Effects of alcohol ingestion on vestibular function in postural control

In order to define the acute effects of a moderate quantity of alcohol on balance, related to the vestibular function, vestibulo-ocular reflex (VOR) test, caloric test and dynamic posturography (EquiTest) were performed. Ten healthy male volunteers aged 19-27 average 22.8) years old imbibed 1.5 ml whisky (alcohol content 43%) per kilogram of body weight within 5 min. Blood alcohol level (BAL) was measured before administration and then after 30, 90, and 150 min. Equilibrium examinations were performed immediately after each blood sample was taken. At the highest alcohol level, significant reductions were found in VOR gain, in the maximum slow-phase velocity of the caloric test and in the equilibrium score of the sensory organization test in condition 5, when compared with those before drinking. In some typical cases, the subjects' response in all tests were most disturbed at the time when the highest alcohol level was measured. From our results, we conclude that a moderate quantity of alcohol affects not only the oculomotor system but also the vestibular system. Furthermore, it was suggested that one of the reasons for postural instability after drinking alcohol may be reduced vestibular function.

Influence of a cold front upon the onset of Meniére's disease in Toyama, Japan

In order to clarify the influence of a cold front (CF) upon the onset of Meniére's disease (MD), major CFs were defined by meteorological observations, and the influence of CFs on MD was evaluated by using the time n method. From our preliminary study it was seen that the onset of MD had its highest incidence exactly on days where a CF passed by. Out of the patients with MD, sudden deafness (SD) and Bell's palsy (BP) who visited our neurotological clinic of the Toyama Medical and Pharmaceutical University from 1987 to 1992, 67 MD patients, 70 SD patients and 70 BP patients could clearly define the date of the onset of their disease, and were therefore selected for this epidemiological study. Thirty-six our of the 67 MD patients had the first attack on the day when a CF passed by or on the next day. The results obtained from these studies were as follows. i) The onset of MD was influenced by the passing of a CF, and this influence was more specific in MD than in SD or BP. ii) In the 36 CF influence MD patients, the majority were over the forty years, and their hearing level was worse than that of the other 31 MD patients during the observation periods.

Epidemiological study of severe cases of Meniére's disease in Japan

In order to clarify the characteristics of severe cases of Meniére's disease (MD), we analyzed various epidemiological factors such as sex ratio, past history, complication, cause of onset of vertiginous attacks, etc., in a series of 958 patients with definite MD. Data were obtained from the three Japan-wide surveys of MD conducted by the Meniére's Disease Research Committee of Japan (1975-76) and the Vestibular Disorders Research Committee of Japan (1982-84 & 1990). Following the ideas proposed by the members of the Vestibular Disorder Research Committee of Japan, we divided severe cases into three categories according to the following criteria i) bilateral MD cases (BMD), ii) unilateral MD cases with prolonged disabled vertigo (UPDV), iii) unilateral MD cases with profound hearing loss (UPHL). About 40% of the subjects were classified as severe cases (UPDV: 23%; BMD: 9%; UPHL: 6%). The ratio of otitis media in past history was statistically different between severe cases and non-severe patients (p < 0.05), suggesting that otitis media in the past may contribute to the severity of Meniére's disease.

Results of surgical treatment of pulmonary metastases

From 1970 to 1993, 155 thoracotomies for metastatic lung tumors were performed on 113 patients in the Department of Surgery, Kanazawa University School of Medicine. Overall 30-day mortality amounted to 0.9% (1/113). The cumulative 3- and 5-year survival rates were 39.4% and 29.1%, respectively. The overall median survival was 24 months. The 5-year survival rate for carcinoma was 37.2% and for sarcoma it was 14.5% (P < 0.01). The other significant predictors of better long-term survival with metastatic lung tumors were solitary lesions, disease-free interval (DFI) > 24 months, and tumor size < or = 20 mm in diameter. There was no significant difference in survival based on the method of pulmonary resection. Repeat thoracotomy for recurrent metastases was performed in 27 patients, whose 5-year survival rate after the first lung resection was 35.5%. For bilateral pulmonary metastases, we recently performed simultaneous bilateral thoracotomy via median sternotomy on 25 patients and transsternal simultaneous bilateral thoracotomy on 8 patients. The latter procedure provides a wide operative field and better survival. We conclude that resection of metastatic lung tumors is safe and effective, and that repeat thoracotomy is warranted in selected patients with recurrent pulmonary metastases.

Occlusion of the left coronary ostium due to fusion of the aortic cusp to the wall

We report on a patient with occlusion of the left coronary ostium and aortic regurgitation due to fusion of the left aortic cusp to the aortic wall. The left coronary flow was restored by excision of the adherent left aortic cusp and aortic valve replacement.

Well-differentiated hepatocellular carcinoma: clinicopathological features and results of hepatic resection

OBJECTIVES

To clarify clinicopathological features and surgical results in patients with well-differentiated hepatocellular carcinoma (wd-HCC) corresponding to Edmondson's cell grading I/I-II.

METHODS

The clinicopathological characteristics, diagnosis, and results of surgery were studied in 14 wd-HCC patients who underwent limited hepatic resection.

RESULTS

All patients had liver cirrhosis and solitary tumors. The tumor sizes ranged from 10 to 25 mm. Serum alpha-fetoprotein levels were normal in 13 patients. The detection rates of sonography, computed tomography (CT), angiography, CT during arterial portography, 1-wk lipiodol CT, and 3-wk lipiodol CT were 100%, 43%, 36%, 69%, 57%, and 0%, respectively. High echoic pattern on sonography and disappearance of lipiodol 3 wk after injection were characteristic findings. There was no operative death. Although seven patients developed intrahepatic tumor recurrence, early treatment including ethanol injection therapy and arterial embolization/infusion therapy controlled the recurrences in five patients. Eleven patients are surviving 25-83 mo after surgery (mean, 44 mo); the remaining three died of pneumonia or hepatic insufficiency 44-62 mo after surgery. Eight patients received successful direct interruption surgery for concurrent esophagocardia varices. Pathological features of wd-HCCs included lack of tumor invasiveness or capsule, nuclear crowding, microacinar formation, fat deposition, presence of portal tracts, and surrounding adenomatous hyperplasia.

CONCLUSION

Wd-HCCs present atypical findings in various imagings and histology because of the earlier developmental stage of HCCs. Hepatic resection for wd-HCCs provides excellent patient survival.

[Reoperation for recurrent and second primary lung cancer]

Thirty patients have undergone multiple resections for non-small cell lung cancer from 1973 to July 1994, constituting 2.6% of 1,153 who had undergone pulmonary resection for such tumor. In the 22 patients for recurrent cancer, 15 resections of the ipsilateral lung and 9 of the contralateral lung were performed with no operative death. The survival rate following second resection in 22 patients was 33.8% at 3 years and 13.5% at 5 years. Survival rate was poor in patients with DNA aneuploid primary tumor and there was not a patients of 5 years survival. Three out of the 5 patients which had a diploid pattern in the primary tumor, showed an aneuploid pattern in the recurrent tumor. Long survival patients were founded only in the patients which had a diploid primary tumor. In the 8 patients for second primary lung cancer, 4 resections of the ipsilateral lung and 4 of the contralateral lung were performed, including two bronchoplastic surgery for early hilar squamous cell carcinoma. The survival rate following second resection in 8 patients was 64.2% at 5 years with good result. We concluded that an aggressive surgical approach is safe and warranted in patients with second primary lung cancer.

Epidemiological and clinical characteristics of Menière's disease in Japan

From 1975 to 1990, nationwide surveys on Menière's disease were performed three times by the Research Committee of Menière's disease (1975-76) and the Research Committee of Peripheral Vestibular Disorders (1982-84 and 1990) in Japan. Nine hundred and fifty-eight definite Menière cases, 520 in the 1st, 230 in the 2nd and 148 in the 3rd survey, were sampled by the members of the Committees. The epidemiological and clinical characteristics of Menière's disease were analyzed and compared with such control cases as other vertiginous patients, ENT patients without vertigo, and healthy subjects. In Menière's disease, the male to female ratio has changed from even to female predominance over the 15 years the study ran. The age distribution at onset peaked in the forties for males and thirties for females. Significant epidemiological results are summarized as follows: Definite Menière's disease has a higher incidence in married persons and in people with a nervous and precise character, whereas the incidence is lower in obese people. Physical and mental fatigue induced the onset of attacks. Menière's disease happened in day time in many cases, especially during the afternoon. As these epidemiological findings were commonly observed in all the surveys, the results are considered to be universal epidemiological characteristics of Menière's disease in Japan. In the same period, regional investigations were performed by Toyama Medical Association and our University. The male to female ratio in Toyama indicated a more significant female predominance than in the nationwide surveys. The prevalence of Menière's disease in Toyama Prefecture has been almost constant in all surveys, about 17/100,000 since 1974.(ABSTRACT TRUNCATED AT 250 WORDS)

Preliminary guidelines for reporting treatment results in Menière's disease conducted by the Committee of the Japanese Society for Equilibrium Research, 1993

In order to draft guidelines for reporting treatment results in Menière's disease (MD) in Japan, 17 committee members elected from the Japanese Society for Equilibrium Research (JSER) have met for about two years. The preliminary guidelines obtained from their discussions are summarized as follows. i) Evaluations of symptoms: Only definitive vertiginous spells with spontaneous nystagmus should be evaluated (AAOO, 1972). The parameter for the assessment of hearing levels should be evaluated using four-frequency pure-tone averages (PTA) at 250 Hz, 500 Hz, 1 kHz and 2 kHz. ii) Evaluation period: Valid results for the evaluation should be based on observations at least six months before treatment and over at least 12 months after initiation of therapy. iii) Evaluation criteria The formula expressing the effects of treatment on vertiginous spells should adopt a numeric vertigo score, which is shown in the AAO-HNS (1985) guidelines. If the duration of pre-treatment evaluation period is less than 6 months, the divisor is replaced by the average of definitive spells per month for the period of observation. iv) Global judgment: For a global judgment, patients and doctors should jointly evaluate the treatment results from the standpoints of their subjective and objective symptoms respectively.

Changes in folate concentration in Yoshida sarcoma after administration of leucovorin or cisplatin

Both leucovorin (LV) and cisplatin (cis-dichlorodiammine platinum II, CDDP) act as modulators of 5-fluorouracil (5-FUra) by increasing the intracellular concentration of reduced folate. We measured intracellular folate levels following the administration of LV or cisplatin in tumor-bearing rats to determine the optimal schedules for their use as 5-FUra modulators. Donryu rats were inoculated with Yoshida sarcoma cells on the right flank. Seven days after tumor inoculation, the animals were injected with LV or CDDP. The kinetic and dose-related changes in intracellular folate concentration were analyzed by means of a binding assay. Folate levels in the tumor tissues were significantly higher than baseline 1 and 2 h after administration of LV and remained significantly high until 8 h after administration. Folate levels in the tumor tissues were significantly higher than baseline 1 and 2 h after cisplatin administration, then decreased to a rather low level 8 h after, and to a significantly lower level than baseline 24 h after administration. The folate levels in the tumor tissue increased in proportion to the dose of LV, but did not increase when the dose of cisplatin was increased from 1 mg/kg to 8 mg/kg. Repeat high-dose administration of LV and repeat low-dose administration of cisplatin are advocated when they are used as modulators of 5-FUra.

Clinicopathological study of primary malignant tumors of the lung: an analysis of 993 tumors resected at the Kanazawa University Hospital between 1979-1993

A retrospective study was conducted of 993 malignant tumors of the lung in 977 patients. The male-female sex ratio was 2.6:1. The age distribution of the males did not differ from that of the females and the overall mean age was 64.3 +/- 9.5 years (range, 13-85 years). Forty-three percent of the patients were in their seventh decade. The location was peripheral in 81% of the tumors and central in 19%. Of the central tumors, 85% were squamous cell (epidermoid) carcinoma (SCC), while 58% of the peripheral tumors were adenocarcinoma (ADENO). In males, 49% of all tumors were SCC and 36% ADENO, while in females 76% were ADENO. The incidence of positive lymph node metastasis increased in parallel with the pT status in both central and peripheral carcinomas. However, it was noted that, of peripheral lung carcinomas, no SCC with a diameter of 15 mm or less had lymph node metastasis, whereas 18.9% of the ADENO of this size were positive for lymph node metastasis. These results indicate that lymph node metastasis can occur even in small-sized peripheral ADENO less than 15 mm. Thus, early detection and surgery together with mediastinal lymph node dissection are necessary even for small-sized tumors to improve the prognosis in patients with peripheral ADENO of the lung.

[New index for prediction of the patients prone to ventricular arrhythmias after acute myocardial infarction]

Recently late potential (LP) has been evaluated using signal averaged electrograms in order to predict the patients prone to the ventricular arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF). However, the predictive accuracy was not satisfactory in clinical use. Therefore some new approach was expected. We tried to find a new index to predict the susceptibility to ventricular arrhythmias using frequency analysis by fast Fourier transformation technique (FFT). Fragmented electrograms are elucidated to be present through QRS complex beside the terminal portion of QRS and ST segment by Cain et al. Eighty-seven body surface electrograms were analyzed by FFT, and the power spectral distribution of specific band width of 25-50 Hz was evaluated. Late potential was also obtained by ordinary technique. The patients after acute myocardial infarction were classified into 5 groups according to Lown's grade; group 1 (grade 0.1), group 2 (grade 2), group 3 (grade 3,4A) and group 4 (grade 4B, non sustained VT), and group 5 (grade 4B, sustained VT/VF). The body surface distribution of 25-50 Hz were classified into 3 types; type A (almost equal two maxima), type B (unequal two maxima) and type C (single maximum). Types A & B were frequently observed, but type C was never seen in high risk group (group 4 and 5). Predictive accuracy of VT/VF was 89.2% by type A and 66.7% by LP. The combination of the two criteria improved the predictive accuracy of VT/VF up to 92.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Genotyping of hepatitis C virus by a simple ELISA method

BACKGROUND

Hepatitis C virus (HCV) has been classified into five distinct types by nucleotide sequence analysis of the genome. The correlation between genotypes of HCV and sensitivity to treatment or prognosis is still controversial.

OBJECTIVES

We tried to establish a simple antibody assay to determine the HCV serotype instead of genotype determined by PCR or nucleotide sequence.

STUDY DESIGN

We made an enzyme-linked immunosorbent assay (ELISA) system by using synthetic oligopeptides of NS4 regions of types 1 (CH) and 2 (KN) HCV, and examined sera of various stages of hepatitis C patients.

RESULTS

Among 13 HCV RNA-positive sera, serotyping was consistent with genotyping. Four sera of type 1 and 7 sera of type 2 were positive to anti-CH and anti-KN antibodies, respectively. Two sera of patients mixedly infected with type 1 and 2 HCV were positive to both antibodies. The number of type 1 and 2 in patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma was 27 and 18, 28 and 15, and 46 and 12 respectively.

CONCLUSIONS

Our result suggests that this simple ELISA method is useful for typing of HCV, and there is no significant relationship between HCV type and liver failure.

Adrenal steroid regulation of neuropeptide Y (NPY) mRNA: differences between dentate hilus and locus coeruleus and arcuate nucleus

Regulation by adrenal steroids of neuropeptide Y (NPY) mRNA was investigated in hilus of the dentate gyrus, arcuate nucleus of hypothalamus and locus coeruleus (LC) of the adult rat brain. Adrenalectomy (ADX) increased NPY mRNA in hilus but decreased NPY mRNA levels in arcuate nucleus and LC. Using a steroid replacement paradigm previously shown to discriminate between Type I and Type II adrenal steroid receptor mediated effects, it was shown that Type I receptor stimulation by aldosterone prevented the ADX-induced increase of NPY mRNA in hilus, whereas Type II receptor stimulation by Ru28362 prevented the ADX-induced decrease in NPY mRNA in arcuate nucleus and LC. The results for hilus are consistent with evidence for a role of Type I receptors in maintaining levels of a number of gene products associated with neurotransmission. The different regulation in hilus from that in arcuate and LC indicate, along with evidence for regulation of NYP expression by insulin, NGF and cyclic AMP and phorbol esters, that the adrenal steroid regulation of NPY gene expression is part of a complex set of regulatory mechanisms that depend on the brain region and cell type.

Molecular characterization of a gene encoding extracellular serine protease isolated from a subtilisin inhibitor-deficient mutant of Streptomyces albogriseolus S-3253

An extracellular serine protease produced by a mutant, M1, derived from Streptomyces albogriseolus S-3253 that no longer produces a protease inhibitor (Streptomyces subtilisin inhibitor [SSI]) was isolated. A 20-kDa protein was purified by its affinity for SSI and designated SAM-P20. The amino acid sequence of the amino-terminal region of SAM-P20 revealed high homology with the sequences of Streptomyces griseus proteases A and B, and the gene sequence confirmed the relationships. The sequence also revealed a putative amino acid signal sequence for SAM-P20 that apparently functioned to allow secretion of SAM-P20 from Escherichia coli carrying the recombinant gene. SAM-P20 produced by E. coli cells was shown to be sensitive to SSI inhibition.

Pharmacokinetics and pharmacodynamics of recombinant human granulocyte colony-stimulating factor (rhG-CSF) following intranasal administration in rabbits

The objective of this study was to evaluate the pharmacokinetics and pharmacodynamics of G-CSF as well as their relationship following intranasal (i.n.) administration of aqueous rhG-CSF preparations with or without additives. In order to achieve a better understanding of the dosage regimen and the effectiveness of intranasally administered rhG-CSF in inducing leukopoiesis, we investigated rhG-CSF absorption and blood leukocyte dynamics with respect to dose in rabbits. RhG-CSF could be absorbed through the nasal cavity of rabbits when rhG-CSF aqueous preparations, especially those containing alpha-cyclodextrin (alpha-CyD) were intranasally administered. We found that serum G-CSF levels and the total count of leukocytes in peripheral blood (total blood leukocyte count) showed a dose-dependent increase with rhG-CSF. The area under the serum G-CSF concentration-time curve (AUC, a pharmacokinetic parameter) and the area under the increased total blood leukocyte count-time curve (AUL, a pharmacodynamic parameter) increased with increase of dose of rhG-CSF administered intranasally. Good agreement was observed between log AUC and AUL; thus, it is concluded that an increase of AUC leads to an increase in effectiveness of rhG-CSF in inducing leukopoiesis in rabbits. A novel rhG-CSF delivery system in the form of i.n. administration of rhG-CSF was thus achieved.

Locus coeruleus lesions potentiate neurotoxic effects of MPTP in dopaminergic neurons of the substantia nigra

The observation that Parkinson's disease (PD) is associated with locus coeruleus (LC) noradrenergic neuronal degeneration suggests that the LC noradrenergic system may be involved in the pathogenesis and natural progression of the destruction of the substantia nigra (SN) dopaminergic neurons in Parkinson's disease. The relationship of these two systems was examined by injection of subtoxic doses of MPTP into unilateral LC 6-hydroxydopamine (6-OHDA) lesioned mice. A significant loss of dopaminergic cells was only found in the SN on the side of the LC lesions. These results suggest that the LC may have protective effects on SN dopaminergic neurons.

D-myo-inositol 1,4,5-trisphosphate binding domain of phospholipase C-delta 1

D-myo-Inositol 1,4,5-trisphosphate (Ins(1,4,5)P3) binding domain of phospholipase C-delta 1 (PLC-delta 1) was determined by examining binding activity of the synthetic peptide corresponding to residues 30-43 of PLC-delta 1. The peptide coupled with carrier proteins such as keyhole limpet hemocyanin or bovine serum albumin bound Ins(1,4,5)P3, whereas a scrambled peptide with the same amino acids did not do so. Polyclonal antibody against the peptide was examined to determine whether it would cause inhibition of the Ins(1,4,5)P3 binding to PLC-delta 1. Fab fragment of antibody to the peptide did inhibit binding to PLC-delta 1, in a dose-dependent manner. Thus it seems likely that the region of residues 30-43 of PLC-delta 1 is responsible for the binding of Ins(1,4,5)P3.

Regulation of low density lipoprotein receptor activity in Chinese hamster ovary cells transfected with the c-fms gene

Chinese hamster ovary (CHO) cells were transfected with the human c-fms gene, which encodes the receptor for macrophage colony-stimulating factor, to examine the effects on the low density lipoprotein (LDL) receptor activity. Degradation of [125I]LDL was significantly reduced in the transfected CHO cells as compared to non-transfected cells when incubated in lipoprotein-deficient serum. Quantitative analysis of LDL receptor mRNA using a competitive PCR method demonstrated that LDL receptor suppression occurred at transcription. These findings suggest that expression of the c-fms gene is involved in the regulation of LDL receptors on macrophages.

Higher-order structure of bovine mitochondrial tRNA(SerUGA): chemical modification and computer modeling

On the basis of enzymatic probing and phylogenetic comparison, we have previously proposed that mammalian mitochondrial tRNA(sSer) (anticodon UGA) possess a slightly altered cloverleaf structure in which only one nucleotide exists between the acceptor stem and D stem (usually two nucleotides) and the anticodon stem consists of six base pairs (usually five base pairs) [Yokogawa et al. (1991) Nucleic Acids Res. 19, 6101-6105]. To ascertain whether such tRNA(sSer) can be folded into a normal L-shaped tertiary structure, the higher-order structure of bovine mitochondrial tRNA(SerUGA) was examined by chemical probing using dimethylsulfate and diethylpyrocarbonate, and on the basis of the results a tertiary structure model was obtained by computer modeling. It was found that a one-base-pair elongation in the anticodon stem was compensated for by multiple-base deletions in the D and extra loop regions of the tRNA(SerUGA), which resulted in preservation of an L-shaped tertiary structure similar to that of conventional tRNAs. By summarizing the findings, the general structural requirements of mitochondrial tRNAs necessary for their functioning in the mitochondrial translation system are considered.

Hypothalamic neuropeptide Y, its gene expression and receptor activity: relation to circulating corticosterone in adrenalectomized rats

Previous evidence has suggested a possible relationship between the adrenal steroid, corticosterone (CORT) and neuropeptide Y (NPY) in the brain. To provide a more systematic analysis of this interaction, the present study employed a variety of techniques, including in situ hybridization to measure NPY gene expression, radioimmunoassay to examine peptide levels and radioligand [125I]peptide YY (PYY) binding for analysis of peptide receptors. The results show that adrenalectomy (ADX), which caused a decline in CORT to levels < 0.3 micrograms %, has generally little impact on the hypothalamic NPY projection system under normal, basal conditions. This includes peptide gene expression or content in the area of its cell bodies (arcuate nucleus, ARC), in addition to peptide binding at its receptor sites. While it also includes peptide content at most hypothalamic terminal sites, there are three notable exceptions, namely, the medial paraventricular (PVN) and dorsomedial nuclei and medial preoptic area, where NPY nerve terminals and glucocorticoid receptors are particularly dense and the decline in CORT through ADX markedly reduces NPY content. In contrast, evidence obtained from CORT replacement in ADX rats shows that this steroid has profound impact on all components of the hypothalamic NPY system. This peptide-steroid interaction is apparent at the level of the cell body (ARC), as well as at the nerve terminal or receptor site (PVN and ARC), where CORT levels > 10 micrograms % strongly potentiate NPY gene expression, peptide content and radioligand binding. These and other findings suggest that this CORT-NPY interaction in the hypothalamus occurs physiologically under conditions, e.g., at the onset of the active feeding cycle, when circulating CORT normally rises.