BK-UM in patients with recurrent ovarian cancer or peritoneal cancer: a first-in-human phase-I study

Background

BK-UM (CRM197) is a mutant form of diphtheria toxin and a specific inhibitor of heparin-binding epidermal growth factor-like growth factor (HB-EGF). We assessed the safety, pharmacokinetics, recommended dose, and efficacy of BK-UM in patients with recurrent ovarian cancer (OC) or peritoneal cancer (PC), and measured HB-EGF levels in serum and abdominal fluid after BK-UM administration.

Methods

Eleven patients with advanced or recurrent OC or PC were enrolled and treated with BK-UM via the intraperitoneal route. The dose was escalated (1.0, 2.0, 3.3, and 5.0 mg/m²) using a 3 + 3 design.

Results

Eight of 11 patients completed treatment. No dose-limiting toxicity (DLT) was experienced at dose levels 1 (1.0 mg/m²) and 2 (2.0 mg/m²). Grade 3 transient hypotension as an adverse event (defined as a DLT in the present study) was observed in two of four patients at dose level 3 (3.3 mg/m²). Treatment with BK-UM was associated with decreases in HB-EGF levels in serum and abdominal fluid in seven of 11 patients and five of eight patients, respectively. Clinical outcomes included a partial response in one patient, stable disease in five patients, and progressive disease in five patients.

Conclusions

BK-UM was well tolerated at doses of 1.0 and 2.0 mg/m², with evidence for clinical efficacy in patients with recurrent OC or PC. A dose of 2.0 mg/m² BK-UM is recommended for subsequent clinical trials.

Trial registration

This trial was prospectively performed as an investigator-initiated clinical trial. The trial numbers are UMIN000001002 and UMIN000001001, with registration dates of 1/30/2008 and 2/4/2008, respectively. UMIN000001001 was registered as a trial for the continuous administration of BK-UM after UMIN000001002.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3071-5) contains supplementary material, which is available to authorized users.

An Effective New Cryopreservation Procedure for Pancreatic Islets Using Hollow Fiber Vitrification

The present study aimed at establishing a new cryopreservation method for mouse pancreatic islets by vitrification using hollow fibers as a container. A unique feature of the hollow fiber vitrification (HFV) method is that this method achieves stable vitrification using a minimum volume of cryoprotectant (CPA) solution, thereby ensuring high viability of the islets. The cytotoxicity, optimum composition, and concentration of the CPAs for vitrifying islets were examined. The viability, functional-integrity of vitrified islets were evaluated in comparison with those vitrified by conventional methods. Insulin secretion was measured in vitro by a static incubation assay and the metabolic functions was tested after transplantation into Streptozotocin-induced diabetic mice. The combination of 15% dimethyl sulfoxide+15% ethylene glycol resulted in the best CPA solution for the HFV of islets. HFV showed the highest viability in comparison to 2 vitrification methods, open pulled straws and vitrification with EDT324 solution. The vitrified islets stably expressed β-cells markers NeuroD, Pancreatic and duodenal homeobox-1, and MafA. Transplantation of the vitrified islets achieved euglycemia of the host diabetic mice and response to an intraperitoneal glucose tolerance test to a similar extent as non-vitrified transplanted islets. The HFV method allows for efficient long-term cryopreservation of islets.

Safety and Anti-tumor Effects of Docetaxel Plus Cisplatin in Intermediate- and High-risk Endometrial Cancer

BACKGROUND

Endometrial cancer (EC) has a poor prognosis due to drug resistance.

PATIENTS AND METHODS

We evaluated the safety and efficacy of adjuvant combination chemotherapy with docetaxel plus cisplatin ((DP) docetaxel, 70 mg/m(2); cisplatin, 60 mg/m(2); every 28 days) in EC patients at intermediate-risk (IR) or high-risk (HR) for recurrence.

RESULTS

Sixty-four patients diagnosed with EC were enrolled. Stage-I, -II, -III and -IV disease was noted in 23, 7, 28 and 6 patients, respectively. Histopathological analyses revealed that 56, 3, 1 and 4 patients had endometrioid, serous, clear-cell or "other" types of carcinoma. Grade-3/4 hematologic toxicities were found at 80% and 95% in patients in IR and HR groups, respectively. In IR and HR groups, mean progression-free (PFS) survival was 69.5 and 29.5, while overall survival (OS) was 59.6 and 47.5 months, respectively.

CONCLUSION

DP may be clinically safe and useful treatment for EC.

The Safety of Pegylated Liposomal Doxorubicin Plus Irinotecan in Recurrent Ovarian Cancer Patients: A Phase I Trial

AIM

The study was designed to evaluate the safety of combined chemotherapy with pegylated liposomal doxorubicin (PLD) and irinotecan (CPT-11) in patients with recurrent ovarian cancer.

PATIENTS AND METHODS

Six patients with platinum-resistant and taxane-pretreated ovarian cancer were enrolled in the study based on the traditional 3-plus-3 design. PLD was administered intravenously on day 1 and CPT-11 on days 1 and 8 of each 28-day course. Initial doses were 30 mg/m(2) PLD and 50 mg/m(2) CPT-11.

RESULTS

Hematotoxicity was the principal toxicity (1 patient developed grade 3 neutropenia and 2 developed grade 3 leukocytopenia); hand-foot syndrome was not observed. Furthermore, 1 patient achieved complete response, whereas 2 patients achieved partial response.

CONCLUSION

The combined PLD and CPT-11 regimen was well-tolerated indicating its potential clinical benefit for ovarian cancer patients.

Clinical Efficacy of Aprepitant in Patients with Gynecological Cancer after Chemotherapy Using Paclitaxel and Carboplatin

AIM

This study aimed to evaluate the efficacy of aprepitant, a neurokinin (NK)1 receptor antagonist, on chemotherapy-induced nausea and vomiting (CINV).

PATIENTS AND METHODS

A randomized, open-labeled, parallel-design study was undertaken in gynecologic-cancer (GC) patients at the Fukuoka University Hospital. Twenty-three patients were divided into without (group A) or with aprepitant (Group B) in the first cycle of paclitaxel and carboplatin (TC) therapy. From the second cycle onwards, all patients used aprepitant. Statistical significance was assessed using McNemar and Chi-square tests.

RESULTS

In the first cycle, the prevalence of a complete response, no episodes of nausea or food intake in group B was significantly increased compared to group A. No significant difference in the prevalence of a complete response or food intake situation was found from the second cycle onwards.

CONCLUSION

Combination of aprepitant with standard anti-emetic therapy may contribute to prevention of CINV in TC therapy for GC patients.

26 IN VIVO EXOGENIC ORGAN GENERATION WITH ORGANOGENESIS-DISABLED CLONED PIGS AS A PLATFORM

The generation of organs from pluripotent stem cells (PSC) is one of the ultimate goals of regenerative medicine. We have demonstrated that functional organs can be generated in vivo from xenogenic PSC in the body of organogenesis-disabled mice using blastocyst complementation. To apply this principle in generating human organs, a technical platform using large non-rodent mammals is essential. The aim of the present study was to establish a blastocyst complementation system using cloned pig embryos. We generated transgenic-cloned pigs with an apancreatic phenotype via the overexpression of Hes1 (hairy and enhancer of split-1) under the Pdx1 promoter (pancreatic and duodenal homeobox-1). Cloned embryos of apancreatic pigs (host embryos, male) were complemented (i.e. chimerized) by blastomeres of cloned embryos (donor cells, female) with normal developmental competence. Chimeric embryos were cultured for 1 or 2 days before being transferred into the uteri of oestrus-synchronized gilts. The complementation of 292 Pdx1-Hes1 cloned embryos gave rise to 260 (89.0%) blastocysts. The transfer of these blastocysts resulted in 5 male chimeric pigs. Chimerism was confirmed by the detection of host embryo-derived Pdx1-Hes1 and marker transgenes of the donor cells, such as humanized Kusabira-Orange (huKO) or Pdx1-Venus. Chimeric pigs possessed normally formed pancreata entirely derived from the exogenous donor cells. We thus established a blastocyst complementation system in the pig using cloned embryos that would otherwise give rise to apancreatic animals. Chimeric pigs obtained developed normally, maintaining normal serum glucose concentrations up to maturity, and became fertile boars. Mating the chimeric boars with 7 wild-type sows gave rise to 72 fetuses/piglets of which 37 (51.4%) exhibited the apancreatic phenotype. These results indicate that a missing organ can be generated from exogenous cells when functionally normal pluripotent cells chimerize with a cloned dysorganogenetic embryo. Blastocyst complementation using cloned porcine embryos may permit the use of a large animal for the generation of functional organs from xenogenic PSC, including human iPSC. The chimeric boar produced by blastocyst complementation sired fetuses/offspring with the apancreatic phenotype in a Mendelian fashion. Porcine fetuses with an organogenesis-disabled phenotype may provide a useful platform for organ regeneration research. Table 1.Production of chimeric pigs by complementation and of Pdx1-Hes1 cloned embryos

49 PRACTICAL APPLICATION OF THE HOLLOW FIBER VITRIFICATION METHOD FOR CRYOPRESERVATION OF MAMMALIAN EMBRYOS

We recently developed the hollow fibro vitrification (HFV) method, which is a novel, high-performance embryo cryopreservation method (Matsunari et al., 2012). In this study, we aimed to verify the applicability of the HFV method for cryopreserving various types of embryos; BDF1 mouse embryos at the 2-cell stage, porcine parthenogenetic morulae derived from in vitro-matured oocytes, bovine morulae produced by in vitro maturation/fertilization (LIAJ Animal Biotechnology Center, Tokyo, Japan), and in vivo-derived blastocysts of common marmosets were vitrified, and their survival was assessed by culture or transfer. The embryos were vitrified using 20 mM HEPES-buffered TCM-199 containing 20% calf serum as a base medium. Cellulose acetate hollow fibres (25 mm) containing 1 to 20 embryos were placed in an equilibration solution containing 7.5% ethylene glycol (EG) and 7.5% dimethyl sulfoxide (DMSO) for 5 to 7 min, followed by incubation for 1 min in vitrification solution containing 15% EG, 15% DMSO, and 0.5 M sucrose. The embryos were then vitrified by immersion in LN. The embryos were devitrified by immersing the hollow fibre in a 1 M sucrose solution at 38.5°C, which was followed by stepwise dilution of the cryoprotectants and washing. For a subset of the vitrified mouse embryos, rewarming in a non-ultra-rapid manner by melting a hollow fibre in air at room temperature for 5 s was tested. Embryo transfer was performed to assess the viability of the vitrified mouse embryos. For porcine embryos, vitrification in LN vapor (–150°C) was tested. Development of the vitrified mouse embryos to blastocysts was equal to that of the non-vitrified embryos [105/110 (95.5%) v. 109/110 (99.1%)]. Post-transfer development to fetuses was also equal between the vitrified and non-vitrified embryos [pregnancy rates: 4/4 v. 2/2; developmental rates: 55/80 (68.8%) v. 35/40 (87.5%)]. Non-ultra-rapid rewarming did not decrease the survival of the vitrified mouse embryos [blastocysts: 94/100 (94.0%); pregnancy: 4/4; fetuses: 55/80 (68.8%)]. Blastocyst formation was equivalent for vitrification of porcine embryos in LN vapor [27/34 (79.4%)], direct immersion into LN [28/35 (80.0%)], and the non-vitrified control [31/32 (96.9%)]. Vitrification of 191 bovine morulae resulted in 153 (80.1%) blastocysts. In preliminary experiments, survival of marmoset blastocysts was 100% (n = 6). These data demonstrate that the HFV method is (1) effective for embryos of various species and production methods; (2) effective even for porcine in vitro-derived morulae, which are highly cryosensitive; and (3) amenable to modifications such as non-ultra-rapid warming and cooling in LN vapor, increasing the potential applicability of the HFV method. For instance, vitrification in LN vapor may allow embryo cryopreservation with high hygienic standards. This study was supported by JST, ERATO, Nakauchi Stem Cell and Organ Regeneration Project.

297 PRODUCTION OF CHIMERIC PORCINE FETUSES BY AGGREGATION METHOD USING PARTHENOGENETIC EMBRYOS

Porcine induced pluripotent stem (iPS) cells are considered to be an invaluable research tool in translational research with pigs as a large animal model. Pluripotency of the iPS cells needs to be verified by their competence to contribute to chimera formation. The aim of the present study is to establish feasible system to create chimeric pig fetuses using parthenogenetic embryos. In Experiment 1, inner cell mass (ICM) was isolated by immunosurgery from Day 6 blastocysts obtained by parthenogenetic activation of in vitro matured (IVM) oocytes. Isolated ICM were used as the donor cells after staining with fluorescent carbocyanine dye (DiI). Using parthenogenetic morulae or 4- to 8-cell embryos as the host embryos, chimeric embryos were prepared by injection or aggregation method. Injection of ICM was performed by micromanipulation: a single ICM was directly injected into the centre portion of the host morulae. In the aggregation method, a single ICM was aggregated with blastomeres isolated from 2 host embryos at the morula or 4- to 8-cell stage in a micro-well (400 µm diameter, 300 µm deep). The chimeric embryos were cultured in PZM-5 (Yoshioka et al. 2008) for 2 to 3 days to examine development to blastocysts and incorporation of donor ICM cells into the resultant blastocysts ICM (ICM chimerism). In Experiment 2, donor blastomeres isolated from a parthenogenetic morula or 4- to 8-cell embryo were stained by DiI and aggregated with a parthenogenetic host embryo at the morula or 4- to 8-cell stage, and the in vitro development to the blastocyst stage and the ICM chimerism were examined. In Experiment 3, ICM isolated from IVF blastocysts harboring humanized Kusabira-Orange (huKO) gene were used as donor cells. Donor ICM were aggregated with the host embryos at the morula or 4- to 8-cell stage, and the resultant blastocysts were transferred to 4 recipient gilts to collect fetuses on Day 18. Results of Experiments 1 and 2 are summarised in Table 1. Combination of the donor ICM and host morulae yielded high rates of blastocyst formation (~95%) and ICM chimerism (~85%), regardless of the method used (injection or aggregation). Transfer of 73 blastocysts developed from host morulae to 2 recipients (Experiment 3) gave rise to 25 (34.2%) fetuses, of which 6 (24.0%) were confirmed to be chimeric by their clear orange fluorescence and immunostaining by anti-huKO antibody. Of 22 (40.7%) fetuses obtained after transfer of 54 blastocysts derived from 4- to 8-cell host embryos to 2 recipients, 3 (13.6%) were chimeric. Contribution of the donor cells in the tissues of the chimeric fetuses measured by image analysis software (ImageJ, NIH, Bethesda, MD, USA) ranged between 16.1 and 65.2%. These results demonstrate that the aggregation method using parthenogenetic host embryos is an efficient means to produce chimeric pig fetuses, and thereby feasible for verification of pluripotent cells such as iPS cells. Table 1.In vitro development of injected or aggregated porcine embryos

324 PRODUCTION OF GENETICALLY MODIFIED PIGS BY ARTIFICIAL REPRODUCTIVE TECHNOLOGIES USING FROZEN EPIDIDYMAL SPERM

Genetically modified (GM) pigs are useful tools for many types of biomedical research. The objective of this study was to develop a reliable protocol for the reproduction of GM pigs using frozen epididymal sperm. Epididymal sperm were collected from 3 GM boars: (1) humanized Kusabira-Orange (huKO) transgenic, (2) mutant human hepatocyte nuclear factor 1α (HNF-1α) transgenic, and (3) α1,3-galactosyltransferase gene knockout (GalT-KO). Additionally, a wild type (WT) boar was also used for sperm collection. After collection, the sperm were frozen in Niwa and Sasaki freezing medium (Niwa et al. 1989 Manual for Cryopreservation of Pig Spermatozoa 19–23; 1.0 × 109 sperm mL–1) using 0.5-mL straws. The sperm were cooled utilising the 2-step method, from 25 to 15°C at a rate of 0.17°C min–1, and then from 15 to 5°C at 0.08°C min–1. After cooling to 5°C, the straws were frozen in liquid nitrogen with 3% glycerol for storage. After storage for 0.5 to 21 months, the straws were thawed by immersion into a 37°C water bath. The recovered sperm were washed by centrifugation in PBS + 1 mg mL–1 BSA and were resuspended in either Beltsville thawing solution (Pursel and Johnson. 1975 J. Anim. Sci. 40, 99–102) for intra-fallopian AI or in porcine fertilization medium (PFM, Research Institute for the Functional Peptides, Yamagata, Japan) for IVF. Prepubertal gilts (6.5 months), in which oestrus was induced by 1000 IU eCG and 1500 IU hCG given 66 or 72 h apart, were surgically inseminated with 0.9–7.9 × 106 progressive motile sperm 41 to 51 h after receiving an hCG injection. Oocytes, which matured in vitro either in modified porcine oocyte medium (IFP) or modified NCSU23 medium, were inseminated in PFM for 8 h with either 0.5 (huKO, GalT-KO) or 1.6 (HNF-1α) × 106 progressive motile sperm mL–1. The in vitro fertilized oocytes were cultured in porcine zygote medium-5 (Research Institute for the Functional Peptides) for 5 to 6 days until they were transferred. Some of these oocytes were examined for their fertilization rates. Blastocysts were transferred into the uterus of the recipient 150 h after hCG treatment. The fertilization rates for huKO, HNF-1α and GalT-KO sperm were 63.5% (61/96), 62.5% (70/112) and 92.4% (61/66), respectively; 50.8% (31/61), 82.9% (58/70) and 60.7% (37/61) of these were monospermic. The rate at which the IVF embryos developed into blastocysts was 47.8–52.4%. This study demonstrates that IVF using frozen epididymal sperm is more efficient method for reproducing genetically modified pigs than AI (87.5 v. 33.3%). Table 1.Pig production efficiencies of frozen epididymal sperm from genetically modified pigs utilising AI and IVF This study was supported by JST, ERATO, NAKAUCHI Stem Cell and Organ Regeneration Project, Tokyo.

67 A HOLLOW FIBER VITRIFICATION METHOD ENABLES CRYOBANKING OF IN VITRO-MATURATION/IN VITRO-FERTILIZATION-DERIVED TRANSGENIC PIG EMBRYOS

We have recently developed a novel high-performance embryo cryopreservation method: the hollow fiber vitrification (HFV) method (Matsunari et al. 2012 J. Reprod. Dev., in press). In this study, we aimed to demonstrate the utility of the HFV method for the cryopreservation of transgenic pig embryos produced by in vitro oocyte maturation/fertilization (IVM/IVF). In vitro-matured oocytes were inseminated with cryopreserved epididymal sperm (Kikuchi et al. 1998 Theriogenology 50, 615–623) from a transgenic pig carrying the humanized Kusabira-Orange gene (Matsunari et al. 2008 Cloning Stem Cell 10, 313–323) and then cultured for 96 h. Morulae with normal morphology were divided into the vitrification and nonvitrification groups. The vitrification of embryos was performed by the HFV method using 20-mM HEPES-buffered TCM199 containing 20% calf serum as a base medium. Cellulose acetate hollow fibers (25 mm), each containing 10 to 20 embryos, were placed in an equilibration solution containing 7.5% ethylene glycol and 7.5% dimethyl sulfoxide for 5 to 7 min and were then placed for 1 min in the vitrification solution containing 15% ethylene glycol, 15% dimethyl sulfoxide, and 0.5 M sucrose. The embryos were then vitrified by immersion in liquid nitrogen and held there for 5 to 10 min. The embryos were warmed by immersing the hollow fiber in a 1-M sucrose solution at 38.5°C, followed by a stepwise dilution of the cryoprotectants using 0.5-M sucrose solution (3 min) and the base medium (10 min). Vitrified and nonvitrified embryos were cultured for 40 h, and their development into blastocysts was evaluated. The in vitro development of vitrified embryos to the blastocyst stage was compared with that of the nonvitrified controls on Day 6. In the embryo-transfer experiments, blastocysts at either Day 5 or Day 6 from both the vitrification and nonvitrification groups were transferred to 3 recipient gilts per group (25–32 blastocysts/gilt), and their development through farrowing was compared. To test long-term preservation, some of the vitrified morulae were kept in liquid nitrogen for 43 days, and their development to Day 30 fetuses was evaluated after transfer to an additional recipient. The differences in proportional data between the 2 groups were analyzed with the χ2-test. Of the 393 putative zygotes obtained by IVM/IVF, 169 (43.0%) developed into morulae. In vitro development of the vitrified morulae to blastocysts (66/85, 77.6%) was comparable with that of the nonvitrified morulae (67/84, 79.8%, not significant: NS). The embryo-transfer experiments resulted in pregnancy in all 6 of the recipients. The production efficiency of piglets (piglets/embryos transferred) was 17/88 (19.3%) for the vitrification group and 27/88 (27.7%, NS) for the nonvitrification group. Approximately 50% of the offspring in both groups were transgenic. Long-term cryopreservation using the HFV method resulted in similar piglet production efficiency (7 piglets produced out of 32 embryos transferred). This study demonstrated for the first time that the HFV method effectively cryopreserves IVM/IVF-derived transgenic pig embryos. Supported by the JST CREST program.

Sialyl-lewis-x antigen immunoreaction of colorectal-cancer and its relationship to hematogenous metastasis

The adhesion of cancer cells to endothelial cells of the target organ is one of the most important steps of hematogenous metastasis. Especially, sialyl Le(X) plays an important role in defining the metastasis. The expression of sialyl Le(X) antigen in colorectal cancer and its usefulness not only as an indicator of metastatic potential but also as a prognostic factor was studied immunohistochemically. Fifty-five (32.4%) sialyl Le(X) antigen-positive tumors were found in 170 colorectal cancers. There was a significant correlation between the expression of sialyl Le(X) antigen and the histological tumor type, venous invasion, lymph node metastasis, as well as liver metastasis. Hematogenous metastases were significantly more frequent in patients with sialyl Le(X)-positive tumor than in those with sialyl Le(X)-negative tumor; and prognosis was significantly poorer in the former. The results suggest that sialyl Le(X) antigen plays a role in hematogenous metastasis of colorectal cancer, and that the expression of sialyl Le(X) is associated with poor prognosis.

Clinical significance of cell-free and concentrated ascites re-infusion therapy for advanced and recurrent gynecological cancer

BACKGROUND

The management of malignant ascites is critical for the treatment of patients with advanced gynecological cancer. The purpose of this study was to assess the clinical significance of cell-free and concentrated ascites re-infusion therapy (CART).

PATIENTS AND METHODS

Adverse events, alterations in Eastern Cooperative Oncology Group performance status, serum albumin, body weight and abdominal circumference, and overall survival were examined in 22 patients with advanced gynecological cancer which were treated with CART.

RESULTS

Most of the adverse events were grade 1 or 2 fever. CART treatment had little effect on ECOG performance status and on levels of serum albumin. There was a significant decrease in body weight and in abdominal circumference post-treatment with CART, relative to pre-treatment (p<0.01). The overall survival rate was significantly prolonged in 14 patients after CART plus chemotherapy, as compared with eight patients after CART alone (p<0.01).

CONCLUSION

CART may contribute to the improvement of quality of life and of survival in patients with advanced gynecological cancer.

Diffusion-weighted imaging for predicting new compression fractures following percutaneous vertebroplasty

BACKGROUND

Percutaneous vertebroplasty (PVP) is a technique that structurally stabilizes a fractured vertebral body. However, some patients return to the hospital due to recurrent back pain following PVP, and such pain is sometimes caused by new compression fractures.

PURPOSE

To investigate whether the apparent diffusion coefficient (ADC) of adjacent vertebral bodies as assessed by diffusion-weighted imaging before PVP could predict the onset of new compression fractures following PVP.

MATERIAL AND METHODS

25 patients with osteoporotic compression fractures who underwent PVP were enrolled in this study. ADC was measured for 49 vertebral bodies immediately above and below each vertebral body injected with bone cement before and after PVP. By measuring ADC for each adjacent vertebral body, ADC was compared between vertebral bodies with a new compression fracture within 1 month and those without new compression fractures. In addition, the mean ADC of adjacent vertebral bodies per patient was calculated.

RESULTS

Mean preoperative ADC for the six adjacent vertebral bodies with new compression fractures was 0.55 x 10(-3) mm(2)/s (range 0.36-1.01 x 10(-3) mm(2)/s), and for the 43 adjacent vertebral bodies without new compression fractures 0.20 x 10(-3) mm(2)/s (range 0-0.98 x 10(-3) mm(2)/s) (P < 0.001). Mean preoperative ADC for the six patients with new compression fractures was 0.55 x 10(-3) mm(2)/s (range 0.21-1.01 x 10(-3) mm(2)/s), and that for the 19 patients without new compression fractures 0.17 x 10(-3) mm(2)/s (range 0.01-0.43 x 10(-3) mm(2)/s) (P < 0.001).

CONCLUSION

The ADC of adjacent vertebral bodies as assessed by diffusion-weighted imaging before PVP might be one of the predictors for new compression fractures following PVP.

Gadolinium-enhanced magnetic resonance imaging after percutaneous vertebroplasty does not improve the short-term prediction of new compression fractures

PURPOSE

To investigate the relationships between contrast-enhanced magnetic resonance imaging (MRI) findings and new compression fractures occurring after percutaneous vertebroplasty (PVP) in order to determine the necessity of contrast-enhanced MRI.

MATERIAL AND METHODS

The material comprised 13 consecutive patients (27 vertebrae) with compression fractures who underwent vertebroplasty. Twenty-nine adjacent vertebrae were monitored for new compression fractures. We performed contrast-enhanced MRI within the 5 days following PVP.

RESULTS

The 29 adjacent vertebrae displayed 10 enhanced lesions and 19 vertebral bodies without enhancement-unenhanced lesions on MRI within the 5 days after PVP. In 4 out of 10 vertebrae, enhanced lesions were seen within the 5 days after PVP, but no abnormalities were seen on preoperative MRI. In these 4 vertebrae, new compression fractures were seen within the 1 month following PVP. In the other 6 vertebrae, enhanced lesions were seen within the 5 days after PVP, and these signal changes were detected by preoperative MRI in the same area. In 3 of these 6 vertebrae, new compression fractures occurred at 4, 8, and 9 months after PVP, respectively. However, all of the enhanced lesions were detectable on unenhanced MRI, which was conducted at the same time as enhanced MRI.

CONCLUSION

New compression fractures after PVP may be predicted with early postoperative MRI. Contrast-enhanced MRI does not improve detection of the new lesions.

[Effects of smoking on pulmonary function: a cross-sectional and longitudinal study]

Cross-sectional and longitudinal studies were done to investigate the influence that a change in smoking habit can have on the pulmonary function. Seventeen hundred and thirty nine people (698 men, 1,041 women), 39 years of age or older, from the population of a farming village located in the central part of Miyazaki Prefecture were examined. A population-based cohort study with a 4-time observation was done over an interval of 12 years. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1.0) were used as the index of respiratory function, and adjusted annual change of FVC and adjusted annual change of FEV1.0 were used as a pulmonary function inspection index. There was a statistical significance in both %FVC and %FEV1.0 to the predicted values between smokers and non-smokers at the beginning of observation. The adjusted annual change of FVC both of male- and female-smokers and the adjusted annual change of FEV1.0 of male-smokers was higher than those of non-smokers in the longitudinal study. Percent FVC, %FEV1.0 and the adjusted FEV1.0 change of former male-smokers were lower than those of continuing smokers. In addition to %FVC and %FEV1.0, annual change of FVC and annual change of FEV1.0 were important predictors of pulmonary function related to cigarette smoking.

Concomitant administration of sodium dichloroacetate and thiamine in west syndrome caused by thiamine-responsive pyruvate dehydrogenase complex deficiency

We treated a female patient with West syndrome caused by thiamine-responsive pyruvate dehydrogenase complex (PDHC) deficiency. Infantile spasms occurred in association with elevated blood and CSF lactate concentrations; these symptoms disappeared when lactate concentrations had been lowered by treatment with concomitant sodium dichloroacetate (DCA) and high dose thiamine. Sequencing the patient's PDHC E(1)alpha subunit revealed a substitution of serine for glycine at position 89 in exon 3 (G89S). This mutation must be a de novo mutation because it was not found in either parents' genome DNA. To our knowledge, five previously described patients with PDHC deficiency have displayed the West syndrome. All six known patients, including our own, were female, even though an approximately equal number of males and females have been identified with PDHC deficiency and overall West syndrome occurs somewhat more frequently in males. These results indicated that West syndrome occurred more frequently in female patients with PDHC deficiency. It is suggested that lactate concentration should be measured in patients with West syndrome for potential PDHC deficiency, especially in females.

Three types of voltage-dependent calcium currents developing in cultured human neuroblastoma cells

Voltage-dependent calcium currents (ICa), which developed in cultured human neuroblastoma cells (NB-I), were studied using a whole-cell recording technique. Three types (T-, N- and L-type) of ICa were identified based on their biological and pharmacological properties. The T-type ICa was observed in about 60% of the cells from day 2 to day 12 and in about 20% after day 14. Likewise, the amplitude gradually decreased from -61.7 +/- 10.1 pA on day 2 to -18.3 +/- 9.1 pA on day 18. The N-type ICa appeared on day 6, with the number of cells exhibiting this current increasing up to 90.9% (-73.4 +/- 16.0 pA) on day 14 and immediately decreasing thereafter. The L-type ICa was observed in 50.0% of the cells on day 2, increasing to 84.6% of the cells on day 6 and remaining thereafter, while the amplitude gradually increased from -37.8 +/- 14.0 pA on day 2 to -158.8 +/- 22.8 pA on day 18, and decreased thereafter. These findings indicate that the expression of the voltage-dependent Ca2+ channels is strongly regulated by the developmental stage of the cell.

Clinical significance of combined immunohistochemical detection of CD44v and sialyl LeX expression for colorectal cancer patients undergoing curative resection

To evaluate their prognostic value, the expressions of CD44v and sialyl LeX (SLX) in colorectal cancers were studied immunohistochemically. Tissue specimens were reacted with monoclonal antibodies (mAb) CD44-1V and CSLEX-1. Of the 145 colorectal cancer patients undergoing curative resection, 59 (40.7%) were positive for mAb CD44-1V, and 40 (27.6%) were positive for mAb CSLEX-1. There was a significant correlation between the combined expression of SLX and CD44v8-10 and lymph node metastasis. The patients with tumors negative for CD44v8-10 and SLX had the most favorable prognoses. Conversely, the patients with tumors positive for both CD44v8-10 and SLX had a high recurrence rate and the poorest prognoses. In a multivariate analysis using the Cox regression model, the combined expression of SLX and CD44v8-10 emerged as an independent prognostic indicator. These results suggested that the combined expression of CD44v8-10 and SLX may be a biologic marker of prognostic significance.

Expression of nm23-H1 gene and Sialyl Lewis X antigen in breast cancer

The nm23 gene has been proposed as a candidate tumor metastasis suppressor in some human cancers. Sialyl Lewis X (sLex) has been demonstrated to play an important role in the adhesion of human cancer cells to human vascular endothelium, inducing metastasis. Little information has been reported about the correlation between the expression of nm23 and sialylated carbohydrate antigens. In the present study, 102 surgically resected primary breast cancer tissues were sectioned and stained with antibody against nm23-H1 and sLex. Of the 102 cases, 39 (38.2%) cases with a reduced expression of nm23-H1 were observed, and the numbers of sLex-positive cases were 61 (59.8%), respectively. The reduced expression of nm23-H1 and the positive expression of sLex were significantly associated with lymph node involvement. Among the 100 patients who underwent curative surgery, the disease-free survival rate was significantly correlated to both the nm23-H1 and sLex expressions. No interrelated expressions were found between nm23-H1 and sLex. In multivariate analysis using Cox regression model, combination assay of nm23-H1 and sLex expression emerged as independent significant prognostic factors. These results suggest that nm23-H 1 gene and sLex may be involved in different steps of the metastatic process in human breast cancer, and immunohistochemical detection of the combination of sLex and nm23-H1 may be a biologic marker of prognostic significance.

Significance of tumor marker SLX in colorectal cancer

We examined serum SLX for its significance as a tumor marker in 109 colorectal cancer patients. There a close correlation with immunohistochemical expression of SLX and serum SLX level. Serum SLX was positive in 16.5% of 109 patients with colorectal cancers. There was no significant correlation between serum SLX level and histologic type or primary tumor status. There were significant correlations between serum SLX positive rates and both lymph node and hematogenous metastasis. In 7 SLX positive cases who underwent curative resection, 4 patients had already recurrence in the liver. Our findings suggest that serum SLX values may be a biologic marker of metastasis.

Lectin-histochemical reactivity of sialic acid in breast cancer and its relationship to prognosis using limulus polyphemus agglutinin

Studies of circulating sialic acid have revealed its relationship with a variety of malignant tumors. It is not vet clear whether sialic acid could be used as a prognostic marker of breast cancer, and few studies have examined sialic acid expression in the cell membrane and cytoplasm of breast cancer cells by means of the lectin-histochemical technique. In the present study, we used biotinylated limulus polyphemus agglutinin (LPA), a special binding lectin of sialic acid, to stain sialic acid in breast cancer cells. Of the 104 cases of breast cancer examined, 59 (56.7%) positive cases were observed. There was a significant correlation between the LPA staining and the clinicopathologic features of all patients, including pathological stage and lymph node metastasis. Among the 100 patients who underwent curative operation, the mean disease-free survival rate of the 45 patients who were LPA-negative was significantly higher than that of the 55 LPA-positive patients (p<0.05). These results suggest that the positive expression of sialic acid in breast cancer could be used as a marker of malignancy potential, as well as a poor survival factor, and the biotinylated LPA assay may provide a convenient and useful method to predict the prognosis of breast cancer.

Mechanisms of T-type calcium channel blockade by zonisamide

We investigated the effects of zonisamide, a new antiepileptic drug, on voltage-dependent T-type calcium current (ICa) in cultured neuroblastoma cells of human origin (NB-I). Zonisamide reduced T-type ICa in a concentration-dependent manner without evoking any change in its inactivation kinetics or voltage dependence of action. The mean percent reduction was 38.3 +/- 5.8% at 50 microM. Further, zonisamide shifted the inactivation curve approximately 20 mV negative compared to the control. These resting blocking actions suggest that zonisamide shifts the channel population toward the inactivation state, allowing fewer channels to open during membrane depolarization. The blockade of T-type calcium channels by zonisamide could suppress an important component of inward current that underlies epileptiform cellular bursting, thereby inhibiting the spread of seizure activity.

[Glucose intolerance after percutaneous ethanol injection therapy (PEI) in liver cirrhosis patients with hepatocellular carcinoma]

We studied the effect of percutaneous ethanol injection therapy (PEI) on glucose tolerance in liver cirrhosis patients with hepatocellular carcinoma. All of 10 patients underwent PEI and aspiration biopsy of the tumor on separate day. Two-time oral glucose tolerance tests (OGTT), before and after PEI, were performed in all patients. There were no significant changes in blood glucose and insulin chronologically measured on aspiration biopsy and PEI. To detect changes in glucose tolerance, we compared the results of OGTT before PEI with those of OGTT after PEI. On the basis of results of OGTT before PEI, patients were classified to impaired glucose tolerance group (4) and diabetes mellitus group (6). Blood glucose at 180 minutes on OGTT after PEI showed significantly higher value than that of OGTT before PEI, but insulin response was not suppressed. From these experiments we speculate that exaggerated insulin resistance due to injected ethanol may be one of the factors influencing glucose tolerance after PEI.

Three types of voltage-dependent calcium currents in cultured human neuroblastoma cells

The voltage-dependent calcium current (ICa) in cultured human neuroblastoma cells (NB-I) was studied by whole-cell recording. The low-threshold current (Il), the high-threshold, fast inactivating current (Ih.f.), and the high-threshold, slow inactivating current (Ih.s.) were identified. Il. was blocked by Ni2+. Ih.f. was blocked by omega-conotoxin GVIA. Ih.s. was blocked by nifedipine, and enhanced by Bay K 8644. These characteristics indicate that Il, Ih.f. and Ih.s. are consistent with the T-, N- and L-type ICa, respectively.

Antiepileptic drugs--calcium current interaction in cultured human neuroblastoma cells

The voltage-dependent calcium channel current (ICa) in the neuroblastoma cell line of human origin (NB-I) was studied by the whole-cell clamp recording. Three types of ICa were identified in NB-I cells. Our electrophysiological and pharmacological findings have suggested that these three types of ICa are consistent with the T-, N- and L-type ICa, respectively. Phenytoin (PHT) inhibited T-type ICa by 13.0% at a concentration of 5 microM, and L-type ICa by 6.3% at a concentration of 100 microM. At a concentration of 100 microM, carbamazepine (CBZ) inhibited T- and L-type ICa by 6.0% and 5.9%, respectively. At a concentration of 50 microM, sodium valproate (VPA) blocked T- and L-type ICa by 6.1% and 47.5%, respectively. At a concentration of 50 microM, zomisamide (ZNS) inhibited T- and L-type ICa by 38.3% and 41.9%, respectively. Na+ channel blockade has been reported to be responsible for the clinical efficacy of PHT or CBZ. Inhibition of T-type ICa by PHT may enhance the efficacy of its anticonvulsant action. CBZ had little effect on ICa. The anticonvulsant activity may be related to the blockade of T-type ICa in the case of VPA and ZNS.

Overexpression of p53 protein and proliferative activity in colorectal adenoma

Overexpression of p53 was studied immunohistochemically in colorectal tumors. We found p53-positive cells in 17 (58.6%) of 29 specimens of cancer in adenoma. Expression of p53 protein was detected in the nuclei of the tumor cells. We also found p53-positive cells in 7 (7.1%) of 99 specimens of adenoma. p53 immunoreactivity for severe dysplasia was higher than that for mild or moderate dysplasia. p53 expression in adenomas was restricted to a few glands, and the proliferating-cell nuclear antigen (PCNA)-positive rate for the p53-positive glands was significantly higher than that for p53-negative glands. The results suggested that the p53-positive glands might have high growth fractions, and that immunohistochemical detection of p53 expression in tubular adenomas might contribute to identifying the potential for malignant transformation.

The network properties of bipolar-bipolar cell coupling in the retina of teleost fishes

Retinal bipolar cells exhibit a center-surround antagonistic receptive field to a light stimulus (Werblin & Dowling, 1969; Kaneko, 1970), and thus constitute an early stage of spatial information processing. We injected Lucifer Yellow and a small biotinylated tracer, biocytin, into bipolar cells of the teleost retina to examine electrical coupling in these cells. Lucifer-Yellow coupling was observed in one of 55 stained bipolar cells; the coupling pattern was one injected bipolar cell and three surrounding cells. Biocytin coupling was observed in 16 of 55 stained bipolar cells, six of which were ON center and ten OFF center. Although biocytin usually coupled to three to six bipolar cells, some OFF-center bipolar cells showed strong coupling to more than 20 cells. The biocytin-coupled bipolar cells were morphologically homologous. Membrane appositions resembling gap junctions were found between dendrites and between axon terminals of neighboring bipolar cells. In the strongest biocytin-coupled bipolar cells, the contacts between bipolar cells and cone photoreceptor cells were examined after reconstruction of the dendritic trees of five well-stained, serially sectioned OFF-center bipolar cells. Each of these bipolar cells was in contact with different numbers of cones: 11 to 20 for twin cones and two to four for single cones. This implies that, although these bipolar cells belong to the same category, the signal inputs differ among bipolar cells. Numerical simulation conducted on a hexagonal array network model demonstrated that the electrical coupling of bipolar cells can decrease the difference in input (approximately 80%) without causing significant loss of spatial resolution. Our results suggest that electrical coupling of bipolar cells has the advantage of decreasing the dispersion of input signals from cones, and permits bipolar cells of the same class to respond to light with similar properties.

Lateral gap junction connections between retinal amacrine cells summating sustained responses

Vertebrate retinal amacrine cells produce transient or sustained responses. Sustained depolarizing amacrine cells in the dace retina were identified by their intracellularly recorded responses to light flashes. The response amplitude produced a notable spatial summation which exceeded that of individual dendritic arbors. When sustained type amacrine cells were intracellularly injected with Lucifer Yellow and biocytin, there was extensive transfer of biocytin, but not Lucifer Yellow, to surrounding cells with similar cellular morphology. Ultrastructural analysis of the interconnections by electron microscopy revealed the presence of gap junctions at the contact area, which did not include conventional synapses. Present results demonstrate that sustained response amacrine cells make direct electrical connections between the cells of the same type and electrical coupling may contribute to extension of their receptive fields.

[Modes of spread and surgical strategy for gallbladder carcinoma with subserosal invasion]

The mode of spread and the prognosis were investigated in 22 patients with resected gallbladder carcinoma invading the subserosal layer. By the Kaplan-Meier method, the 5-year survival rate was 68.8% in patients receiving curative or relatively noncurative resection. On the other hand, no patient survived for more than 3 years after noncurative resection. The mode of subserosal infiltration was classified according to the general rules for gastric cancer study. At least systemic lymph node dissection (R2) should be performed in patients with ss alpha cancer, because lymph node metastasis in these patients were confined to the 1st group. More extensive lymph node dissection (R2 with 9, 16) is essential for patients with ss beta and ss gamma, because lymph node metastasis to at least the 2nd group were seen in 75% of them. The surgical margin was positive for cancer in all patient with infiltration of the hepatoduodenal ligament. Therefore, it was considered that hepatoligamentectomy should be performed in these patients to obtain a cancer free surgical margin. Among patients undergoing curative or relatively noncurative resection, the recurrence rate was 43% in those with lymph node metastasis and 50% in those with DNA aneuploidy. Therefore, it appears that adjuvant chemotherapy should be given to such patients.

Dimethyl sulfoxide (DMSO) increases expression of sialyl Lewis x antigen and enhances adhesion of human gastric carcinoma (NUGC4) cells to activated endothelial cells

Dimethyl sulfoxide (DMSO) exerts a number of biological effects including the promotion of cell differentiation in cultured cells. In this study, we examined the effect of DMSO on the adhesion of tumor cells to endothelial cells. In vitro treatment of human gastric adenocarcinoma (NUGC4) cells with DMSO resulted in increased adhesion to interleukin-I (IL-I)-activated human endothelial cells compared with DMSO-untreated NUGC4 cells. In flow cytometry, treating NUGC4 cells with DMSO enhanced the expression of sialyl Lewis x (sialyl Le(x)) and sialyl dimeric Le(x) antigens on their surface. Also, the binding of Limulus polyphemus agglutinin (LPA), which specifically binds to cell-surface sialic acids, was increased by DMSO. The adhesion of DMSO-treated NUGC4 cells to activated endothelial cells was blocked by neuraminidase pre-treatment of tumor cells or by antibody against either endothelial leukocyte adhesion molecule-I (ELAM-I) or sialyl Le(x). Thus, it is suggested that enhanced adhesion following DMSO treatment is mediated by the interaction of sialyl Le(x) expressed on NUGC4 cells with ELAM-I of endothelial cells. The modulation of sialyl Le(x) antigen by DMSO provides a useful system for studying the regulatory mechanism of Lewis-related carbohydrate antigens and also for understanding the metastatic properties of cancer cells.

Diagnostic and therapeutic strategies of pyogenic liver abscess

The infectious routes and etiologies of 26 cases with pyogenic liver abscess were portal spread in one, hematogenous in three, biliary in 12, transarterial embolization (TAE) in three, posthepatectomy in one and cryptogenic in five cases. Portal and hematogenous cases tend to show solitary and cystic pattern on echogram, and the majority of the bacteria detected was Klebsiella. While most biliary cases show multiple and cystic with tumor pattern on echogram, and an unhomogeneous low density in CT feature, anaerobic bacteria and candida were isolated only from the biliary or TAE cases. Most cases could be cured completely by the various kinds of abscess drainage, but two TAE cases with PTAD (percutaneous transhepatic abscess drainage) and two biliary cases with PTBD (PT-biliary drainage) and PTAD died due to a delay in establishing a diagnosis and to the severity of the condition. An early diagnosis followed by PTAD or PTBD were thought to be of prime importance.

The presence of concanavalin-A(Con-A)-like molecules on natural-killer (NK)-sensitive target cells: their possible role in swainsonine-augmented human NK cytotoxicity

In the present study we examined the expression of concanavalin-A(Con-A)-like molecules on natural-killer (NK)-sensitive target cells and investigated their possible role in the human NK-cell phenomenon. The incubation of either peripheral-blood lymphocytes (PBL) or large granular lymphocytes (LGL) with swainsonine (SW), an inhibitor of mannosidase II, resulted in the augmentation of cytotoxicity against K562 leukemia cells. The enhanced cytotoxicity was associated with increased binding of fluorescein isothiocyanate-conjugated Con-A to SW-treated effector cells, and immunofluorescence staining of the target K562 cells using goat anti-Con-A antibody (Ab) showed a significant positive shift in the flow cytometric pattern. Electrophoretic separation and immunoblotting analysis revealed that 4 components with a molecular weight of approximately 95, 80, 60 and 50 kDa were recognized by anti-Con-A Ab from the detergent-extract of K562 cells. The addition of Con-A during the antibody incubation step of the Western blotting abolished their expression, thus excluding non-specific binding of the antibody. The addition of Con-A also strongly inhibited the cytotoxicity of SW-treated effector cells (PBL or LGL) against K562 cells, and this inhibition was abolished by 40 mM alpha-methyl-mannopyranoside (alpha-MM), which binds to Con-A. Furthermore, Con-A increased the binding frequency of SW-treated LGL to K562, in spite of the inhibited cytotoxicity, and this effect could be neutralized by the further addition of alpha-MM. Our results suggest that Con A-like molecules might play an important role in cell-cell interactions between SW-treated effector cells and NK target cells.

Hyperpolarizing interplexiform cell of the dace retina identified physiologically and morphologically

One type of interplexiform cell (IPC) in the dace retina was discriminated physiologically from other cell classes and identified morphologically with HRP staining. This type responded with slow hyperpolarizing potentials to white diffuse light, and in addition a slow hyperpolarization (after potential) was observed after the cessation of light with relatively high intensities. The latency of the ON phase of the response was always longer than that of the second-order neurons and the amacrine cells. Morphologically, this type of IPC was similar in appearance with the dopaminergic IPC. The conventional synaptic specialization between this type of IPC and horizontal cells was observed, and the IPC was presynaptic.

Increment of alpha B-crystallin mRNA in the brain of patient with infantile type Alexander's disease

To estimate the expression level of alpha B-crystallin in the brain of infantile type Alexander's disease, the amounts of protein and mRNA of alpha B-crystallin were measured by enzyme immunoassay (EIA) and Northern blot analysis, respectively, in the brain of patient and controls, and in the tissues from glioblastoma and astrocytoma. The alpha B-crystallin protein in the brain of patient was remarkably increased as compared with those of controls. The amount of alpha B-crystallin mRNA of patient was increased about 7-fold compared to the mean value of the control group and higher than that of glioblastoma tissue. These data suggest that increment of alpha B-crystallin mRNA in astrocytes leads to the overexpression of this protein and may be one of the main causes of infantile type Alexander's disease.

Detection of platelet mitochondrial DNA deletions in Kearns-Sayre syndrome

To establish a noninvasive genetic diagnosing method for Kearns-Sayre syndrome, the authors used the polymerase chain reaction (PCR) technique for detecting mitochondrial DNA (mtDNA) deletions in the platelets and directly sequenced the crossover regions of the deleted mtDNA using the fluorescence-based automated sequencing system. The mtDNA deletions were identified in the platelets of three of four patients. The sizes and locations of deletions were determined by the nesting primer PCR method, in which the primary PCR products derived from deleted mtDNAs undergo reamplification using a series of nesting primers. With the fluorescence-based sequencing of templates amplified by the asymmetric PCR method, deleted mtDNA was sequenced directly without cloning. In patient 1, guanine (G) was found at the boundaries of a deleted segment spanning 8400 base pairs (bp) between the CO1 and ND6 genes. In patient 2, a 9-bp directly repeated sequence of 5'-ACCTCCCTC-3' (where A = adenine, C = cytosine, and T = thymine) was found at the boundaries of a deleted segment spanning 7221 bp between the CO1 and ND5 genes. In patient 3, an 8-bp sequence of 5'-TCGCTGTC-3' was found at the boundaries of a deleted segment spanning 4664 bp between the ATPase6 and ND5 genes. Deletions were not detected in the mtDNA of patient 4 or in that of the mothers of the patients. Previously, the genetic diagnosis of this syndrome required muscle biopsy specimens and the use of Southern blot analysis. However, this method requires neither muscle biopsy nor isotopes and is more rapid than the Southern blot method.(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of alpha-ketoglutarate dehydrogenase activity in tissue extracts and human platelets using reversed-phase high-performance liquid chromatography

A new method for the determination of the activity of alpha-ketoglutarate dehydrogenase complex (KGDHC) in mouse brain and liver mitochondria and in human platelets using reversed-phase high-performance liquid chromatography is described. This method is based on the quantification of succinyl-CoA formed in the reaction catalyzed by KGDHC. Succinyl-CoA was separated using a YMC-Pack C8 column employing isocratic elution and detected spectrophotometrically at 254 nm. The detection limit of succinyl-CoA was 0.05 nmol. Succinyl-CoA in the supernatant of the assay mixture was stable for several hours at 4 degrees C and for a week when stored at -20 degrees C. The KGDHC assay showed good linearity with time and added protein, and all tissues demonstrated an absolute requirement for added alpha-ketoglutarate, nicotinamide dinucleotide, and coenzyme A and partial or no requirement for thiamine pyrophosphate, magnesium chloride, and dithiothreitol. The specific activities in liver and brain mitochondria and platelet homogenates determined by the present method were 19.2 +/- 0.9, 18.1 +/- 2.8, and 2.6 +/- 0.3 nmol/min/mg protein, respectively. In human platelets, the present method gives higher specific activity and lower blank values than a prior method using 14CO2 and may be useful in the diagnosis of KGDHC deficiency. This method is simple, rapid, and can be readily employed for the determination of KGDHC activity in various animal tissues and human platelets.

Benign infantile epilepsy with complex partial seizures

Benign infantile epilepsy with complex partial seizures is characterized by a high incidence of family history of benign childhood convulsions, normal development prior to onset, infantile onset, no underlying disorders, no neurological abnormalities, normal interictal EEGs, good response to treatment, and complete remission with normal developmental outcome. Seizures often occur in clusters, consisting of motion arrest, decreased responsiveness, staring or blank eyes mostly with simple automatisms, and mild convulsive movements associated with focal paroxysmal discharges, most frequently in the temporal area.

Seizure prognosis and EEG evolution in complex partial seizures of childhood onset

We studied the clinical course and seizure prognosis of 126 children with complex partial seizures regularly followed up for more than 4 years in our clinic. Clinical and EEG features of 63 seizure-free patients were compared with those of 63 patients with persistent seizures. The features contributing to poor prognosis were 1) mental retardation, 2) a history of status epilepticus and 3) abnormal basic rhythm in EEG. CT abnormality, a history of febrile convulsions (FC), the clustering of seizures and association with other types of seizures did not influence prognosis. We divided the patients into four groups according to the evolutionary pattern of seizure discharges: Group A, 55 (43.7%) patients with spike focus always fixed in the same region; Group B, 20 (15.9%) patients with wandering foci; Group C, 10 (7.4%) patients with multifocal spikes; and group D, 41 (32.5%) patients with no focal discharges. There was no difference in seizure prognosis among these four groups, but the patients with a focus in the anterior temporal region in Group A evidenced the worst prognosis.

Moyamoya disease presenting with chorea

Three children with moyamoya disease are reported whose initial and predominant manifestations were choreic movements. Two of the patients presented with unsteady gait and the other with clumsiness. Choreic movements were recurrent and were often triggered by excitement, emotional tension, or crying. They occurred unilaterally or bilaterally and often alternated between the right and left. Moyamoya disease must be considered in the differential diagnosis of acquired chorea in children.

Magnetic resonance imaging in complex partial seizures

Magnetic resonance imaging (MRI) and computed tomography (CT) were performed on 45 patients with intractable complex partial seizures. MRI was performed with a superconducting whole-body scanner operating at 0.5 tesla (T) and 1.5 T. In patients with temporal lobe epilepsy, 8 of 24 patients had abnormal CT, but 16 of 24 patients showed abnormal MRI. 1.5 T MRI detected more abnormality than 0.5 T MRI when CT was normal. In patients with frontal lobe epilepsy, 5 of 7 patients had normal CT and MRI. In 2 other patients, MRI demonstrated an arachnoid cyst and increased signal intensity area on the T2-weighted images which were not detected by CT. In patients with occipital lobe epilepsy, 5 of 6 patients show abnormal CT and MRI. In patients with tuberous sclerosis, MRI revealed some increased signal intensity areas on the T2-weighted images in the occipital and temporal lobe, which were not detected by CT. Most surface EEG foci corresponded with the side of MRI abnormality. These data indicate that MRI is more informative than CT in complex partial seizures. MRI is the imaging technique of choice in the diagnosis of complex partial seizures.