A case of ALK-positive large T-cell lymphoma expressing epithelial membrane antigen with favorable prognosis

We describe the case of a 59-year-old woman with Ki-1-negative, T cell-type, anaplastic lymphoma kinase (ALK)-positive large cell lymphoma that was positive for epithelial membrane antigen. She was histopathologically diagnosed as having a metastatic undifferentiated carcinoma from a cervical lymph node biopsy. Clinical and radiographic studies revealed no other primary tumor. The patient underwent a left radical neck dissection. Surgically resected lymph nodes revealed an ALK1-positive large cell lymphoma. Thereafter the patient has had an unusually favorable prognosis.

Optimal phases of dynamic CT for detecting hepatocellular carcinoma: evaluation of unenhanced and triple-phase images

BACKGROUND

To determine the optimal phases of dynamic computed tomography (CT) for detecting hepatocellular carcinoma (HCC).

METHODS

Fifty-two patients with 85 HCC nodules were examined by means of unenhanced and triple-phase CT images of the whole liver. The time for obtaining the arterial-phase images was 25-55 s after intravenous bolus injection of contrast material, the time for obtaining the portal venous-phase images was 65-100 s, and the time for obtaining late-phase images was 145 s to 4 min. Detectability of the HCC nodules for all phases was statistically compared.

RESULTS

The detection rates for the arterial- and late-phase images were significantly higher than for the unenhanced and portal venous-phase images (p < 0.01). The combination of arterial- and late-phase images showed the same number of HCC nodules in the same number of patients as did the combination of unenhanced and triple-phase images.

CONCLUSION

The combination of the arterial- and late-phase imagings was best for detecting HCC nodules.

Diffusion-weighted single-shot echoplanar MR imaging for liver disease

OBJECTIVE

The aims of this study were to determine apparent diffusion coefficients (ADCs) of the abdominal organs and liver lesions, to determine the effect of the magnitude of b values on the ADCs, and to determine whether measured ADCs of liver tumors help differentiate benign from malignant lesions.

SUBJECTS AND METHODS

Six healthy volunteers and 126 patients were examined with diffusion-weighted single-shot echo-planar imaging using multiple b values (maximum, 846 sec/mm2). The ADCs of the liver, spleen, kidney, 49 malignant liver lesions (33 hepatocellular carcinomas, 15 metastatic liver tumors, and one cholangiocellular carcinoma), and 30 benign lesions (17 cysts, 12 hemangiomas, and one angiomyolipoma) were calculated.

RESULTS

The ADCs of the abdominal organs and liver lesions showed smaller values when calculated with the greater maximum b values. The ADCs of the benign lesions calculated with all the b values of less than 850 sec/mm2 (2.49+/-1.39 x 10(-3) mm2/sec) were significantly (p = .0024) greater than those of the malignant lesions (1.01+/-0.38 x 10(-3) mm2/sec). When the maximum b value is 846 sec/mm2, use of a threshold ADC of 1.6 x 10(-3) mm2/sec would result in a sensitivity of 98% and a specificity of 80% for differentiation of malignant liver lesions from benign lesions.

CONCLUSION

Measurement of ADC has good potential for characterizing liver lesions, but the calculated ADCs could be affected by the magnitude of the maximum b value.

Tubal pregnancy in a unicornuate uterus with rudimentary horn: a case report

OBJECTIVE

To report a case of tubal pregnancy in a unicornuate uterus with rudimentary horn on the side of the rudiment and its pathology.

DESIGN

Case report.

SETTING

University hospital.

PATIENT

An 18-year-old woman, primigravida, with tubal pregnancy.

INTERVENTION(S)

Systemic administration of methotrexate, salpingectomy by laparotomy, and laparoscopic surgery for resection of rudimentary horn.

MAIN OUTCOME MEASURE(S)

Emergent laparotomy revealed that the intraperitoneal hemorrhage was caused by the rupture of the tubal pregnancy on the same side as the rudimentary horn of the unicornuate uterus. A corpus luteum was found at the ipsilateral ovary of the rudimentary horn.

RESULT(S)

Image diagnosis and pathological examination of the rudimentary horn revealed that this uterine malformation was a unicornuate uterus with a noncommunicated, noncavitary rudimentary horn, corresponding to class IIc of the American Fertility Society classification of müllerian anomalies.

CONCLUSION(S)

This is the first report of a tubal pregnancy on the side of the noncommunicating rudimentary horn with the ipsilateral ovary carrying a corpus luteum in a unicornuate uterus.

The cyclic AMP response element modulator family regulates the insulin gene transcription by interacting with transcription factor IID

We analyzed a mechanism of transcriptional regulation of the human insulin gene by cyclic AMP response element modulator (CREM) through four cyclic AMP response elements (CREs). We isolated two novel CREM isoforms (CREMDeltaQ1 and CREMDeltaQ2), which lack one of the glutamine-rich domains, Q1 and Q2 respectively, and six known isoforms (CREMtaualpha, CREMalpha, inducible cyclic AMP early repressor (ICER) I, ICER Igamma, CREM-17X, and CREM-17) from rat pancreatic islets and the RINm5F pancreatic beta-cell line. CREM isoforms functioned as efficient transcriptional activators or repressors to modulate insulin promoter activity by binding to all of the insulin CREs. The binding activity of repressors is higher than that of activators and suppressed not only basal activity but also activator-induced activities. Furthermore, CREM activator interacted directly with the transcription factor IID components hTAF(II)130 and TATA box-binding protein (TBP). These results suggest that the activation of the insulin gene transcription by CREM activator is mediated by not only direct binding to the CREs but also by recruiting transcription factor IID to the insulin promoter via its interaction with hTAF(II)130 and TBP. On the other hand, the CREM repressor ICER competitively interrupts the binding of the activators to CREs and does not interact with either TBP or hTAF(II)130; therefore, it might fail to stabilize the basal transcriptional machinery and repress transactivation.

MR imaging of non-squamous vaginal tumors

We reviewed the MR images and pathologic findings of five cases of primary vaginal neoplasms of non-squamous origin. Histologic types consisted one case each of adenocarcinoma, adenosarcoma, melanoma, lymphoma, and neurilemoma. Magnetic resonance imaging was found useful for evaluating the type and the extension of vaginal tumors.

Surgical treatment for dysphagia of neuromuscular origin

There are a number of surgical procedures which can be used to improve swallowing in selected dysphagic patients. These include: vocal fold augmentation or medialization, cricopharyngeal myotomy, laryngeal suspension, intrahyoid myotomy, lateral thyrolaminectomy and tracheoesophageal separation procedures. This article describes these various procedures and their appropriate application to selected dysphagic patients. Results of a study of the location of the recurrent laryngeal nerve in relation to the cricopharyngeal muscle are also presented.

Cisplatin-induced toxicity in LLC-PK1 kidney epithelial cells: role of basolateral membrane transport

Cytotoxicity of cisplatin was evaluated after apical and/or basolateral treatment of LLC-PK1 cell monolayers grown on porous membrane filters with 300 microM cisplatin. When LLC-PK1 cells were exposed from basolateral side for 0.5-4 h, lactate dehydrogenase (LDH) release into culture medium was markedly stimulated. However, apical treatment of the cells with cisplatin for 0.5 h did not stimulate LDH release. gamma-Glutamyltransferase activity and amount of protein in the cell homogenate were markedly decreased by basolateral treatment with cisplatin. However, in the apical treatment with cisplatin, these changes were relatively small, suggesting that degrees of the toxicities were different between basolateral and apical treatment with cisplatin. Cellular platinum level after basolateral treatment with cisplatin was higher compared to that following apical treatment. Furthermore, both accumulation and toxicity of cisplatin in LLC-PK1 cells were decreased by treatment with cisplatin at 4 degrees C. These results suggested that there were specific mechanisms mediating cisplatin uptake at the basolateral membranes of LLC-PK1 cells.

The association between Trp64Arg polymorphism of the beta3-adrenergic receptor and autonomic nervous system activity

The beta3-adrenergic receptor plays a significant role in the control of lipolysis and thermogenesis in brown adipose tissue through autonomic nervous system (ANS) activity. As the Trp64Arg polymorphism of the beta3-adrenergic receptor gene might affect ANS activity, we investigated the association of the polymorphism with ANS activity. The prevalence of the polymorphism was determined in 204 subjects. Ten normal homozygous, 10 heterozygous, and 1 variant homozygous subjects were examined for ANS activity during supine rest and standing by electrocardiogram R-R interval power spectral analysis. Subjects with the variant did not differ from subjects without the variant in body mass index, plasma glucose, plasma insulin, or family history of diabetes or obesity. The total power of heterozygotes at supine rest was lower than that of normal subjects (1124.6 +/- 191.6 vs. 3029.8 +/- 758.8 ms2; mean +/- SE). With a postural change to standing, the parasympathetic and sympathetic nervous system activity indexes of heterozygotes showed a higher response than those of normal subjects (parasympathetic nervous system index, 0.10 +/- 0.02 vs. 0.17 +/- 0.02; sympathetic nervous system index, 10.55 +/- 1.47 vs. 6.26 +/- 1.09), and the difference in total power disappeared. These findings show that subjects with the variant, even the heterozygotes, had lower resting ANS activity than normal subjects.

Nisoldipine improves the impaired erythrocyte deformability correlating with elevated intracellular free calcium-ion concentration and poor glycaemic control in NIDDM

AIMS

To explore the mechanisms underlying the impaired erythrocyte deformability (RBC-df) in diabetic patients, the relationship between erythrocyte intracellular free calcium-ion concentration ([Ca2+]i) and RBC-df, and the effects of Ca2+-channel blocker on [Ca2+]i and RBC-df were evaluated.

METHODS

Forty-eight patients with NIDDM and 24 control subjects were enrolled in this study. [Ca2+]i was determined using fura-2, and RBC-df by filtration method expressed as Deformability Index (DI). Erythrocytes were treated with nisoldipine to evaluate the effects of a Ca2+-channel blocker.

RESULTS

[Ca2+]i was significantly higher (82.6 (78.0-87.2) vs 76.6 (74.3-81.2) nmol lRBC-1, P<0.001), and DI was significantly lower (0. 14 (0.09-0.28) vs 0.22 (0.16-0.28), P<0.01) in NIDDM than in controls. There was a significant correlation between HbA1c and [Ca2+]i (r=0.38, P<0.01), between HbA1c and DI (r=-0.51, P<0.01), and between [Ca2+]i and DI (r=-0.42, P<0.01). Stepwise multiple regression analysis revealed HbA1c and [Ca2+]i as independent determinants for the impaired RBC-df. Nisoldipine treatment in vitro significantly decreased [Ca2+]i, and significantly improved RBC-df.

CONCLUSIONS

These data indicate that the impaired RBC-df in NIDDM may at least partly be attributed to the elevated [Ca2+]i and poor glycaemic control. In addition, favorable effects of a Ca2+-channel blocker on both [Ca2+]i and RBC-df have been demonstrated.

Non-linear analysis of the sleep EEG

A sleep electroencephalogram was analyzed by non-linear analysis. The polysomnography of a healthy male subject was analyzed and the correlation dimensions calculated. The correlation dimensions decreased from the 'awake' stage to sleep stages 1-3 and increased during rapid eye movement (REM) sleep. These results were seen during each sleep cycle. In each sleep cycle, the correlation dimensions decrease for slow wave sleep, and increase for REM sleep.

A new 200 kV Omega-filter electron microscope

A new 200 kV Omega-filter electron microscope was developed under a project supported by a Grant-in-Aid for Specially Promoted Research of the Ministry of Education, Science, Sports and Culture of Japan. The performance of the microscope is described.

[Change in prevalence of allergic diseases in primary school children in Fukuoka City for the last fifteen years]

We have been investigating the yearly change of prevalence rate of childhood allergic diseases using same method and in same region in five primary schools in Fukuoka City for the last fifteen years. From 1981 to 1995, revised ATS-DLD questionnaire had been administered yearly to the first graders of primary school children (6-7 yrs). The total number of subjects for fifteen years were 8000. The average number of children in each year was 533. 1. The cumulative prevalence of bronchial asthma statistically increased from 5.7% (average of 1981 to 1983) to 7.7% (1993 to 1995). It was 1.7 times higher on boys. 2. The cumulative prevalence of atopic dermatitis did not change yearly and its average was 36.3%. The boys/girls ratio was 1.2. Remission rate of atopic dermatitis statistically increased from 14.3% (average of 1987 and 1988) to 19.6% (1994 and 1995). 3. The cumulative prevalence of allergic rhinitis did not change yearly and its average was 17.6%. It was 1.5 times higher on boys. 4. The cumulative prevalence of allergic conjunctivitis statistically increased from 8.4% (average of 1987 and 1988) to 11.1% (1994 and 1995).

Distribution of NADPH-diaphorase activity in the feline laryngeal mucosa

We studied nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase activity in the feline laryngeal mucosa using a histochemical technique in an effort to clarify the role of nitric oxide (NO) in the larynx. Many NADPH-diaphorase-positive nerve fibres were distributed around the blood vessels and the laryngeal glands. The majority of neuronal cells in the intralaryngeal ganglia were NADPH-diaphorase-positive. It is likely that NADPH-diaphorase-positive nerve fibres around the blood vessels and glands in the laryngeal mucosa originate from the intralaryngeal ganglia, and that NO regulates circulation and secretion in the larynx.

Ultrastructure of the myelinated nerve fibers in the feline laryngeal mucosa

We studied the myelinated sensory nerve fibers in the feline laryngeal mucosa. Myelinated afferent nerve fibers (A-delta type) present in the lamina propria showed deterioration of the myelin sheath and Schwann cells under the basement membrane. Axons penetrated the basement membrane and entered the intercellular space of the epithelium. Nerve endings with many mitochondria and small clear vesicles existed in the intercellular space. No synapse-like structure was found between the endings and the surrounding epithelial cells. It is likely that these endings act as mechanosensitive receptors that respond to water or chemical stimuli and that participate in eliciting swallowing, coughing, and bronchoconstriction.

Distribution and origin of the intraepithelial nerve fibres in the feline pharyngeal mucosa

Sensory inputs from the pharynx play an important role in initiation of the swallowing reflex and in feedback control of motor activities. Using an immunohistochemical technique and denervation procedures, we examined the distribution and origin of the intraepithelial nerve fibres in the feline pharyngeal mucosa to clarify the role of the afferent nerve in swallowing. The posterior pillar was very densely innervated, and the posterior and lateral walls of the mesopharynx had a moderate nerve density. In contrast, the base of the tongue, the vallecula, the pharyngeal surface of the epiglottis, and the pyriform sinus had only a few nerve fibres. The epithelium of the rostral and caudal portions of the pharyngeal mucosa were innervated by the glossopharyngeal nerve and superior laryngeal nerve, respectively, with a borderline at the middle level of the epiglottis. A portion of the intraepithelial nerve fibres in the lateral and posterior walls of the mesopharynx originated from the pharyngeal branch of the vagus nerve. It is hypothesized that the intraepithelial nerve fibres that exist in densely innervated areas are related to the initiation of the swallowing reflex induced by stimulation of the pharyngeal mucosa.

Effects of swimming training on aerobic capacity and exercise induced bronchoconstriction in children with bronchial asthma

BACKGROUND

A study was undertaken to determine whether swimming training improved aerobic capacity, exercise induced bronchoconstriction (EIB), and bronchial responsiveness to inhaled histamine in children with asthma.

METHODS

Eight children with mild or moderate asthma participated in swimming training every day for six weeks. The intensity of training was individually determined and set at 125% of the child's lactate threshold (LT), measured using a swimming ergometer. Another group of eight asthmatic children served as control subjects. Aerobic capacity and the degree of EIB were assessed by both cycle ergometer and swimming ergometer before and after swimming training.

RESULTS

The mean (SD) aerobic capacity at LT increased by 0.26 (0.11) kp after training when assessed with the swimming ergometer and by 10.6 (4.5) W when assessed with the cycle ergometer, and these changes were significantly different from the control group. The mean (SD) maximum % fall in forced expiratory volume in one second (FEV1) to an exercise challenge (cycle ergometer) set at 175% of LT decreased from 38.7 (15.4)% before training to 17.9 (17.6)% after training, but with no significant difference from the control group. There was, however, no difference in histamine responsiveness when compared before and after the training period.

CONCLUSION

A six week swimming training programme has a beneficial effect on aerobic capacity but not on histamine responsiveness in children with asthma.

Adrenomedullin and membrane fluidity of erythrocytes in mild essential hypertension

OBJECTIVE

Adrenomedullin is a newly discovered 52 amino acid peptide that has a potent vasodilating action. The present study was undertaken to investigate the role of adrenomedullin in the regulation of membrane fluidity of erythrocytes in patients with essential hypertension.

METHODS AND RESULTS

We used an electron paramagnetic resonance and spin-labeling method. Adrenomedullin significantly decreased the order parameter for 5-nitroxide stearate and peak height ratio for 16-nitroxide stearate obtained from electron paramagnetic resonance spectra of erythrocyte membranes in normotensive volunteers (mean +/- SEM order parameter value: control, 0.718 +/- 0.003, n = 16; adrenomedullin at 10(-9) mol/l, 0.692 +/- 0.004, n = 16, P < 0.05; adrenomedullin at 10(-8) mol/l, 0.690 +/- 0.004, n = 16, P < 0.05; adrenomedullin at 10(-7) mol/l, 0.683 +/- 0.004, n = 16, P < 0.05). The findings showed that adrenomedullin increased the membrane fluidity of erythrocytes. In addition, the effect of adrenomedullin was significantly potentiated by prostaglandin E1 and dibutyryl cyclic AMP. In contrast, the calcium ionophore A23187 counteracted the actions of adrenomedullin. In patients with essential hypertension, who had higher order parameter values, the membrane fluidity of erythrocytes was significantly lower than in the normotensive control subjects (order parameter: 0.728 +/- 0.004 in hypertensives, n = 20; 0.692 +/- 0.002 in normotensives, n = 36, P < 0.01). The effect of adrenomedullin on membrane fluidity was more pronounced in the erythrocytes of essential hypertensive than in the erythrocytes of normotensive subjects (change in the order parameter with adrenomedullin at 10(-9) mol/l: -4.2 +/- 0.3% in hypertensives, n = 20; -1.8 +/- 0.2% in normotensives, n = 20, P < 0.05; adrenomedullin at 10(-8) mol/l: -4.5 +/- 0.3% in hypertensives, n = 20; -1.8 +/- 0.2% in normotensives, n = 36, P < 0.05).

CONCLUSIONS

The results of the present study demonstrate that adrenomedullin significantly increased the membrane fluidity of erythrocytes. The mechanisms were partially mediated by a prostaglandin E1- and cyclic AMP-dependent pathway which might be linked to changes in intracellular calcium kinetics. The greater effect of adrenomedullin in patients with essential hypertension suggests that the peptide might actively participate in the regulation of membrane functions in hypertension.

The MH1 domains of smad2 and smad3 are involved in the regulation of the ALK7 signals

The biological responses of the transforming growth factor beta (TGF-beta) superfamily are induced by activation of a receptor complex and Smad proteins. We surveyed the TGF-beta superfamily receptors using the degenerate PCR strategy, and found activin receptor-like kinase 7 (ALK7) to be abundantly expressed in fetal rat pancreatic islets. ALK7 is also expressed in adult rat islets and pancreatic beta-cell-derived MIN6 cells. The constitutively active form of ALK7, ALK7(T194D), activated Smad3 and a chimeric Smad protein, Smad3-2, containing the MH1 domain of Smad3 and the MH2 domain of Smad2, and translocated them to nuclei and then induced activation of the human PAI-1 promoter. However, neither Smad2 nor Smad2-3 protein, containing the MH1 domain of Smad2 and the MH2 domain of Smad3 were activated. These results indicate that the ALK7 signal regulates nuclear localization and activation of Smad2 and Smad3, and the MH1 domain of Smad2 has inhibitory effects on the nuclear localization.

Disordered expression of the sucrase-isomaltase complex in the small intestine in Otsuka Long-Evans tokushima fatty rats, a model of non-insulin-dependent diabetes mellitus with insulin resistance

To clarify the relationship between diabetes mellitus and carbohydrate digestion, the activities of sucrase and isomaltase, which form a complex enzyme (SI complex) on the brush border membranes, were compared in the progression of diabetes mellitus in Otsuka Long-Evans Tokushima fatty (OLETF) rats, a model of human non-insulin-dependent diabetes mellitus with insulin resistance, and Long-Evans Tokushima Otsuka (LETO) rats as non-diabetic controls. Until 40 weeks of age, OLETF rats were obese and had a high plasma glucose level, compared to age-matched LETO rats, but the sucrase and isomaltase activities showed no significant differences between the two strains. Oral glucose tolerance test revealed that during 40-48 weeks of age, NIDDM became very severe with advancing insulin resistance in OLETF rats. In OLETF rats, in contrast to LETO rats, at 48 weeks of age, abnormal increases in the sucrase and isomaltase activities occurred, along with a remarkable decrease in body weight and a further great increase in the plasma glucose level in the non-fasting state. Hyperinsulinemia occurred in 20-week-old OLETF rats; however, at 40 and 48 weeks of age, the plasma insulin level in the non-fasting state in OLETF rats was not significantly different from that in LETO rats. The level of mRNA encoding the SI complex increased abnormally in 48-week-old OLETF rats. These results suggest that the advance of insulin resistance leads to an increase in the expression of the SI complex on the transcriptional level.

Detection of extracapsular extension of prostate cancer: role of fat suppression endorectal MRI

PURPOSE

The purpose of this work was to compare the efficacy of fat-suppressed and non-fat-suppressed fast spin echo (FSE) endorectal MRI in the detection of extracapsular extension (ECE) of prostate cancer by experienced and inexperienced readers.

METHOD

Seventy-nine patients with biopsy-proven prostate cancer underwent axial FSE T2-weighted endorectal MRI of the prostate prior to radical prostatectomy. Twenty-one patients were imaged with frequency-selective fat suppression, and 58 were imaged without fat suppression. All images were retrospectively and independently reviewed by two readers of different experience levels who were blinded to clinical and pathological findings. Readers assessed the presence or absence of ECE on a 5 point scale for each side of the prostate, and step-section pathology was used as the standard of reference in all patients. Receiver operating characteristics analysis was used to compare the performance of fat-suppressed and non-fat-suppressed images by both readers.

RESULTS

ECE was present in 33 of 79 (42%) patients. The more experienced reader demonstrated better diagnostic performance (p < 0.05) than the less experienced reader in terms of sensitivity and area under the ROC curve (Az) for MRI without fat suppression. Use of frequency-selective fat suppression did not result in any significant improvement in diagnosis of ECE compared with MRI without fat suppression for either the experienced (Az 0.81 vs. 0.79) or the inexperienced (Az 0.76 vs. 0.68) reader.

CONCLUSION

Even when reader experience is considered, use of frequency-selective fat suppression did not significantly improve the diagnosis of ECE by MRI. The decision to use fat suppression and the selection of a fat suppression technique can be left to the discretion of the individual reader.

A case of fallopian tube carcinoma: successful preoperative diagnosis with MR imaging

We report a case of fallopian tube carcinoma, successfully diagnosed preoperatively. The patient was a 64-year-old woman. Transvaginal sonography and computed tomography showed a cystic and solid tumor on the left side of the uterus, suggesting ovarian cancer. The tumor was, however, suspected to be a fallopian tube carcinoma on MR imaging. MR images showed a solid mass surrounded by a tube-shaped cystic part. At surgery, a solid and cystic tumor was found in the left fallopian tube. MR imaging may be useful to assist in the diagnosis of fallopian tube carcinoma.

[The role and significance of acid suppressive drugs in the eradication of H. pylori]

Recently a new triple therapy with PPI and two antimicrobials is widely accepted instead of classical triple therapy. PPI has direct and indirect effects on H. pylori. Practically a single use of PPI is almost noneffective for eradication of H. pylori. In the combination therapy PPI is supposed to contribute to successful eradication through the inhibition of acid secretion. Because a raise of pH in stomach protects antimicrobials from the degradation by acidic environment. The decrease in the volume of gastric juice also contributes to concentrate antibiotics. Recently interaction between PPI and clarithromycin on metabolic enzyme in liver was reported that explains the synergistic effects of these drugs. The heterogeneity of genotype of metabolic enzyme was also elucidated which might be responsible for the difference in the effect of PPI between the patients. To accomplish successful eradication, full inhibition of acid secretion has to be done. To consider the interactions between PPI and antimicrobials and the heterogeneity of genotype of metabolic enzyme may improve eradication therapy of H. pylori.

MRI of cervical adenocarcinoma with cystic components

We encountered two cases of endocervical well-differentiated adenocarcinoma with cystic components. Magnetic resonance findings of the first case showed cystic lesion with enhanced mural nodule in the uterine cervix. The second case showed multicystic lesion in the uterine cervix. The cystic walls were thickening in the postcontrast T1-weighted image. The cervical adenocarcinoma with cystic components should be added to one of differential diagnosis of the uterine cervical cystic lesion.

Transcriptional repressors are increased in pancreatic islets of type 2 diabetic rats

To further clarify the mechanism of impaired insulin gene transcription in the diabetic state, we investigated the expression and function of the transcriptional repressor CREM (CRE modulator) in rat pancreatic islets. The CREM gene generates both transcriptional activators and repressors by alternative splicing and an intronic promoter. We isolated a novel alternatively spliced CREM isoform, CREM-17X, which efficiently represses insulin gene transcription, in addition to the three previously reported repressors. We also compared mRNA levels of insulin and the CREM repressors in pancreatic islets of Wistar and GK (Goto-Kakizaki) rats, the well-characterized spontaneous animal model of type 2 diabetes. The CREM repressor levels are increased, and the expression of insulin mRNA is decreased in GK rats, suggesting that increased CREM repressor expression in pancreatic islets could contribute to the decreased insulin gene transcription that results in impaired insulin secretion in type 2 diabetes.

Effects of galanin on dopamine release in the central nervous system of normotensive and spontaneously hypertensive rats

Galanin is a 29-amino acid peptide and widely distributed in the brain, although its significance in the control of neural activities is undefined. In the present study, we describe the effects of galanin on the electrically evoked release of dopamine in the rat central nervous system. In addition, to elucidate a possible role of galanin in the regulation of dopaminergic transmission in hypertension, we examined whether the effect of galanin on dopamine release might be altered in the central nervous system of spontaneously hypertensive rats (SHR). Galanin (1 x 10(-8) to 1 x 10(-7) mol/L) inhibited the stimulation (1 Hz)-evoked [3H]dopamine release by a comparable amount in striatal slices of Sprague-Dawley rats, although the basal release of dopamine was not affected by the peptide. In the striatum of SHR, the electrical stimulation (1 Hz)-evoked [3H]dopamine release was significantly smaller than in the striatum of Wistar-Kyoto (WKY) rats. However, the inhibitory effect of galanin on the stimulation-evoked [3H]dopamine release was significantly more pronounced in SHR than in WKY rats. These results show that galanin significantly reduced the release of dopamine in rat striatum. Furthermore, the greater inhibitory effect of galanin on dopamine release in SHR suggests that galanin might actively participate in the regulation of dopaminergic nerve activity in hypertension.

Captopril inhibits both dopaminergic and cholinergic neurotransmission in the central nervous system

1. The present study was performed to investigate the effects of captopril on both dopaminergic and cholinergic neurotransmission in the rat central nervous system. 2. Slices of rat striatum were prepared and prelabelled with [3H]-dopamine or [3H]-choline. Slices were continuously superfused with Krebs'-Ringer solution and electrical stimulation (1 Hz) was performed. 3. Captopril significantly inhibited stimulation-evoked [3H]-dopamine release from rat striatal slices in a concentration-dependent manner (S2/S1 ratios: control 0.835 +/- 0.018 (n = 6); 1 x 10(-5) mol/L captopril 0.597 +/- 0.035 (n = 6; P < 0.05); 5 x 10(-5) mol/L captopril 0.561 +/- 0.041 (n = 6; P < 0.05)). However, the basal release of [3H]-dopamine was not affected by captopril. 4. Captopril also reduced stimulation-evoked [3H]-acetylcholine release in the striatum (S2/S1 ratios: control 0.891 +/- 0.016 (n = 6); 1 x 10(-5) mol/L captopril 0.794 +/- 0.011 (n = 6; P < 0.05)). 5. These results show that captopril inhibits the release of both dopamine and acetylcholine in the rat striatum. Although the mechanisms underlying the neurosuppressive effects of captopril remain to be determined, the findings suggest that the inhibition of dopaminergic and cholinergic neurotransmission may be related to the central action of the angiotensin-converting enzyme inhibitor.

MRI appearance of ruptured corpus luteum

A 20-year-old woman was admitted complaining of lower abdominal pain. Transabdominal ultrasound revealed a fluid collection in the pouch of Douglas and an irregularly shaped ovary with cystic lesions. Malignant cystic mass of the right ovary was highly suspected from the ultrasound findings. Transvaginal peritoneal centesis yielded a bloody fluid, but the pregnancy test was negative. On the third day of admission, menstruation began. MR examination performed four days after the initial onset of pain showed a subacute hematoma just adjacent to the right ovary, and segmental interruption of the right ovarian cortex. Based on these MR findings and the patient's history, subacute hemorrhage from the right ovarian corpus luteum was suspected, and this was confirmed with surgical exploration.

Flow-through vascularized toe-joint transfer for reconstruction of segmental loss of an amputated finger

A segmental finger defect was reconstructed in a 46-year-old woman with a free flow-through vascularized toe-joint, including the proximal interphalangeal joint, the plantar digital nerve, and tendons of the second toe. The advantages of this composite flap are: (1) The segmental loss of the finger can be easily reconstructed to achieve a normal anatomic structure. (2) Excellent cosmesis is achieved, compared with conventional flaps such as the groin flap. (3) The distal segment of the donor toe can be preserved. (4) The transected digital arteries of the amputated finger can be simultaneously reconstructed with a flow-through arterial interposition. (5) The digital nerve can be repaired with a vascularized plantar digital nerve graft.

The effect of cold cardioplegic cardiac arrest and electrically induced ventricular fibrillation on human cardiac beta-adrenoceptors during open-heart surgery

This study was designed to test the hypothesis that distinct alterations in cardiac beta-adrenoceptors (betaARs) may occur during cardiopulmonary bypass (CPB) alone, during CPB with cold cardioplegic cardiac arrest (CCCA), and during CPB with electrically induced ventricular fibrillation (EIVF). We assessed the density and affinity of right atrial betaARs in 27 patients undergoing open-heart surgery by (-)-[125I]iodocyanopindolol binding before CPB, defined as the "control," immediately after initiation, defined as "before," and immediately before the cessation of CCCA or EIVF, defined as "after." The density of betaARs was equivalent between the "control" and "before" groups; however, during CPB with EIVF, the density of betaARs decreased significantly (P < 0.001), whereas during CPB with CCCA, it increased significantly (P < 0.01). The rate of changes of the betaAR density was not correlated with the "before"-"after" interval, and the affinity of the betaARs did not change throughout these CPBs. These findings demonstrate that: CPB alone does not affect cardiac betaARs, at least until the onset of EIVF or CCCA; CPB with EIVF induces rapid desensitization of cardiac betaARs; and CPB with CCCA induces rapid sensitization of cardiac betaARs.

Effects of injection rates of contrast material on arterial phase hepatic CT

OBJECTIVE

Our goal was to assess the effects of the i.v. injection rate of contrast material on arterial phase hepatic CT.

SUBJECTS AND METHODS

One hundred patients were randomly divided into four groups of 25 with different injection rates of 90 ml of contrast material: 2, 3, 4, or 5 ml/sec. Single-level serial CT was performed at the level of the middle section of the main portal vein before injection and every 2 sec from 12 sec to 60 sec after injection of contrast material. The enhancement value was calculated as the difference in attenuation value between the unenhanced and contrast-enhanced images for the aorta and liver parenchyma. The duration of the arterial phase was defined as the interval beginning when the enhancement value for the aorta reached 100 H and ending when the value for the liver parenchyma reached 20 H.

RESULTS

Faster injection rates increased the maximum enhancement of the aorta. Although faster injection rates decreased the time from injection to the beginning and the end of the arterial phase, faster injection rates did not decrease the duration of the arterial phase itself.

CONCLUSION

A faster injection rate increases arterial enhancement of the liver, and the duration of the arterial phase remains the same as that occurring with a slower injection rate. We hypothesize that faster injection rates can provide better results using CT to reveal hypervascular liver tumors.

Beaded nerve terminals in feline laryngeal mucosa

To investigate the mechanism of airway defense reflex, beaded nerve terminals were studied by immunohistochemical techniques. In the supraglottic region the density of PGP 9.5-immunoreactive nerve fibers was the highest at the base of the glottic surface in the epiglottis, and in the glottic region it was the highest in the arytenoid region. In the subglottic region the number of positive nerve fibers was less than the number at the base of the glottic surface in the epiglottis, and when the laryngeal mucosa was processed with NaOH to dissolve the epithelium, it was possible to observe beaded nerve terminals more clearly. These beaded nerve terminals were found just beneath, in the epithelial basement membrane. Electron microscopic examination of beaded nerve terminals revealed a large quantity of secretory granules and mitochondria, suggesting that their structure is similar to that of nerve terminals. Thus these beaded nerve terminals may function as mechanoreceptors.

Mitochondrial abnormalities in selenium-deficient myopathy

We report a man who developed selenium-deficient myopathy during long-term parenteral nutrition. Muscle biopsy showed marked mitochondrial depletion in the deep sarcoplasm and enlarged mitochondria at the periphery mainly in type 2 fibers. Muscle weakness improved gradually after the second course of selenium supplementation. The peculiar mitochondrial abnormalities in muscle fibers appear to play a key role in the pathogenesis of selenium-deficient myopathy.

Theta rhythms associated with sucking, crying, gazing and handling in infants

In order to specify the locations and to clarify the electrophysiological significance of the transitory rhythmic theta activities detected on scalp electrodes in infants, we performed simultaneous EEG and video recording with power spectral map analysis in 29 normal infants of less than 1 year of age. The rhythmic theta activities appeared in posterior temporal regions with sucking or crying, in the parietal region with gazing, and in the frontal region with handling. Each specific location of the theta rhythm seemed to correspond to the functional localization in the infant's brain. We thus concluded that these rhythmic theta activities might originate from direct cortical activation, or from the cortical activation driven by the neuronal impulses from the limbic system through the connection between that system and the cortex.

Clinical manifestations due to a point mutation of the mitochondrial tRNAleu(UUR) gene in five families with diabetes mellitus

It has been shown that an adenine (A) to guanine (G) transition at position 3243 of the mitochondrial transfer RNA(tRNA)leu(UUR) gene is associated with a subgroup of diabetes mellitus. Therefore, we screened for this transition in 86 patients with non-insulin-dependent diabetes mellitus (NIDDM) in which two or three generations were affected with diabetes, in 14 patients with insulin-dependent diabetes mellitus, and in 9 families with diabetes mellitus and/or associated disorders suggesting mitochondrial gene abnormalities. We failed to identify the mutation in 100 diabetic patients, 86 NIDDM and 14 insulin-dependent diabetes mellitus (IDDM). Out of the latter 9 families, we identified an A to G transition in 14 individuals in 5 families. Diabetes mellitus was shown to be maternally inherited in one family. In 9 of 14 patients with the mutation, insulin was required to treat diabetes mellitus, indicating impaired insulin secretion. A hyperglycemic clamp test performed in one subject revealed significant impairment of insulin secretion, whereas euglycemic clamp test showed normal insulin sensitivity in this patient. The heteroplasmy of the mutant mitochondrial DNA (mtDNA) in leukocytes does not appear to correlate with the severity of diabetes in terms of the insulin therapy required. Body mass index of the affected individuals was less than 23.3. In one family, in addition to diabetes mellitus and hearing loss, hypoparathyroidism was associated with the mutation, suggesting that hypoparathyroidism is caused by the impaired processing and/or secretion of proparathyroid hormone due to the mutation. In addition, the affected subjects presented with proteinuria at the time of diagnosis of diabetes mellitus which appeared not to be related with diabetic nephropathy.

Properties of a new picorna-like virus of the brown-winged green bug, plautia stali

A picorna-like virus was isolated from the brown-winged green bug, Plautia stali. The virus was named Plautia stali intestine virus (PSIV) based on the multiplication site of the virus in the infected insects. PSIV is a spherical particle with a diameter of 30 nm. Particles of PSIV were found to contain a 9.1-kb single-stranded RNA. Polyacrylamide gel electrophoresis of purified PSIV particles revealed three major (33, 30, 26 kDa), one medium (35 kDa), and one minor (4.5 kDa) structural proteins. The molar ratios of the proteins suggested that the 35-, 33-, 30-, 26-, and 4.5-kDa proteins corresponded to VP0, VP1, VP2, VP3, and VP4 of vertebrate picornaviruses. Immunological assays indicated that PSIV and Nezara viridula virus-1, which is a picorna-like virus of the green stinkbug in South Africa, were serologically distinct. PSIV was detected in the intestine with enzyme-linked immunosorbent assay but not in the salivary glands, fat bodies, Malpighian tubules, and reproductive organs of viruliferous P. stali. The virus was also detected on the surface of the eggs and in the feces of infected insects. These results suggest that excrement of infected insects are the primary inoculum of the virus in a colony of P. stali. The nonviruliferous adults of P. stali usually survive a few months in laboratory, while the average of adulthood lifetime in viruliferous P. stali was about 13 days. PSIV also infected two other stinkbugs, Nezara viridula and Halyomorpha halys. Copyright 1998 Academic Press.

Helical CT angiography of living renal donors: comparison with 3D Fourier transformation phase contrast MRA

PURPOSE

The purpose of this study was to determine whether helical CT angiography (CTA) or MR angiography (MRA) is the optimal method to use as a preoperative examination for anatomic arterial assessment of living renal donors.

METHOD

Eighteen candidates to be renal donors underwent helical CTA, 3D Fourier transformation phase contrast (3D-FT-PC) MRA, and digital subtraction angiography (DSA). The CTA and MRA were interpreted separately by three readers independently, and these results were correlated with the findings of DSA.

RESULTS

DSA showed nine accessory renal arteries and 10 prehilar branches. CTA revealed seven or eight accessory renal arteries. MRA showed six or seven accessory arteries. Of 10 prehilar branches, 7-9 branches were detected with CTA and 5-8 branches with MRA.

CONCLUSION

Helical CTA is superior to 3D-FT-PC MRA for evaluating the arterial anatomy of living renal donors.

[Three-dimensional gadolinium-enhanced dynamic MRI of whole liver using spectrally selected enhanced fast gradient recall sequence]

Three-dimensional gadolinium-enhanced dynamic MRI of whole liver using the spectrally selected enhanced fast gradient recall sequence (spec IR-efgre3d) was performed in five patients with HCC. Ten HCC nodules were confirmed by CTA, CTAP and Lipiodol CT, and all of them were detected with dynamic MRI. MIP images reconstructed from 3D gadolinium-enhanced dynamic MR studies clearly showed the main portal vein and its branches in all cases. Portal vein thrombosis was also demonstrated with the MIP images.

Preoperative staging of endometrial carcinoma: diagnostic effect of T2-weighted fast spin-echo MR imaging

PURPOSE

To evaluate the usefulness of T2-weighted fast spin-echo magnetic resonance (MR) imaging with a 512 x 256 matrix for assessment of the preoperative stage of endometrial carcinoma.

MATERIALS AND METHODS

Twenty-eight women with histopathologically proved endometrial carcinoma underwent preoperative T2-weighted fast spin-echo, dynamic T1-weighted fast spin-echo, and postcontrast T1-weighted spin-echo MR imaging with a phased-array surface coil. The uterine long-axis planes in each sequence were reviewed at separate sessions by three radiologists blinded to the histopathologic data.

RESULTS

For the diagnosis of myometrial invasion, no statistically significant differences were found among T2-weighted imaging, dynamic imaging, and postcontrast T1-weighted imaging. For the diagnosis of deep myometrial invasion, T2-weighted and dynamic images showed higher specificity than postcontrast T1-weighted images (T2-weighted, 89%; dynamic, 88%; and postcontrast T1-weighted, 80%). For cervical invasion, T2-weighted and dynamic images showed larger areas under receiver operating characteristic curves than did postcontrast T1-weighted images (T2-weighted, 0.78; dynamic, 0.71; and postcontrast T1-weighted, 0.67).

CONCLUSION

T2-weighted imaging is useful for identifying the stage of endometrial carcinoma.

Metabolic inhibition impairs ATP-sensitive K+ channel block by sulfonylurea in pancreatic beta-cells

The effect of metabolic inhibition on the blocking of beta-cell ATP-sensitive K+ channels (KATP channels) by glibenclamide was investigated using a patch-clamp technique. Inhibition of KATP channels by glibenclamide was attenuated in the cell-attached mode under metabolic inhibition induced by 2,4-dinitrophenol. Under a low concentration (0.1 microM) of ATP applied in the inside-out mode, KATP channel activity was not fully abolished, even when a high dose of glibenclamide was applied, in contrast to the dose-dependent and complete KATP channel inhibition under 10 microM ATP. On the other hand, cibenzoline, a class Ia antiarrhythmic agent, inhibits KATP channel activity in a dose-dependent manner and completely blocks it, even under metabolic inhibition. In sulfonylurea receptor (SUR1)- and inward rectifier K+ channel (Kir6.2)-expressed proteins, cibenzoline binds directly to Kir6.2, unlike glibenclamide. Thus, KATP channel inhibition by glibenclamide is impaired under the condition of decreased intracellular ATP in pancreatic beta-cells, probably because of a defect in signal transmission between SUR1 and Kir6.2 downstream of the site of sulfonylurea binding to SUR1.

The role of sodium-potassium adenosine triphosphatase in the regulation of membrane fluidity of erythrocytes in spontaneously hypertensive rats: an electron paramagnetic resonance investigation

To determine a possible role of sodium-potassium adenosine triphosphatase (Na+, K+-ATPase) in the regulation of membrane functions in hypertension, we investigated the effects of ouabain on the membrane fluidity of erythrocytes in spontaneously hypertensive rats (SHR) by means of an electron paramagnetic resonance (EPR) and spin labeling method. Erythrocytes obtained from SHR were examined compared with age matched Wistar-Kyoto (WKY) rats, and the EPR spectra for 5-nitroxide stearate incorporated into the erythrocyte membranes were studied. The value of order parameter (S) of the EPR spectra was significantly higher in the erythrocytes of SHR than in the erythrocytes of WKY rats (S value: SHR, 0.721+/-0.009, n = 10; WKY, 0.652+/-0.008, n = 10; P < .05). The finding shows that the membrane fluidity of erythrocytes was lower in SHR than in WKY rats. Ouabain loading to erythrocytes significantly decreased the membrane fluidity (S value was increased) in both SHR and WKY rats. The ouabain induced change was significantly greater in SHR than in WKY rats. These results demonstrate that the membrane fluidity of erythrocytes might be highly dependent on the Na+, K+-ATPase activity in SHR, which would suggest an abnormality in Na+ related cellular functions in hypertension.

Ag(I)-N bond-containing compound showing wide spectra in effective antimicrobial activities: polymeric silver(I) imidazolate

A neutral, Ag(I)-N bonding compound, polymeric silver(I)-imidazolate [Ag(imd)]n (1) consisting of Ag+: imd = 1:1 (Himd = imidazole, C3H4N2), showed wide spectra in effective antimicrobial activities against bacteria, yeast and mold. Of particular note are the activities against a wide range of mold. This polymeric solid does not crystallize and is sparingly soluble in all solvents. The monomeric, cationic, water-soluble Ag(I)-N bonding complex, [Ag(Himd)2](NO3) (2), has also shown wide spectra of effective antimicrobial activities. These activities observed here were significantly different from those of the recently prepared oligomeric Ag(I)-S bonding complexes; the latter have shown narrow spectra. It is proposed that the Ag(I)-N bonding is one of the key factors showing the wide spectra of antimicrobial activities and the potential targets for inhibition of bacteria and yeast by these Ag(I) complexes are proteins, but not nucleic acids. The physico-chemical properties of (1), in comparison with those of (2), with various measurements (FT-IR, Laser Raman scattering spectroscopy, ESCA and solid 13C CP-MAS NMR spectroscopies) are described.

[Ruptured thymic cysts with mediastinal hemorrhage and hemothorax--a case report and reviews of the literature]

We report a rare case with rupture of thymic cyst including mediastinal hemorrhage and hemothorax. A 68-year-old man was referred to our hospital for the treatment of right hemothorax. A chest roentgenogram following thoracentesis demonstrated a widened mediastinum. Chest computed tomograms revealed a large anterior mediastinal mass extending to the right pleural cavity and bilateral pleural effusion. Digital subtraction angiography showed a normal aorta and great vessels. A median stenotomy revealed a large encysted hematoma along the thymic cyst extending from the right anterior mediastinum into the right pleural cavity and ending with rupture. Pathological examination demonstrated that the largest thymic cyst was continued to the hematoma resulting from partial destruction of its epithelial lining. To our knowledge, only five cases including our's with ruptured thymic tumors were reported, and this is the first report of ruptured thymic cyst resulting in mediastinal hemorrhage and hemothorax.

Extensive interbreeding occurred among multiple matriarchal ancestors during the domestication of dogs: evidence from inter- and intraspecies polymorphisms in the D-loop region of mitochondrial DNA between dogs and wolves

To test the hypothesis that the domestic dogs are derived from several different ancestral gray wolf populations, we compared the sequence of the displacement (D)-loop region of the mitochondrial DNA (mtDNA) from 24 breeds of domestic dog (34 individual dogs) and 3 subspecies of gray wolf (Canis lupus lupus, C.l. pallipes and C.l. chanco; 19 individuals). The intraspecific sequence variations within domestic dogs (0.00-3.19%) and within wolves (0.00-2.88%) were comparable to the interspecific variations between domestic dogs and wolves (0.30-3.35%). A repetitive sequence with repeat units (TACACGTA/GCG) that causes the size variation in the D-loop region was also found in both dogs and wolves. However, no nucleotide substitutions or repetitive arrays were specific for domestic dogs or for wolves. These results showed that there is a close genetic relationship between dogs and wolves. Two major clades appeared in the phylogenetic trees constructed by neighbor-joining and by the maximum parsimony method; one clade containing Chinese wolf (C.l. chanco) showed extensive variations while the other showed only slight variation. This showed that there were two major genetic components both in domestic dogs and in wolves. However, neither clades nor haplotypes specific for any dog breed were observed, whereas subspecies-specific clades were found in Asiatic wolves. These results suggested that the extant breeds of domestic dogs have maintained a large degree of mtDNA polymorphisms introduced from their ancestral wolf populations, and that extensive interbreedings had occurred among multiple matriarchal origins.