[Discontinuation of tyrosine kinase inhibitors before epiphyseal closure leading to improved short stature in pediatric chronic myelogenous leukemia]

A 3-year-old boy was referred to our hospital with splenomegaly. Blood tests revealed hyperleukocytosis and bone marrow examination showed major BCR::ABL1 fusion, leading to the diagnosis of chronic myelogenous leukemia (CML). Due to intolerance, the tyrosine kinase inhibitor (TKI) was changed from imatinib to dasatinib to nilotinib. The patient achieved molecular remission but became markedly short in stature, measuring 129.3 cm (height standard deviation score [SDS] -3.3) at the age of 12. TKI therapy was discontinued at age 12 years and 10 months, which was 9 years and 8 months after the start of TKI and 1 year and 6 months after achievement of MR4.0, as discontinuation before epiphyseal closure would not improve short stature. At 2 years and 6 months after discontinuation, the patient's height improved to 156.1 cm (SDS-2.0) without relapse. Growth suppression by TKIs is a problem in the management of pediatric CML. This case illustrates how improvement in severe short stature can be achieved by discontinuing TKI therapy before epiphyseal closure.

Source Identification Analysis of Lead in the Blood of Japanese Children by Stable Isotope Analysis

Considering the negative effect of lead (Pb) on children's neurodevelopment, Pb exposure should be minimized to the lowest extent possible, though the blood Pb (BPb) concentrations in Japanese children are among the lowest in the world. To identify the sources of Pb in blood, isotope ratios (IRs: 207Pb/206Pb and 208Pb/206Pb) of Pb (PbIR) in whole blood from eight Japanese children were measured by multi-collector ICP mass spectrometry. Further, samples of house dust, soil, duplicate diet, and tobacco, collected from home environments, were also measured and were compared with PbIR of blood case by case. The relative contribution of Pb in the home environment to BPb were estimated by linear programming (finding an optimal solution which satisfy the combination of IRs and intakes from various sources) when appropriate. Source apportionment for three children could be estimated, and contributions of diet, soil, and house dust were 19-34%, 0-55%, and 20-76%, respectively. PbIR for the remaining five children also suggested that non-dietary sources also contributed to Pb exposure, though quantitative contributions could not be estimated. Non-dietary sources such as soil, house dust, and passive tobacco smoke are also important contributors to Pb exposure for Japanese children based on PbIR results.

A Novel Case of Somatic KCNJ5 Mutation in Pediatric-Onset Aldosterone-Producing Adenoma

Aldosterone-producing adenoma (APA), a subtype of primary aldosteronism, is a common cause of secondary hypertension in adults. Somatic KCNJ5 mutations have been identified in about 12%–80% of adult-onset APA. In contrast, there has been no previous reported case of pediatric-onset APA in whom a somatic KCNJ5 mutation was confirmed.

We report an 11-year-old Japanese girl who had experienced recurrent headaches and nausea for more than 2 years before hypertension was observed (blood pressure, 150/82 mm Hg). Plasma renin activity was <0.1 ng/mL per hour even after a captopril-challenge or upright furosemide-loading test. Plasma aldosterone concentrations (PACs) before and after saline-infusion test were 28.0 and 40.6 ng/dL, respectively. Plasma adrenocorticotropic hormone (ACTH) and serum cortisol levels were 16.5 pg/mL and 16.7 µg/dL, respectively. The patient was diagnosed with APA in the left adrenal gland on the basis of selective adrenal venous sampling after ACTH stimulation (PAC in the left adrenal vein, 3630 ng/dL) and histopathologic findings of the tumor obtained by laparoscopic left adrenalectomy. Sanger sequencing of KCNJ5 using genomic DNA from peripheral lymphocytes and laser-captured microdissected APA tissues demonstrated the presence of a somatic KCNJ5 mutation p.L168R, previously reported only in adult-onset APA. Immunohistochemistry detected strong immunoreactivity for CYP11B2, but not for CYP11B1 in the APA, consistent with the endocrinologic findings in this patient.

Somatic KCNJ5 mutations are also identified in pediatric-onset APA. Further cases are needed to elucidate functional characteristics of pediatric-onset APA with a somatic KCNJ5 mutation.

Long-term clinical course in three patients with MAMLD1 mutations

Although MAMLD1 on chromosome Xq28 is known as a causative gene for 46,XY disorders of sex development, clinical information is virtually limited in patients of infancy to early childhood. Here, we report long-term genital and hormonal findings in three previously described Japanese patients with MAMLD1 mutations, i.e., patients 1 and 2 with p.E197X and patient 3 with p.R726X. As previously reported, patients 1-3 exhibited penoscrotal hypospadias with chordee, microphallus, bifid/hypoplastic scrotum, and/or bilateral cryptorchidism/retractile testes, in the presence of sufficiently high serum basal or hCG-stimulated testosterone values in the mini-pubertal period to early childhood. Subsequently, patient 1 had low serum hCG-stimulated testosterone value (126 ng/dL) at 13 11/12 years of age, and manifested microphallus (4.5 cm), relatively small testes (left 8 mL and right 10 mL), Tanner stage 3 genitalia and pubic hair development at 18 3/12 years of age. Similarly, patients 2 and 3 showed mild hypergonadotropic hypogonadism at 7 0/12 and 9 9/12 years of age, respectively, with serum GnRH-stimulated LH values of 5.5 and 7.2 mIU/mL and FSH values of 10.3 and 19.8 mIU/mL and hCG-stimulated testosterone values of 70 and 80 ng/dL, respectively. Testis ultrasound studies delineated microlithiasis in patients 1 and 3. These results imply for the first time deterioration of testicular function with age in patients with pathologic MAMLD1 mutations.

Detecting sweet and umami tastes in the gastrointestinal tract

Information about nutrients is a critical part of food selection in living creatures. Each animal species has developed its own way to safely seek and obtain the foods necessary for them to survive and propagate. Necessarily, humans and other vertebrates have developed special chemosensory organs such as taste and olfactory organs. Much attention, recently, has been given to the gastrointestinal (GI) tract as another chemosensory organ. Although the GI tract had been considered to be solely for digestion and absorption of foods and nutrients, researchers have recently found taste-signalling elements, including receptors, in this tissue. Further studies have revealed that taste cells in the oral cavity and taste-like cells in the GI tract appear to share common characteristics. Major receptors to detect umami, sweet and bitter are found in the GI tract, and it is now proposed that taste-like cells reside in the GI tract to sense nutrients and help maintain homeostasis. In this review, we summarize recent findings of chemoreception especially through sweet and umami sensors in the GI tract. In addition, the possibility of purinergic transmission from taste-like cells in the GI tract to vagus nerves is discussed.

The role of the GABAergic and dopaminergic systems in the brain response to an intragastric load of alcohol in conscious rats

The brain's response to ethanol intake has been extensively investigated using electrophysiological recordings, brain lesion techniques, and c-Fos immunoreactivity. However, few studies have investigated this phenomenon using functional magnetic resonance imaging (fMRI). In the present study, we used fMRI to investigate the blood oxygenation level-dependent (BOLD) signal response to an intragastric (IG) load of ethanol in conscious, ethanol-naive rats. An intragastrically infused 10% ethanol solution induced a significant decrease in the intensity of the BOLD signal in several regions of the brain, including the bilateral amygdala (AMG), nucleus accumbens (NAc), hippocampus, ventral pallidum, insular cortex, and cingulate cortex, and an increase in the BOLD signal in the ventral tegmental area (VTA) and hypothalamic regions. Treatment with bicuculline, which is an antagonist of the gamma-aminobutyric acid A (GABA(A)) receptor, increased the BOLD signal intensity in the regions that had shown decreases in the BOLD signal after the IG infusion of 10% ethanol solution, but it did not affect the BOLD signal increase in the hypothalamus. Treatment with SCH39166, which is an antagonist of D1-like receptors, eliminated the increase in the BOLD signal intensity in the hypothalamic areas but did not affect the BOLD signal decrease following the 10% ethanol infusion. These results indicate that an IG load of ethanol caused both a GABA(A) receptor-mediated BOLD decrease in the limbic system and the cortex and a D1-like receptor-mediated BOLD increase in the hypothalamic regions in ethanol-naive rats.

Mutation and gene copy number analyses of six pituitary transcription factor genes in 71 patients with combined pituitary hormone deficiency: identification of a single patient with LHX4 deletion

CONTEXT

Mutations of multiple transcription factor genes involved in pituitary development have been identified in a minor portion of patients with combined pituitary hormone deficiency (CPHD). However, copy number aberrations involving such genes have been poorly investigated in patients with CPHD.

OBJECTIVE

We aimed to report the results of mutation and gene copy number analyses in patients with CPHD.

SUBJECTS AND METHODS

Seventy-one Japanese patients with CPHD were examined for mutations and gene copy number aberrations affecting POU1F1, PROP1, HESX1, LHX3, LHX4, and SOX3 by PCR-direct sequencing and multiplex ligation-dependent probe amplification. When a deletion was indicated, it was further studied by fluorescence in situ hybridization, oligoarray comparative genomic hybridization, and serial sequencing for long PCR products encompassing the deletion junction.

RESULTS

We identified a de novo heterozygous 522,009-bp deletion involving LHX4 in a patient with CPHD (GH, TSH, PRL, LH, and FSH deficiencies), anterior pituitary hypoplasia, ectopic posterior pituitary, and underdeveloped sella turcica. We also identified five novel heterozygous missense substitutions (p.V201I and p.H387P in LHX4, p.T63M and p.A322T in LHX3, and p.V53L in SOX3) that were assessed as rare variants by sequencing analyses for control subjects and available parents and by functional studies and in silico analyses.

CONCLUSIONS

The results imply the rarity of abnormalities affecting the six genes in patients with CPHD and the significance of the gene copy number analysis in such patients.

Effects of isoflurane and alpha-chloralose anesthesia on BOLD fMRI responses to ingested L-glutamate in rats

It is important to investigate the effect of anesthesia on blood oxygenation level-dependent (BOLD) signals in an animal model. Many researchers have investigated the BOLD response to visual, sensory, and chemical stimuli in anesthetized rats. There are no reports, however, comparing the differences in the BOLD signal change between anesthetized and conscious rats when a visceral nutrient signal arises. Here, using functional magnetic resonance imaging (fMRI), we investigated the differences in the BOLD signal changes after intragastric administration of l-glutamate (Glu) under three anesthesia conditions: conscious, alpha-chloralose-anesthetized, and isoflurane-anesthetized condition. Under the conscious and alpha-chloralose condition, we observed the significant BOLD signal increase in the medial prefrontal cortex (mPFC), insular cortex (IC), hippocampus, and several hypothalamic regions including the lateral and ventromedial nucleus. In chloralose group, however, gut Glu stimulation induced BOLD signal increase in the prelimbic cortex and orbital cortex, which did not activate in conscious condition. Meanwhile, under isoflurane-anesthetized condition, we did not observe the BOLD signal increase in these areas. BOLD signal intensity in the nucleus of the solitary tract (NTS), to which vagus nerve transmits the visceral information from the gastrointestinal tract, increased in all conditions. Importantly, under conscious condition, we observed increased BOLD signal intensity in several regions related to the metabolic state (i.e. hunger or satiety), such as the mPFC, ventromedial and lateral hypothalamus (LH). Our results suggest that alpha-chloralose and isoflurane anesthesia caused distinct effects on BOLD response to the gut l-Glu stimulation in several brain regions.

Cytochrome P450 oxidoreductase deficiency: identification and characterization of biallelic mutations and genotype-phenotype correlations in 35 Japanese patients

CONTEXT

Cytochrome P450 oxidoreductase (POR) deficiency is a rare autosomal recessive disorder characterized by skeletal dysplasia, adrenal dysfunction, disorders of sex development (DSD), and maternal virilization during pregnancy. Although multiple studies have been performed for this condition, several matters remain to be clarified, including the presence of manifesting heterozygosity and the underlying factors for clinical variability.

OBJECTIVE

The objective of the study was to examine such unresolved matters by detailed molecular studies and genotype-phenotype correlations.

PATIENTS

Thirty-five Japanese patients with POR deficiency participated in the study.

RESULTS

Mutation analysis revealed homozygosity for R457H in cases 1-14 (group A), compound heterozygosity for R457H and one apparently null mutation in cases 15-28 (group B), and other combinations of mutations in cases 29-35 (group C). In particular, FISH and RT-PCR sequencing analyses revealed an intragenic microdeletion in one apparent R457H homozygote, transcription failure of apparently normal alleles in three R457H heterozygotes, and nonsense mediated mRNA decay in two frameshift mutation-positive cases examined. Genotype-phenotype correlations indicated that skeletal features were definitely more severe, and adrenal dysfunction, 46,XY DSD, and pubertal failure were somewhat more severe in group B than group A, whereas 46,XX DSD and maternal virilization during pregnancy were similar between two groups. Notable findings also included the contrast between infrequent occurrence of 46,XY DSD and invariable occurrence of 46,XX DSD and pubertal growth pattern in group A mimicking that of aromatase deficiency.

CONCLUSIONS

The results argue against the heterozygote manifestation and suggest that the residual POR activity reflected by the R457H dosage constitutes the underlying factor for clinical variability in some features but not other features, probably due to the simplicity and complexity of POR-dependent metabolic pathways relevant to each phenotype.

[Appropriate use of rapid diagnostic testing for influenza]

To determine a more timely acquisition of accurate results for influenza patients, a rapid diagnostic testing for influenza were studied on 877 pediatric patients performed during the 2002-2003 flu season in our hospital. Of these, 337 patients were finally diagnosed as influenza based on the test results and treated with antiviral agents, amantadine or oseltamivir. Ten (29%) of the 34 patients whose tests were negative within 12 hours after onset became positive over 12 hours after onset. On the other hand, diagnoses based on antigen tests over 12 hours after onset were reliable because all 13 patients first confirmed negative were unchanged when tested afterward. These 10 patients missed the opportunity to take antivirals early, which possibly caused them to have significantly longer (p = 0.0003) febrile duration and higher frequency of admission (p < 0.0001) than the 106 patients first confirmed positive within 12 hours after onset. Days from onset until starting antivirals (mean 1.4 days), the febrile duration (mean 2.7 days) and frequency of hospitalization (20.5%) of the 219 patients who tested positive over 12 hours after onset were significantly worse (p < 0.0001, p < 0.0001 and p = 0.0406, respectively) than those of patients testing positive within 12 hours after onset (mean 0.2 days, mean 1.7 days and 11.3%, respectively). The febrile duration (mean 2.3 days) of the patients confirmed positive even over 12 hours, but within 48 hours, of onset was tolerable but significantly longer (p < 0.0001) than that of patients confirmed positive within 12 hours after onset. The frequency (19.6%) of hospitalization of the patients confirmed positive even over 12 hours, but within 48 hours, of onset was not significantly different from that of patients confirmed positive within 12 hours after onset. These results suggested that over 12 hours but within 48 hours after onset of illness is the best period for the rapid diagnosis to correctly determine whether a patient should be treated with antiviral agents based on the result.

Parental origin of normal X chromosomes in Turner syndrome patients with various karyotypes: implications for the mechanism leading to generation of a 45,X karyotype

The parental origin of the X chromosome of 45,X females has been the subject of many studies, and most of them have shown that the majority (60-80%) of the X chromosomes are maternal in origin. However, studies on the parental origin of normal X chromosomes are relatively limited for Turner syndrome (TS) females with sex chromosome aberrations. In this study, we used PCR-based typing of highly polymorphic markers and an assay of methylation status of the androgen receptor gene to determine the parental origin of normal X chromosomes in 50 unbiased TS females with a variety of karyotypes. Our results showed a higher paternal meiotic error rate leading to the generation of abnormal sex chromosomes, especially in the case of del(Xp) and abnormal Y chromosomes. Isochromosome Xq and ring/marker X chromosomes, on the other hand, were equally likely the result of both maternal and paternal meiotic errors. A thorough review of previous results, together with our data suggests, that the majority of TS karyotype are caused by paternal meiotic errors that generate abnormal sex chromosomes, and that most 45,X cells are generated by mitotic loss of these abnormal sex chromosomes, resulting in maternal X dominance in these cells.

Results of posterior iliopsoas transfer for hip instability caused by cerebral palsy

The incidence of subluxation or dislocation of the hip in 185 cerebral palsied patients was 25.4%. Posterior iliopsoas transfer will decrease hip deformities but complications such as weakness of hip flexion or abduction contracture are to be expected in some cases. Posterior iliopsoas transfer did not give uniformly satisfactory results; 9 out of 17 patients were fair to poor even combined with innominate osteotomy and/or versus derotation osteotomy of the femur. Early prophylactic surgery of lesser extent such as adductor release is desirable since treatment of established subluxation or dislocation is often unsatisfactory.

Molecular and clinical analysis of Japanese patients with 3-hydroxy-3-methylglutaryl CoA lyase (HL) deficiency

Deficiency of mitochondrial 3-hydroxy-3-methylglutaryl CoA lyase (HL, EC4.1.3.4.) is an autosomal recessive genetic disorder characterized by acute episodes of vomiting, hypotonia, and lethargy in the neonatal period or in infancy. Except in Saudi Arabia, where HL deficiency is the most common organic acidemia, the disorder is quite rare with only 41 cases being reported in the English literature, and only five known cases among Japanese. In this study, we present the results of a molecular analysis of all five Japanese patients together with their clinical phenotypes. Five different mutations in the HL gene were identified: one large deletion, one nonsense mutation, one missense mutation, and two splice mutations. Except for G835A (E279K) with its relatively common occurrence among Japanese, these mutations were unique to each family. The results of expression studies with mutated HL cDNAs confirmed the pathogenicity of these mutations and supported the importance of previously identified functional domains of the HL molecule, i.e., the putative catalytic site or dimerization site. In addition, we identified an alternative splicing event that resulted in the skipping of exons 5 and 6. This alternatively spliced product did not show HL activity and was present in various tissues of normal subjects. Clinically, all patients presented with similar symptoms, except that the timing of the initial presentation varied considerably, from 1 day to 1 year 3 months. In general, patients with null-activity mutations presented earlier in life, whereas those with residual activities presented later.

Living-related liver transplantation for neonatal-onset propionic acidemia

We report a child with neonatal-onset propionic acidemia treated with living-related liver transplantation. Despite minimal improvement in the levels of circulating propionyl CoA metabolites, hyperammonemia was corrected, and no episode of metabolic decompensation was experienced after the transplantation was performed. Natural protein intake could be increased from 0.5 g/kg per day to 2 g/kg per day. Anemia was corrected, and the growth rate and mental development improved significantly.

Identification of a novel single base-pair polymorphism in the glutamate dehydrogenase (GLUD1) gene

A novel single base-pair polymorphism, G/A at ntd 955, was identified within the coding region of the glutamate dehydrogenase gene (GLUD1). This polymorphism should prove useful for the study of human disorders with altered ammonia and/or blood glucose levels.

Hyperinsulinism-hyperammonemia syndrome caused by mutant glutamate dehydrogenase accompanied by novel enzyme kinetics

Hyperinsulinism-hyperammonemia syndrome (HHS) is a recently identified genetic disorder characterized by hyperinsulinemic hypoglycemia with concomitant hyperammonemia. In patients with HHS, activating mutations in the glutamate dehydrogenase (GDH) gene have been identified. GDH is a key enzyme linking glutamate metabolism with the Krebs cycle and catalyzes the conversion of glutamate to alpha-ketoglutarate. The activity of GDH is controlled by allosteric inhibition by GTP and, so far, all the mutations of HHS patients have been located within the GTP-binding site. Characteristically, GDH from these individuals have therefore normal basal activity in conjunction with a loss of GTP inhibition. In this study, however, we have identified a novel variant GDH in a patient with a more severe form of HHS. The mutation is located outside the GTP-binding site and the patient's GDH shows consistently higher activity, even in the absence of allosteric effectors. These results further support the hypothesis that the activating mutation of GDH is the cause of HHS. The mechanism leading to the activation of GDH, however, is not always related to the loss of GTP inhibition as was originally suggested.

Relatively longer hand in patients with Ullrich-Turner syndrome

We analyzed the total hand length (HL) and length of noncarpal bones (NCL) in 50 Japanese patients with Ullrich-Turner syndrome (UTS) and in 443 other patients with short stature used as controls. In each patient group we calculated relative HL (RHL= HL/height) and relative NCL (RNCL= NCL/height). UTS patients had significantly greater RHL than controls. The greater RHL in UTS patients is mainly due to their longer, short tubular bones. The RHL is not affected by ages and karyotypes of UTS patients or growth hormone treatments given to them. We conclude that relatively longer hands are a common manifestation of UTS and that this parameter is useful for the diagnosis of the syndrome among short females, who usually need chromosome analysis.

X-inactivation pattern in the liver of a manifesting female with ornithine transcarbamylase (OTC) deficiency

Ornithine transcarbamylase (OTC) deficiency is the most common urea cycle disorder. It is X-linked and hemizygous new-born males usually suffer fatal hyperammonemia. In contrast, carrier females manifest variable phenotypes, ranging from asymptomatic carriers to those with severe hyperammonemia. In order to understand the correlation between X-inactivation status and the clinical phenotype of carrier females with this disorder, we analyzed the X-inactivation pattern of peripheral blood leukocytes in a family consisting of a clinically normal mother and two daughters with severe manifestation. In addition, we obtained tissue samples from various parts of the liver of one of these daughters and analyzed X-inactivation patterns and the residual OTC activities. The X-inactivation of peripheral blood leukocytes was nearly random in these carrier females and showed no correlation with the disease phenotype. However, the X-inactivation of the liver was much more skewed and correlated well with the OTC activity of all samples. Interestingly, the degree of X-inactivation varied considerably, even within the same liver.

Uniparental and functional X disomy in Turner syndrome patients with unexplained mental retardation and X derived marker chromosomes

We analysed parental origin and X inactivation status of X derived marker (mar(X)) or ring X (r(X)) chromosomes in six Turner syndrome patients. Two of these patients had mental retardation of unknown cause in addition to the usual Turner syndrome phenotype. By FISH analysis, the mar(X)/r(X) chromosomes of all patients retained the X centromere and the XIST locus at Xq13.2. By polymorphic marker analysis, both patients with mental retardation were shown to have uniparental X disomy while the others had both a maternal and paternal contribution of X chromosomes. By RT-PCR analysis and the androgen receptor assay, it was shown that in one of these mentally retarded patients, the XIST on the mar(X) was not transcribed and consequently the mar(X) was not inactivated, leading to functional disomy X. In the other patient, the XIST was transcribed but the r(X) appeared to be active by the androgen receptor assay. Our results suggest that uniparental disomy X may not be uncommon in mentally retarded patients with Turner syndrome. Functional disomy X seems to be the cause of mental retardation in these patients, although the underlying molecular basis could be diverse. In addition, even without unusual dysmorphic features, Turner syndrome patients with unexplained mental retardation need to be investigated for possible mosaicism including these mar(X)/r(X) chromosomes.

[A case of pulmonary metastasis of ovarian leiomyosarcoma responsive to CTP therapy]

One case of pulmonary metastasis of leiomyosarcoma responsive to CTP therapy was reported. The patient was a 44-year-old woman who had undergone total simple hysterectomy for uterine myoma 6 years before. Five years after the operation she underwent ovariectomy for ovarian tumor. Based on the histopathological findings, she was diagnosed to have leiomyosarcoma. One year later the patient was referred to use because of pulmonary metastasis. After admission to our hospital CTP therapy was started. Disappearance of the metastatic lesion was demonstrated by the chest X-ray findings at the end of five courses of treatment.

[The incidence of pulmonary tuberculosis in an urban area]

The incidence and prevalence of pulmonary tuberculosis has declined steadily in Japan, but the trends differ greatly by area according to epidemiological status. We studied the incidence and trends of pulmonary tuberculosis in an urban area (population approx. 150,000) during the period of 1979-1988. The area studied is a part of a large commercial city, characterized as having the most prevalent rate of tuberculosis area in that city. Of 1245 newly registered cases, 80% were over 40 years of age. While the incidence rate decreased to 57% in the last 10 years in this area, compared to 69% decrease for all of Japan, it was still considerably higher than the national average. Especially in the 20-59 age group it continued to be 2 times higher than that of the whole of Japan. Moreover, the positive rate of tubercle bacilli at the time of registration had increased remarkably from 27% in 1979 to 62% in 1988. These results suggest the tuberculosis continues to be a significant problem in this urban area, although the steady decline in the incidence of tuberculosis had led to a lack of awareness of this disease.

Application of a local drug delivery system to periodontal therapy: I. Development of collagen preparations with immobilized tetracycline

For the purpose of applying a local drug delivery system to periodontal therapy, atelocollagen preparations with immobilized tetracycline (TC) were prepared by modifying the form of the collagen, the concentration of the immobilized TC, and the time of the cross-link process with glutaraldehyde. The course of the TC release from the collagen preparations into an aqueous solution was determined in relation to time. The preparations were also inserted into periodontal pockets, and the amount of TC remaining in the pocket was determined daily. The results obtained were as follows: 1) The degree of drug release could be controlled to some extent by adjusting the TC concentration and the time of the cross-link process; and 2) an amount of TC exceeding the effective dose in the gingival crevicular fluid was present in the periodontal pocket even 10 days after the insertion of TC fixed in the cross-linked processed collagen film in the periodontal pockets.

Peplomycin and bleomycin effects on human colon cancer cells

The lethal effects of peplomycin and bleomycin on cultured human colon cancer cells (LoVo) were compared by using the technique of inhibition of colony formation. The survival of LoVo cells after treatment for 1 h with either peplomycin or bleomycin was characterized by a biphasic exponential curve. When the exposure time was extended to 24 h, both drugs produced much greater cytotoxic effects, with survival decreased to less than 0.10% for bleomycin and less than 0.02% for peplomycin. Both peplomycin and bleomycin, in a dose-dependent manner, inhibited the incorporation of thymidine into cells. On an equal-weight basis, the cytotoxicity of peplomycin (24-h exposure) was similar to that of bleomycin. Both agent also inhibited the incorporation of leucine and uridine after 24 h of drug exposure, but to a lesser extent than inhibition of thymidine incorporation. However, after 1 h of exposure, such inhibitory effects were minimal. These results demonstrate that prolonged peplomycin or bleomycin exposure produces greater cell-kill than shorter drug exposure. Schedules with continuous drug administration should be explored clinically.

Gonadectomy-induced reduction of blood pressure in adult spontaneously hypertensive rats

Adult male and female spontaneously hypertensive rats (SHR-Okamoto, Kyoto) were gonadectomized when they were 17 weeks old. Intact SHR showed a progressive increase of their blood pressure with growth, attaining systolic pressure levels of 194-208 in males and 163-173 mmHg in females when they were 29-30 weeks old. During this same period, the gonadectomized animals showed a significant reduction in blood pressure ranging from 168-175 in males and from 158-163 mmHg in females. These studies indicate that male and female SHR gonadectomized at 17 weeks of age do not show the progressive blood pressure rise that occurs in intact SHR. There was no change in heart rate in either sex. Corticosterone (B) levels in plasma were increased in the orchidectomized males, and 18-OH-DOC levels in plasma were increased in the adrenal glands of ovariectomized females indicating that these hormonal changes probably do not play a role in SHR hypertension. It appears that gonadal and other hormones are involved in the pathogenesis of SHR hypertension.

[Dynamics of steroid hormones in hypercholesterolemic rats]

We evaluated the dynamics of endogeneous steroid hormones in hypercholesterolemic rats (HLR) F14, F10 in part, obtained by brother-sister mating of Sprague Dawley strain animals. Plasma free and total cholesterol levels in F14 and F10 were significantly high both in both sexes as compared with controls, however, hypertension did not always occur in the HLR; in one group the pressure was elevated but in another, it was normal. Weight of the ovaries was significantly higher than in the controls while weight of the uterus was significantly lower than in the controls. Progestin (progesterone, 20 alpha-OH-P) levels in the ovary were significantly higher (2-3 times) than in the controls, but the estradiol levels were significantly lower (1/2-1/3). Cyclic changes in vaginal smears were somewhat irregular and a continuous diestrus was infrequent. Weight of the testicles and the testosterone levels were significantly lower than in the controls while the estradiol level was somewhat higher. Weight of the prostate was normal. In both sexes, adrenal weights were significantly higher than in the controls. In female rats, adrenal corticosterone and 18-OH-DOC were significantly higher than in the controls, but such was not the case in the adrenals of male rats. All our results taken together, suggest that disturbance in hormonal regulation, particularly of the reproductive system in rats occurred in genetically induced hypercholesterolemia.

Lymphocyte transformation during pregnancy: an analysis using whole-blood culture

In an effort to provide information on maternal immunocompetence, a study was undertaken to measure lectin-induced transformation of maternal lymphocytes. Whole-blood culture was used. The phytohemagglutinin (PHA)-induced lymphocyte transformation of 137 pregnant women was significantly (P less than 0.05 to 0.001) diminished until 21 weeks' gestation, and concanavalin A (Con A)-induced lymphocyte transformation of 116 pregnant women was also significantly (P less than 0.01 to 0.001) diminished at all stages of gestation, as compared with those of 39 nonpregnant women. In addition, the Con A-induced lymphocyte transformation of ovarian venous blood and uterine venous blood from a pregnant woman was prominently diminished, as compared with that of basilic venous blood. It is suggested that there are maternal T-cell subpopulations that have different reactivities to PHA and Con A.

Role of radionuclide joint imaging in high tibial osteotomy

The importance of a preoperative bone scan before tibial osteotomy is to detect the extent of specific compartmental involvement of the osteoarthritic knee. It is not necessary to obtain a bone scan in every case, but when difficulty arises in the selection of patients for surgery, whether the opposite compartment is involved by disease or not, a preoperative bone scan becomes useful and may eliminate the need for other procedures such as arthroscopy and arthrotomy. In a series of cases of osteotomy in 21 knees of 22 patients, with an average follow-up of 15 months, all had a preoperative bone scan, 14 repeated postoperatively. Satisfactory functional results were obtained in 71%.

Intercarpal fusion for treatment of carpal instability: a preliminary report

Post-traumatic instability was once considered to be a rare but important injury recognized among the various carpal trauma. However, recent literature suggests that reports on this entity are increasing in number. Methods of treatment for this injury were few in the past and were not well established. Following the lesson of 2 cases of failure with open reduction and ligamentous reconstruction, 4 such cases were treated by intercarpal fusion; 3 had no pain or tenderness at a follow-up period of 16 months to 27 months. This procedure should be performed before radiocarpal degenerative arthritis develops.

Arthrodesis of the shoulder: posterior approach

Shoulder arthrodesis through the posterior approach in 6 patients with the average follow-up of 20 months has been described. There were no surgical complications. In all cases the position of the arm was determined clinically and placed in 20 degrees abduction, 30 degrees forward flexion, and 40 degrees internal rotation.

Scapulectomy for the treatment of malignant tumors of the scapula

Two cases of Tikhor-Linberg resection for rhabdomyosarcoma and malignant chondromyxoid fibroma and two cases of scapulectomy for metastatic disease of the shoulder girdle are reviewed. After resection of the scapula, active motion of the shoulder will be severely restricted, but normal function of elbow, wrist, and hand permit use of the extremity in many activities of daily living. Surgical treatment for metastatic bone disease in the upper extremity and the role of radiation therapy for metastatic bone disease are discussed.

Malignant chondromyxoid fibroma of the scapula

A rare case of malignant chondromyxoid fibroma developed in the scapula of a woman who was treated with interscapulothoracic resection. When a biopsy specimen was submitted for study, difficulty was encountered in establishing the histologic diagnosis. A large dose of radiation was given before surgery, based on an original biopsy diagnosis of osteosarcoma; in retrospect, preoperative irradiation probably was contraindicated. Two years and four months after surgery, the patient was working with no evidence of recurrence or metastasis.