Different phenotypes of multiple endocrine neoplasia type 1 (MEN1) in monozygotic twins found in a Japanese MEN1 family with MEN1 gene mutation

We report monozygotic twins who showed different MEN1 phenotypes. The proband (28 y.o., female) had both primary hyperparathyroidism (PHP) and insulinoma, and genetic analysis revealed a point mutation (569del1, exon 3) of the MEN1 gene. This mutation causes a frameshift and produces a stop codon at codon 184. Restriction digestion (HinfI) analysis confirmed the same mutation of the MEN1 gene in six of the affected members including her two sisters, the monozygotic twins, and no such mutation in two unaffected members. In two generations of this family, eight of eleven family members had PHP and four of them were found to have other MEN1-related lesions. Both of the monozygotic twins had PHP. Interestingly, one had pancreatic tumor but the other had no evidence of it. Pituitary MRI showed no pituitary lesion in either of them. This is the first Japanese case of monozygotic twins with different MEN1 phenotypes.

Polyadenylation signal facilitates the expression of foreign gene that is driven by an internal promoter located in the reverse orientation to long terminal repeat of retrovirus

We examined whether the presence of a polyadenylation [poly(A)] signal in a retrovirus vector could affect the expression level of exogenous gene(s) that was controlled by an internal promoter. Three suicide genes were placed under a promoter of the human midkine gene, whose expression is elevated in lung cancer cells. Orientation of the internal transcriptional unit was designed to be opposite to the viral long terminal repeat. Expression of each suicide gene was greater in ecotropic packaging cells transfected with a retrovirus vector without a poly(A) signal than in those with a poly(A)-containing vector. Sensitivity to ganciclovir, a prodrug that becomes an active drug by herpes simplex virus-thymidine kinase, was significantly improved in retrovirally transduced lung cancer cells compared with wild-type cells. However, the sensitivity was much greater in the cells transduced with poly(A)-containing vector than in those with poly(A)-deleted construct. The presence of a poly(A) signal downstream of exogenous gene(s) therefore favors the expression of foreign gene(s) driven by an internal promoter.

Computerized tomographic ureteroscopy for diagnosing ureteral tumors

PURPOSE

Helical computerized tomography (CT) image acquisition has led to the availability of improved data sets for CT endoscopic imaging that represent virtual endoscopy using CT. We assessed the usefulness of CT ureteroscopic imaging for diagnosing ureteral tumors.

MATERIALS AND METHODS

A total of 16 patients with ureteral stenosis underwent surface rendering CT ureteroscopy after the intravenous administration of contrast material and furosemide. To distinguish ureteral tumors from ureteral strictures 2 observers blinded to other patient history and evaluation data independently and prospectively evaluated CT ureteroscopy with reformatted CT ureterograms in these 16 patients. CT ureteroscopic images were then correlated with surgical and pathological findings, which served as the gold standard.

RESULTS

Surgical and pathological findings in the 16 patients revealed 16 ureteral tumors, including carcinoma in 10 (carcinoma in situ in 1, fibroepithelial polyps in 2 and hyperplastic polypoids in 4), inflammatory intrinsic stricture in 2 and extrinsic stricture in 4 caused by retroperitoneal fibrosis in 2 and lymph node metastasis in 2. CT ureteroscopy correctly detected all lesions except 1 carcinoma in situ, 1 polypoid carcinoma and 1 hyperplastic polypoid. The sensitivity and specificity of CT ureteroscopy for detecting ureteral tumors and carcinoma were 81% and 100%, and 80% and 75%, respectively, when tumors without stalks were considered carcinoma.

CONCLUSIONS

CT ureteroscopy is useful for visualizing the complex morphology of ureteral tumors and distinguishing tumor from ureteral stricture.

VFEU water quality control in STS-95 mission

In STS-95 Space Shuttle mission, an aquatic animal research facility, Vestibular Function Experiment Unit (VFEU), was flown to perform neurobiological experiment with marine fish, oyster toadfish. For this purpose, we have developed a sea water purification system using highly active nitrifying bacteria at low temperature. With this system, the water quality in the VFEU was maintained in sufficient condition to keep the toadfish in healthy state for 9 days of the mission. This report summarizes the efficiency of the filter system based on the results from pre-flight bacterial preparation, water analysis of samples taken during flight, and the post-flight analysis of the bacterial filter.

Water quality management for low temperature marine fishes in space

Vestibular Function Experiment Unit (VFEU), one of the Spacelab facility flown in Neurolab mission (STS-90) in April, 1998, was to support neurophysiological research using a marine fish, Opsanus tau (oyster toadfish). The functions of the VFEU were primarily a quality management of environmental water during the mission at 14 degrees C and for acquiring physiological signals from implanted micro-electrodes in the otolith nerves as well as the spatial acceleration of the fish. A key element of the life support system was a balanced biological filter containing two types of nitrifying bacteria, Nitrosomonas for ammonia oxidization and Nitrobacter for nitrite oxidization. Although the 16 days mission was successful, two toadfishes died in late phase of the mission. Ammonium concentration in those two life support systems elevated to remarkably high level at the end of the mission whereas the other two indicated very low. This report summarizes the results of the water quality management of the VFEU during the Neurolab mission based on analysis of water samples taken during the flight and those taken prior and just after the flight.

NASDA aquatic animal experiment facilities for Space Shuttle

National Space Development Agency of Japan (NASDA) has been developed aquatic animal experiment facilities for space experiments using NASA Space Shuttle. Vestibular Function Experiment Unit (VFEU) has been firstly designed and developed for Spacelab-J mission (STS-47), and 8 days space experiment with carp has been performed. Following, the VFEU, Aquatic Animal Experiment Unit (AAEU) has been developed to accommodate small aquatic animals second International Microgravity Laboratory mission (IML-2, STS-65). Four kinds of space experiments with goldfish, medaka, newt, and newt eggs have been performed for 15 days mission duration. Then, VFEU has been improved to accommodate marine fish under low temperature condition for Neurolab (STS-90) and STS-95 missions. 17 days (STS-90) and 9 days (STS-95) experiments with oyster toadfish have been performed by using the VFEU. This report summarizes the outline of these aquatic animal experiment facilities.

No evidence of germline mutation or somatic deletion of the MEN1 gene in a case of familial multiple endocrine neoplasia type 1 (MEN1)

The MEN1 gene has recently been cloned as the gene responsible for multiple endocrine neoplasia type 1 (MEN1) and its germline mutations have been identified in a number of familial MEN1 patients. However, mutation-negative cases have also been reported in some MEN1 families. We report here a Japanese MEN1 family, including a proband with no evidence of MEN1 gene mutation. The proband (51 y.o., female) had three major MEN1 lesions, including primary hyperparathyroidism (HP), prolactinoma, and pancreatic tumor. Her father and brother had HP, and her daughter had both HP and prolactinoma. When we analyzed the proband for a germline mutation of the MEN1 gene, the direct sequencing analysis showed no mutation in the coding region, on the promoter, 5' and 3' untranslated regions of the MEN1 gene. We next examined the loss of heterozygosity (LOH) in the proband's parathyroid tumors using two benign polymorphisms (C2249G in intron 1 and 2248del3 in exon 10) in the MEN1 gene to detect LOH. LOH was not found in any of the four separate regions of the tumor tissues.

Enzyme-cytochemically detectable NADPH-diaphorase activity is present in the endoplasmic reticulum and nuclear envelope of the syncytiotrophoblast of the human placenta

We investigated the subcellular localization of nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) activity, a histo- and cyto-chemical marker of nitric oxide synthase, in human placental trophoblast obtained from women with normal term pregnancies. Tetrazolium salt BSPT was used as the capturing agent. Precipitates of BSPT-formazan indicative of NADPH-d reaction were observed on the membranes of endoplasmic reticulum and nuclear envelope of syncytiotrophoblasts. Our results indicate these two intracytoplasmic organellae are the sites of nitric oxide generation in the syncytiotrophoblasts of normal term human placenta.

Meconium-stained amniotic fluid activates polymorphonuclear leukocytes ultrastructural and enzyme-cytochemical evidence

The purpose of the present study was to demonstrate morphological evidence that meconium-stained amniotic fluid activates polymorphonuclear leukocytes. We used Boyden chamber techniques to determine the chemotactic activity of meconium-stained amniotic fluid for leukocytes, and ultrastructural enzyme-cytochemistry for peroxidase and alkaline phosphatase to characterize the leukocyte features induced by contact with meconium-stained amniotic fluid. Amniotic fluid with meconium staining enhanced migration of leukocytes. These leukocytes exhibited more numerous cytoplasmic processes and more prominent phagosomes compared to peripheral blood leukocytes. Peroxidase and alkaline phosphatase activity were evident on the phagosomal membranes. Our results indicate that meconium-stained amniotic fluid activates or stimulates polymorphonuclear leukocytes. Meconium-stained amniotic fluid induced leukocyte activation might play important roles in the pathophysiology of initiation of term labor or of the meconium aspiration syndrome.

MR findings of bowlegs in toddlers

BACKGROUND

Toddlers with severe physiologic tibial bowing are considered to be at risk for the development of Blount's disease. Objective. To correlate MR findings of the knee with the clinical outcome in toddlers with severe physiological tibial bowing.

MATERIALS AND METHODS

MR findings were evaluated in 22 affected legs of 14 children with severe tibial bowing (mean age 1.9 years). In 18 affected legs, MR findings were compared with the transition of the tibial metaphyseal-diaphyseal angle (MDA) and tibiofemoral angle (TFA) measured serially between 2 and 3 years of age.

RESULTS

MR findings of severe tibial bowing comprised undulation of the posteromedial physis of the tibia (3/22), signal alterations in the medial tibial metaphysis (10/22), T2 prolongation in the posteromedial tibial epiphyseal cartilage (14/22) and signal changes in the medial menisci (18/22). The decrease in the TFA was different in the legs with and without increased signal in the epiphyseal cartilage, and the decrease in the MDA was different in the legs with and without physeal undulation.

CONCLUSION

MR imaging findings can predict the retarded resolution of tibial bowing, which may be a risk factor for the development of Blount's disease.

Hyperfunctional parathyroid glands with 99mTc-MIBI scan: semiquantitative analysis correlated with histologic findings

The purpose of this study was to correlate the semiquantitative analysis of 99mTc-methoxyisobutyl isonitrile (MIBI) scan with histologic findings of hyperfunctional parathyroid glands.

METHODS

Early and delayed cervical images of MIBI scans were reviewed in 31 patients who eventually underwent parathyroidectomies because of biochemically suspected hyperparathyroidism ([HPT], primary, n = 13; secondary, n = 18). The sensitivity of a scan for localizing the diseased glands was determined by comparing scan findings with pathologic findings, which were considered the gold standard. The average ratio of parathyroid-to-thyroid (P/T) count was compared between glands with large and small areas of whole gland, chief cell, oxyphil cell or cellular components. The mean areas of whole gland, chief cells and oxyphil cells were also compared between glands detected by MIBI scan and those that the scan missed.

RESULTS

There were 99 resected lesions, including 9 parathyroid adenomas and 61 hyperplastic parathyroids. The sensitivity for localizing the diseased glands in patients with primary HPT (91%) was higher than that in patients with secondary HPT (83%). Significantly greater average P/T counts ratio on both early and delayed images was observed in the diseased glands with greater areas of whole gland, chief cells, oxyphil cells or cellular components. Fifty-nine MIBI-positive glands had significantly greater average areas of whole gland (P < 0.001) and chief cell (P = 0.002) than did 11 MIBI-negative glands.

CONCLUSION

The uptake of MIBI in hyperfunctional parathyroid is dependent on gland size and the amount of cellular components, chief cells and oxyphil cells. However, the amount of oxyphil cells does not clearly affect the results of MIBI parathyroid scintigraphy, because it is small in most hyperfunctional glands.

Uterine leiomyoma in pregnancy: its influence on obstetric performance

OBJECTIVE

To assess the effects of uterine leiomyoma on obstetrical performance.

METHODS

We reviewed the medical records of 102 women with singleton pregnancies who were found ultrasonographically to have uterine leiomyomas during the first half of their pregnancy and who gave birth at our hospital at > or = 22 weeks of gestation between January 1990 and December 1997.

RESULTS

The 102 women gave birth to 101 healthy infants, weighing 2,974 +/- 579 g at 38.8 +/- 2.6 weeks of pregnancy. One woman experienced an unexplained antepartum fetal death at 24 weeks of gestation. Bleeding at the first trimester occurred in 16% of the women. Pain localized in the lower abdomen and requiring relief occurred in 28% of the women during the first or second trimester. Tocolytic treatment was required in 25% of the pregnancies, and preterm delivery occurred in 12% thereof. A cesarean section was performed in 39% of the pregnancies. Bleeding > or = 500 ml occurred at delivery in 48% of the cases. The largest fibroid, > 6 cm in diameter, which was seen in 51 women, was associated with higher frequencies of tocolytic treatment (41%), preterm delivery (24%), bleeding > or = 500 ml at delivery (59%), and cesarean delivery (51%). In 76 women (75%) who attempted vaginal delivery, the obstetrical outcome was comparable to that of 115 control women who were matched regarding age, parity, and gestational week.

CONCLUSIONS

Although pain in the lower abdomen, the requirement of tocolytic treatment, preterm delivery, and cesarean delivery were common, the neonatal outcome was fairly good in women with uterine leiomyomas. The present data might be encouraging to pregnant women with uterine leiomyomas.

Fukuyama-type congenital muscular dystrophy: close relation between changes in the muscle basal lamina and plasma membrane

Despite the recent advance in genetic study of Fukuyama-type congenital muscular dystrophy (FCMD), the mechanism of muscle degeneration in the disease remains unclear. To clarify it, muscle biopsies from six cases of FCMD were subjected to immunohistochemical and ultrastructural studies. On the muscle cell surface, decreased expression of laminin alpha2 subunit was seen along with aberrant expression of laminin alpha5 and neural cell adhesion molecule. Electron microscopy revealed breach of muscle basal lamina. The electron density of plasma membrane was significantly lower at the places without identifiable basal lamina. Thus in FCMD changes of laminin and other proteins on the cell surface involve a process common to developing muscles, and loss of normal structure of the basal lamina is closely associated with changes of the plasma membrane. This suggests that the primary cause of FCMD is related to formation and maintenance of the basal lamina.

Glucose-6-phosphate dehydrogenase cytochemistry using a copper ferrocyanide method and its application to rapidly frozen cells

We describe an improved copper ferrocyanide-based method for cytochemical detection of glucose-6-phosphate dehydrogenase (G6PD), which was used to localize the enzyme within the ultrastructure of rat hepatocytes and adrenocortical cells. With this method, glutaraldehyde fixation and the addition of exogenous electron carriers (for example, phenazine methosulfate) to the cytochemical reaction medium were essential. Copper ferrocyanide reaction product showing the distribution of G6PD was readily recognized at the light microscopic level as Hatchett's brown staining and at the electron microscopic level as electron-dense deposits. Within stained regions, enzyme cytochemical G6PD activity was found to be associated with ribosome-like structures. Because G6PD is a soluble, cytosolic enzyme, its displacement or extraction may occur during conventional fixation. We, therefore, combined a rapid-freezing technique with G6PD enzyme cytochemistry. The resultant rapid-freezing enzyme cytochemistry enabled us to show the subcellular distribution of G6PD in a more life-like state; the localization of G6PD in rapidly frozen cells was in substantial agreement with that in conventionally fixed cells.

Computerized tomography nephroscopic images of renal pelvic carcinoma

PURPOSE

Computerized tomography (CT) endoscopy is an interactive 3-dimensional image acquired by helical CT. We assess the usefulness of CT nephroscopy in the diagnosis of renal pelvic cancers.

MATERIALS AND METHODS

Surface rendering CT nephroscopy was performed after intravenous administration of contrast agent and furosemide in 32 patients with suspected renal pelvic carcinoma. Retrospective review revealed that 23 patients later underwent nephroureterectomy. Two observers blinded to the pathology results independently reviewed the CT nephroscopic and axial CT images of the 23 patients to localize pelvic tumors and to determine the extent of the disease. The CT nephroscopic and axial CT images were correlated with the pathological findings.

RESULTS

Pathological examination revealed 4 polypoid, 6 pedunculated, 7 sessile, 1 sessile with ulceration and 6 infiltrating renal pelvic carcinomas in the 23 patients. CT nephroscopy revealed 22 carcinomas (92%) and CT demonstrated 20 (83%). CT nephroscopy was superior to axial CT in detecting 4 pedunculated and 3 infiltrating carcinomas but failed to detect 1 sessile carcinoma which completely replaced the upper portion of a double renal pelvis and 1 polypoid tumor associated with infiltrating carcinoma. The CT nephroscopic images correlated well with pathological findings.

CONCLUSIONS

CT nephroscopy is useful to visualize the complex morphology of renal pelvic carcinomas noninvasively and is superior to axial CT for the detection of infiltrating and pedunculated carcinomas.

Decreased urinary concentrations of type IV collagen in amyotrophic lateral sclerosis

OBJECTIVES

Type IV collagen (IV-C) abnormalities of skin and serum have been reported in patients with amyotrophic lateral sclerosis (ALS). However, there has been no study of urinary IV-C in ALS. The present study investigates urinary IV-C and the relation to its skin content in patients with ALS.

MATERIAL AND METHODS

We studied IV-C immunoreactivity of skin and measured urinary levels of IV-C in ALS patients and controls.

RESULTS

The basement membrane as well as blood vessels of skin in ALS patients was weakly positive for IV-C as compared with those of controls. Immunostaining became even weaker as ALS progressed. The urinary level of IV-C in ALS patients was significantly decreased as compared to diseased controls (P<0.001) and healthy controls (P<0.001), and was negatively and significantly associated with duration of symptoms (r=-0.85, P<0.001). There was an appreciable positive correlation between urinary IV-C levels and the density for IV-C immunoreactivity in ALS patients (r=0.84, P<0.01).

CONCLUSION

These data suggest that a metabolic alteration of IV-C may occur in ALS patients and decreased levels of urinary IV-C may be related to the decreased IV-C immunoreactivity of skin in ALS.

Effects of placental chorionicity on outcome in twin pregnancies. A cohort study

OBJECTIVE

To examine the effects of the chorionicity of the placenta on infant outcome at 1 year of age in twin pregnancies.

STUDY DESIGN

Cohort study and retrospective review of the medical records of 44 monochorionic (MC) and 164 dichorionic (DC) twin gestations that had been followed at our institution since < 20 weeks' gestation. Physical and neurologic status was assessed at 1 year of corrected age in infants born to these 208 women.

RESULTS

Adverse infant outcomes, such as death, cerebral palsy and mental retardation, occurred in 9 (10%) of 88 MC infants (4 deaths and 5 disabled infants) as compared with 12 (3.7%) of 328 DC infants (6 deaths and 6 disabled infants) (P < .05). Although delivery occurred one week earlier in MC than in DC twins (34.7 +/- 2.8 vs. 35.7 +/- 2.3 weeks, P < .01), there was no significant difference in gestational age at birth or birth weight between the 9 MC and 12 DC infants with adverse outcomes. A presumptive antenatal diagnosis of twin-twin transfusion syndrome (TTTS) was made in 14 (32%) of the 44 MC twin gestations. TTTS was considered to be responsible for adverse outcome in 7 MC infants. All 9 MC infants with adverse outcomes and 4 (33%) of 12 DC infants with adverse outcomes belonged to pairs that had weight discordance > or = 25% (P < .01).

CONCLUSION

MC twins had an increased risk of adverse outcomes as compared with DC twins, mainly because of TTTS. In both MC and DC twins, a birth weight discordance > or = 25% was associated with adverse infant outcomes. The number of infants with disabilities at 1 year of age was equal to the number of deaths.

Cytokine secretion of periodontal ligament fibroblasts derived from human deciduous teeth: effect of mechanical stress on the secretion of transforming growth factor-beta 1 and macrophage colony stimulating factor

The periodontal ligament may play an important role in tooth eruption, root development and resorption. The tissue physiologically receives mechanical force during mastication. We focused on the effects of intermittent mechanical strain on the cytokine synthesis of periodontal ligament (PDL) fibroblasts in vitro. The cells were derived from human periodontal ligament of deciduous teeth (HPLF-Y) and permanent teeth (HPLF). The two kinds of PDL cells and human gingival fibroblasts (HGF) were cultured in flexible bottomed culture plates. The cells were mechanically stretched at 5% elongation, 3-cycles/min for 24 h on d 7 in culture using a Flexercell strain unit. After the stretching, we measured DNA content and alkaline phosphatase activity in the cell layer, transforming growth factor beta 1 (TGF-beta 1) and macrophage colony stimulating factor (M-CSF) contents in the conditioned medium. The TGF-beta 1 level in the conditioned medium of HPLF was significantly higher than that of HPLF-Y and HGF. It was stimulated by mechanical stretching only on HPLF, whereas no significant effect was observed on HPLF-Y and HGF. M-CSF secretion was inhibited by the stretching on all of HPLF, HPLF-Y and HGF. 1 alpha, 25 dihydroxy vitamin D3 (D3) stimulated M-CSF secretion into the culture medium of both HPLF and HPLF-Y, but the stretching inhibited M-CSF secretion and completely blocked the enhancement by D3. These data suggest that periodontal ligament cells synthesize and secrete the molecules as autocrine or paracrine factors that affect bone remodelling and root resorption and the level of those factors change in response to mechanical stress.

Changes in the cytoskeletal proteins, sarcoplasmic reticulum, and capillaries in acute relaxant-steroid myopathy (ARSM) in contrast to the corticosteroid myopathy

Since we reported a case of acute relaxant-steroid myopathy (ARSM) in 1994, we continued histological studies and compared the findings with those in a case of corticosteroid myopathy (CM). It was revealed that (1) dystrophin, spectrin, beta dystroglycan, and sarcoglycans on the cell surface were decreased, (2) regular arrangement of the sarcoplasmic reticulum was lost, and (3) some capillaries were degenerated. Since none of these changes were seen in CM, it became clear that ARSM is different from CM. It was estimated that continuous administration of non-depolarizing muscle relaxant produces a state akin to denervation. Combination of denervation, immobilization and circulatory disturbance in ARSM not only augments the effects of corticosteroids, but they produce changes different from CM, namely impairment of the cell membrane system (both internal and external) and capillary degeneration.

[Uptake of 201TlCl and 99mTc-tetrofosmin in neurofibroma: a case report]

A 34-year-old man with neurofibromatosis type 1 (von Recklinghausen's disease) was examined by 201TlCl and 99mTc-tetrofosmin scintigraphies. Hypervascularity was observed in the largest tumor of the right thigh. The tumor was also depicted on both scintigrams. Tumorectomy was performed and the pathologic examination revealed it to be a neurofibroma measuring 10 x 7 x 4 cm in size. These findings suggested that 201TlCl and 99mTc-tetrofosmin scintigraphies generally were unable to distinguish malignant from benign neurofibromas with certainty.

Comparative studies on sleep disturbance in the elderly based on questionnaire assessments in 1983 and 1996

We made an attempt to compare the complaints about sleep disturbance in the elderly based on the questionnaires using self-rating scales carried out in 1983 and 1996. It was noted that the score of awakening frequency from the course of sleep was the highest of all the items in men and women in both the 1983 and 1996 inquiries. The scores of insomnia nights per week and the difficulty in falling asleep were slightly higher in women than in men in both inquiries.

Normal in-plane respiratory motion of the bilateral hemidiaphragms evaluated by sequentially subtracted fast magnetic resonance images

The purpose of this study was to demonstrate hemidiaphragmatic motion using magnetic resonance imaging. The subjects were 13 healthy, nonsmoking volunteers. The sequence consisted of a fast gradient-recalled echo for coronal images and a single-shot fast spin echo with half Fourier transformation for sagittal images. The coronal and sagittal acquisition times were 0.83 msec and 0.58 msec per image, respectively. Thirty sequential images were obtained during quiet, deep respiration. Two series of subtraction images were made from these original sequential images (a given image was subtracted from the preceding or the next image in the original series). Hemidiaphragmatic motion was visualized as white or black bands on subtraction images. In the coronal plane through the left ventricle, there was a difference in motion between the right and left hemidiaphragms in 10 subjects during tidal respiration and in 12 subjects during deep respiration. On the sagittal images, the dorsal part of the hemidiaphragm moved more rapidly during quiet, deep respiration, especially on the left side.

Association of a decrease in antithrombin III activity with a perinatal elevation in aspartate aminotransferase in women with twin pregnancies: relevance to the HELLP syndrome

BACKGROUND/AIMS

Decreased antithrombin III (AT-III) activity and/or thrombocytopenia associated with an elevated serum level of aspartate aminotransferase in late pregnancy can threaten the lives of both the mother and the fetus. We investigated whether antenatal declines in AT-III activity and the platelet count occur in late twin pregnancy and whether reduced AT-III activity and/or thrombocytopenia precedes an increase in the serum level of aspartate aminotransferase.

METHODS

The platelet count, AT-III activity, and the serum level of aspartate aminotransferase were determined weekly or biweekly in 237 women with twin pregnancies in a longitudinal and partly prospective study.

RESULTS

Both AT-III activity and the platelet count decreased gradually in the last month of pregnancy, irrespective of the presence or absence of clinical signs of pre-eclampsia. A perinatal elevation in aspartate aminotransferase occurred in 36 (15%) of 237 women. The risk of a perinatal elevation in aspartate amino-transferase increased as the antenatal AT-III activity and/or the platelet count decreased. Pre-eclampsia developed in 60 women (25%). The relative risk of a perinatal aspartate aminotransferase elevation (95% confidence interval) for the 60 women with pre-eclampsia, the 60 women with a platelet count < or = the 25th percentile (164 x 10(9)/1), and the 60 women with AT-III activity < or = the 25th percentile (76% of normal) was 1.9 (1.0 to 3.4), 4.1 (2.3 to 7.5), and 5.9 (3.2 to 11.1), respectively, compared with the remaining 177 women.

CONCLUSIONS

AT-III activity and platelet count gradually decreased in the last month of twin pregnancies. A perinatal aspartate aminotransferase elevation was preceded by marked decreases in these parameters in women with twin pregnancies. The monitoring of AT-III activity and platelet count in women who exhibit a gradual decline in these parameters may help to avoid the development of severe HELLP syndrome.

A novel germline mutation of multiple endocrine neoplasia type 1 (MEN1) gene in a Japanese MEN1 patient and her daughter

Familial multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant inherited disorder characterized by tumors of the parathyroid, anterior pituitary and gastro-entero-pancreatic endocrine tissues. The MEN1 gene has recently been cloned and its germline mutations have been considered to play an important role in the tumorigenesis of MEN1. We analyzed a Japanese MEN1 patient and her daughter for germline mutations of the MEN1 gene. The proband (60 y.o.) had primary hyperparathyroidism (PHP) and gastrinoma, and her daughter (30 y.o.) had prolactinoma. Clinical examinations revealed no evidence of PHP in the daughter. We identified a novel heterozygous germline mutation (712 A del) at codon 201 in exon 3 of the MEN1 gene in the proband. Restriction digestion analysis revealed the same mutation pattern in her daughter. These findings suggest that this family has familial MEN1 including a rare case of MEN1 with a single lesion of the pituitary. Genetic examinations are useful as diagnostic tools for any rare or variant case of familial MEN1.

Frequent expression of midkine gene in esophageal cancer suggests a potential usage of its promoter for suicide gene therapy

We have examined the expression of midkine (MK), a neurotrophic factor with heparin-binding activity, in human esophageal cancer cells. Seven esophageal cell lines tested expressed the transcript and 8 out of 14 human esophageal tumor specimens were positively stained with anti-MK antibody, while surrounding normal esophageal tissues in these specimens were not stained. The 5'-flanking, 2.3 kb genomic region of the MK gene was shown to drive the transcription of a reporter gene in the esophageal cell lines in a cis acting manner. Forced expression in esophageal cancer cells of herpes simplex virus-thymidine kinase gene mediated by the flanking region of the MK gene conferred sensitivity to a prodrug, ganciclovir. The 5'-upstream region of the MK gene thus possesses putative promoter activity which can be used for suicide gene-based gene therapy for esophageal cancer.

Comparison between fractionated high dose rate irradiation and continuous low dose rate irradiation in spheroids

Recent interest in clinical brachytherapy focuses on the possible radiobiological equivalence between fractionated high dose rate (HDR) and continuous low dose rate (LDR) irradiations. This study is designed to compare the radiobiological effects between the two in vitro using multicellular spheroids of human tumor. Both HDR and LDR irradiations were delivered by 137Cs source, the dose rates of which were as 1.18 Gy/min and 5.5 mGy/min, respectively. Fractionated HDR irradiation of various fraction sizes was applied twice a day. We found that: (1) The fractionated HDR irradiation (8 Gy/2 fr/day) was more effective radiobiologically than continuous LDR irradiation (8 Gy/day) and the ratio of radiobiological effects of these irradiations was estimated as 0.82, based on the 50% spheroid cure dose (SCD50); (2) the radiobiological effectiveness was independent of the fraction size of HDR irradiation administrated, and the repair of sublethal damage (SLD) was absent, suggesting that the sparing effect of fractionated HDR irradiations was absent in spheroids. Our findings could provide important information for the clinical usage of the fractionated HDR radiotherapy to replace continuous LDR radiotherapy.

Polymorphonuclear leukocytes in the fetal membranes are activated in patients with preterm delivery: ultrastructural and enzyme-histochemical evidence

The purpose of this study was to examine evidence for the presence of activated leukocytes in the fetal membranes from patients with preterm delivery. Polymorphonuclear leukocytes in fetal membranes from seven patients with preterm delivery (26-32 weeks of gestation) were analysed using transmission electron microscopy and ultrastructural enzyme-histochemistry for peroxidase and alkaline phosphatase. A large number of leukocytes accumulated in the fetal membranes from preterm deliveries. Phagosome, phagocytosis of cell debris, attachment of primary granules to the phagosomal membrane and cell surface projections were observed in fetal membrane leukocytes from preterm delivery but not in peripheral blood leukocytes. Peroxidase and alkaline phosphatase activity was demonstrated on the plasma membrane of the phagosomes. Morphological and enzyme-histochemical observation indicated that polymorphonuclear leukocytes in the fetal membrane in patients with preterm delivery were stimulated or activated. Such activated leukocytes may play a role in the pathophysiology or pathogenesis of preterm delivery.

Using helical CT to evaluate renal cell carcinoma in patients undergoing hemodialysis: value of early enhanced images

OBJECTIVE

The purpose of this study was to evaluate early and delayed enhanced helical CT for revealing renal cell carcinoma in patients undergoing hemodialysis.

MATERIALS AND METHODS

Over the course of 3 years, 630 chronic hemodialysis patients underwent early and delayed contrast-enhanced and unenhanced helical CT to detect renal cell carcinoma. Retrospective review showed that 23 of these patients later underwent either unilateral or bilateral nephrectomy. Two radiologists, unaware of the pathology results, independently reviewed these 23 examinations. The sensitivity and specificity of each early and delayed scan for revealing neoplasms were determined using pathology as the gold standard. The mean attenuation values of the neoplasms and parenchymas of end-stage kidneys on both early and delayed enhanced images were also compared.

RESULTS

Helical CT revealed 225 lesions, 24 of which were found to be renal cell carcinomas at pathology. Delayed enhanced helical CT failed to detect one papillary carcinoma in an end-stage kidney with acquired cysts. Three nonpapillary carcinomas were not detected on delayed scans, and one was missed on an early scan of a patient without acquired cysts. The sensitivity and specificity of early enhanced CT for revealing renal cell carcinoma were 96% and 95%, respectively. In contrast, delayed enhanced CT achieved a sensitivity of 83% and a specificity of 94%. A significant difference in mean attenuation values between carcinomas and renal parenchymas was observed on the images with early enhancement but not on those with delayed enhancement (p < .0001).

CONCLUSION

Early enhanced helical CT is superior to delayed enhanced helical CT for revealing renal cell carcinoma in end-stage kidneys.

Glucose-6-phosphatase is present in normal and pre-eclamptic placental trophoblasts: ultrastructural enzyme-histochemical evidence

The purpose of the present study was to localize glucose-6-phosphatase (G6Pase) activity in the human placenta at various gestational stages and to compare them to pre-eclamptic placenta activity. Ultrastructural enzyme-histochemical analysis of G6Pase was performed using cerium and lead as capturing agents. Precipitates indicative of G6Pase activity were observed in the endoplasmic reticulum and the nuclear envelope of the syncytiotrophoblasts in near-term placenta obtained from women with normal pregnancies. In placenta taken from women with severe pre-eclampsia, the localization pattern, enzyme activity intensity, and morphology of the endoplasmic reticulum did not differ from normal pregnancies. Stringent control experiments were performed also to ensure specific detection of G6Pase activity. The results indicate that cytochemically detectable G6Pase is present in the human placenta. This enzyme may play significant roles in carbohydrate metabolism in the human placenta.

Difference in outcome of twins between early and delayed referrals

Data on the prognosis of twins from tertiary institutions may not represent the general incidence of adverse infant outcomes. We retrospectively investigated the infant outcome in 32 twin gestations referred to us at 29.9 +/- 3.7 weeks of gestation (range, 21 to 38 weeks) (late referral group) and 237 twin gestations that had been monitored by us since < 20 weeks' gestation (control group). The physical and neurological status of infants was assessed at 1 year of corrected age. Delivery occurred 3.1 weeks earlier in the late referral group than in the control group (32.4 +/- 3.9 vs 35.5 +/- 2.4 weeks, p < 0.001). Deaths by 1 year of age and disabilities such as cerebral palsy, mental retardation, and epilepsy occurred in 16 (25%) of 64 infants in the late referral group compared with 24 (5.1%) of 474 infants in the control group (p < 0.001). Thus, the inclusion of data on women who were referred late increased the incidence of adverse infant outcomes in our tertiary hospital from 5.1% to 7.4% (40/538). It was not known whether an early referral to a tertiary hospital would have improved the outcome in the late referral group. These findings suggest that data from tertiary institutions on the prognosis of twins may be affected adversely by the inclusion of data on women who are referred because of complications.

A family of MEN1 with a novel germline missense mutation and benign polymorphisms

The gene responsible for multiple endocrine neoplasia type 1 (MEN1) has recently been cloned, and its germline mutations were identified in patients with this syndrome. The majority of the mutations, frameshift or nonsense mutations, are expected to result in a loss of function of the gene product menin. Since the consequence of less common missense or in-frame deletion mutations is not clear, careful judgment is necessary regarding the role(s) of such mutations in MEN1 disease. Here we describe a large multigenerational MEN1 family with a novel germline missense mutation and three benign polymorphisms. The proband was a man with hyperparathyroidism and thymic carcinoid. We performed biochemical studies and DNA analyses of the MEN1 gene simultaneously and independently as family screening studies. Seven patients including the proband were identified, and all of them carried a heterozygous germline missense mutation E45G, but 5 members with normal biochemical results did not. This mutation was not observed in 50 normal volunteers. This novel missense mutation is therefore almost conclusively responsible for the disease. Although all of the mutant gene carriers in the present study already had clinical diseases, an MEN1 gene analysis in younger individuals at risk would be very useful in identifying carriers before the onset of the symptoms.

Germline mutation of the multiple endocrine neoplasia type 1 (MEN1) gene in a family with primary hyperparathyroidism

Familial primary hyperparathyroidism (FHP) is a rare hereditary disorder characterized by isolated parathyroid tumors without any other lesions related to multiple endocrine neoplasia (MEN). Primary hyperparathyroidism is usually expressed at an early age and is highly penetrated in MEN type 1 (MEN1), suggesting that some FHP may be a variant type or early stage of MEN1. The MEN1 gene has recently been cloned and its germline mutations have been considered to play an important role in the tumorigenesis of MEN1. We studied a Japanese family with primary hyperparathyroidism which included 4 patients. To investigate the possible relationship between primary hyperparathyroidism in this family and the MEN1 gene, we analyzed a proband for a germline mutation of the MEN1 gene in this study. We identified a novel heterozygous mutation (1350del3) at codon 414 in exon 9. Restriction digestion analysis revealed the same mutation pattern in his brother with hyperparathyroidism. These findings suggest that our patients may belong to a variant type of MEN1.

Influence of anti-androgens on the anterior horn cells of rat spinal cord: morphometric and in-situ hybridization studies

To examine the roles of the androgens for growth and maintenance of anterior horn cells (AHCs) of the spinal cord, one of the two anti-androgen agents, flutamide or cyproterone, was injected into young rats. Morphometric analysis of the spinal cords after the injections showed that the average area occupied by an AHC was significantly smaller in the rats treated with the anti-androgens than in the controls. By contrast, neurons in the posterior horns did not show significant difference in their size. Moreover, an in-situ hybridization of choline acetyltransferase (CAT) messenger RNA revealed a significant reduction in the signal density in AHCs in the treated rats. These results show that androgens play an important role in the growth and maintenance of AHCs, and influence a wide range of protein synthesis, including that of CAT.

Cellular signaling mechanisms for stimulation of growth hormone secretion and growth hormone primary transcripts by immunosuppressant agents, FK506 and cyclosporin A, in cultured rat pituitary cells

Although an immunosuppressant, FK506, has been known to stimulate growth hormone (GH) release from rat somatotropes, the cellular signaling mechanism is unknown. In the present study, intracellular signaling pathways were investigated for FK506- and cyclosporin A (CsA)-induced GH release in cultured rat anterior pituitary cells. Northern and Western blot analysis revealed that the FK506-binding protein (FKBP12) and the CsA-binding protein (cyclophilin A) exist at the mRNA and protein level in the rat anterior pituitary tissue. FK506 and CsA increased GH release in a dose-dependent manner and inhibited calcineurin (CaN) activity in the cultured pituitary cells. The third immunosuppressant, rapamycin (RP), inhibited the FK506-induced GH release, although RP alone had no effect. Protein kinase A (PKA) inhibitors, H-89 and HA-1004 and EGTA blocked FK506- and CsA-induced GH release. TGF-beta did not alter basal GH release, but inhibited FK506-induced GH release. GH primary transcripts were increased by FK506, and the effects were blocked by H-89 and HA-1004. These results suggest that the immunosuppressants, FK506 and CsA, stimulate GH release by inhibiting CaN activity which results in the activation of the PKA system in the rat somatotropes. TGF-beta receptors might be involved in FK506-induced GH release as a separate pathway. FK506 also stimulates GH primary transcripts via a PKA-dependent mechanism in a manner similar to its effects on GH release.

Identification of five novel germline mutations of the MEN1 gene in Japanese multiple endocrine neoplasia type 1 (MEN1) families

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder characterised by tumours of the parathyroid glands, the anterior pituitary, and endocrine pancreas. The MEN1 gene has recently been cloned and germline mutations have been identified in MEN1 patients in the United States, Canada, and Europe. We examined MEN1 gene mutations in MEN1 and MEN1 related cases in eight unrelated Japanese families. These families include five familial MEN1 (FMEN1), two sporadic MEN1 (SMEN1), and one familial hyperparathyroidism (FHP). Direct sequence analysis of the protein coding regions was carried out in all the probands. We identified six different heterozygous mutations in the coding region, of which five were novel, including one missense mutation (E45G) in both FMEN1 and SMEN1, three deletions (569del, 711del, and 1350del3) in FMEN1 and FHP, and two nonsense mutations (R29X and Y312X) in FMEN1 and SMEN1. Only one of these mutations (Y312X) has previously been reported. One proband with FMEN1 had no mutation in the entire exon sequence including the 5' and 3' untranslated regions. A restriction digestion analysis of 19 relatives from the five families showed a close correlation between the existence of the MEN1 gene mutation and disease onset. Four different polymorphisms, including two novel ones, were identified. These findings imply that a diversity of MEN1 gene mutations exists in Japanese MEN1 and MEN1 related disease, suggesting that analysis of the entire coding region of the MEN1 gene is required for genetic counselling in Japan.

Detection of a novel nonsense mutation of the MEN1 gene in a familial multiple endocrine neoplasia type 1 patient and its screening in the family members

We identified a novel nonsense mutation(R29X) of the MEN1 gene in a familial multiple endocrine neoplasia type 1 (MEN1) patient. Molecular analysis of the MEN1 gene was performed in the family members by a restriction digestion method. The same mutation pattern was seen in both the proband's younger brother and cousin diagnosed as MEN1, and was also observed in the son of the cousin who showed signs of normal levels of serum PTH associated with mild hypercalcemia and hypophosphatemia. These findings suggest that mutation analysis of the MEN1 gene is very useful in identifying the subclinical state of MEN1 as well as clinical MEN1.

[Severe Legionella micdadei pneumonia effectively treated with hemofiltration therapy]

A 42-year-old man was admitted because of fever, productive cough, and progressive dyspnea. Chest x-ray films and computed tomographic scans disclosed dense consolidation in the left and right lung fields. No pathogenic agent was found despite extensive bacteriological examinations. Based on serological findings, the patient was given a diagnosis of acute pneumonia caused by Legionella micdadei. It has been reported that Legionnaire's disease is easily complicated by fatal systemic illnesses such as disseminated intravascular coagulation (DIC) and multiple organ failure. In fact, the patient suffered from severe hypotension and DIC on admission. Treatments against systemic complications were started together with intravenous administration of antibiotics including erythromycin. Continuous intravenous cathecolamin, however, failed to alleviate the patient's shock. We therefore applied endotoxin eliminating therapy using a polymyxin-B-column (PMX) and continuous hemofiltration (CHF). The patient recovered from critical shock immediately after the start of PMX, which together with CHF, alleviated his systemic complications. Although the factors responsible for fatal systemic complications in Legionnare's disease are not well-documented, our findings suggested that some substances removable by PMX and CHF play an important role in pathogenesis.

[A study of neuroleptic malignant syndrome in the presenium and senium]

Recently, with the increase in elderly population, we have had more opportunities to administer neuroleptics to elderly patients for hallucinatory delusional state, delirium, psychomotor excitement, wandering etc. However, little is known about the characteristics of the neuroleptic malignant syndrome (NMS) in elderly patients, which is the most serious side effect of neuroleptics. In this paper, we present the clinical course of five NMS patients in the presenium and senium. Case 1 was 72-year-old male who was diagnosed as having dementia of Alzheimer's type (with late onset). He showed nocturnal wandering, insomnia, and irritability. Tiapride 60 mg per day had been administered previously. Just after the addition of oxypertine 10 mg per day, NMS occurred, and he died of pneumonia a week later. Case 2 was 75-year-old male who was diagnosed as having vascular dementia. He showed insomnia, hyperactivity and wandering. He had been given levomepromazine (LPZ) 10 mg per day over a long period of time. At first, he had daily episodic fever, however, serum CPK levels did not increase at that time. A month later, all the symptoms of NMS appeared and then the patient's condition suddenly deteriorated and he died three days later. Case 3 was a 64-year-old male who was diagnosed as having dementia of Alzheimer's type (with early onset). He showed insomnia, irritability and violence. Tiapride 50-125 mg per day was administered along with oxypertine 50-115 mg per day. Almost two months later, NMS occurred. He had daily episodic fever at first, extrapyramidal symptoms and autonomic instabilities gradually increased. Soon after symptoms of NMS were completed. In this case, NMS seemed to be induced by bacterial pneumonia after long term administration of LPZ 5 mg per day. Case 4 was a 75-year-old female who was diagnosed as having dementia of Alzheimer's type (with late onset). She showed hallucinatory delusional state. Although she had autonomic instabilities just after adminstration of haloperidol 1-2 mg per day, NMS itself occurred after discontinuing the neuroleptic. Case 5 was a 61-year-old female who was diagnosed as having schizophrenia at the age of forty. She was given various neuroleptics over a period of time. The neuroimaging in SPECT showed her cerebral cortex was generally hypoactive. She had a tendency to have autonomic instabilities after the administration of relatively high potential neuroleptics. Risperidone 3-6 mg per day was administered, and almost a month later, autonomic instabilities increased and she was diagnosed as having NMS. All the patients would be able to have brain dysfunction, which suggested that such patients may be liable to NMS. In our patients, NMS occurred after the additional administration of oxypertine 10 mg per day or after long time administration of LPZ 5 mg per day. It was suggested that NMS could occur after the administration of low dose and relatively low potential neuroleptics in elderly patients. Our 3 of 5 patients showed the delayed type of NMS, which might be relatively more frequent in senior and presenior patients than in younger patients. In case 3, NMS was induced by the somatic disease (bacterial pneumonia), however in other cases, NMS was not always induced by somatic disease. Our 4 of 5 patients experienced some of the symptoms of NMS--episodic fever, extrapyramidal symptoms and autonomic instabilities--before the onset of NMS. Such symptoms may be "pre-steps" to NMS. Once NMS occurred, the patient's systemic condition tended to deteriorate acutely. Due to the fact that our 2 of 5 patients died, it was suggested that the prognosis of the NMS patients in presenium and senium tends to be much worse. It is important to find the "pre-steps" to NMS and treat them as soon as possible for better prognosis.

Effects of soy milk and bifidobacterium fermented soy milk on lipid metabolism in aged ovariectomized rats

The effects of soy milk and fermented soy milk on lipid metabolism were studied in aged ovariectomized rats. Twenty 8-mo-old Wistar rats were randomly assigned to four treatment groups: sham-operated + control diet (sham-C); ovariectomized (OVX) + control diet (OVX-C); OVX + soy milk diet (OVX-SM); and OVX + fermented soy milk diet (OVX-FSM). The rats were fed on these diets for 6 weeks. Ovariectomy induced an increase in the plasma cholesterol level by 40%. The plasma total cholesterol level of the OVX-FSM rats was decreased by 20% compared to that of the OVX-C rats. The plasma total cholesterol level of the OVX-SM group was not significantly different from that of the OVX-C and sham-C rats. The plasma triglyceride level of the OVX-FSM rats was lower than that of the sham-C rats. The liver cholesterol content in OVX-SM and OVX-FSM rats was lower than that of the OVX-C rats. The liver triglyceride contents of the sham-C, OVX-SM, and OVX-FSM groups were lower than that of the OVX-C group. Fecal steroid excretion did not differ among the groups. Ovariectomy decreased the uterus weight. The OVX-SM and OVX-FSM groups had the same uterus weights as those of the OVX-C group. Thus, the diet including fermented soy milk prevented the cholesterol elevation induced in rats by ovarian hormone deficiency.

DNA fragmentation induced by a cytoplasmic extract from irradiated cells

Apoptosis is a mode of cell death characterized by distinct morphological features and DNA fragmentation. The program that leads to apoptosis has been considered to be predominantly extranuclear, and a signal transduction pathway to the nucleus exists during apoptosis, while characteristic events occur in the nucleus. As for radiation-induced apoptosis, the signal transduction pathway remains unclear, especially the sites where the primary effect of radiation occurs. In this study, we demonstrate that a cytoplasmic extract prepared from irradiated cells has the ability to cause DNA fragmentation and that caspase-3 is activated in this extract. Normal nuclei of HeLa S3 cells were added to a cytoplasmic extract made from HL60 cells which had been irradiated with 30 Gy of 137Cs gamma rays and were incubated. Agarose gel electrophoresis of the added nuclei showed a characteristic DNA laddering pattern. This reaction was blocked by a caspase-3 inhibitor but not by an ICE inhibitor. These observations suggest that a signal transduction pathway from an unknown target of gamma radiation may exist upstream of caspase-3 during radiation-induced apoptosis.

Effect of daily vaginal disinfection on duration of gestation after premature rupture of the membranes and on infant outcome

OBJECTIVES

We examined the effects of daily vaginal disinfection on the interval between premature rupture of the membranes (PROM) and delivery and on infant outcome.

METHODS

Daily vaginal disinfection with povidone iodine was performed on 43 women with PROM. The control group consisted of 59 women with PROM who did not undergo vaginal disinfection. In both groups, the infants born to these women were followed until 1 year of corrected age.

RESULTS

The degree of cervical dilatation, the leukocyte count, and the serum C-reactive protein level on admission did not differ between the 2 groups. Although there was no difference in the gestational week at delivery between the groups, the interval between PROM and delivery was significantly longer in the disinfectant group than among the control subjects (9.5 +/- 14.9 days vs. 3.9 +/- 5.1 days, p < 0.01). There was no difference in infant outcome between the 2 groups.

CONCLUSIONS

These findings suggest that daily vaginal disinfection with povidone iodine prolongs the duration of gestation in women with PROM and dose not have an adverse effect on the fetus.

Triplet pregnancy complicated by a gradual decline in antithrombin-III activity and HELLP syndrome: a case report

We prospectively evaluated the antenatal changes in antithrombin-III (AT-III) activity and liver enzymes in a woman with a triplet pregnancy. A gradual decline in AT-III activity occurred in the absence of clinical signs of preeclampsia and preceded the onset of the typical HELLP syndrome in this patient. Monitoring of AT-III activity might help to avoid the development of severe HELLP syndrome.

Lower risks of adverse outcome in twins conceived by artificial reproductive techniques compared with spontaneously conceived twins

The outcomes of twins conceived by 136 women after medical assistance (MA) such as ovulation induction with or without assisted reproductive techniques, and twins conceived spontaneously (SP) by 72 women were compared. All 208 women were monitored from < 20 weeks gestation; they all delivered at > or = 24 weeks gestation. The chorionicity of the placenta was diagnosed antenatally and confirmed after delivery. There were 10 perinatal deaths; the physical and neurological status of the remaining 406 infants was assessed at 1 year of corrected age. There were no differences in gestational age at birth, the birth weights of the larger and smaller twins, the birth weight discordance, or the incidence of life-threatening major malformations between groups. Adverse infant outcomes, such as death, cerebral palsy and mental retardation occurred in nine (3.3%) of 272 MA twins compared with 12 (8.3%) of 144 SP twins (P < 0.05). The placenta was monochorionic in only three (2.2%) of 136 MA twin pregnancies compared with 41 (57%) of 72 SP twin pregnancies (P < 0.001). Of the 21 infants with adverse outcomes, nine had monochorionic placentas. Thus, the risk of an adverse outcome was 2.8-fold higher (95% confidence interval (CI) 1.2-6.4) in monochorionic twins than in dichorionic twins (10 versus 3.7%; P < 0.05). There was no difference in the incidence of adverse infant outcomes between SP (4.8%) and MA (3.4%) twins with dichorionic placentas. These findings suggest that ovulation induction in itself was not associated with an adverse outcome of twin pregnancies. The lower frequency of monochorionic placentas in MA twins may have been responsible for the lower risk of an adverse outcome in MA twins.

In vivo occupation of dopamine D1, D2 and serotonin (5-HT)2A receptors by sertindole in the rat brain

OBJECTIVE

To determine the in vivo occupation of dopamine D1, D2 and serotonin (5-HT)2A receptors by novel antipsychotic agent sertindole using N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline (EEDQ), an irreversible antagonist at these receptor sites.

DESIGN

Animal study.

INTERVENTIONS

Intraperitoneal administration to Wistar rats of 1 of 4 test compounds: a control compound of 0.15% tartaric acid, or a compound of either sertindole (0.5 mg/kg or 2.0 mg/kg) or clozapine (20 mg/kg) dissolved in 0.15% tartaric acid 1 hour before intraperitoneal administration of EEDQ (8 mg/kg) or ethanol/water solution.

RESULTS

Sertindole exhibited little or no effect on D1 and D2 binding sites in vivo. On the other hand, sertindole occupied 5-HT2A receptors more extensively and firmly than EEDQ. This study indicates that sertindole is characterized by high occupancy of 5-HT2A receptors and by low or minimum occupancy of D1 and D2 receptors.

CONCLUSIONS

These characteristics are very similar to atypical antipsychotic agents such as clozapine. Sertindole's low liability to cause extrapyramidal side effects (EPS) may be related to greater long-term binding for 5-HT2A receptors relative to D2 receptors.