Daidzein and genistein but not their glucosides are absorbed from the rat stomach

Absorption of isoflavone aglycones and glucosides was compared in rats. Daidzein, genistein, daidzin and genistin were orally administered at a dose of 7.9 micromol/kg in 25 mM Na2CO3 and next their metabolite concentration in blood plasma was monitored for 30 min. After isoflavone glucosides administration, their metabolites appeared in plasma with a few minutes delay as compared to aglycones, which suggested that aglycones, but not glucosides, were absorbed already in the rat stomach. This observation was confirmed when absorption site was restricted solely to the stomach and absorption was shown to be independent of the vehicle pH used for administration.

Volatile components in stored rice [Oryza sativa (L.)] of varieties with and without lipoxygenase-3 in seeds

Lipoxygenase (LOX) is thought to play an important role in the formation of desirable or undesirable flavor and aroma in many plant products. In rice seeds, LOX activity is localized in the bran fraction and LOX-3 is the major isozyme component. We used gas chromatography-mass spectrometry to determine whether the degree of staleness in the flavor of stored brown rice was related to the presence of LOX-3. We found that the amount of hexanal, pentanal, and pentanol in normal raw LOX-3 rice markedly increased during storage at 35 degrees C. That in LOX-3-less rice increased slightly but was a third to a fifth that of normal LOX-3 rice. In cooked rice, the amount of these components from glutinous rice exceeded that in nonglutinous rice, and that in normal LOX-3 rice exceeded that in LOX-3-less rice. These results indicate that the stale flavor production in LOX-3-less rice during storage is less than that in normal LOX-3 rice.

[Two cases of bladder tumor producing granulocyte colony stimulating factor]

Two cases of bladder tumor producing granulocyte colony-stimulating factor (G-CSF) are reported. The first case was in a 79-year-old female patient. A large bladder tumor was diagnosed as right-sided hydronephrosis. The tumor consisted mostly of squamous cell carcinoma with a few transitional cells. Total cystectomy could not be performed because of direct invasion by the tumor into the pelvis. The patient died without aggressive treatment about 7 months after admission. Her leukocyte count consistently increased up to 76,200/mm3. The serum G-CSF levels were not analyzed. However, immunohistochemical examination revealed a high concentration of G-CSF in the tumor specimen. The other case was in an 80-year-old male patient. The patient, who had refused total cystectomy for bladder tumor (transitional cell carcinoma, grade 2, T2N0M0) 2 years earlier, underwent ureterocutaneostomy for obstructive renal insufficiency. Total cystectomy was not performed at this admission because of tumor invasion into the rectum and his advanced age. Radiotherapy was administered. However, he developed ileus caused by direct tumor invasion into the ileum. He died about 10 months after the urinary diversion. Leukocytosis, which improved transiently following radiotherapy, became more severe. The maximum leukocyte count was 49,500/mm3 just before death. The serum G-CSF levels during and after radiotherapy were 54 pg/ml and < 30 pg/ml, respectively. Immunohistochemical examination revealed the presence of G-CSF in the tumor. These findings suggest the production of G-CSF by the bladder tumor.

[Application of ultrafast 3D-CT in cervical spine injury]

The authors investigated the usefulness of the ultrafast three-dimensional computed tomography (UF-3D-CT) in cervical spine injury. At Osaka City General Hospital, between April 1995 and March 1998, the authors examined 38 patients with cervical spine injury using UF-3D-CT. The ultrafast CT reduces scanning time. There were no complications associated with the examination. We examined 12 patients with vertebral body fracture, 11 patients with lamina fracture, 8 cases with subluxation including locking facet, 2 patients with atlanto-axial dislocation and 8 patients without bony abnormality. Results suggested that UF-3D-CT was very useful for helping us to understand the bony deformity and the relationship between the bone and the important vessels. UF-3D-CT is very useful for preoperative evaluation and pathophysiological evaluation in cervical spin injury.

Rupture mechanism of a thrombosed slow-growing giant aneurysm of the vertebral artery--case report

A 76-year-old male developed left hemiparesis in July 1991. The diagnosis was thrombosed giant vertebral artery aneurysm. He showed progressive symptoms and signs of brainstem compression, but refused surgery and was followed up without treatment. He died of rupture of the aneurysm and underwent autopsy in March 1995. Histological examination of the aneurysm revealed fresh clot in the aneurysmal lumen, old thrombus surrounding the aneurysmal lumen, and more recent hemorrhage between the old thrombus and the inner aneurysmal wall. The most important histological feature was the many clefts containing fresh blood clots in the old thrombus near the wall of the distal neck. These clefts were not lined with endothelial cells, and seemed to connect the lumen of the parent artery with the most peripheral fresh hemorrhage. However, the diameter of each of these clefts is apparently not large enough to transmit the blood pressure of the parent artery. Simple dissection of the aneurysmal wall by blood flow in the lumen through many clefts in the old thrombus of the distal neck may be involved in the growth and rupture of thrombosed giant aneurysms of the vertebral artery.

Differential expression of SHP2, a protein-tyrosine phosphatase with SRC homology-2 domains, in various types of renal tumour

SHP2, a widely distributed protein-tyrosine phosphatase with src homology-2 (SH2) domains, is highly expressed in the brain and may play a role in synaptic communications or cellular proliferation. In this study, we examined SHP2 protein expression in 110 renal cell tumours of various histological subtypes, including clear, granular, papillary, chromophobe, collecting duct, and sarcomatoid-type renal cell carcinoma (RCC), and oncocytoma. SHP2 was expressed predominantly in normal distal tubules and collecting ducts, and positivity in various types of renal tumours was as follows: clear cell RCC, 0% (0/77 cases); granular, 7.7% (1/13); papillary, 50% (3/6); sarcomatoid, 0% (0/1); chromophobe, 85.7% (6/7); collecting duct carcinoma, 0% (0/2); oncocytoma, 100% (4/4). Clear and granular-type RCCs showed a very low but positive expression of SHP2. Chromophobe RCC and oncocytoma showed the highest rates and strongest intensities of SHP2 protein on immunostaining. SHP2 may serve as a powerful marker in detecting rare tumours. Estimates of its expression may be useful in histological diagnosis.

[Report of four cases of lymphocytic infundibuloneurohypophysitis]

We reported 4 cases of lymphocytic infundibuloneurohypophysitis. All four patients had diabetes insipidus as initial symptoms without anterior pituitary dysfunction. All patients showed pituitary stalk swelling and two patients showed enlargement of the pituitary gland. No patients were operated on for a histological diagnosis. No patients received corticosteroid treatment for this pathology. The mean follow-up period was 36 months. The diabetes insipidus continued in all cases, but radiological findings showed improvement in all cases. In one case, adrenal insufficiency occurred after 10 months, but had disappeared 6 months later. We think lymphocytic infundibuloneurohypophysitis can be diagnosed without histological examinations and can be treated conservatively without corticosteroid treatment. It seems to be a self-limiting disease. This disease can be distinguished from lymphocytic adenohypophysitis, but in some cases, both the anterior and posterior pituitary glands are invaded, and in this situation lymphocytic hypophysitis may be an appropriate name. Even if the initial symptom is diabetes insipidus, careful follow-up is needed for the duration of the disease.

[Management of elderly patients with incidentally discovered unruptured aneurysms]

Long-term natural history of unruptured cerebral aneurysms is not found frequently. Hence, the indications for surgery on unruptured asymptomatic cerebral aneurysms are still unclear. The benefit of treatment ultimately depends on the relative risk of subsequent aneurysm rupture in untreated patients versus the risk involved in surgery. Clinical features of fourteen elderly patients aged over 70 years with incidentally discovered unruptured aneurysms were analyzed. Two were male and 12 were female, with ages ranging from 70 to 82 years (mean: 74.5 years). Aneurysms were located in the anterior circulation in 13 patients and in the posterior circulation in 1 patient. One patient had multiple aneurysms, that is, bilateral middle cerebral aneurysms. The size of all these aneurysms was less than 10 mm. The indication for surgery was determined case by case. General information about the natural history of incidentally discovered aneurysms was given to the patients and their relatives. Informed consent was based on the fact that subarachnoid hemorrhage was associated with a poor prognosis, while excellent operative results were common in patients with unruptured aneurysms. Five patients agreed to surgical treatment. Four of them, their ages being 70, 70, 72 and 72 years old, with aneurysms located on the middle cerebral arteries, underwent neck clipping of their aneurysms with no operative morbidity or mortality. However, the remaining one patient was not recommended for surgery in spite of her consent to having it, because of her high age (82 years) and the location of her aneurysm (intracavernous internal carotid artery). Consequently, 10 patients who didn't receive surgery were followed-up at periods ranging from 3 months to 7 years. Two patients developed rupture of the aneurysms, either proven (one patient) or presumed (one patient). The former patient made an uneventful recovery after surgery, but the latter died. None of the remaining eight patients have experienced rupture of the aneurysms. It is our clinical impression, however, that they harbor an unruptured aneurysm with at least mild trepidation. With the rapid aging of the population, withholding aneurysm surgery merely because a patient is elderly may not necessarily be the most appropriate decision. Our conclusions are as follows: (1) Elderly patients in their early seventies are apt to agree to having surgical treatment for their unruptured aneurysms. (2) The cases reported herein show that asymptomatic middle cerebral artery aneurysms were able to be clipped very safely. (3) Most patients have experienced a decrease in quality of life from knowing they are living with an unruptured aneurysm.

Succinylated collagen crosslinked by thermal treatment for coating vascular prostheses

Vascular prostheses coated with collagen carefully prepared to avoid contamination were tested to see if it could induce endothelial cell lining throughout the graft surface in a natural way. The collagen fibers were succinylated. Hydrogel produced with the succinylated collagen was used for the sealant to reduce the amount of solid substance. To avoid contamination and the side effects of chemical reagents, the collagen thermally crosslinked under sterile conditions. A suspension of the collagen fibers was enmeshed in the interstices of Dacron fibers of fabric prostheses, which were then thermally crosslinked at 130 degrees C for 20 h. The prostheses were porous when the collagen fiber network was dry. Under wet conditions, however, the water permeability of the grafts was reduced to 0.1 ml/min from the 1,250 ml/min of the original prostheses. Three weeks after implantation in the abdominal aortas of dogs, 81.2 +/- 11% of the luminal surface was macroscopically thrombus free, and 56 +/- 14% was endothelialized. More than 95% of the coated collagen had been absorbed. Numerous fibroblasts had migrated into the graft walls, and capillary blood vessels had infiltrated the inside of the graft walls without foreign body reaction. In the controls, thrombus free areas averaged 9.0 +/- 5%, and endothelialized areas averaged 5.2 +/- 4%. Many giant cells, plasma cells, and lymphocytes had migrated into the graft walls, but no fibroblasts. These results suggest that rapid endothelialization is possible when clean collagen is used.

[Type A acute aortic dissection: late reoperations for dilatation of the distal false lumen and aortic regurgitation]

From January 1990 to December 1996, 71 patients aged 33 to 79 years (mean 60 +/- 11) underwent an emergency operation for type A acute aortic dissection. Fifty-three (74.6%) survived, and were followed 7 to 94 months (mean follow up 2.9 +/- 1.8 years) after the first operation. Five patients underwent reoperation for dilatation of the distal false lumen 7 to 52 months (mean period, 25 months) after primary repair. One patient underwent replacement of the arch and descending aorta, three patients underwent replacement of the descending aorta, and one patient underwent the stented graft implantation, resulting in closure of the entry site. Three patients underwent reoperation for severe aortic valve regurgitation 12 to 31 months (mean period, 24 months) after primary repair. Two patients underwent aortic valve replacement, and one patient underwent aortic root replacement. The actuarial freedom from reoperations was 81 +/- 6.9% at 3 years, and 73 +/- 9.9% at 5 years.

[Antimicrobial activity of macrolides against clinical isolates]

Antimicrobial activity of 6 macrolides was determined using a micro-broth dilution method, against 535 clinical isolates of 22 species, which were isolated in 1996 from 325 facilities in Japan. Results were as follows. 1. In general, antimicrobial activities of 14-membered macrolides were higher than those of 16-membered macrolides. The antimicrobial activities of 14-membered macrolides were in the order of clarithromycin (CAM), erythromycin (EM), roxithromycin (RXM). Among 16-membered macrolides, rokitamycin (RKM) was the most potent, josamycin (JM) was next potent followed by midecamycin (MDM). More numbers of highly-resistant strain of > 100 micrograms/ml were recognized in 14-membered macrolides than in 16-membered macrorides. 2. Most of S. pyogenes (group A) strains were distributed in the susceptible range and almost none was found in the resistant range. 3. S. pneumoniae strains were distributed widely from the susceptible range to the highly resistant range, and as high as 37.1% fell into the high resistance of > 100 micrograms/ml range. 4. Against Peptostreptococcus spp. and MRSA, 16-membered macrolides were more effective than 14-membered macrorlides, and their antibacterial activities were in the order of RKM, JM, MDM. Ratio of high-resistant strains of > 100 micrograms/ml against 14-membered macrolides was much higher than that against 16-membered macrolies. 5. Most of M. (B.) catarrhalis strains were distributed in the susceptible range of < or = 1.56 micrograms/ml, and most of H. influenzae strains were distributed within the moderately resistant and the resistant ranges. 6. In M. (B.) catarrhalis and H. influenzae, no correlation between macrolide resistance and beta-lactamase production was recognized. 7. Most of C. jejuni strains were susceptible to all macrolides used in this study.

Intracranial aneurysms in identical twins

BACKGROUND

Though familial intracranial aneurysms are well documented, only a few cases of intracranial aneurysms in identical twins have been reported.

CASE REPORT

Our patient, a 46-year-old woman, presented with a subarachnoid hemorrhage (SAH) due to a ruptured aneurysm. At the age of 36, her identical twin sister had also suffered SAH from a ruptured aneurysm. Both twins were treated successfully.

CONCLUSION

The likelihood of the occurrence of an aneurysm may be higher for a twin whose identical twin has developed an aneurysm than for the general population. Therefore, it is reasonable to perform certain screening procedures for aneurysms on an asymptomatic twin when the other presents with SAH due to a ruptured aneurysm.

Development of a health promotion system for the elderly: Committee of Health Evaluation for Elderly Persons Council of Japan AMHTS Institutions

A new health promotion approach for elderly persons is required which maintains not only their physical health but also their quality of life. We are developing a health promotion system which makes use of questionnaires dealing with physical conditions and quality of life, and makes health reports. Health evaluation is carried out in three steps. First, detailed information about the physical health of each client is collected. Second, quality of life is evaluated according to five health indicators. Last, health recommendations are generated. An artificial intelligence (AI) program produces detailed questions to collect necessary information for the evaluation of a client's health. The information related to quality of life is converted into five health indicators and presented as a radar-chart in documents and displays. The knowledge-based AI program automatically generates the health recommendation documents. This information is available for physicians and nurses for health counseling.

[Indications for external ventricular drainage after clipping of ruptured aneurysms in the acute stage]

The indication for external ventricular drainage after clipping of ruptured aneurysms in the acute stage is evaluated. Since 1990, 234 patients who presented with subarachnoid hemorrhage (SAH) and underwent aneurysmal clipping in the acute stage were evaluated retrospectively. Patients with ventricular dilatation had intraoperative placement of a ventriculostomy to obtain intraoperative brain relaxation, but the ventricular catheter was removed at the end of the surgery. All these patients were managed postoperatively in a similar fashion with no ventricular drainage, avoidance of dehydration complemented by a course of sodium ozagrel and nicardipine or fasudil hydrochloride. Acute hydrocephalus was defined as clinically and radiographically demonstrated ventricular dilatation that developed within 2 weeks of the onset of SAH and that required ventricular drainage. Three surgical approaches were employed; pterional approach (PA) for the aneurysms of the anterior circulation and upper basilar artery in 207 patients, interhemispheric approach (IHA) for the aneurysms of the pericallosal artery in 11 patients and lateral suboccipital approach (LSA) for the aneurysms of the vertebral arteries in 16 patients. No significant differences were found among these three approach groups in Fisher CT classification and the Hunt & Kosnik gradings. Four patients developed acute hydrocephalus within two weeks of surgery: three patients were operated on via LSA and one through IHA. Compared to the IHA or LSA, PA was superior for reestablishing cerebrospinal fluid circulation, because it is possible to remove more subarachnoid clot in the basal cisterns than to do so in the other two approaches. Opening of the lamina terminalis and the Liliequist membrane are also possible using PA. In conclusion, PA can prevent development of acute hydrocephalus, whereas postoperative ventricular drainage may be necessary in patients operated upon via IHA or LSA.

Sheath proteins: synthesis, secretion, degradation and fate in forming enamel

We investigated expression of ameloblastin and sheathlin, recently cloned enamel matrix proteins from the rat and pig, in forming enamel immunocytochemically and immunochemically, using region-specific antibodies. The results obtained from the rat and pig were essentially the same. Antibodies which recognize the N-terminal region stained the secretory machinery of the secretory ameloblast and the entire thickness of the enamel matrix, especially the peripheral region of the enamel rod. Immunostained protein bands were observed near 65 or 70 kDa and below 20 kDa. C-terminal-specific antibodies stained the secretory machinery of the ameloblast and the immature enamel adjacent to the secretion sites. Immunostained protein bands were found ranging from 25 to 70 kDa. Antibodies which recognize a region in the protein just prior to the C-terminal region stained the cis-side of the Golgi apparatus but not the enamel matrix. Immunostained protein bands were observed of about 55 kDa. These results suggest that post-translational and post-secretory modifications of ameloblastin and sheathlin are similar to each other, and further showed that their cleaved N-terminal polypeptides concentrate in the prism sheath. We propose that sheathlin and ameloblastin share the same role in amelogenesis and should be classified as sheath proteins.

Bilateral dissecting aneurysms of the vertebral arteries resulting in subarachnoid hemorrhage: case report

OBJECTIVE AND IMPORTANCE

We present the case of a patient with bilateral dissecting aneurysms of the vertebral arteries resulting in subarachnoid hemorrhage.

CLINICAL PRESENTATION

A 44-year-old man suffered a sudden onset of severe occipital headache and nausea and then dysphasia caused by subarachnoid hemorrhage. A computed tomographic scan demonstrated right side dominant subarachnoid hemorrhage mainly in the posterior fossa. Angiography revealed bilateral, vertebral dissecting aneurysms. The right aneurysm was larger and had a bleb-like protrusion, which strongly suggested a causative lesion of the subarachnoid hemorrhage. Six months later, the patient was referred to our hospital for further evaluation and treatment.

INTERVENTION

The ruptured right aneurysm was trapped surgically through a lateral suboccipital approach. The patient's postoperative course was unremarkable, and he was discharged on the 14th day after surgery. However, postoperative angiography demonstrated slight enlargement of the left nonruptured aneurysm. Four months after surgery, the patient developed brain stem ischemic symptoms. The angiography conducted at that time showed further enlargement of the left aneurysm. Five months after surgery, fatal rupture of the left aneurysm occurred.

CONCLUSION

These results indicate that sacrifice of the unilateral vertebral artery may result in an enlargement of the contralateral nonruptured aneurysm and may thus be dangerous in the case of a patient with bilateral dissecting aneurysms.

Multiple remote brain hemorrhages after removal of a giant colloid cyst of the third ventricle--case report

A 59-year-old male presented with progressive gait and memory disturbance. Computed tomography (CT) showed a huge high density mass, of about 45 mm maximum diameter, in the third ventricle with marked hydrocephalus. Magnetic resonance imaging showed the mass as mixed iso- to hypointensity on T2-weighted imaging and high intensity on T1-weighted imaging. Bifrontal craniotomy was carried out. The histological diagnosis was colloid cyst. Six hours after the operation, a large quantity of cerebrospinal fluid (CSF) was discharged via an epidural drainage, accompanied by generalized convulsion. CT showed multiple brain hemorrhages and subarachnoid hemorrhage remote from the operative field. The cause of hemorrhages is obscure, but postoperative overdrainage of CSF through epidural drainage over a short time following excessive intraoperative CSF aspiration may have contributed to this rare complication.

[Management of subarachnoid hemorrhages without detectable aneurysm]

In this study, 21 patients with subarachnoid hemorrhage (SAH) but negative angiography were evaluated. Angiography was performed twice on each patient, that is, on admission and at 2 weeks following admission. All patients had severe headache of sudden onset, a characteristic manifestation of SAH. Clinical grades on admission (Hunt and Kosnik classification) were generally good: 17 patients were in grade I or II and 4 patients were in grade III. SAH was confirmed by the presence of subarachnoid clot on CT in all cases. Based on the distribution of SAH, CT findings were classified into two patterns, i.e., perimesencephalic and non-perimesencephalic patterns. Four patients showed the perimesencephalic pattern and the remaining 17 the non-perimesencephalic. The period of follow-up ranged from 20 days to 11 years 6 months, with a mean of 6 years 10 months. Except for three recent cases, the mean follow-up period in 8 years 9 months. Exploratory craniotomies probing for aneurysms have been performed in four patients, but no aneurysms have been found in any of these cases. Clinical deterioration associated with vasospasm was observed in one patient. A communicating hydrocephalus requiring a shunting procedure was observed in three patients showing the non-perimesencephalic type CT pattern. Rebleeding occurred in one patient who subsequently died of what may be a dissecting aneurysm of the vertebral artery. One patient who was able to return to full activity experienced symptoms attributable to SAH such as frequent headaches and increased fatigability. Complete recovery was observed in the remaining 19 patients. Two of them, however, later died due to myocardial infarction and aging, respectively. Given these generally positive outcomes, it should be possible to inform such patients of the benignity of their condition. Angiography may not demonstrate a ruptured aneurysm on initial examination in all cases of aneurysmal SAH. Serial angiography, however, can provide a definite diagnosis of the dissecting aneurysm. Therefore, repeat angiography, particularly, when possible, digital subtraction angiography, is necessary to rule out aneurysmal SAH. While small aneurysms or microaneurysms are often found through exploratory craniotomy, we do not agree with the opinion that surgery may be appropriate for certain patients with SAH but with negative angiography. The natural history concerning rebleeding in such cases, as well as morbidity and mortality associated with hemorrhage, remains to be defined. Furthermore, there are reservations regarding whether coagulation of these abnormalities with bipolar cautery constitutes definitive treatment.

Novel detoxification of the trichothecene mycotoxin deoxynivalenol by a soil bacterium isolated by enrichment culture

A mixed microbial culture capable of metabolizing deoxynivalenol was obtained from soil samples by an enrichment culture procedure. A bacterium (strain E3-39) isolated from the enrichment culture completely removed exogenously supplied deoxynivalenol from culture medium after incubation for 1 day. On the basis of morphological, physiological, and phylogenetic studies, strain E3-39 was classified as a bacterium belonging to the Agrobacterium-Rhizobium group. Thin-layer chromatographic analysis indicated the presence of one major and two minor metabolites of deoxynivalenol in ethyl acetate extracts of the E3-39 culture filtrates. The main metabolite was identified as 3-keto-4-deoxynivalenol by mass spectroscopy and 1H and 13C nuclear magnetic resonance analysis. The immunosuppressive toxicity of 3-keto-4-deoxynivalenol was evaluated by means of a bioassay based on the mitogen-induced and mitogen-free proliferations of mouse spleen lymphocytes. This compound exhibited a remarkably decreased (to less than one tenth) immunosuppressive toxicity relative to deoxynivalenol, indicating that the 3-OH group in deoxynivalenol is likely to be involved in exerting its immunosuppressive toxicity. Strain E3-39 was also capable of transforming 3-acetyldeoxynivalenol but not nivalenol and fusarenon-X.

Direct extracranial-intracranial bypass for children with moyamoya disease

To improve cerebral hypoperfusion in the ischemic type of Moyamoya disease, we have applied superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses in combination with encephalo-myo-synangiosis (EMS) for 19 hemispheres of 10 children (age from 5 to 11 years at surgery). Two branches of the STA were anastomosed to the two cortical arteries which were selected in the watershed area of the cerebral hemisphere estimated as a hypoperfusion area on the preoperative angiograms. Before surgery transient ischemic attacks (TIAs) developed from every month to every 6 months in association with hyperventilation or sobbing. No perioperative completed stroke or wound complications was observed, although single TIA developed in four patients within 1 month after surgery. Postoperative angiogram demonstrated that, not only the preoperative watershed area, but also the most of the middle cerebral artery territory was oppacified via the 2 branches of the STA in all 19 hemispheres. In a mean follow-up period of 4 years, no ischemic episode was induced by hyperventilation, and there was no mental or neurological deterioration. STA-MCA double anastomoses, to the cerebral watershed area, in combination with EMS are safe and effective even for younger children with Moyamoya disease.

Amphistin, a new melanogenesis inhibitor, produced by an actinomycete

A new melanogenesis inhibitor, named amphistin, was isolated from the fermentation broth of an actinomycete strain KP-3052. Amphistin was purified from the culture filtrate by the combination of cation exchange, gel filtration, and aminosilyl silica gel chromatographic methods. The structure of amphistin was elucidated as gamma-(beta-histidinoalanino)homoalanine by NMR experiments including 1H-15N HMBC experiment and other spectroscopic analyses. Amphistin inhibited the melanogenesis of B16 melanoma cells at concentration of 6.8 microM.

[Rupture of previously documented asymptomatic saccular intracranial aneurysms]

The authors report four cases of patients with documented asymptomatic intact aneurysms that subsequently ruptured. Case 1 involves a 64-year-old woman who had two unruptured aneurysms, i.e., an anterior communicating artery aneurysm and a posterior inferior cerebellar aneurysm, both were discovered during evaluation of cerebral ischemic symptoms. At that time, only the posterior inferior cerebellar aneurysm was clipped. Seven years later, the patient bled fatally from a 5-mm untreated anterior communicating artery aneurysm that had measured approximately 3 mm on an angiogram obtained 7 years earlier. Case 2 is that of a 50-year-old woman who bled from an anterior communicating artery aneurysm that had been discovered 6 years earlier when she suffered subarachnoid hemorrhage (SAH) from a left middle cerebral artery aneurysm. At that time, she had refused surgery for the anterior communicating artery aneurysm. She recovered well from the second SAH. Case 3 is that of a 74-year-old woman who bled from a left paraclinoid internal carotid artery aneurysm that had been discovered incidentally 3 years earlier during evaluation of vertigo. She had not agreed to have a clipping at that time the aneurysm was first discovered because of her age and the difficult location of the aneurysm. She eventually made an uneventful recovery. In the fourth case, during evaluation of cerebral ischemic symptoms, a 59-year-old man was discovered to have a large basilar bifurcation aneurysm. He underwent a craniotomy for clipping of the aneurysm. The aneurysm, however, was unclippable and was instead coated with Bemsheet. Four months later, the patient bled from the aneurysm and entered a vegetative state. The indications for surgery on unruptured asymptomatic cerebral aneurysms are still unclear. The cases reported herein show that asymptomatic aneurysms, especially anterior communicating aneurysms and aneurysms once exposed surgically, do carry a certain risk for future hemorrhage and should not be dismissed as innocuous. Neurosurgeons have recognized the importance of considering life expectancy in managing patients with asymptomatic, unruptured, intracranial aneurysms. With the rapid aging of the population, withholding aneurysm surgery merely because a patient is elderly may not necessarily be the most appropriate decision.

Fluorescence polarization study of a salt bridge between a single chain Fv and its antigen ribonuclease A

The interaction between a single chain Fv (sFv) of the monoclonal antibody 3A21 and its antigen, bovine pancreatic ribonuclease A (RNase A), was studied by site-directed mutagenesis of the hypervariable regions and fluorescence polarization analysis. The affinity constants of wild-type sFv and a mutant sFv D31A (Asp31 of heavy chain was replaced by Ala) for RNase A were found to be 2.7 x 10(7) and 4.7 x 10(6) M(-1) in PBS at pH 7.2 and 37 degrees C, respectively. Whereas the affinity constant of D31A is not affected by NaCl concentration, that of wild-type sFv is almost the same as that of D31A in the presence of more than 1 M NaCl. These results demonstrate that Asp31 of the heavy chain interacts electrostatically with a positively charged amino acid residue of RNase A.

Fluorescence polarization study of a salt bridge between a single-chain Fv and its antigen ribonuclease A

The interaction between a single-chain Fv (sFv) of the monoclonal antibody 3A21 and its antigen, bovine pancreatic ribonuclease A (RNase A), was studied by site-directed mutagenesis of the hypervariable regions and fluorescence polarization analysis. The affinity constants of wild-type sFv and a mutant sFv D31A (Asp31 of heavy chain was replaced by Ala) for RNase A were found to be 2.7 x 10(7) and 4.7 x 10(6) M-1 in PBS at pH 7.2 and 37 degrees C, respectively. While the affinity constant of D31A is not affected by NaCl concentration, that of wild-type sFv is almost the same as that of D31A in the presence of more than 1 M NaCl. These results demonstrate that Asp31 of the heavy chain interacts electrostatically with a positively charged amino acid residue of RNase A.

Axon patterning requires DN-cadherin, a novel neuronal adhesion receptor, in the Drosophila embryonic CNS

We identified DN-cadherin, a novel Drosophila cadherin that is expressed in axons and in the mesoderm. Although DN-cadherin has diverged from vertebrate classic cadherins in terms of its extracellular structure, it still can form a complex with catenins and induce cell aggregation, as do the vertebrate molecules. Loss-of-function mutations of the gene resulted in either embryonic lethality or uncoordinated locomotion of adults. In the central nervous system of null mutant embryos, subsets of ipsilateral axons displayed a variety of aberrant trajectories including failure of position shifts, defective bundling, and errors in directional migration of growth cones. These results suggest that processes of axon patterning critically depend on DN-cadherin-mediated axon-axon interactions.

[Interstitial tubercle in Chinese and Japanese young adults]

A comparative study on the incidence of interstitial tubercle from standardized stone casts of 160 Chinese and 190 Japanese young adults,ages from 20-30.The following results were obtained:(1)No significant difference in the incidence of interstitial tubercle on maxillary first premolar between Chinese and Japanese groups(P>0.05),but on maxillary second premolar,Japanese is higher than Chinese(P<0.05).(2)The incidence of interstitial tubercle on maxillary first premolar is higher than second premolar in two groups(P<0.05).(3)The intestitial tubercle occurs in unilateral more frequently than in bilateral.The incidence of maxillary first premolar in mesial of occlusal is higher than in distal.No difference between mesial and distal on occlusal of maxillary second premolar in the Chinese group,and the incidence in mesial is higher than in distal in the Japanese group.

[Intraoperative aneurysmal rupture at the neck]

Intraoperative rupture of an aneurysm can lead to disastrous results when the rupture occurs at the neck. The authors have encountered eight cases (5%) of intraoperative rupture in a series of 155 patients. All patients were operated on in the acute stage by one of the authors of this paper (T.Y.). In six cases, the aneurysm ruptured at the dome and in two, at the neck. We report these two patients with intraoperative rupture at the neck. The first case, a 50-year-old female, developed SAH, but a 4-vessel study failed to show an aneurysm. The second series of angiograms obtained ten days later showed a broad-based, left proximal A1 aneurysm. It was decided to employ a right pterional approach. The aneurysm was arising from the right A1 segment just proximal to the anterior communicating artery. The neck was wide, with thin walls. Thus, it seemed better to apply a clip parallel to the A1 segment axis than to apply it from a direction perpendicular to the A1 segment axis. However, the right pterional approach precluded a parallel clipping, so the blades of a clip were applied perpendicularly. The clip seemed not to be completely across the neck of the aneurysm. After applying a temporary clip to the A1 segment proximal to the aneurysm, the clip blades were opened and advanced just when bursting of the sac at the base occurred and microvascular suture repair was required to control the bleeding. The second case, a 57-year-old female, underwent clipping of a right IC-PC aneurysm. However, two years postoperatively, the patient again suffered SAH. Cerebral angiography at this time revealed a relatively large recurrent IC-PC aneurysm in which the old clip was situated on the dome of the aneurysm. Aneurysmal clipping was performed on the day of rupture. Tough granular tissue was removed from the ICA, PcomA, aneurysmal neck, and the old clip. After the true neck was identified, a straight clip was applied to the neck parallel to the ICA. Soon after the clipping, arterial bleeding occurred near the neck. The ruptured aneurysm was trapped using two temporary clips. A curved clip was applied to the ruptured neck, including the wall of the ICA, to control the bleeding. This clipping caused a substantial stenosis of the ICA. Both patients demonstrated postoperative neurological deficits due to ischemia caused by temporary clipping. These encounters dramatically demonstrated that a very thin-walled aneurysm or a recurrent aneurysm has a fragile neck. In surgical treatment of these unusual aneurysms, a clip should be placed on the neck parallel to the parent artery. Furthermore, temporary clipping is advisable when dissecting the neck or applying the clip to the neck to reduce the damage to the neck.

Vertebral artery occlusion after subarachnoid hemorrhage from a dissecting aneurysm of the vertebral artery: case report

BACKGROUND

Generally speaking, occlusion of the vertebral artery is a finding of a dissecting aneurysm associated with completed stroke. We present a case of a vertebral dissecting aneurysm that produced subarachnoid hemorrhage (SAH). Angiography on the day of hemorrhage, however, demonstrated complete occlusion of the vertebral artery.

CASE PRESENTATION

A 44-year-old hypertensive woman suffered a sudden onset of headache and vomiting followed by loss of consciousness due to SAH. Angiography on the day of hemorrhage revealed a complete occlusion of the right vertebral artery just distal to the dissecting aneurysm. This is the first report of such a case. The patient was still considered to be at significant risk of rerupture. Craniotomy and clip occlusion of the right vertebral artery and the origin of the right posterior inferior cerebellar artery were carried out to trap the thin-walled sac. At discharge, the patient had recovered completely except for some left limb ataxia, which subsequently disappeared.

CONCLUSIONS

Two options are available for the treatment of such a case: surgical or medical treatment. We employed surgery. Which is the preferred approach, however, is a difficult judgment to make at this juncture.

[Sjögren's syndrome complicated by thymoma]

A 43-year-old woman with a history of Sjögren's syndrome was admitted to our hospital because of dyspnea due to anemia. Her chest X ray film on admission revealed an anterior mediastinal tumor. We diagnosed this tumor as a thymoma based on a chest CT scan and magnetic resonance imaging. Because the latter indicated that the thymoma may have involved the mediastinal great vessels, preoperative chemotherapy with cisplatin, doxorubicin hydrochloride, vincristine sulfate and cyclophosphamide. Thereafter the tumor was successfully resected along with part of the right pleura. Thymoma as a complication of Sjögren's syndrome is rare. Here we also discuss the treatment of thymoma and the combination of these two diseases.

A collagen coated fabric vascular prosthesis as a punctureable A-V shunt

A fabric vascular prosthesis sealed with succinylated collagen (SC) was developed as an arteriovenous (A-V) shunt graft for hemodialysis. The SC graft was soft, pliable, flexible, and puncturable, with quick hemostasis. A needle puncture made a smaller hole in the SC graft wall than in a control expanded-polytetrafluoroethylene (e-PTFE) graft such as is usually used for an A-V shunt. The SC graft was extremely hydrous, because it is sealed with water, which is absorbed into the intermolecular spaces of negatively charged collagen. The SC suspension was injected with pressure into a knitted fabric vascular prosthesis wall (water permeability, 1,200 ml) so as to become entangled in the Dacron network. The graft then was lyophilized and thermally cross-linked. Water leakage from six holes created by an 18 G needle puncture in vitro under water pressure of 120 mmHg was 34.5 +/- 29.9 ml/min in the SC graft and 169.9 +/- 38.5 ml/min in the control e-PTFE graft. Hemostatic time at six 18G needle puncture sites on grafts implanted in the abdomen of 12 dogs was 4.5 +/- 2.5 mins in the SC graft and 34.2 +/- 11.5 mins in the control graft. After implantation, the luminal surface of the SC grafts had a thinner thrombus layer than did the control grafts. After 1 week, a thin thrombus layer covered the luminal surface of the SC grafts, and puncture sites were recognized as small dots under it, but in the control grafts, the thrombus layer was thick and the puncture sites could not be seen. These results suggest that the SC graft is less thrombogenic and has less blood leakage from the puncture sites than does the control graft.

Thermal cross-linking for biologically degradable materials. Preliminary report

To diminish undesirable side effects of chemical cross-linking of biodegradable materials, the authors developed a thermal cross-linking method that involved esterification by dehydration under dry conditions. The optimal condition for cross-linking was heating at 130-140 degrees C for 40 hr. Efficacy of the cross-linking was evaluated using enzymatic digestion of 0.01% protease in phosphate buffer at pH 7.4. Collagenous materials without cross-linking were digested completely within 30 min. However, with thermal cross-linking, it required 7 days for digestion. The capacity for holding onto water also was tested. Water content decreased when the cross-link density was increased. As an in vivo experiment, six succinylated collagen sealed vascular grafts treated with thermal cross-linking were implanted in the abdominal aortae of dogs and removed 21 days later. These grafts showed no foreign body reaction, and the collagen layer was almost completely absorbed. A collagen sealed graft cross-linked with formaldehyde used as a control showed a strong foreign body reaction. These results suggest that the physical cross-linking method was suitable for biodegradable biologicals, such as collagenous materials, without the undesirable side effects of chemical cross-linking regents.

Development of a thermal cross-linking heparinization method and its application to small caliber vascular prostheses

The authors developed a heparinization method for biomaterials without using chemical reagents and applied it to small caliber vascular prostheses. The vascular prostheses (4 mm diameter expanded polytetrafluoroethylene [e-PTFE], fibril length 90 microns) heparinized by thermal cross-linking, and control grafts (4 mm diameter e-PTFE, fibril length 30 microns), were implanted in the carotid arteries of eight adult dogs. Four pairs of grafts were explanted 1 hr after implantation, and the remaining four pairs were explanted 7 days after implantation. Patency was assessed macroscopically, and the grafts were examined microscopically. The anti thrombogenicity of the vascular prostheses heparinized by thermal cross-linking was good in comparison with that of the control group. However, on the outer surface of the grafts, the author found more infiltration of fibroblasts into the wall of the control grafts than in the heparinized grafts. The author surmised that heparinized gelatin injected into the interfibril space of the graft inhibited cellular infiltration. The infiltration of inflammatory cells was slight in both grafts. Thus, the author was successful in heparinizing the vascular prostheses by thermal cross-linking and obtaining slow release of heparin to maintain early antithrombogenicity. The high concentration of heparin in the graft wall, however, was thought to be an obstacle to integration of the vascular prostheses.

Kurasoins A and B, new protein farnesyltransferase inhibitors produced by Paecilomyces sp. FO-3684. II. Structure elucidation and total synthesis

The structures of new protein farnesyltransferase inhibitors, kurasoins A and B, were elucidated by NMR study. Kurasoins A and B are acyloin compounds having in common a 3-hydroxy-1-phenyl-2-butanone moiety, to which p-hydroxyphenyl and 3-indolyl moieties respectively, are connected at C-4. The structures were confirmed by total synthesis.

[A case of rheumatoid factor-positive pachymeningitis]

We report a case of rheumatoid pachymeningitis involving the posterior fossa. A 71-year-old woman presented with headache, vertigo and dizziness. MRI demonstrated hypertrophic masses in the meninges of the left cerebellar tentorium, cerebellopontine angle and the fourth ventricle. Six months of treatment with betamethasone, prednisolone and azathioprine improved the patient's neurological status. Because an inappropriate immune process and systemic immune disease may cause idiopathic pachymeningitis, the performance of immunological studies for idiopathic cases is mandatory.

IS431mec-mediated integration of a bleomycin-resistance gene into the chromosome of a methicillin-resistant Staphylococcus aureus strain isolated in Japan

A methicillin-resistant Staphylococcus aureus (MRSA) strain B-26, isolated clinically in Hiroshima University Hospital, is resistant to bleomycin together with kanamycin. In the present study, we analysed the nucleotide sequence of the 5.1-kb HindIII fragment containing the bleomycin- and kanamycin-resistance genes, which were previously cloned [Bhuiyan et al. (1995) Appl Microbiol Biotechnol 43: 65-69] from the chromosomal DNA of MRSA B-26. The present study found that the DNA sequence contains the duplicated target sequence (GATTAGAT) consisting of 8 bp for transposase and the entire nucleotide sequence of the plasmid pUB110, together with the sequence of inverted repeats (16 bp), designated IR-r and IR-1 in IS431 mec. The 8-bp duplication sequence, produced by the transposable element, was first found by us. We proposed that bleomycin resistance in MRSA B-26 is attributed to the IS431 mec-mediated integration of pUB110 into the chromosome.

Arisugacins A and B, novel and selective acetylcholinesterase inhibitors from Penicillium sp. FO-4259. I. Screening, taxonomy, fermentation, isolation and biological activity

An in vitro screening method for selective acetylcholinesterase (AChE) inhibitors was established. Inhibitory activity of AChE and butyrylcholinesterase (BuChE) was measured and the culture broths of microorganisms that showed selective inhibition against AChE were characterized. By using this method, a strain producing the novel and selective inhibitors of AChE, arisugacins A and B, was picked out among over seven thousand microorganisms tested. Arisugacins were obtained as white powders from the culture broth together with three known compounds, territrems B and C and cyclopenin that also showed selective inhibition against AChE. Arisugacins and territrems are members of the meroterpenoid compounds. They showed potent inhibitory activities against AChE with IC50 values in range of 1.0 approximately 25.8 nM. Furthermore, they showed greater than 2,000-fold more potent inhibition against AChE than BuChE.

Very poor prognosis in cases with extravasation of the contrast medium during angiography

BACKGROUND

The rebleeding of a ruptured intracranial aneurysm in the acute stage has been thought to indicate a very poor prognosis. In our experience, the outcome of patients with extravasation of the contrast medium is worse than that of patients with rerupture under circumstances other than angiography. We demonstrated the poorer outcome of the patients with extravasation, compared to that of the patients developing rerupture under circumstances other than angiography, and examined the factors that contributed to the poorer outcome of the patients with extravasation.

METHODS

Among the 641 cases of ruptured intracranial aneurysm, we have handled over the past 10 years, 36 (5.6%) patients have rebled before surgery was performed. Thirteen patients rebled during angiography (Group I), and the remaining 23 patients rebled in other circumstances (Group II). We compared the outcome of both groups.

RESULTS

The rebleeding occurred within 6 hours of the initial rupture in 29 (80%) patients. The outcome of Group I was significantly poorer than that of Group II (p < 0.05). In Group I, SD was achieved in only 1 patient and the remaining 12 patients died, while in Group II, 8 patients were in GR or MD, 2 were in SD, and the remaining 13 patients died.

CONCLUSION

Because rebleeding during angiography most often occurs in the acute stage and because the outcome of patients with extravasation is very poor, we recommend that the performance of angiography be delayed at least between 3 and 6 hours after the initial rupture.

Andrastins A-C, new protein farnesyltransferase inhibitors produced by Penicillium sp. FO-3929. I. Producing strain, fermentation, isolation, and biological activities

New protein farnesyltransferase inhibitors, andrastins A-C, have been discovered in the cultured broth of Penicillium sp. FO-3929. Andrastins extracted from broth supernatant were purified by silica gel chromatography, ODS chromatography and HPLC. The IC50 of andrastins A, B, and C against protein farnesyltransferase were 24.9, 47.1, and 13.3 microM, respectively.

[Relationship between diaphragm weight and body composition]

To study the relationship between diaphragm weight and body composition, we measured fat body mass and lean body mass by dual-energy X-ray absorptiometry (XR-26, Norland), and weighed the diaphragms of patients at autopsy. The subjects were 22 patients with various diseases (13 men and 9 women, aged 72.6 +/- 9.5 years). In 8 of the patients, respiratory muscle strength was assessed with maximal pressure at the mouth. The diaphragm weight was 185.2 +/- 58.2 g and it correlated significantly with lean body mass (r = 0.77, r = 0.73, p < 0.01). Maximal inspiratory pressure at TLC correlated significantly with diaphragm weight. These results show that respiratory muscle strength is related to diaphragm weight and that analysis of body composition may be useful in assessing changes in the mass of the diaphragm.

Andrastins A-C, new protein farnesyltransferase inhibitors produced by Penicillium sp. FO-3929. II. Structure elucidation and biosynthesis

The structures of new protein farnesyltransferase inhibitors, andrastins A-C, were elucidated. The cyclopentane ring of andrastins exhibited keto-enol tautomerism, which made the structure hard to elucidate. Therefore, the structure of andrastin A was elucidated by INADEQUATE and 13C-13C couplings using 13C-labeled andrastin A. The absolute configuration of the p-bromobenzoyl derivative of andrastin A was elucidated by X-ray crystallographic analysis and its skeleton was shown to be ent-5 alpha,14 beta-androstane. The biosynthesis of andrastin A was also studied by the incorporation of 13C-labeled acetates. Though the andrastins had a common androstane skeleton, they were biosynthesized from a sesquiterpene and a tetraketide.

Xanthoquinodin B3, a new anticoccidial agent produced by Humicola sp. FO-888

Xanthoquinodin B3, a new component of anticoccidial xanthoquinodins, which was detected in the culture broth of Humicola sp. FO-888, was isolated by heat treatment of the xanthoquinodins complex. Structural elucidation indicated that xanthoquinodin B3 has the same heterodimer of xanthone- and anthraquinone-derived monomers as other xanthoquinodins. Schizont formation of monensin-resistant Eimeria tenella in BHK-21 cells was inhibited by xanthoquinodin B3 at concentrations greater than 0.035 microM.

Herquline B, a new platelet aggregation inhibitor produced by Penicillium herquei Fg-372

A new herquline analog, herquline B was isolated from the culture broth of Penicillium herquei Fg372. Herquline B contains one piperazine and two cyclohexenones. The pyrrolidine ring of herquline A was cleaved to yield herquline B. The IC50 value of herquline B against platelet aggregation induced by ADP and platelet-activating factor were 1.6 and 5.0 microM, respectively.