered on routine chest radiographs and successfully resected. Computed tomography (CT) scan findings of this rare mediastinal tumor are also presented. This is the first case report in the English language of primary myelolipoma in the mediastinum that was detected clinically and resected successfully.

Post-stimulus facilitatory and inhibitory effects on respiration induced by chemical and electrical stimulation of thin-fiber muscular afferents in dogs

In anesthetized, vagotomized, paralyzed, and artificially ventilated dogs, respiratory responses to both electrical stimulation of the muscle nerve and chemical stimulation of muscular (polymodal) receptors by means of intra-arterial injection of NaCl solution were studied by recording phrenic nervous discharges. During the period of stimulation both types of stimulation caused intensity-dependent facilitation of neural respiratory outputs. After cessation of stimulation, facilitation persisted for a long time (more than 5 min) with a lower intensity stimulation; however, suppression was observed with a higher intensity stimulation. The present results suggest that afferent inputs from the muscular polymodal receptors activate long-acting central mechanisms for enhancement or suppression of respiration.

Outbreaks of diarrhea associated with Clostridium difficile and its toxin in day-care centers: evidence of person-to-person spread

Clostridium difficile was associated with five outbreaks of diarrhea occurring in three day-care centers caring for children less than 2 years of age during a three and one-half-month period; two centers had one outbreak of diarrhea, and one had three outbreaks. The frequency of isolation of C. difficile and its toxin was determined in stool specimens from 65 children attending the three day-care centers. Twelve of 21 (57%) children who had diarrhea excreted C. difficile and its toxin, whereas only four of 44 (9%) children who did not experience diarrhea yielded the organism and the toxin. Five of the 12 symptomatic children with C. difficile and its toxin had received prior antimicrobial therapy for upper respiratory tract infections. An eight-month prospective study was then carried out in one room of the center where the three outbreaks had occurred. Initially, one child had culture-positive stools for C. difficile. During the first 13-week study period six additional children of the 12 (50%) in the room under study became colonized with C. difficile. Six of the seven children who excreted C. difficile and its toxin experienced diarrhea with C. difficile toxin-positive stools by the end of the 13 weeks. Environmental contamination increased as more children became colonized and developed diarrhea. Electrophoretic evaluation of environmental and stool isolates obtained during one outbreak of diarrhea showed that the isolates had an identical protein pattern. Findings of this study indicate the importance of searching for C. difficile in children in day-care centers who develop diarrhea.

Malignant fibrous histiocytoma. Cytologic, light microscopic and ultrastructural studies

Studies of the cytologic, light-microscopic and electron-microscopic features of three malignant fibrous histiocytomas (MFH) confirmed the presence of histiocytelike and fibroblastlike cells. The ultrastructural features suggest that the neoplasm possibly originates in undifferentiated mesenchymal cells that are capable of differentiating into histiocytic and fibroblastic cells. Cytologic features seen in smears obtained by thin needle aspiration included loose aggregates of markedly pleomorphic, elongated cells, histiocytelike cells and isolated bizarre giant cells. Phosphotungstic acid hematoxylin (PTAH) and oil red O staining of air-dried smears were helpful in differentiating MFH from pleomorphic variants of liposarcoma and rhabdomyosarcoma.

Nuclear magnetic resonance imaging and evaluation of human breast tissue: preliminary clinical trials

In vivo clinical evaluations of human mammary tissue, including normal, dysplastic, and neoplastic breasts, were initiated using the FONAR method of nuclear magnetic resonance (NMR) imaging. Spin-lattice relaxation times (T1) were determined and correlated with other diagnostic modalities including mammography, xeroradiography, and sonography. Normal breasts and breasts with extensive fatty replacement were found to have the lowest T1 values, whereas T1 values of malignant tissue were elevated. T1 values for mammary dysplasia extended over a wide range, and NMR images exhibited lower proton density than normal tissue. In several patients with severely dysplastic breasts, T1 values overlapped those from patients with documented breast neoplasms. Markedly elevated T1 values were obtained from fluid-filled cysts that were well beyond the range of malignancy.

Site location and requirements for the installation of a nuclear magnetic resonance scanning unit

The installation of a nuclear magnetic resonance unit in any diagnostic facility involves certain location and environmental requirements. Based on our experience with the FONAR QED 80 system, we have delineated the major factors which must be considered when planning for such an installation. The major requirements are location and space. Suggested layouts for the suite and the control room are included. Certain environmental specifications will vary depending on the location of the facility and the type of unit installed.

Basis of observed resistance of L1210 leukemia in mice: methotrexate, 6-thioguanine, 6-methylmercaptopurine riboside, 6-mercaptopurine, 5-fluorouracil, and 1-beta-D-arabinofuranosylcytosine administered in different combinations

Schmid et al. (Cancer Treat. Rep., 60: 23-27, 1976) reported rapid emergence of resistance of L1210 leukemia cells in mice to two schedules of six antimetabolites and much slower development of resistance to a third schedule. Such rapid development of resistance to six drugs presents a striking puzzle, and one whose solution gives some insights into the basis for general emergence of drug resistance. Our approach was to examine the consequences of applying these drugs singly or in pairs and, from the results, to infer interactions in six-drug combinations. 6-Thioguanine (TG) and 6-mercaptopurine are the key drugs since, as shown by Schmid et al., resistance of leukemic cells appeared to six-drug combinations at the same time as did resistance to the purine analogs; sensitivity to the other drugs remained. We demonstrated that cells which emerged were resistant to both of the purine analogs, owing to a deficiency of the activating enzyme hypoxanthine-guanine phosphoribosyltransferase. TG resistance arose in the presence of TG because of an overgrowth of TG-resistance mutants that were present as one cell in 10(4) in the original L1210 population. L1210 cultures were prepared free of TG-resistant mutants. With these cells, TG administered shortly after inoculation was very effective in delaying their death. The cells that finally grew out were still TG sensitive. Simultaneous treatment with all the drugs greatly delayed appearance of TG resistance in vivo and in vitro. Methotrexate alone was responsible for this result, owing to its ability preferentially to kill TG-resistant cells. The other three drugs were not effective in delaying TG resistance. Methotrexate was effective only if it was added daily; one large injection was ineffective. Therefore, TG and methotrexate added daily for 6 days (simultaneous schedule) was the most effective drug regimen tested.

Naloxone effects on the blood pressure response induced by thin-fiber muscular afferents

Naloxone effects on the blood pressure level and on the blood pressure responses induced by thin-fiber muscular afferent stimulation were studied in anesthetized, bilaterally vagotomized and carotid sinus nerve-denervated dogs under artificial ventilation. Repetitive pulses of 8 Hz with various intensities were applied to the gastrocnemius nerve for 1 min while monitoring the compound action potentials. The mean arterial pressure significantly (P less than 0.001) rose by 10.95 +/- 1.78 mmHg (mean +/- S.E.) about 5 min after a naloxone injection. Compared with the reflexive response in the control period, the depressor effect significantly decreased by 3.80 +/- 1.06 mmHg, and the pressor effect significantly increased by 3.63 +/- 0.73 mmHg for 30 min after the injection of naloxone. No correlation was found between naloxone effects on the blood pressure level and on the reflex response, indicating an involvement of different mechanisms with these naloxone effects. We suggest that endogenous opiates might participate in the regulation of the blood pressure level, as well as of the blood pressure responses caused by thin-fiber muscular afferents.

A possible participation of endogenous opiates in respiratory reflexes induced by thin-fiber muscular afferents

In anesthetized, vagotomized, paralyzed, and artificially ventilated dogs, naloxone effects on respiratory responses induced by thin-fiber muscular afferents were studied by recording phrenic nerve discharges. Naloxone augmented respiratory outputs, before, during, and after the stimulation. Two different types were found in the returning phase of the respiratory response by thin-fiber muscular afferent stimulation: respiratory outputs were supressed below the pre-stimulus level within several minutes after the cessation of the stimulus in some cases, while in the other cases they remained above the pre-stimulus level. In the latter cases, naloxone did not change the pattern of returning phase of the response, on the other hand, in the former cases, the after-suppression was significantly reduced by naloxone. The present results suggest that endogenous opiates play a role in setting the level of respiratory outputs and that in addition to facilitatory effects on respiration, thin-fiber muscular afferents drive a negative feedback system via neurohumoral mechanisms.

Malfunction of a Björk-Shiley mitral valve prosthesis due to excessive platelet-fibrin deposition on its sewing cuff. A case report

A Bjork-Shiley mitral valve prosthesis had to be replaced 4 years after implantation because of disc entrapment by an over-grown fibrous tissue on its sewing cuff. This abnormal fibrous tissue was found out to be an organizing platelet-fibrin deposit, of which luminal surface was only incompletely endothelialized. It is indicated that the heart valve prosthesis generally remains non-endothelialized for a prolonged period of time after implantation in man. Anticoagulation therapy should thus be given throughout the postoperative period for patients with the heart valve prosthesis.

Cytologic screening for gynecologic cancer

In the past 30 years there has been no improvement in the five-year survival rate for endometrial carcinoma. Any change comparable to improved survival in cervical carcinoma will be accomplished only by similar detection of the early asymptomatic and precursor lesions of endometrial carcinoma. Reasons why the conventional Pap smear taken today has only a 25% to 50% screening accuracy for endometrial carcinoma are explained along with methods to improve these percentages. With our technic, endometrial aspiration cytology has the capabilities of screening for varying stages of endometrial hyperplasia that are considered precursors of endometrial carcinoma, as well as an 85% accuracy rate for screening detection of established endometrial carcinoma. These technics and methods, along with accompanying photographs and photomicrographs of representative cytologic and histologic specimens of varying representative lesions are shown.

Hepatitis B virus and alcoholic liver damage in the Airin district. (Osaka's skid row area)

Healthy adults and non-liver disease patients in the Airin district gave a positivity rate for HBs antigen of approximately 2%, which is not so much different from the average of the entire Japanese population. In this district, the positive rate of HBs antigen 5% (11 out of 244) in chronic liver disease is much lower than that (31%) of control group patients at Osaka City University Hospital (O.C.U.H.). However the positive rate of anti-HBs antibody in this district is 46% which is extremely high compared with that (23.4%) in the rest of Japan. The positive for anti-HB antibodies (including of anti-HBs and anti-HBc antibody) accounted for 67% of non-liver disease patients and 68% of chronic liver disease patients in the Airin district. Corresponding values for patients at O.C.U.H. were 44% and 43% respectively. There were no significant differences in the histological picture between HBs antigen-negative patients with and those without demonstrable anti-HBs antibodies. Changes in the liver exhibited by heavy drinkers inhabitating the Airin district were primarily those of alcoholic liver damage.

Theoretical study of hydration of RNA

The hydration phenomena of A-RNA double helix and the anticodon loop of transfer RNA have been theoretically investigated using the empirical potential energy functions. The hydration schemes of a model compound of A-RNA and a polynucleotide which has the structure of the anticodon loop of yeast tRNAPhe have been determined, and their stabilization energies produced by the introduction of water in the first hydration shell were calculated by considering the hydrated ones as supermolecules. The results indicate that hydration scheme of A-RNA considerably differs from that of B-DNA and stabilization energy due to hydration of A-RNA is not so great as B-DNA. In the anticodon loop structure, however, stabilizing effect of the bound water molecules upon the structure is significant. From the results, the reason why the structure of RNA remains unchanged with the change of hydration degree while that of DNA is altered was studied.

The changing trends of uterine cancer and cytology: a study of morbidity and mortality trends over a twenty year period

Data on squamous carcinoma of the cervix from a 20 year study period (1955 to 1974) in metropolitan Toledo revealed a 66% reduction of the average annual age-adjusted incidence rate and a 61% reduction in death rate of cervical squamous carcinoma when the first time period (1955 to 1958) was compared with the last time period (1971 to 1974). The decrease for both morbidity and mortality rates was more pronounced in women age 50 years and younger. The age-adjusted death rate during this study period revealed 15.5/100,000 for black women and 8.7/100,000 for white women. The reduction in death rate of 83% in black women is more prominent than 54.5% in white women. The decrease in both morbidity and mortality for cervical squamous carcinoma has a close relation to cytologic screening activity. The factors of age and race, probably related to socioeconomic status, are two known determinants of risk for cervical squamous carcinoma. Data for endometrial carcinoma during this study period revealed 15.5/100,000 women in the average age-adjusted incidence and an increase of 13.8% in average yearly rates when the first time period (1955 to 1958) were compared with the last time period (1971 to 1974). The peak age was 60 to 64 years old in the first time period and shifted to 70 to 74 years old in the last time period. The trend in metropolitan Toledo is comparable to that of Louisville, Kentucky. The mass cytologic screening program which contributed to a remarkable reduction in morbidity and mortality for the cervical squamous carcinoma, did not have any beneficial effect on endometrial carcinoma.