Somatic mutations of LKB1 and beta-catenin genes in gastrointestinal polyps from patients with Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is characterized by multiple gastrointestinal hamartomatous polyps, mucocutaneous melanin deposition, and increased risk of cancer, mainly in the gastrointestinal tract. We examined mutations of the LKB1, beta-catenin, APC, K-ras, and p53 genes in 27 gastrointestinal hamartomatous polyps from 10 patients in nine PJS families. Of these hamartomatous polyps, one intestinal polyp had an adenomatous lesion, and one gastric polyp contained adenomatous and carcinomatous lesions. Germ-line mutations of the LKB1 gene were detected in six PJS families. Somatic mutations of the LKB1 gene were found in 5 polyps, whereas loss of heterozygosity (LOH) at the LKB1 locus at 19p was seen in 14 other polyps. In adenomatous lesions microdissected from hamartomatous polyps, both beta-catenin mutation and 19p LOH were detected. Furthermore, a carcinomatous lesion in a gastric hamartomatous polyp was found to contain a mutation of the p53 gene and LOH at the p53 locus in addition to LOH at the LKB1 locus and a beta-catenin mutation. K-ras mutations were detected in a few polyps, whereas no APC mutation or 5q LOH was detected in hamartomatous polyps. These results suggest that gastrointestinal hamartomatous polyps in PJS patients develop through inactivation of the LKB1 gene by germ-line mutation plus somatic mutation or LOH of the unaffected LKB1 allele, and that additional mutations of the beta-catenin gene and p53 gene convert hamartomatous polyps into adenomatous and carcinomatous lesions.

Spontaneous intracranial hypotension successfully treated by epidural patching with fibrin glue

We report a case of spontaneous intracranial hypotension due to a cerebrospinal fluid leak at the C2 level, which was successfully treated by epidural fibrin glue patching. Epidural blood patching was performed twice, first with 6 mL of autologous blood and then with 10 mL, but the intracranial hypotension was unresponsive. Although successful treatment of postdural puncture headache and persistent leak after intrathecal catheterization by epidural patching with fibrin glue has been reported, fibrin glue has not been previously applied in spontaneous intracranial hypotension. Our observation suggests that epidural patching with fibrin glue should be considered in patients with spontaneous intracranial hypotension, if epidural blood patching fails to resolve the symptoms.

Cytology of microcystic meningioma in crush preparation

Microcystic meningioma is a rare variant of meningioma, showing microcystic formations throughout the tumor. To the best of our knowledge, there have been no reports describing cytologic findings of microcystic meningioma. Our case was a 66-yr-old woman with a tumor mass adhered to the dura matter. The crush preparations of a small tissue fragment resected from the mass showed medium- to large-sized, well-cohesive clusters or sheets of uniform tumor cells. The tumor cells did not show a feathering-off pattern. Various-sized cystic spaces were observed within the clusters and sheets. The cytoplasm was relatively abundant, and the nuclear:cytoplasmic ratio was lower than that of classic meningioma. We believe that the cystic spaces within the cell clusters or sheets are characteristic of microcystic meningioma. The cytology of microcystic meningioma seen in our case was similar to that of metastatic adenocarcinoma, but relatively monotonous bland cells, smooth nuclear outline, and inconspicuous nucleoli led us to the diagnosis of meningioma rather than adenocarcinoma.

Theta rhythm increases in left superior temporal cortex during auditory hallucinations in schizophrenia: a case report

Auditory hallucinations (AH), the perception of sounds and voices in the absence of external stimuli, remain a serious problem for a large subgroup of patients with schizophrenia. Functional imaging of brain activity associated with AH is difficult, since the target event is involuntary and its timing cannot be predicted. Prior efforts to image the patterns of cortical activity during AH have yielded conflicting results. In this study, MEG was used to directly image the brain electrophysiological events associated with AH in schizophrenia. We observed an increase in theta rhythm, as sporadic bursts, in the left superior temporal area during the AH states, whereas there was steady theta band activity in the resting state. The present finding suggests strong association of the left superior temporal cortex with the experience of AH in this patient. This is consistent with the hypothesis that AH arises from areas of auditory cortex subserving receptive language processing.

Spontaneous regression of hepatocellular carcinoma and review of literature

A 68-year-old man presented with multiple hepatocellular carcinoma, which was considered to be unresectable at the first admission in January 1994. Pathological diagnosis was made by biopsy of the one lesion among them. From January 1994 to December 1997, 10 transarterial chemoembolizations and six percutaneous ethanol injection therapies were performed on the tumours in the cirrhotic liver. In February 1998 the tumour situated in the right lobe began to increase in size. The maximum tumour diameter was 6.3 cm measured by computed tomography (CT). In the beginning of May 1998 moderate ascites was present and mild hepatic encephalopathy was noticed. The patient was in the terminal stage of hepatocellular carcinoma and no further treatment was possible at that time. However, serum alpha-fetoprotein and protein induced by vitamin K absence or antagonist II dramatically decreased in June 1998. The CT scan also showed that the tumour had completely regressed without specific treatment. In February 1999 a new biopsy-proven hepatocellular carcinoma, 2 cm in diameter, developed in the lateral segment of the liver. It was well treated by percutaneous ethanol injection therapy. The patient was alive in good condition without any symptoms or tumour recurrence in June 1999. It was concluded that a rare case of spontaneous regression of hepatocellular carcinoma had occurred.

Prader-Willi syndrome in a child with XYY

We report a 26-month-old boy with XYY syndrome, with the complication of Prader-Willi syndrome (PWS) due to uniparental maternal disomy of chromosome 15. To our knowledge, this is the first case of XYY syndrome and PWS. Clinical findings were fully compatible with the diagnostic criteria for PWS. Molecular analysis revealed a maternal heterodisomy of chromosome 15, indicating that non-disjunction of chromosome 15 had occurred at maternal meiosis I, and that the non-disjunction of chromosome Y and of chromosome 15 had occurred independently.

[Induction of protective immunity for Bordetella pertussis by nasal inoculation of pertussis vaccine in mice]

Although nasal vaccination has emerged as an interesting alternative to intramuscular or oral vaccination, knowledge is scarce about the immune responses after such immunization. In the present study, we inoculated purified Pertussis Toxin (PT) and Filamentous Haemagglutinin (FHA) with or without adjuvant (kayexalate), or Diphtheria acellular Pertussis Tetanus (DaPT) combined vaccine to mice intranasally three times every four weeks to investigate the references of the immunoresponses between nasal and intramuscular vaccination. The levels of pertussis specific serum IgG antibodies (Abs) and secretory IgA Abs in the nasal wash were measured by ELISA, and cytotoxic T cell activities were examined by proliferative response, and compared with the result from intramuscular inoculation. We also studied the efficacy of adjuvant in the nasal vaccination. The intramuscular inoculation of pertussis vaccine induced serum IgG antibodies and cellular immunity against PT and FHA, but did not induce local IgA antibodies. On the other hand, the nasal inoculation induced both serum and local antibody responses. Moreover, it also induced significant cellular immunity to pertussis antigen. In nasal vaccination, the inoculation with adjuvant was superior to inoculation without adjuvant for the induction of both humoral and cellular immunity.

Endosaccular aneurysm occlusion with Guglielmi detachable coils for obstructive hydrocephalus caused by a large basilar tip aneurysm. Case report

The authors present the case of a 60-year-old man with obstructive hydrocephalus caused by a large basilar artery tip aneurysm, in whom direct surgical clipping of the aneurysm neck was considered hazardous. After endosaccular aneurysm occlusion, his symptoms (headache, intellectual impairment, and gait disturbance) and ventricular dilation immediately improved without placement of a ventricular shunt. To the authors' knowledge, this is the first case of its kind treated solely endovascularly.

Serotonergic blockade in the treatment of the cancer anorexia-cachexia syndrome

BACKGROUND

Imbalanced amino acid diets in animals rapidly produce anorexia and weight loss. Blockade of type 3 serotonergic receptors (5HT(3)) can ameliorate anorexia in this animal model. Imbalanced plasma amino acid levels also have been documented in both animal models and human patients with cancer cachexia. Therefore a trial of the 5HT(3) receptor antagonist, ondansetron, was undertaken in the treatment of patients with cancer cachexia.

METHODS

Patients with metastatic cancer who were not undergoing chemotherapy or radiotherapy and who had lost >5% of their body weight were eligible. Baseline physical examination; weight; anthropometric studies; levels of retinol binding protein, albumin, and prealbumin; and skin testing for anergy were obtained. The ability to enjoy food was assessed utilizing a seven-point hedonic category scale for specific foods. Therapy was comprised of oral ondansetron, 8 mg twice a day.

RESULTS

Twenty-seven patients were enrolled; all were evaluable for toxicity and 20 patients were evaluable for response. Toxicity of ondansetron was minimal. Patients demonstrated significant weight loss prior to disease entry (mean baseline weight of 76.9 kg vs. 72. 1 kg; P < 0.000002). Patients continued to lose weight on study (Week 0: 72.5 kg vs. Week 4: 71.4 kg; P = 0.027); in addition, there was significant deterioration of midarm circumference and hand grip strength, all of which indicated worsening nutritional status. However, a significant improvement in food enjoyment was noted (P = 0.04).

CONCLUSIONS

Although it apparently improved the ability of patients to enjoy food, the blockade of 5HT(3) receptors failed to prevent weight loss in patients with cancer cachexia or alter laboratory parameters of protein nutrition.

[Necessity and usefulness of detection by PCR of mecA and aac(6')/aph(2") genes for identification of arbekacin-resistant MRSA]

Arbekacin (ABK)-resistant bacteria (43 strains) isolated as MRSA by regular clinical procedures in Japanese clinics in 1998 were characterized in terms of taxonomic properties, aminoglycoside resistance, and mecA and aac(6')/aph(2") genes linking with ABK-resistant MRSA. Taxonomically the 43 strains fell into Staphylococcus aureus (33 strains) and Enterococcus (10 strains). As to ABK resistance, the 13 strains of MRSA clinically reported as high ABK resistance (128 micrograms/ml or higher) did not show clear high ABK resistance except for 2 strains when their ABK resistance was tested using 0.5% NaCl containing nutrient agar. We designed and established the primers and conditions for PCR to detect the above two resistance genes. PCR analysis of DNAs from the 43 strains clearly indicated that only 33 strains identified taxonomically as S. aureus possessed mecA indicating MRSA and 23 out of them possessed aac(6')/aph(2"). The other 10 strains of MRSA lacking aac(6')/aph(2") were ABK-sensitive. Thus, there were a good correlation between ABK resistance and aac(6')/aph(2") existence. Based on these, it was conclusive that the appropriate ABK resistance test as well as the detection of mecA and aac(6')/aph(2") genes by PCR are necessary and useful to avoid false ABK-resistant MRSA strains.

Inhibitory effects of hydrolyzable tannins from Melastoma dodecandrum Lour. on nitric oxide production by a murine macrophage-like cell line, RAW264.7, activated with lipopolysaccharide and interferon-gamma

An extract of Melastoma dodecandrum LOUR. with 80% aqueous acetone (MDL) inhibited nitric oxide (NO) production by a murine macrophage-like cell line, RAW264.7, activated with lipopolysaccharide (LPS) and recombinant mouse interferon-gamma (IFN-gamma). On further fractionation of the extract, the majority of the inhibitory activity was recovered in the 50% methanol extracts, which contained hydrolyzable tannins. Among the latter, casuarinin, casuarictin, pedunclagin and nobotannin B exhibited strong inhibitory activities toward NO production, with ID50 values between 2.0 and 5.1 microM. Both MDL and the purified tannins significantly reduced the induction of the inducible nitric oxide synthase (iNOS) protein in the course of macrophage activation with LPS and IFN-gamma. In addition, the NO production by macrophages preactivated with LPS and IFN-gamma for 16 h was also inhibited by these tannins, with IC50 values around 30-130 microM, but not by MDL. These results suggest that MDL has the pharmacological ability to suppress NO production by activated macrophages and that the hydrolyzable tannins have major inhibitory activities.

Medial prefrontal cortex generates frontal midline theta rhythm

Frontal midline theta rhythm (Fm theta) is a distinct theta activity of EEG in the frontal midline area that appears during concentrated performance of mental tasks in normal subjects and reflects focused attentional processing. To tomographically visualize the source current density distributions of Fm theta, we recorded Fm theta by using a 64-channel whole-head MEG system from four healthy subjects, and applied a new analysis method, synthetic aperture magnetometry (SAM), an adaptive beam forming method. Fm theta was observed in the MEG signals over the bilateral frontal regions. SAM analysis showed bilateral medial prefrontal cortices, including anterior cingulate cortex, as the source of Fm theta. This result suggests that focused attention is mainly related to medial prefrontal cortex.

Propofol does not affect the canine cardiac conduction system under autonomic blockade

PURPOSE

To determine the effects of propofol on the cardiac conduction system in dogs with pharmacological autonomic blockade.

METHODS

In eight mongrel dogs receiving 6 mg.kg-1.hr-1 propofol and vecuronium under pharmacological autonomic blockade with atropine and propranolol the infusion rates of propofol were increased from 6, (baseline), to 12, 18 and 24 mg.kg-1.hr-1 at 60-min intervals. An electrophysiological study assessed sinus rate, sinus node recovery time, corrected sinus node recovery time, intraatrial conduction time, AV nodal effective refractory period, Wenckebach cycle length and AV conduction times. Electrocardiographical variables and arterial pressures were also measured. All measurements were repeated at 30 min after the beginning of each infusion of propofol.

RESULTS

Propofol did not produce direct effects on the electrophysiological or electrocardiographical variables at any infusion rates. Heart rates did not change at higher infusion rates in the presence of decreases in arterial pressures.

CONCLUSION

Propofol did not affect the cardiac conduction system in the presence of autonomic blockade. Thus, the direct cardiac effects of propofol do not play a causative role in the genesis of propofol-associated bradyarrhythmias.

Effects of moguisteine on the cough reflex induced by afferent electrical stimulation of the superior laryngeal nerve in guinea pigs

The study aimed to further demonstrate the peripheral antitussive properties of moguisteine. Firstly, the antitussive effect of moguisteine on the cough reflex induced by inhalation of citric acid aerosol was evaluated in conscious guinea pigs. Secondly, the effects of both moguisteine and codeine on the centrally mediated cough reflex induced by afferent electrical stimulation of the superior laryngeal nerve were investigated in anesthetized guinea pigs. Moguisteine (2.5-10 mg/kg, intravenously, i.v.) reduced the cough reflex induced by 7.5% citric acid aerosol in a dose-dependent manner, with an ED50 value of 0.55 mg/kg. Both i.v. (0.5-4 mg/kg) and intracerebroventricular (i.c.v., 5-20 microg) injection of codeine dose dependently inhibited the cough reflex induced by afferent electrical stimulation of the superior laryngeal nerve; the ED50 values were 0.91 mg/kg and 7.90 microg, respectively. The inhibitory effect of codeine (4 mg/kg i.v.) was abolished by pretreatment with naloxone (2 mg/kg intraperitoneally). In contrast to codeine, neither i.v. (4 and 20 mg/kg) nor i.c.v. (20 microg) injection of moguisteine affected the cough reflex. These results suggest that the antitussive effect of codeine is mediated by central opioid mechanisms, whereas the antitussive effect of moguisteine is mediated by peripheral mechanisms.

[Sevoflurane anesthesia for myotonic dystrophy]

We successfully anesthetized a 14-year-old boy with myotonic dystrophy for orthopedic surgery using sevoflurane. Sevoflurane enabled anesthetic induction and tracheal intubation without intravenous anesthetics and muscle relaxants. Sevoflurane also provided stable anesthetic maintenance without intravenous anesthetics. The patient showed rapid anesthetic recovery and adequate spontaneous breathing. We conclude that sevoflurane is a useful anesthetic for patients with myotonic dystrophy.

[Relationship between the retinal nerve fiber layer thickness and the effect of aging in normal eyes]

We studied the correlation between the thickness of the retinal nerve fiber layer and the role of age in 155 normal eyes of 83 subjects without significant ocular diseases. Subjects with a refractive error exceeding +/- 5 diopters were excluded. We divided the peripapillary area into four quadrants: superior (S), inferior (I), temporal (T), and nasal (N). We measured peripapillary retinal nerve fiber layer thickness (NFLT) in these four quadrants and in the total area (T(o)) using a confocal scanning laser polarimeter (Nerve Fiber Analyzer), and determined the correlation coefficients. The retinal nerve fiber layer thickness of the total area and of the four quadrants was not significantly associated with an increase in age. Since changes in the thickness were small in the nasal and temporal quadrants, we measured the relative ratios of the thickness in each quadrant to that in the nasal and temporal quadrants. The ratio of the total area to the nasal quadrant (T(o)/N), the superior to the nasal quadrant (S/N), the inferior to the nasal quadrant (I/N), the total area to the temporal quadrant (T(o)/T), the superior to the temporal quadrant (S/T), and the inferior to the temporal quadrant (I/T) was significantly associated with an increase in age. Multiple comparison in each age group revealed no age-related significant decreases in any of the parameters. These findings suggest that these parameters may reflect the degree of aging in normal eyes, but age-related abnormality in the retinal nerve fiber layer thickness may be small.

[Relationship between visual field loss and retinal nerve fiber layer thickness in open-angle glaucoma]

We studied the correlation between retinal nerve fiber layer thickness and visual field loss in 117 eyes of 62 patients with open angle glaucoma using the Aulhorn Classification as modified by Greve. We divided the peripapillary area into four quadrants [superior (S), inferior (I), temporal (T), nasal (N)] and the total (T0), and measured the peripapillary retinal nerve fiber layer thickness (NFLT) with a confocal scanning laser polarimeter (Nerve Fiber Analyzer). We also obtained the relative ratios (mean ratios) of the total circumference to the nasal quadrant (T0/N), the superior to the nasal quadrant (S/N), the temporal to the nasal quadrant (T/N), the inferior to the nasal quadrant (I/N), the total to the temporal quadrant (T0/T), the superior to the temporal quadrant (S/T), the nasal to the temporal quadrant (N/T), and the inferior to the temporal quadrant (I/T). Significant decreases were observed in the mean ratios to the temporal quadrant, i.e., T0/T, S/T, and I/T, in stages I to VI when compared with stage 0. However, no significant differences were observed among stages I to VI. These results suggest that these parameters may not precisely reflect the progression of the disease, but may aid differential diagnosis of the early stage (stage 0) from the middle and late stages (stages I to VI).

Cerebral mycotic aneurysm treated with endovascular occlusion--case report

A 56-year-old male with two mycotic aneurysms associated with infective endocarditis was treated by endovascular surgery before mitral valve replacement. Angiography revealed a ruptured proximal aneurysm and an unruptured distal aneurysm on the right middle cerebral artery. The ruptured aneurysm was successfully treated with an interlocking detachable coil, and patency of the parent artery was preserved. The unruptured distal aneurysm disappeared as a result of antibiotic therapy. Endovascular surgery of the mycotic aneurysm is less invasive and more effective than craniotomy under general anesthesia for patients with infective endocarditis.

Changes in plasma and urinary norepinephrine following transdermal clonidine in spontaneously hypertensive rats

To support a long-lasting antihypertensive effect of transdermal clonidine (CAS 4205-90-7), changes in plasma norepinephrine (NE) levels and urinary NE excretion as indices of the sympathetic nervous activities were investigated following transdermal and oral clonidine in conscious spontaneously hypertensive rats. Plasma NE levels were significantly reduced for 24 h during transdermal application of clonidine patch at 1.5 and 4.5 mg/kg on the back of each rat. Oral clonidine at 100 microgram/kg also lowered plasma NE levels. However, significant falls in the levels lasted only for 4 h after oral dosing. Urinary NE excretion was significantly decreased during both 4-8 and 8-24 h periods, and during an 8-24 h period following transdermal clonidine at 1.5 and 4.5 mg/kg, respectively. Significant decrease in urinary NE excretion was also produced during a 4-8 h period following oral clonidine at 100 micrograms/kg. Total urinary NE excretion during a 0-24 h period was dose-dependently reduced following transdermal clonidine, but was not altered following oral dosing. These findings suggest that the sympathoinhibitory effect of transdermal clonidine is more persistent than that of oral clonidine. Therefore, long-lasting antihypertensive effect of transdermal clonidine is closely associated with the sustained suppression of the sympathetic nervous activity.

Brainstem lesion in Aicardi-Goutières syndrome

Aicardi-Goutières syndrome is characterized by the calcification of basal ganglia, leukodystrophy, and lymphocytosis in cerebrospinal fluid. No brainstem lesion has been described. We report a Japanese girl who presented with delayed development and microcephalus at early infancy. Magnetic resonance imaging revealed T2-weighted high intensity in the cerebral white matter and brainstem, and nerve conduction velocity was delayed in the central nervous system, indicating that she manifested dysmyelination in the brainstem white matter similar to that in the cerebral white matter.

Simultaneous determination of five macrolide antibiotics in meat by high-performance liquid chromatography

A simple and rapid method using high-performance liquid chromatography (HPLC) for the simultaneous determination of five macrolides (josamycin, kitasamycin, mirosamicin, spiramycin and tylosin) in meat has been developed. The drugs were extracted with 0.3% metaphosphoric acid-methanol (7:3, v/v), and the extracts were cleaned up on a Bond Elut SCX (500 mg) cartridge. The HPLC separation was performed on a Puresil 5C18 column (150 x 4.6 mm I.D.) with a gradient system of 0.025 M phosphate buffer (pH 2.5)-acetonitrile as the mobile phase at a flow-rate of 1.0 ml/min. The drugs were detected at 232 mn for josamycin, kitasamycin, mirosamicin and spiramycin, and 287 mn for tylosin. The calibration graphs were rectilinear from 2.5 to 100 ng for each drug. The recoveries at the level of 1.0 microgram/g were 70.8-90.4%, and detection limits were 0.05 microgram/g for each drug.

Unequal cleavage in the early Tubifex embryo

Unequal cleavage that produces two blastomeres of different size is a cleavage pattern that many animals in a variety of phyla, particularly in Spiralia, adopt during early development. This cleavage pattern is apparently instrumental for asymmetric segregation of developmental potential, but it is also indispensable for normal embryogenesis in many animals. Mechanically, unequal cleavage is achieved by either simple unequal cytokinesis or by forming a polar lobe at the egg's vegetal pole. In the present paper, the mechanisms for unequal cytokinesis involved in the first three cleavages in the oligochaete annelid Tubifex are reviewed. The three unequal cleavages are all brought about by an asymmetrically organized mitotic apparatus (MA). The MA of the first cleavage is monastral in that an aster is present at one pole of a bipolar spindle but not at the other. This monastra form, which arises as a result of the involvement of a single centrosome in the MA assembly, is both necessary and sufficient for unequal first cleavage. The egg cortex during the first mitosis is devoid of the ability to remodel spindle poles. In contrast to the non-cortical mechanisms for the first cleavage, asymmetry in the MA organization at the second and third cleavages depends solely on specialized properties of the cell cortex, to which one spindle pole is physically connected. A cortical attachment site for the second cleavage spindle is generated de novo at the cleavage membrane resulting from the first cleavage; it is an actin-based, cell contact-dependent structure. The cortical microtubule attachment site for the third cleavage, which functions independently of contact with other cells, is not generated at the cleavage membrane resulting from the second cleavage, but is located at the animal pole; it may originate from the second polar body formation and become functional at the 4-cell stage.

Magnetic resonance imaging of non-specific inflammatory granulation involving the skull base--two case reports

A 55-year-old male presented with a 20-day history of nuchal pain and hypoglossal nerve paresis on the right. T2-weighted magnetic resonance (MR) imaging showed an isointense lesion with a small hypointense part in the hypoglossal canal and caudal clivus. A 66-year-old female presented with a long-standing history of left orbital pain. T2-weighted MR imaging showed a hypointense lesion occupying the orbital apex which on recurrence became isointense. The histological diagnosis of both lesions was non-specific inflammatory granulation. The T2-weighted MR imaging appearance of this entity is variable, and can change within the clinical course of the same lesion.

Equalization of unequal first cleavage in the Tubifex egg by introduction of an additional centrosome: implications for the absence of cortical mechanisms for mitotic spindle asymmetry

The first cleavage in the Tubifex egg is unequal and involves a monastral mitotic apparatus (MA), which remains at the egg's center from metaphase through telophase. The monastral form of the MA is thought to arise due to the involvement of a single maternal centrosome in the MA assembly (R. Ishii and T. Shimizu, Dev. Growth Differ. 37, 687-701, 1995). To investigate the mechanisms that generate asymmetry in this division, we have examined the cleavage patterns in eggs that are manipulated to inherit two centrosomes during the first mitosis. When eggs are prevented from extruding polar bodies, centrosomes located at both poles of the first meiotic spindle persist into the first mitosis without showing any sign of duplication and generate astral spindle poles. Eggs that inherit these centrosomes exhibit two types of MA configurations, viz., an amphiastral MA and twin monastral MAs. We found that eggs with amphiastral MAs undergo bipolar equal divisions, while those with twin MAs divide into three cells simultaneously (tripolar divisions). The amphiastral MAs are located at the egg's center and their astral poles are organized symmetrically, suggesting that Tubifex eggs are unable to generate asymmetry in the amphiastral MAs during the first mitosis. These results suggest that inheritance of a single centrosome during the first mitosis is critical for Tubifex eggs to undergo unequal cleavage. We propose that the cortical mechanisms for MA asymmetry are lacking in the Tubifex egg during the first mitosis.

Effects of magnesium sulphate on the cardiovascular system, coronary circulation and myocardial metabolism in anaesthetized dogs

We have studied the effects of i.v. bolus doses of magnesium sulphate (MgSO4) 60, 90 and 120 mg kg-1 on haemodynamic state, the coronary circulation and myocardial metabolism in nine dogs anaesthetized with pentobarbitone and fentanyl. MgSO4 produced dose-dependent decreases in arterial pressure, heart rate, left ventricular dP/dtmax and left ventricular minute work index (LVMWI) and an increase in the time constant of left ventricular isovolumic relaxation. Stroke volume increased, systemic vascular resistance decreased and cardiac output did not change significantly. MgSO4 produced decreases in coronary perfusion pressure, coronary vascular resistance and myocardial oxygen consumption (MVO2). Coronary sinus blood flow, lactate extraction ratio and the ratio of LVMWI to myocardial MVO2, that is an index of cardiac efficiency, did not change significantly. This study indicated that the depressant effect of MgSO4 on cardiac function was offset by lowering of peripheral vascular resistance, so that cardiac pump function remained effective, and the almost constant coronary sinus blood flow resulted from the decrease in coronary vascular resistance even at higher doses.

Inclusion of trithia[5]heterohelicene by various serum albumins. An effective probe for chiral discrimination

Racemic 2-hydroxymethyltrithia[5]heterohelicene (2-HT), which has a labile helical structure was incorporated into serum albumins of nine species in 1% ethanolic aqueous solution, giving 1:1 complexes which exhibited induced circular dichroism spectra with species specificity. The application of 2-HT to bovine serum as a probe for chiral recognition revealed that the serum itself manifested an apparent chiral discrimination between enantiomers of 2-HT.

A comparison of young and aged populations for the diphtheria and tetanus antitoxin titers in Japan

The antitoxin levels for diphtheria and tetanus were measured with samples of a young group immunized with diphtheria-tetanus-acellular pertussis combined vaccine and those of an aged group, members of which had not received vaccination in their youth. In the young group members of which had already received basic immunization with diphtheria-tetanus-acellular pertussis combined vaccine, the levels of both antitoxins rose well after injection at 11 to 12 years old with diphtheria-tetanus combined toxoids and remained high until 20 years of age. In the aged group, more than 80% showed antitoxin levels above 0.01 u/ml for diphtheria, while all had levels below that for tetanus, except three persons with confirmed tetanus immunization history. Maintenance of the protective antitoxin levels in the population by vaccination is necessary to prevent outbreaks of infection among unvaccinated or only partially immunized persons.

Three-dimensional combined flaps for reconstruction of complex facial defects following cancer ablation

Instead of conventional multiple-paddle or folded free flaps, the authors introduce three types of free combined tissue transfers for cosmetic and functional restoration of massively large facial defects. Three cases reported here were repaired with combined flaps consisting of two or more tissues, such as combined free anterolateral thigh flaps and vascularized muscle or bone grafts. In cases with complex defects in the upper lateral face, facial dynamics were also reconstructed with a free vascularized innervated muscle graft. A complex hemifacial defect involving the orbita and nose can be easily reconstructed with free osteocutaneous flaps in two stages. For complex craniofacial defects, the concept of combined chimeric tissue transfers is most suitable. The ideal pedicle vessels for the combined flaps are considered to be those in the lateral circumflex femoral system, which is far from the head and neck regions, because flap elevation can proceed simultaneously with tumor resection.

Effects of magnesium sulphate on atrioventricular conduction times and surface electrocardiogram in dogs anaesthetized with sevoflurane

We have studied the effects of magnesium on atrioventricular (AV) conduction times and surface electrocardiogram during both sinus rhythm and atrial pacing in seven dogs anaesthetized with 1 MAC of sevoflurane. A bolus dose of magnesium sulphate (MgSO4) 30, 60 and 90 mg kg-1 significantly increased plasma magnesium concentrations from 1.3 (SEM 0.1) to 15.3 (1.3) mg dl-1. MgSO4 significantly prolonged A-H (AV nodal conduction time during sinus rhythm), St-H (intra-atrial and AV nodal conduction time during atrial pacing) and H-S (total ventricular conduction time) intervals at doses > or = 30 mg kg-1 ; H-V interval (His-Purkinje conduction time) at doses > or = 60 mg kg-1; RR and PR intervals and QRS duration at doses > or = 30 mg kg-1 in a dose-related manner during both sinus rhythm and atrial pacing. QTc interval remained unchanged during sinus rhythm. The doses of MgSO4 used did not have deleterious effects on AV conduction times and surface electrocardiogram during 1 MAC of sevoflurane anaesthesia. This finding suggests that MgSO4 in high doses was safe and may be indicated for cardiac arrhythmia and hypertension during sevoflurane anaesthesia. However, further study is required to apply these findings to clinical anaesthesia.

Sevoflurane anaesthesia for a patient with adult polyglucosan body disease

PURPOSE

Adult polyglucosan body disease (APBD) is a rare neurological disorder of unknown cause characterized by four manifestations: upper motor neuron signs, peripheral neuropathy with motor and sensory loss, urinary incontinence, and dementia. The purpose of this report is to present a patient with APBD anaesthetized successfully with sevoflurane and nitrous oxide.

CLINICAL FEATURE

A 51-yr-old man with APBD was scheduled for haemorrhoidectomy. Paraesthesia, dysaesthesia, distal muscular atrophy and fasciculation were recognized in the extremities. Dementia, bulbar paralysis and respiratory insufficiency were basent. Anaesthesia was induced with inhalation of sevoflurane and nitrous oxide, and the trachea was intubated without the use of muscle relaxants. Maintenance of anaesthesia was performed with sevoflurane (inspired concentration: 1.5-2.5%) and nitrous oxide (50%). Emergence from anaesthesia and the postoperative course were uneventful, and no exacerbation of neurological signs and symptoms was recognized. No postoperative analgesia was required.

CONCLUSION

General anaesthesia and tracheal intubation with sevoflurane and nitrous oxide provided safe anaesthesia for a patient with APBD.

Dural caroticocavernous fistula with both ophthalmic arteries arising from middle meningeal arteries

A 60-year-old woman presented with a dural caroticocavernous fistula (CCF) in whom both by ophthalmic arteries arose from the middle meningeal arteries instead of from the internal carotid arteries. Transarterial embolisation of the CCF was contraindicated because of the risk of blindness. Transvenous coil embolisation was therefore performed. Bilateral origin of the ophthalmic artery from the middle meningeal artery is extremely rare.

Atrioventricular conduction during adenosine-induced hypotension in dogs anaesthetized with sevoflurane

We have studied the effects of adenosine-induced hypotension on A-H interval (atrioventricular (AV) nodal conduction time during sinus rhythm), St-H interval (intra-atrial plus AV nodal conduction time during atrial pacing), H-V interval (His-Purkinje conduction time) and H-S interval (total ventricular conduction time) by His-bundle electrocardiography in addition to surface electrocardiogram during both sinus rhythm and atrial pacing in nine dogs anaesthetized with 1 MAC of sevoflurane. Stepwise increases in infusion rates of adenosine to 0.1, 0.3, 0.5 and 1.0 mg kg-1 min-1 produced a dose-related decrease in mean arterial pressure from 91 (6) to 38 (2) mm Hg. Adenosine significantly increased the A-H interval at infusion rates of 0.5 mg kg-1 min-1 and above, and the St-H interval at 1.0 mg kg-1 min-1. The H-V and H-S intervals remained unchanged. Heart rate decreased significantly only at 1.0 mg kg-1 min-1 with a significant increase in the PR interval. Adenosine-induced hypotension did not have deleterious effects on AV conduction times and the surface electrocardiogram in dogs anaesthetized with 1 MAC of sevoflurane. This may indicate that the effects of adenosine on AV conduction were small and therefore are unlikely to be a contraindication to the use of adenosine for inducing hypotension in patients with initially normal conduction during sevoflurane anaesthesia.

Effect of 8-sulfophenyl theophylline on endogenous noradrenaline release from sympathetic nerves of the rabbit ear artery

1. The release of endogenous noradrenaline (NA) and adenyl purine (ATP, ADP, AMP and adenosine) from the rabbit ear artery, evoked by electrical stimulation (ES; 16 Hz), was examined. 2. ES evoked a significant release of NA and purine; the ratio of the amount of total purine released to NA released was approximately 180 on a molar base. 3. ES-evoked purine release was significantly reduced by the denudation of the endothelium and abolished by the alpha 1-adrenoceptor antagonist, prazosin (1 mumol/L). 4. ES-evoked NA release was significantly reduced by a P1-purinoceptor antagonist, 8-sulfophenyl theophylline (8SPT). Purine release was slightly reduced by 8SPT. 5. These results suggest that endogenous NA released by ES results in the release of a large amount of purine, which may, in turn, increase the release of NA by acting on prejunctional purinoceptors on sympathetic nerve terminals.

Free vascularized deep peroneal nerve grafts

An ideal donor site for vascularized nerve grafts should have a constant anatomy, minimal functional loss after the nerve has been sacrificed, and a dependable blood supply parallel to the nerve over a relatively long distance. Creating a pedicle for a free vascularized deep peroneal nerve graft with the anterior tibial vessels seems to be a most suitable method for repairing long nerve gaps of over 20 cm and digital nerve defects with severe finger damage. Applications of this nerve graft to digital nerve losses with severely scarred beds created by avulsion injury, and two-stage reconstruction in some partial brachial plexus palsies (free vascularized nerve graft in the first stage and free vascularized muscle graft in the second stage) are well indicated. Advantages of this technique are: (1) A long nerve graft (up to 25 cm) can be obtained, and anomalies are rare (the nerve is absent in only 4 percent of cases). (2) The caliber of the vascular pedicle is large (approximately equal to 3 mm). (3) The nerve has a sufficient blood supply from the collateral blood vessels. (4) The graft can be easily obtained in the supine position. (5) A monitoring skin flap, based on the inferior lateral peroneal artery, can be attached to the nerve graft. (6) Sensory loss resulting from the sacrifice of the nerve covers a minimal area. (7) A donor scar on the anterior aspect of the lower leg is more acceptable than one on the posterior aspect because of less movement in walking. Disadvantages of this technique are: (1) Sacrifice of the large vessels in the lower leg may result in circulatory complications in the donor foot; to avoid this problem, preoperative angiography is recommended. (2) The donor scar is in an exposed area in female patients. (3) There may be temporary postoperative edema and disability in the donor leg.

Regional differences of endogenous ATP release in rabbit arteries

The releases of endogenous ATP from ear, femoral, renal and pulmonary arteries of rabbit were compared. Adenyl purines, such as ATP, ADP, AMP and adenosine, and norepinephrine (NE) were quantified by HPLC-fluorescence detection and HPLC-electrochemical detection, respectively. In all four blood vessels, electrical stimulation (ES) at 16 Hz significantly increased overflow of adenyl purine and NE. ATP was the main largest among adenyl purine released; release of adenosine was very small. The rank order of amounts of total purine released by ES was ear artery > renal artery = femoral artery >> pulmonary artery. There was no significant difference among the amounts of NE release induced by ES from these four arteries. ES-induced purine release was notably reduced by denudation of endothelium and prazosin at 1 muM. Methoxamine, alpha 1-adrenoceptor agonist, also produced release of adenyl purines in the four arteries. The rank order of amount of total purine released was ear artery > renal artery = femoral artery >> pulmonary artery. These suggest that the sources of ATP released by sympathetic nerve stimulation, which seems to be alpha 1-adrenoceptors on endothelial cells, not distributed homogeneously in the vasculature.

Antihypertensive effects of a new transdermal delivery system for clonidine in genetic and experimental hypertensive rats

The antihypertensive effects of a new transdermal delivery system for clonidine (CAS 4205-90-7, clonidine tape, M-5041T) were investigated in spontaneously hypertensive rats (SHR), 2-kidney, 1-clip renal hypertensive rats (RHR) and deoxycorticosterone acetate (DOCA)-salt hypertensive rats. M-5041T (0.5-4.5 mg/kg) elicited a long-lasting hypotensive effect that was accompanied by bradycardia in a dose-dependent manner during 24-h patching on the backs of rats in all three hypertensive rat models. The hypotensive effect of M-5041T was more persistent than that of oral administration of clonidine (50 and 100 micrograms/kg) in both SHR and RHR. The most pronounced hypotensive effect of M-5041T was observed in DOCA-salt hypertensive rats. Plasma clonidine concentrations following transdermal application of M-5041T (1.5 mg/kg) were approximately 2-3 fold higher in DOCA-salt hypertensive rats compared with SHR. Electrical conductance of the skin surface, an index of the water content of the stratum corneum, was greater in DOCA-salt hypertensive rats than in SHR, suggesting that the delivery of clonidine may have been enhanced as a result of an increase in skin permeability due to the increase in water content of the stratum corneum in DOCA-salt hypertensive rats. Co-administration of M-5041T (0.5 mg/kg) with either trichloromethiazide (1 mg/kg, orally) or nifedipine (3 mg/kg, orally) at each sub-dose which affected both systolic blood pressure and heart rate produced significant hypotensive and bradycardic effects in SHR. Following repeated daily applications of M-5041T (1.5 mg/kg) for 7 consecutive days in SHR, significant hypotensive and bradycardic effects were produced at 6 h post-patching and then disappeared at 24 h post-patching in each trial. The plasma clonidine concentrations at 6 and 24 h post-patching were similar from the first to the seventh trial. No significant changes in blood pressure and heart rate were observed after termination of the regimen. These findings suggest that M-5041T could serve as an efficient and useful antihypertensive transdermal delivery system in humans without producing tolerance to the hypotensive effect and withdrawal syndrome after abrupt cessation of the treatment when used alone or with either a diuretic or a calcium channel blocker.

Preclinical assessment of a new transdermal delivery system for clonidine (M-5041T)

The effects of a new transdermal delivery system for clonidine (M-5041T) on hypotensive effect, urine volume, plasma renin activity (PRA) and antidiuretic hormone (ADH) in spontaneously hypertensive rats (SHRs) were compared to the effects of the continuous infusion of clonidine. Both M-5041T (1.5 and 4.5 mg/kg) and the continuous infusion of clonidine (250 micrograms/kg/24 h) elicited hypotensive effects persisting for 12 hours or more. These effects were based on consistent plasma concentrations of clonidine. These two treatments produced diuresis followed by antidiuresis, which was remarkably observed by continuous infusion of clonidine. Single subcutaneous injection of clonidine (50 micrograms/kg) produced diuresis accompanied by increases in electrolytes corresponding to plasma levels of clonidine. M-5041T at 1.5 mg/kg did not affect PRA until 12 h, and produced an increase in PRA at 24 h. M-5041T at 4.5 mg/kg and the continuous infusion of clonidine resulted in a decrease in PRA at 2 and 1 h followed by an increase at 12 and 24 h, respectively. M-5041T at 1.5 mg/kg did not affect plasma levels of ADH. Plasma ADH did increase at 2 and 4 h accompanied by diuresis following M-5041T at 4.5 mg/kg or the continuous infusion of clonidine, respectively. Clonidine-induced diuresis was not at least due to the inhibition of ADH release. The decrease in urine volume observed by continuous infusion of clonidine may be due to decrease in renal blood flow based on stimulation of peripheral adorenoceptors of clonidine. These findings suggest that the increases in ADH and PRA are due to the compensatory effects related to both diuresis and the long-lasting hypotensive effect induced by high plasma concentrations of clonidine. Thus, it can be expected that M-5041T at 1.5 mg/kg showing the minimum effective plasma concentration of clonidine will not result in tolerance to the hypotensive effect of clonidine associated with the retention of sodium in SHRs.

Hypotensive effects of a new transdermal delivery system for clonidine (M-5041T) in spontaneously and renal hypertensive rats

1. Antihypertensive effects of a new transdermal delivery system for clonidine (clonidine tape; M-50417) were investigated in spontaneously hypertensive rats (SHR), 2-kidney, 1-clip renal hypertensive rats (RHR) and deoxycorticosterone acetate/salt (DOCA/Salt) hypertensive rats. 2. M-5041T (0.5-4.5 mg/kg) elicited long-lasting hypotensive effects and bradycardia in a dose-dependent manner during 24 h patching in three hypertensive models compared with oral clonidine (100 mu g/kg). 3. The most hypotensive effect of M-5041T was observed in DOCA/salt hypertensive rats. 4. Co-administration of M-5041T with either trichloromethiazide (1 mg/kg, orally) or nifedipine (3 mg/kg, orally) at each dose without hypotensive effects per se induced significant hypotension in SHR. 5. Repeated administrations of M-5041T (1.5 mg/kg per day) for a consecutive 7 days produced significant hypotensive effects at postpatching 6 h, and recovered a postpatching 24 h in SHR. 6. Repetitive M-5041T administrations displayed no tolerance on the hypotensive effects and were devoid of any withdrawal syndrome. 7. These findings suggest that M-5041T may serve as an efficiently useful antihypertensive transdermal delivery system in humans.

Effects of graded infusion rates of propofol on cardiovascular haemodynamics, coronary circulation and myocardial metabolism in dogs

We have studied the effects of a 30-min infusion of propofol 6, 9, 12, 15, 18 and 21 mg kg-1 h-1 on cardiovascular haemodynamics, coronary circulation and myocardial metabolism in 12 mongrel dogs. Mean plasma concentrations of propofol after infusion of 6 and 21 mg kg-1 h-1 increased from 2.9 (SEM 0.3) to 11.5 (0.1) micrograms ml-1. Propofol produced a progressive decrease in arterial pressure. Heart rate tended to decrease at 15, 18 and 21 mg kg-1 h-1 and cardiac index decreased significantly at infusion rates > or = 9 mg kg-1 h-1. Systemic vascular resistance tended to increase except at 21 mg kg-1 h-1 and left ventricular systolic and diastolic function were depressed. Both coronary sinus blood flow and myocardial oxygen consumption decreased in parallel with a decrease in left ventricular minute work index without producing lactate. Propofol produced progressive decreases in coronary blood flow and myocardial oxygen consumption but did not exert adverse effects on the coronary circulation.

High potassium-evoked release of ATP from rabbit pulmonary artery via endogenous noradrenaline

1. High potassium 30 mM and noradrenaline at 10 microM significantly evoked the release of ATP and produced remarkable vasoconstriction in the rabbit pulmonary artery. 2. Phentolamine and prazosin at 0.1 microM inhibited ATP release but not vasoconstriction by 30 mM potassium. 3. 30 mM potassium significantly evoked the release of noradrenaline. 4. There was a significant positive correlation between the amounts of release of total purines, sum of ATP, ADP, AMP and adenosine, and noradrenaline evoked by 30 mM potassium. 5. 30 mM potassium-evoked ATP release was significantly reduced by denudation of endothelium.

[Pharmacokinetics of SK & F 104864 in experimental animals. I. Plasma level]

A camptothecin derivative, SK & F 104864 (topotecan), was injected for 30 minutes into the rabbit ear vein at a dose of 2 mg/kg or 5 mg/kg, and the plasma concentration was assayed by a HPLC method. The plasma level of SK & F 104864 (lactone form) decreased bi-exponentially with mean alpha and beta half-lives of 0.101 h and 0.849 h at 2 mg/kg, respectively, and 0.518 h and 7.57 h at 5 mg/kg, respectively. The AUCs were 0.846 micrograms.h/ml at 2 mg/kg and 2.14 micrograms.h/ml at 5 mg/kg. The plasma level of total topotecan (SK & F 104864 plus SK & F 105992) decreased bi-exponentially with mean alpha and beta half-lives of 0.696 h and 9.07 h at 2 mg/kg, respectively, and 0.795 h and 8.97 h at 5 mg/kg, respectively. The AUCs were 2.15 micrograms.h/ml at 2 mg/kg and 5.73 micrograms.h/ml at 5 mg/kg. The AUCs of lactone form were 39.3% of total topotecan at the 2 mg/kg dose and 37.3% at the 5 mg/kg dose, respectively. After intravenous bolus injection of SK & F 104864 at 20 mg/kg into Sarcoma 180 bearing mice, the alpha and beta half-lives of SK & F 104864 were 0.401 h and 3.99 h, respectively, and the AUC was 5.49 micrograms.hr/ml. The alpha and beta half-lives of total topotecan were 0.517 h and 4.27 h, respectively, and the AUC was 9.88 micrograms.hr/ml. The ratio of lactone form to total topotecan was 55.6%.

[Pharmacokinetics of SK & F 104864 in experimental animals. II. Tissue distribution]

After intravenous bolus injection of a camptothecin derivative, SK & F 104864 (topotecan), at 20 mg/kg into Sarcoma 180 bearing mice, the tissue concentration of total topotecan (SK & F 104864 plus SK & F 105992) in the mice decreased bi-exponentially, and the beta half-lives in most tissues were longer than those in plasma. The AUCs of total topotecan were extremely large in the kidney, that was followed by the pancreas > intestine > stomach > spleen > liver > thymus > lung > tumor > uterus > plasma. The concentration of total topotecan after 24 hours decreased to less than 2% of the peak level in most tissues except the kidney.

Regional difference of endogenous ATP release in the pulmonary artery of rabbits

1. The release of adenyl purines such as ATP, ADP, AMP and adenosine, from the pulmonary artery trunk (PAT), extrapulmonary artery (EPA) and intrapulmonary artery (IPA) were compared. 2. The amount of basal overflow of adenyl purines from the PAT was significantly smaller than those from EPA and IPA. There was no significant difference between the amount of the overflow from EPA and PAT. 3. Methoxamine, an alpha 1-adrenoceptor agonist, significantly increased the overflow of adenine nucleotides from the PAT, EPA and IPA, but did not increase those of adenosine. Methoxamine-induced release of adenyl purines from IPA was significantly larger than those from EPA and PAT. 4. These results suggest that an alpha 1-adrenoceptor-mediated mechanism for ATP-release is not homogeneously distributed in the pulmonary artery and a larger amount of ATP may be released in the peripheral part of the artery.