Comparative features of double-contrast barium studies in patients with isosporiasis and strongyloidiasis

OBJECTIVE

To compare the gastrointestinal features of isosporiasis and strongyloidiasis.

METHODS

Two patients with isosporiasis and three patients with strongyloidiasis were assessed by double-contrast radiography of the duodenum and small intestine, with reference to histology of the duodenal biopsy specimens.

RESULTS

Both conditions affected the duodenum and the proximal jejunum, and showed similar radiographic changes as the diseases progressed. Thus, three patients with diarrhoea lasting 1 year or less showed only minimal or irregularly thickened mucosal folds, which seemed to result from mucosal inflammation. Two patients with long-standing disease periods (17 years and 30 years) presented a markedly granular mucosal appearance with effacement of the folds on radiography. These chronological differences in the radiographic features seemed to reflect the degree of villous atrophy.

CONCLUSION

Isosporiasis has similar radiographic features of strongyloidiasis.

Improvement of P300 latency by treatment in non-insulin-dependent diabetes mellitus

P300 event-related potentials were investigated in 24 cases of non-insulin-dependent (Type II) diabetes mellitus (NIDDM) without apparent central nervous system (CNS) symptoms and without cerebrovascular diseases on head magnetic resonance imaging, and in 16 age-matched healthy control subjects. N200 and P300 latencies were significantly prolonged and N200 and P300 amplitudes were significantly smaller in the NIDDM group than in the healthy control group. P300 latency was significantly shorter after the treatment than before. N200 and P300 waves have been recognized as useful indicators of cognitive function. The present study suggests that cognitive function is impaired in NIDDM patients and may improve with treatment of hyperglycemia.

Multiple sclerosis presenting as acute disseminated encephalomyelitis

This is a case report of a woman who presented with acute disseminated encephalomyelitis and subsequently had relapses compatible with the diagnosis of multiple sclerosis.

Central motor conduction time and regional cerebral blood flow in patients with leuko-araiosis

Central motor conduction time (CMCT) and regional cerebral blood flow were investigated in 21 patients with leuko-araiosis. The severity of dementia was examined using mini-mental state examination. The head magnetic stimulation was performed using an SMN-1100 magnetic stimulator and a round coil with a diameter of 17 cm. The regional cerebral blood flow was measured using the stable xenon computed tomography method. The CMCT was significantly longer in the patients with dementia than in the patients without dementia. The blood flows in the parietal cortex, frontal white matter and thalamus were significantly lower in the patients with dementia than in the patients without dementia. There were significant negative correlations between the CMCT and the blood flows in the frontal cortex, temporal cortex, frontal white matter and thalamus. The significant negative correlations suggest that the prolongation of CMCT in patients with leuko-araiosis is related to the decrease in regional cerebral blood flows.

Selection of human ovarian carcinoma cells with high dissemination potential by repeated passage of the cells in vivo into nude mice, and involvement of Le(x)-determinant in the dissemination potential

Cells of the human tumor cell line RMG-1, derived from a clear-cell adenocarcinoma of the ovary, were injected intraperitoneally into nude mice, and the cells obtained from the tumor nodules in the mesenterium were found to form a larger number of, and larger-sized, tumor nodules than the original RMG-1 cells. The RMG-1-h cells, transferred into culture from the tumor nodules after a 4th in vivo passage, showed a dissemination potential as high as that of cells disseminating directly from the tissues, and exceedingly higher than that of RMG-1 cells. To assess the molecular bases of the different biological properties of RMG-1 and RMG-1-h cells, we compared the content and expression of various carbohydrate antigens in both cells. The chromosomal profile of RMG-1-h cells revealed their human origin and was identical to that of the original RMG-1 cells. In contrast to the broad histogram for the Le(x)-bearing cells among RMG-1 cells in flow cytometry, the weakly and moderately positive cells toward anti-Le(x) antibody were found to be eliminated from the histogram for the RMG-1-h cells, resulting in the enrichment of cells strongly expressing Le(x), which may account for the high dissemination potential. In addition, the adhesion of RMG-1 cells to mesothelial cells was found to be significantly inhibited by pretreatment of the cells with anti-Le(x) antibody, indicating Le(x)-mediated cell-to-cell interaction between ovarian cancer cells and mesothelial cells. By TLC-immunostaining, two Le(x)-glycolipids, III3Fuc alpha-nLc4Cer and V3Fuc alpha-nLc6Cer were detected in both RMG-1 and RMG-1-h cells, and their total concentrations were not significantly different from each other. However, the hydrophobic moieties of Le(x)-glycolipids in RMG-1-h cells were different from those in RMG-1 cells, suggesting that a difference in the structure of the hydrophobic moieties of Le(x) is partly involved in the enhanced reactivity of RMG-1-h cells toward anti-Le(x) antibody. Thus, the high dissemination potential of ovarian cancer cells was shown to be mediated by the Le(x)-determinant and the Le(x)-bearing cells are enriched by repeated in vivo passage of the cells into nude mice.

Growth and maturation of small hepatocytes

Proliferation of adult rat hepatocytes is observed in serum-free Dulbecco's modified Eagle's medium (DMEM) supplemented with 10 mmol/L nicotinamide and 10 ng/mL epidermal growth factor (EGF). The proliferating cells are mainly mononucleate and form small cell colonies surrounded by mature hepatocytes. Although these cells in focal colonies have a less-differentiated appearance, immunocytochemically and ultrastructurally they possess hepatic characteristics. The size of small hepatocytes is one-third to half that of mature hepatocytes. Therefore, we call the cells forming a colony, small hepatocytes. The small hepatocytes can be subcultured for several passages. Furthermore, the cells are rich in the supernatant following 50 g centrifugation for 1 min after collagenase liver perfusion. When the cells are cultured in DMEM supplemented with 10% foetal bovine serum, 10 mmol/L nicotinamide, 1 mmol/L ascorbic acid 2-phosphate, 10 ng/mL EGF and 1% dimethyl sulphoxide, each small hepatocyte can clonally proliferate for more than 3 months. A small hepatocyte divides to form a colony and the number of cells reaches more than 100 within 20 days. With time in culture, cells with a large cytoplasm appear within a colony. They have many mitochondria and large peroxisomes with crystalline nucleoids and are typical, mature hepatocytes. Immunoreactivity to connexin 32 and well-developed bile canaliculus structures are often observed in the cell-cell borders. Thus, we suggest that small hepatocytes may be considered to be 'committed progenitor cells' that can further differentiate into mature hepatocytes.

[Clinical and histopathological features of hemangiopericytoma-like tumor of the nasal cavity]

A 65-year-old woman consulted our hospital complaining of left nasal obstruction. On nasal examination, a reddish half round tumor arising from the left nasal septum was found. We removed the tumor together with normal septal mucosa. Histologically, the tumor was diagnosed as a hemangiopericytoma-like tumor. It has been reported that a hemangiopericytoma-like tumor is microscopically distinguished from similar type tumors arising from other sites of the body. The most notable microscopic features of intranasal hemangiopericytoma-like tumors are their uniformity of cells and the absence of nuclear or cytoplasmic pleomorphism with a sheetlike arrangement, and no evidence of varying growth phases or necrosis. This is the second case report of this type of tumor in Japan.

Interleukin-6 and "complex" cardiac myxoma

A rare case of "complex" cardiac myxoma is reported. Complex cardiac myxoma manifests with more constitutional signs than the sporadic type. These constitutional signs are known to be associated with the overproduction of interleukin-6 by cardiac myxomas. In our study, immunohistochemical staining of the myxoma for interleukin-6 was strongly positive. The serum interleukin-6 level decreased after surgical removal of the tumor and has remained undetectable for the past 2 years.

Magnetic resonance imaging findings of the skeletal muscle of a patient with nemaline myopathy

This is the first magnetic resonance imaging (MRI) report of nemaline myopathy in which muscle atrophy was not apparent clinically in the lower extremities because of subcutaneous fat. The patient is a 38-year-old woman who was admitted to our hospital because of muscle weakness of the four extremities. Until the age of 17 years, she was asymptomatic except that her running speed was slow. The T1-weighted image of muscle MRI at the mid-thigh level showed hyperintensity of the quadriceps femoris muscle and relatively spared hamstring muscle. The T2-weighted image of muscle MRI at the maximum diameter of the lower leg showed hyperintensity of the tibialis anterior muscle and a relatively spared triceps surae muscle. The biopsy specimen of the right deltoid muscle showed nemaline bodies and type II fiber deficiency.

[Myopathy with cerebral white matter abnormality--a case report]

A 45-year-old man noticed mild numbness of the feet at the age of 40 years and difficulty in standing up from squatting position at 43 years. His birth and developmental milestones were normal and the family history was unremarkable. He was alert and intelligent with global IQ of 91. There was mild muscle weakness as well as atrophy in bilateral hips and thighs. The serum creatine kinase level was 542 U/l. On computed tomography, the hamstrings were preferentially involved. The biopsied specimens from the right quadriceps femoris and peroneal muscles showed myogenic changes with evidence of necrotic and regenerating process. Dystrophin, dystrophin-associated glycoproteins and merosin were normally expressed. From the clinical and pathologic findings, he was diagnosed as having myopathy. The electroencephalogram was normal but the P300 latency was prolonged. T2-weighted head magnetic resonance imaging showed diffuse high intensity in the cerebral white matter. Myopathy with cerebral white matter abnormality in adult patients has not yet been reported. Asymptomatic cerebral white matter abnormality should be considered in adult patients with myopathy.

Effectiveness of traditional Chinese medicine in Alzheimer disease

Effects of traditional Chinese medicine on dementia, P300, cerebral blood flow, and cerebrospinal fluid (CSF) examination were investigated. Ten patients with Alzheimer disease (AD) who agreed to take traditional Chinese medicine were studied. The traditional Chinese medicine was given for 3 months and the Mini-Mental State Examination (MMSE), P300 examination, cerebral blood flow examination, and CSF examination were performed before and after taking the traditional Chinese medicine. The scores of the MMSE, the P300 latency, and blood flow in the cerebral cortex in AD improved with treatment with the traditional Chinese medicine. The concentration of alpha-aminobutyric acid in the CSF decreased with treatment with the traditional Chinese medicine. The improvement is considered to be not a placebo effect. Key Words: T

Circadian blood pressure and heart rate profiles in normotensive patients with mild hyperthyroidism

We investigated the influence of thyroid hormones on the circadian blood pressure (BP) and heart rate (HR) variations in 12 normotensive subjects and 12 normotensive patients with mild hyperthyroidism. BP and HR were monitored every 30 minutes for 48 h, and electrocardiograms (ECGs) were recorded to measure the RR interval of the ECGs. We analyzed the circadian BP and HR variations, HR variability, and the morning rise in BP and HR. There was no significant difference in the average 24 h BP between groups. HR and pulse pressure were higher in the hyperthyroid group than in the control group. Though the circadian BP pattern was similar in both groups, HR decreased at night in the control group, but not in the hyperthyroid group. Spectrum analysis of the RR interval showed no increase in the high-frequency (HF) component at night in patients with hyperthyroidism. The HR did not show a morning rise in the hyperthyroid group. These findings indicate that the circadian rhythm of HR was not preserved in patients with mild hyperthyroidism. The circadian BP rhythm was similar in normotensive subjects and normotensive patients with mild hyperthyroidism, suggesting that it resulted from factors other than thyroid hormone.

Significant risk factors of recurrence in muscularis proprial carcinoma of the stomach

BACKGROUND/AIMS

The aim of this study is to elucidate significant risk factors of recurrence in muscularis proprial gastric cancer (MPGC).

METHODOLOGY

Seventy-three patients who underwent curative gastrectomy for MPGC were divided into 14 patients with postoperative recurrence (Group 1) and 59 patients without recurrence (Group 2). A retrospective study of Group 1 compared the clinicopathological features with Group 2.

RESULTS

There were no significant differences of age, gender and operative method including frequency of lymph node dissection between Group 1 and Group 2. Although tumor size, gastric location and histological type did not significantly differ between the two groups, the rate of Borrman type in Group 1 (71.4%) was significantly higher than in Group 2 (42.4%). Significant risk factors of recurrence in pathological findings were the presence of secondary lymph node metastasis or more, lymphatic and venous involvement. Median survival in Group 1 (28.8 months) was significantly worse than in Group 2 (59.0 months). The 1-year, 3-year, and 5-year survival rates between Group 1 versus Group 2 were 71.4% versus 98.3% (p<0.01), 28.6% versus 96.7% (p<0.01), and 7. 1% versus 95.0 (p<0.01), respectively.

CONCLUSIONS

Prognosis of the postoperative recurrence in MPGC was very poor. More careful prophylactic treatment against recurrence of MPGC should therefore, be prescribed in patients with the aforementioned risk factors of recurrence.

Correlation between contingent negative variation and regional cerebral blood flow

The relationship between contingent negative variation (CNV) and regional cerebral blood flow was investigated, using the stable xenon computed tomography method. Seventeen cases of chronic multiple cerebral infarction in the perforating artery areas (vascular dementia, mean age 67.0), 6 cases of Alzheimer's disease (mean age 69.5) and 8 healthy controls (mean age 62.5) were studied. Regional cerebral blood flows in the frontal, temporal, parietal and occipital cortex, frontal, temporal and occipital white matter, caudate nucleus, putamen and thalamus were measured. The amplitude of early CNV was significantly smaller in the vascular dementia group than in the healthy control group. The blood flows in the parietal cortex and thalamus were significantly lower in the vascular dementia group than in the healthy control group. There was a significant positive correlation between the amplitude of early CNV and frontal cortex blood flow. No significant correlations were present between the CNV and the other regional cerebral blood flows nor in healthy controls. The amplitude of CNV has been reported to be decreased in dementia. From the present study, the amplitude of early CNV was considered to be influenced by the blood flow in the frontal cortex.

Relation between spontaneous contraction and sarcoplasmic reticulum function in cultured neonatal rat cardiac myocytes

The relation between spontaneous contraction, Ca2+ oscillations, and sarcoplasmic reticulum (SR) function was studied in cultured neonatal rat cardiac myocytes. Spontaneous contraction and Ca2+ oscillations were irregular at day 2 of culture but became regular at day 6 of culture in neonatal rat cardiac myocytes. The rate of spontaneous contraction and the frequency of Ca2+ oscillations were decreased by verapamil and were abolished in the absence of extracellular Ca2+ at both day 2 and day 6 of culture. Ryanodine and thapsigargin increased the rate of contraction and the frequency of Ca2+ oscillations at day 2 of culture but did not affect contractions and Ca2+ oscillations at day 6 of culture. Ultrastructural observation showed that the structure of SR developed less at day 6 of culture. The present results suggest that spontaneous contraction and Ca2+ oscillations are due mainly to extracellular Ca2+ influx but not to Ca2+ release from SR in neonatal rat cardiac myocytes.

[Clear cell ependymoma--a case report]

A case of intraaxial clear cell ependymoma is reported. A 46-year-old man complained of right hemiparesis. CT scan showed a mass lesion on the median plane with a huge cyst in the left frontal lobe. MRI showed an iso-low intensity mass by T1-weighted image. The tumor was heterogeneously enhanced by Gd-DTPA and the wall was enhanced as well. Angiogram revealed a tumor stain from the right internal carotid artery. The main mass of the tumor was totally removed but the cystic wall was left removed. Histopathological examination revealed clear cell ependymoma. Immunohistochemical examination revealed that, although vimentin and NSE were positive, GFAP, synaptophysin and S-100 were negative. Ultrastructual examination revealed cilia, microvilli and desmosomal junctions. The patient fully recovered after operation and showed no sign of recurrence after an year of follow-up. Clear cell ependymoma is a rare variant of ependymoma. Ultrastructual examination was more useful than immunohistochemical examination for diagnosis.

[A case report of recurrent self inserted needle in heart]

A 17-year-old female who had, on two occasions, inserted a total of 7 needles into her heart and chest wall, resulting in autolesion on both occasions, was examined. On the first occasion, because the needle end was recognizably protruding from the right ventricle, we successfully removed the needle without using ECC. No complications arose prior to discharge, after which she regularly visited the psychiatric department for treatment. Two months after discharge, she again inserted needles into her chest wall and was admitted to hospital. At that time, five needles were evident in the chest wall. During preparation for removal of the needles under local anesthetic, she escaped from the room. When found in a ward several hours later, six needles were embedded in her chest wall, the sixth, most recently inserted needle was an injection needle. Due to the depth to which the needle had been inserted in the heart, neither the point nor end were visible, and thus the needle had to be removed using ECC and fluoroscopy.

Limited reproducibility of circadian variation in blood pressure dippers and nondippers

The relation between blood pressure (BP) variation and hypertensive organ damage is controversial. The reproducibility of the circadian variation pattern acceptable as the standard for discriminating between "dippers" and "nondippers" has not yet been evaluated. We evaluated the reproducibility of "dipper" and "nondipper" patterns in essential hypertensives by monitoring BP for 48 h. Noninvasive ambulatory BP and heart rate (HR) monitoring for 48 h every 30 min were performed in 253 untreated patients with mild-to-moderate essential hypertension. Mean daytime (awake) and nighttime (sleeping) systolic BP, diastolic BP, and HR values were analyzed by reviewing the patients' diaries. Patients were divided into two groups by presence (dippers) and absence (nondippers) of a reduction of both systolic and diastolic BP during the night of > 10% of the daytime pressure. A subject who was a dipper on day 1 remained a dipper on day 2 in 41% (n = 103, DD group) and changed to nondipper in 16% (n = 41, DN group). A subject who was a nondipper on day 1 remained a nondipper on day 2 in 30% (n = 75, NN group) and changed to a dipper in 13% (n = 34, ND group). Our findings indicate that there is a high risk of false-positive or false-negative results when 24-h recordings are used to identify dipper and nondipper profiles.

[Correlation between event-related potentials and regional cerebral blood flow in chronic alcoholism]

We report a correlation between P300 and cerebral blood flow in 11 patients with chronic moderate alcoholism. The patients had been drinking more than 83 ml pure alcohol equivalent everyday for more than 10 years and did not have any other neurological diseases. The P300 latency was significantly longer in the chronic alcoholism group than in the age-matched healthy control group. There was a significant negative correlation between the P300 latency and the thalamus blood flow in the chronic alcoholism group. These findings suggest that there is a subclinical disturbance of cognitive function in chronic alcoholism and that the prolongation of P300 latency is related to the decrease in thalamus blood flow in chronic alcoholism.

[A case of MIDCAB to the left circumflex via the left posterolateral thoracotomy]

There have been many reports of MIDCAB to left anterior descending artery via a small dissection utilizing the left anterolateral thoracotomy. We report here a case of CABG reoperation to the circumflex artery by MIDCAB via the left posterolateral thoracotomy. A 66-year-old male patient had received a 3 branch bypass graft on the LITA-LAD and the SVG-OM-4 PD at another institution. Postoperative angiography revealed a SVG occlusion. Since repeated intervention was unsuccessful, reoperation was necessary. To preserve the patency of the LITA, the 4th left intercostal posterolateral thoracotomy was selected. We utilized a commercially available rib retractor for MIDCAB, as well as a stabilizer and a CO2 blower to obtain a nearly perfect bloodless stabilized view. A new SVG was used to connect the left circumflex artery. The operation was successful without any postoperative complications or need for transfusion. After a two week hospital stay, the graft patency was confirmed and the patient was discharged.

Alteration of expression of liver-enriched transcription factors in the transition between growth and differentiation of primary cultured rat hepatocytes

In the present study, we showed the role of the liver-enriched transcription factors in the transition during which proliferating hepatocytes become quiescent. We used primary rat hepatocytes cultured in modified L-15 medium. The cells proliferated and, after the addition of 2% dimethyl sulfoxide (DMSO) from day 4, they stopped growing and gradually differentiated. During hepatic proliferation, expression of hepatocyte nuclear factors (HNF)1alpha, HNF4, C/EBP alpha, and C/EBP beta mRNAs was depressed, whereas that of HNF3alpha and HNF3beta transcripts was enhanced. After the addition of DMSO, the expression of HNF1alpha, HNF3gamma, and HNF4 returned to the level in isolated cells and HNF1beta mRNA expression gradually increased. However, expression of C/EBP alpha and C/EBP beta mRNAs was partially recovered. The mitoinhibitory agents, IL-1beta, IL-6, TGF-beta, and activin A, were examined to determine whether they could induce differentiation of proliferating hepatocytes as shown in cells treated with DMSO. Although these factors inhibited cell growth, the cells did not differentiate. The expression pattern of HNF3gamma mRNA was quite different in the cells cultured with DMSO and those cultured with cytokines. Therefore, hepatic differentiation requires not only inhibition of DNA synthesis but also induction of appropriate transcription factors. Thus, expression of HNF3gamma, C/EBP alpha, and C/EBP beta may be necessary for hepatocytes to acquire highly differentiated functions in addition to coexpression of certain amounts of transcripts of HNF1alpha, HNF1beta, HNF3alpha, HNF3beta, and HNF4 as well as suppression of C/EBP delta.

QT dispersion in dipper- and nondipper-type hypertension

The aim of this study was to identify the relationship of QT dispersion on 12-lead electrocardiograms and left ventricular mass index on echocardiograms associated with the circadian rhythm of blood pressure (BP). Heart rate and BP were monitored every 30 min for 48 h in 62 patients with essential hypertension using an ambulatory BP monitoring device. The patients were divided into four groups according to gender and circadian BP pattern (nocturnal BP dipper or nondipper). The patients were classified as dippers if their daytime BP decreased by at least 10% during the night and all the other subjects were classified as nondippers. Age, body mass index, and 48-h mean BP were similar among the four groups. During the night-rest period, the systolic and diastolic BP were significantly decreased in dipper-type hypertensives. The maximum QTc interval and QTc dispersion were longer in nondippers than in dippers. Left ventricular mass index (LVMI) had a tendency to increase in nondippers. The nocturnal reduction of BP significantly correlated with QTc dispersion and LVMI. The QTc dispersion significantly correlated with LVMI and interventricular septum thickness.