Longitudinal changes in dynamic characteristics of neonatal external and middle ears

OBJECTIVES

Neonates have smaller and less mature ears than adults. Developmental changes in structure and function continually occur after birth and may affect the diagnostic results obtained by audiometric assessment instrumentation, such as tympanometry and otoacoustic emission. In the present study, we investigated longitudinal changes in external and middle ear dynamic characteristics by performing sweep frequency impedance (SFI) tests.

METHODS

SFI tests were longitudinally performed on healthy Japanese neonates (1 female and 1 male) from birth to 3 and 5 months, respectively. A sound of sweeping sinusoidal frequency, ranging from 0.1 kHz to 2 kHz, was presented to the ear canal at 50-daPa intervals of static pressure from +200 to -200 daPa. Test results were expressed a curve showing the sound pressure level (SPL) relative to probe tone frequency, called SPL curve.

RESULTS

The first fluctuation in resonance frequency (RF₁) and SPL (ΔSPL₁), related to the external ear, showed significant developmental changes as chronological age increased; that is, RF₁ and ΔSPL₁ were respectively increased and decreased and thereafter became unmeasurable by 5 months of age. In contrast, the second fluctuation in resonance frequency (RF₂) and SPL (ΔSPL₂), related to the middle ear, did not show significant changes over the measurement period.

CONCLUSIONS

The present results suggest that the dynamic characteristics of the external ear canal wall changed with increases in chronological age; the resonance of the wall at about 0.3 kHz at birth tended to increase to about 0.7 kHz and to be unmeasurable by 5 months of age, while those of the middle ear did not significantly changed. These results showing how neonatal-ear dynamics changes with chronological age may be an important key in further hearing research and the development of hearing devices and diagnostic tools suitable for neonates.

The expression of 11 beta hydroxysteroid dehydrogenase in severe allergic rhinitis

OBJECTIVE

To clarify the roles of 11 beta-HSD in resistance to glucocorticoid therapy for allergic rhinitis, a case series study was conducted.

METHODS

The patient group consisted of 20 subjects with allergic rhinitis, aged from 21 to 46 years (mean age 26.5), who showed persistent GC resistance necessitating surgical removal of the inferior turbinate after 6 months' GC treatment. The patients with poor response to GC treatment for 6 months' were defined as GC resistance. The control group consisted of 10 subjects aged from 16 to 39 years (mean age 24.5) who underwent maxillofacial surgery, from whom nasal tissues were taken and who did not receive GC treatment. Nasal mucosal tissues from patients and cntorol subjects were examined immunohistochemically. The sections were washed with 0.01 M phosphate-buffered saline (PBS; pH 7.2) containing 0.15 M NaCl and 0.01% Triton X-100, and incubated for 2 h with rabbit polyclonal anti-11 beta HSD1 and 11 beta-HSD2 antibody (Santa Cruz Biotechnology, Inc., Santa Cruz, CA, USA), each diluted 1:200 in PBS containing 0.1% bovine serum albumin. Immunostained sections were assessed under an Olympus microscope with an eyepiece reticule at 200 X magnification. Cell counts are expressed as means per high-power field (0.202 mm2). Control group means (arithmetic mean ± SD) were compared with patient group means by Mann-Whitney U-test at P = 0.05.

RESULTS

Although 11 beta-HSD1 was expressed to a similar extent in patients and controls, 11 beta-HSD2 was expressed significantly more in patients with severe allergic rhinitis, resulting in a increased HSD-1/HSD-2 ratio. The significantly increased expression of 11 beta-HSD2 in the nasal epithelium and submucosal inflammatory cells of patients with severe nasal allergy were observed in the present study.

CONCLUSION

Our findings suggest that 11 beta-HSD2 plays an important role in resistance to glucocorticoid therapy for allergic rhinitis, and its expression might be used as an additional parameter indicating steroid resistance in allergic rhinitis.

Possible interaction between the bacterial transcription factor ArtA and the eukaryotic RNA polymerase III promoter

Eukaryotic RNA polymerase III (RNAP III) transcribes tRNA genes and short interspersed elements that have internal promoters consisting of A- and B-blocks. The B-block binding subunit of the transcription initiation factor TFIIIC binds to the B-block. The mobile bacterial insertion sequence (IS) 1 contains a RNAP III promoter-like sequence, which stimulates bacterial transcription along with the bacterial ArtA protein. Here, the DNA-binding ability of ArtA was examined in vitro using a simple, newly developed method. Various DNA fragments, including RNAP III promoter fragments, were separately incubated with purified ArtA, and then loaded onto a polyacrylamide gel. Since DNAs bound by ArtA remain in the gel wells during electrophoresis, SDS was added into the wells at the electrophoresis halfway point. It was hypothesized that SDS would dissociate the DNA-ArtA complexes in the wells, and then the DNAs would begin to migrate. In fact, new bands appeared in all of the lanes at similar intensities, indicating that ArtA binds nonspecifically to DNA. Therefore, labeled wild-type RNAP III promoter fragments were incubated with either the unlabeled wild-type or mutant fragments and ArtA, and electrophoresed. The B-block(-like) sequences of IS1, a human Alu element, and an anuran tRNA gene were important for binding to ArtA. Additionally, in silico analyses revealed the presence of the RNAP III promoter-like structures in the IS1 isoforms and the IS3 family elements. These results suggest the presence of parts of the RNAP III transcription machinery in bacteria, and might imply that its prototype existed in the common ancestor.

Unusual Parapharyngeal Extension of Peritonsillar Abscess to the Masticator Space

Objective:

The object was to describe 2 novel cases of peritonsillar abscess showing peculiar extension to the masticator space.

Methods:

The methods included clinical case records, including computed tomography and surgical approaches.

Results:

Both patients we encountered were suffering from systematic diseases, with case 1 involving a 75-year-old man with diabetes mellitus and case 2 involving a 90-year-old woman taking immunosuppressive medications. The abscesses were peritonsillar in origin, extending primarily to the parapharyngeal space, with unusual secondary extension to the masticator space. Extraoral drainage conducted in case 1 was useful for assessing the masticator space and surrounding spaces, but endoscopy-assisted intraoral drainage in case 2 was less invasive, obviating the need for identifying the facial nerve.

Conclusions:

It is important to bear in mind that patients suffering from systemic diseases may display unusual extension of deep head and neck infections, and enhanced computed tomography is a useful modality for evaluating such extensions.

Dynamic characteristics of the middle ear in neonates

OBJECTIVE

Early diagnosis and treatment of hearing disorders in neonates is highly effective for realization of linguistic competence and intellectual development. To objectively and quickly evaluate the dynamic characteristics of the middle ear, a sweep frequency impedance (SFI) meter was developed, which allowed the diagnosis of middle-ear dysfunctions in adults and children. However, this SFI meter was not applicable to neonates since the size of the measurement probe was too large. In the present study, therefore, the SFI meter was improved, i.e., the diameter of the probe was reduced to that of the neonatal external ear canal. By using this newly designed SFI meter, SFI tests were performed in healthy neonates.

METHODS

A sound of the sweeping sinusoidal frequency between 0.1 kHz and 2.0 kHz in 0.02-kHz step intervals is presented to the ear canal by an SFI probe while the static pressure of the ear canal is kept constant. During this procedure, the sound pressure level (SPL) is measured. The measurements are performed at 50-daPa intervals of static pressure from 200 daPa to -200 daPa.

RESULTS

Measurements were conducted in 10 ears of 9 neonates. The SPL showed two variations at 0.26 ± 0.03 kHz and 1.13 ± 0.12 kHz. Since the SPL is known to show a variation at frequencies from 1.0 kHz to 1.6 kHz due to the resonance of the middle ear in adults and children with normal hearing, the second variation is probably related to such resonance in neonates. The measurement of gel models, which mimics the neonatal external ear canal, showed a variation in SPL at around 0.5 kHz. This implies that the source of the first variation may possibly be related to the resonance of the external ear canal wall.

CONCLUSIONS

SFI tests revealed that there were two variations in the SPL curve in neonates, one at 0.26 ± 0.03 kHz and the other at 1.13 ± 0.12 kHz, the former and the latter being possibly related to the resonance of the external ear canal wall and that of the middle ear, respectively. This result suggests that the dynamic characteristics of the middle ear in neonates are different from those in adults.

Addition formulae for Abelian functions associated with specialized curves

We discuss a family of multi-term addition formulae for Weierstrass functions on specialized curves of low genus with many automorphisms, concentrating mostly on the case of genus 1 and 2. In the genus 1 case, we give addition formulae for the equianharmonic and lemniscate cases, and in genus 2 we find some new addition formulae for a number of curves.

Links between repeated sequences

L1 and Alu elements are long and short interspersed retrotransposable elements (LINEs and SINEs) in humans, respectively. Proteins encoded in the autonomous L1 mediate retrotransposition of the nonautonomous Alu and cellular mRNAs. Alu is the only active SINE in the human genome and is derived from 7SL RNA of signal recognition particle. In the other eukaryotic genomes, various tRNA- and 5S rRNA-derived SINEs are found. Some of the tRNA- and 5S rRNA-derived SINEs have partner LINEs of which 3′ sequences are similar to those of the SINEs. One of the tRNA-derived SINEs is shown to be mobilized by its partner LINE. Many copies of tRNA and 5S rRNA pseudogenes are present in the human genome. These pseudogenes may have been generated via the retrotransposition process using L1 proteins. Although there are no sequence similarities between L1 and Alu, L1 functionally links with Alu and even cellular genes, impacting on our genome shaping.

Therapeutic effect of balloon-occluded retrograde transvenous obliteration for gastric varices in relation to haemodynamics in the short gastric vein

The aim of this study was to elucidate the relationship between the therapeutic effect of balloon-occluded retrograde transvenous obliteration (B-RTO) and haemodynamic features in the short gastric vein (SGV) in patients with gastric fundal varices (GV). The subjects in this retrospective cohort study comprised 34 patients who had moderate- or large-grade GV with the SGV both on retrograde venography and Doppler ultrasound. The diameter, flow velocity and flow volume in the SGV measured by Doppler ultrasound before B-RTO with 1 h balloon occlusion were compared with the therapeutic effect. Embolisation of GV was achieved in 30/34 patients (88.2%): 27 by initial B-RTO and 3 by second B-RTO. Flow velocity and flow volume in the SGV before B-RTO were significantly lower in the 27 patients with a complete effect on initial B-RTO (7.19+/-2.44 cm s(-1), p = 0.0246; 189.52+/-167.66 ml min(-1), p = 0.002) than in the 7 patients with an incomplete effect (10.41+/-5.44 cm s(-1), 492.14+/-344.94 ml min(-1)). Neither endoscopy nor contrast-enhanced CT had recurrent findings of GV in the subject during the follow-up period (94-1440 days; mean, 487.2+/-480.5 days). In conclusion, haemodynamic evaluation of the SGV using Doppler ultrasound may be useful for the prediction of the therapeutic effect of B-RTO.

Efficacy of early dental and ENT therapy in preventing nephropathy in pediatric Henoch-Schönlein purpura

In a previous study, we demonstrated the benefit of tonsillectomy for early recovery from Henoch-Schönlein purpura (HSP) nephritis (HSPN), suggesting the pathological role of tonsils in HSP (Inoue et al., Clin Nephrol 67:298-305, 2007). In this study, we evaluated the efficacy of extensive eradication of infectious foci directly connected to the tonsils, including those involved in oral as well as ear, nose, and throat (ENT) diseases, in reducing the nephropathy in HSP. For this purpose, we examined the focal points of infection in 40 newly diagnosed HSP patients. After these focal points of infection had been identified, they were extensively eradicated; when the clinical course was intractable, we also considered tonsillectomy. After administering such therapy to HSP patients, we prospectively followed them up for 0.6 to 8 years. The identified focal infections included dental caries in 28 (70%), apical periodontitis in 21 (53%), rhinosinusitis in 19 (48%), tonsillitis in five (13%), and otitis media in four (10%) of the 40 patients. Seventeen patients (43%) had more than two simultaneous infectious foci, whereas, in five (13%), no infectious focus was found. In 32 patients, antimicrobial treatment with concurrent dental and/or ENT therapy resulted in a complete cure without development of HSPN or recurrent attacks. In eight patients, we performed tonsillectomy-adenotonsillectomy to treat their clinical symptoms, including aggravated purpura and recurrent attacks of HSP or HSPN. All patients were completely cured. The overall incidence of HSPN was only three out of the 40 patients (8%). Oral and ENT diseases were found with high percentages in HSP patients. Early and extensive treatment for these lesions and tonsillectomy-adenotonsillectomy for intractable cases may prevent the complication of HSPN, contributing to the early curing of HSP.

Application of percutaneous ultrasound-guided treatment for ultrasonically invisible hypervascular hepatocellular carcinoma using microbubble contrast agent

AIM

To evaluate the efficacy of contrast-enhanced ultrasound for the localization of ultrasonically invisible hypervascular lesions in the liver to facilitate percutaneous ultrasound-guided treatment.

MATERIALS AND METHODS

Forty patients with 47 ultrasonically invisible hypervascular lesions (5-20mm) diagnosed on contrast-enhanced computed tomography were enrolled in the retrospective study. Contrast-enhanced ultrasound (CEUS) with Levovist was performed to localize the lesions both in the early phase and liver-specific phase. Diagnosis of was confirmed by percutaneous needle biopsy where feasible, and on the basis of on treatment outcomes or changes in computed tomography findings in those not amenable to biopsy.

RESULTS

Thirty-two lesions were diagnosed as hepatocellular carcinoma (HCC). Contrast-enhanced ultrasound localized hepatocellular carcinoma in 24/32 (75%) lesions, the mean diameter (15.1+/-4.9mm), as measured using computed tomography, being significantly larger than that of the remaining eight lesions (10.5+/-2.1mm). Ultrasound-guided treatment was performed in 19 of the 24 lesions, and transarterial chemoembolization (TACE) was applied for the other five lesions because of difficult percutaneous access. Five of the eight non-visualised lesions were treated by transarterial chemoembolization, and the other three by surgical resection. The beneficial effect of CEUS was significantly greater when the reason for poor initial visualisation was the coarse liver architecture (17/17) than when it was due to adverse location (seven of 15, p<0.005). Fifteen of the CT-detected hypervascular lesions were considered to represent false positives for HCC, based on their behaviour during follow-up.

CONCLUSION

Contrast-enhanced ultrasound with Levovist facilitates the application of percutaneous ultrasound-guided treatment by improving localization of ultrasonically invisible hypervascular hepatocellular carcinomas in the liver.

Tonsillectomy in the treatment of pediatric Henoch-Schönlein nephritis

The exact pathophysiology of HSN remains to be elucidated. Hence, a therapeutic strategy that enables curative treatments for all the various grades of HSN patients has yet to be established. We report our experience performing tonsillectomy combined with steroid therapy for 16 pediatric proteinuric Henoch-Schönlein nephritis (HSN) patients. All patients exhibited hematuria and proteinuria in their first HSN attack with the mean age of onset 7.7 years (range 4.75 - 13.9 years). Nine patients were diagnosed with clinically severe HSN presenting with massive proteinuria (> 1 g/m(2)/day). Renal biopsy findings performed in 6 patients were Grade II (3), Grade III (2) and Grade IV (1) according to the International Study of Kidney Diseases in childhood classification. Tonsillectomy was performed after 1-4 cycles of methylprednisolone pulses during oral prednisolone (0.5 - 1.5 mg/kg/day) therapy. In 2 patients, oral cyclophosphamide therapy was added before the tonsillectomy. The interval between the onset of HSN and tonsillectomy was 97.4 +/- 24.5 days (range 27 424 days). In all patients, proteinuria had disappeared by 6 months after the tonsillectomy and the urine findings had normalized. The interval between therapy initiation and complete remission was 9.6 +/- 2.0 months (range 2 - 26 months). Over follow-up periods of 4.9 +/- 0.6 years (range 2.2 - 9.3 years), no recurrences of Henoch-Schonlein purpura or HSN were observed. There was a significant correlation between early tonsillectomy performance and decreased time until normalization of the urine findings, indicating that the tonsils may have pivotal roles in the initiation and progression of HSN. Their elimination might promote the reversal of nephritis. Although this study is retrospective, we suggested that tonsillectomy at an early stage of HSN may be beneficial by shortening the period of illness and contributing to clinical recovery. Randomized controlled trials will be needed to confirm this supposition.

Possible presence and role of the promoter sequence for eukaryotic RNA polymerase III in bacteria

The bacterial repetitive sequence IS1, is a translocatable DNA segment. The internal region of IS1 acts as a cis-element to stimulate RNA synthesis from the upstream promoter. The product of the bacterial artA gene works with this cis-element to stimulate transcription. Eukaryotic genes for small RNAs and short interspersed repetitive elements (SINEs) have internal promoters, transcribed by RNA polymerase III (RNAP III). RNAP III requires the multisubunit protein factor TFIIIC in transcription initiation. TFIIIC contains the B-block binding subunit which recognizes the internal promoter. Here, I report that the eukaryotic RNAP III promoter-like sequence was found in the cis-element of bacterial IS1. Mutations in the cis-element which affect transcription were present in the RNAP III promoter-like sequence. The RNAP III promoter sequence of Alu, which is a human SINE, was cloned into Escherichia coli, and was shown to stimulate bacterial transcription like the cis-element of IS1. Furthermore, the primary structures of ArtA protein and B-block binding subunits were compared. The amino acid sequence of ArtA appeared to be similar to the N- and C-terminal regions conserved in many B-block binding subunits. Prokaryotes and eukaryotes have been thought to have inherent transcription machineries. The results shown here, however, suggest a new aspect of the evolution of the RNAP III transcription machinery.

[Treatment of Henoch-Schönlein purpura nephritis in children with tonsillectomy]

Henoch-Schönlein purpura nephritis (HSPN) is an important complication of Henoch-Sch6nlein purpura (HSP). Pathological findings in the kidney are similar to those for IgA nephritis, which is characterized by the deposition of IgA immune complex in the glomerular mesangium. Since a tonsillectomy is useful for IgA nephritis, this procedure holds great promise for the treatment HSPN. In the present study, we assessed the effectiveness of a tonsillectomy in children with HSPN whose conditions could not be controlled by medication, including predonisone and cyclophosphamide. Seven patients (four boys and three girls) with histologically well-defined HSPN who had undergone a tonsillectomy between 1998 and 2000 and who had been followed for more than 6 postoperative months were retrospectively examined. The age of the patients ranged between 3 and 13 years (average, 7.6 +/- 3.2 years) at the time of operation. Postoperative changes in urinary data were assessed according in the severity of the pathological findings in the kidney and the patient's clinical condition. The severity of the pathological findings in the kidney was determined based on the classification of the International Study of Kidney Disease (ISKDC) and the Index of Glomeruler Lesion (IGL). All patients examined in the present study had an ISKDC classification of over grade II. One patient had a grade IV classification, 3 had a grade III classification, and 3 had a grade II classification. The patients were placed in one of five clinical groups: (1) nephritic-nephrotic syndrome, (2) acute nephritic syndrome, (3) nephritic syndrome, (4) over 1 g/day of proteinuria without hypoalbuminemia or oedema, or 5) below 1 g/day of proteinuria with or without hematuria. One patient was classified in group 1, 1 was group classified in 2, 2 were classified in group 3, 2 were classified in group 4 and 1 was classified in group 5. The mean observation period was 74 +/- 6.4 months. The hematuria and proteinuria resolved in all patients, regardless of their preoperative pathological or clinical severity, within 12 postoperative months. During the observation period, no relapse was observed. Moreover, all medication, including steroid use, was stopped within the observation period. Therefore, a tonsillectomy was considered to be effective for the treatment of children with HSPN whose conditions cannot be controlled using medication.

Real-time blood-pool images of contrast enhanced ultrasound with Definity in the detection of tumour nodules in the liver

Lower mechanical index (MI) technique with newer microbubble agents has been introduced into clinical practice as a newer ultrasound (US) imaging. However, the efficacy in detecting tumour nodules has not been proven scientifically. The aim of this study was to elucidate the efficacy of a blood-pool image of real-time contrast-enhanced US under low MI in detecting liver tumours. 15 rabbits with VX-2 tumour were used; the number of implantations was none in two rabbits, one in four, two in five and three in four. US equipment was APLIO (Toshiba) with linear probe (3.5/7.0 MHz). The number, location and size of tumour nodules were examined by non-contrast tissue harmonic imaging (NC-US) or contrast-enhanced pulse subtraction harmonic imaging (C-US) under extra-low MI (MI 0.065) with the injection of Definity (30 microl kg(-1)). The number of tumour nodules detected by both NC-US and C-US were consistent with the histopathological results in five rabbits - two with none, two with one nodule and one with two nodules. In the other 10 rabbits, C-US showed all the implanted tumours and small daughter nodules around them that were confirmed by histopathology. However, NC-US failed to demonstrate two implanted nodules and all the daughter nodules. On the basis of the histopathological results, detectability of implanted tumour was not significantly different between NC-US (24/26, 92.3%) and C-US (26/26, 100%). However C-US was superior to NC-US in delineating the nodules and in detecting small daughter nodules. The sizes of the implanted tumour nodules measured by histopathology correlated closely with those measured by C-US. Real-time blood-pool images by pulse subtraction harmonic imaging under extra-low MI with Definity will contribute to the improvement of the ultrasound delineation and detection of liver tumours.

Similarities in transcription factor IIIC subunits that bind to the posterior regions of internal promoters for RNA polymerase III

Background

In eukaryotes, RNA polymerase III (RNAP III) transcribes the genes for small RNAs like tRNAs, 5S rRNA, and several viral RNAs, and short interspersed repetitive elements (SINEs). The genes for these RNAs and SINEs have internal promoters that consist of two regions. These two regions are called the A and B blocks. The multisubunit transcription factor TFIIIC is required for transcription initiation of RNAP III; in transcription of tRNAs, the B-block binding subunit of TFIIIC recognizes a promoter. Although internal promoter sequences are conserved in eukaryotes, no evidence of homology between the B-block binding subunits of vertebrates and yeasts has been reported previously.

Results

Here, I reported the results of PSI-BLAST searches using the B-block binding subunits of human and Shizosacchromyces pombe as queries, showing that the same Arabidopsis proteins were hit with low E-values in both searches. Comparison of the convergent iterative alignments obtained by these PSI-BLAST searches revealed that the vertebrate, yeast, and Arabidopsis proteins have similarities in their N-terminal one-third regions. In these regions, there were three domains with conserved sequence similarities, one located in the N-terminal end region. The N-terminal end region of the B-block binding subunit of Saccharomyces cerevisiae is tentatively identified as a HMG box, which is the DNA binding motif. Although I compared the alignment of the N-terminal end regions of the B-block binding subunits, and their homologs, with that of the HMG boxes, it is not clear whether they are related.

Conclusion

Molecular phylogenetic analyses using the small subunit rRNA and ubiquitous proteins like actin and α-tubulin, show that fungi are more closely related to animals than either is to plants. Interestingly, the results obtained in this study show that, with respect to the B-block binding subunits of TFIIICs, animals appear to be evolutionarily closer to plants than to fungi.

Brain-derived neurotrophic factor induces rapid morphological changes in dendritic spines of olfactory bulb granule cells in cultured slices through the modulation of glutamatergic signaling

While the acute physiological effects of brain-derived neurotrophic factor (BDNF) have been well demonstrated, little is known regarding possible morphological effects that occur within a short period of time. The acute effects of BDNF on dendritic spine morphology were examined in granule cells in cultured main olfactory bulb slices. Organotypic slices prepared from 7-day-old rats were cultured for 1 day, and BDNF was applied at varying time points prior to fixation. Granule cell dendrites were labeled with a membrane dye and observed with a confocal laser scanning microscope. The addition of BDNF into the culture medium 6 h before fixation decreased the mean diameter of the dendritic processes (filopodia/spines), but the length and density of the processes were not affected. Both filopodia/spines in the external plexiform layer and those in the granule cell layer exhibited similar changes. Considering the slow penetration into the slices, BDNF was then applied to the top of each slice. When applied 1 h before fixation, 5 ng and 0.5 ng of BDNF induced the same changes in the external plexiform layer and the granule cell layer, respectively. The changes became detectable as early as 30 min when 50 ng of BDNF was applied. The pretreatment with tetanus toxin or an N-methyl-D-aspartate receptor antagonist abolished the acute effects of BDNF on spine morphology. These results indicate that BDNF can alter spine morphology within a shorter period of time than previously observed and that the effects are mediated by enhanced glutamatergic signaling.

Arterio-portal shunt in liver rescued by hepatectomy after arterial embolization

Arterio-portal shunts are generally treated with transcatheter arterial embolization, as a therapeutic measure for bleeding of esophageal varices. However, transcatheter arterial embolization is frequently associated with reestablishment of arterio-portal shunts. We now report our experience with partial hepatectomy to remove the arterio-portal shunt associated with esophageal varices, which recurred after transcatheter arterial embolization. The patient was a 60-year-old female, who had massive hematemesis caused by rupture of esophageal varices. Doppler sonography and arteriography demonstrated an arterio-portal shunt in the right anterior superior segment of the liver. Temporary hemostasis was achieved with transcatheter arterial embolization, however, hemorrhage recurred one month later. The second transcatheter arterial embolization failed to manage the shunt and varices. The patient developed hepatic coma. After recovery from coma, she was referred to our hospital. We carried out partial hepatectomy, which provided remarkable hemodynamic improvement; the portal vein flow changed from hepatofugal to hepatopetal. Esophageal varices and hepatic coma have totally disappeared. This patient has had no complaint and has remained free of esophageal varices, for 3 years postoperatively. She is having a normal life. The partial hepatectomy to remove the arterio-portal shunt induced complete resolution of the arterio-portal shunt, as well as dramatic improvement in portal flow and hepatic coma. Our experience in the present case suggests that partial hepatectomy should be considered as a radical therapy for arterio-portal shunt, without insistence on transcatheter arterial embolization.

Eosinophils are activated in middle ear mucosa and middle ear effusion of patients with intractable otitis media associated with bronchial asthma

BACKGROUND

Although patients with intractable otitis media associated with bronchial asthma have extensive accumulation of eosinophils in the middle ear mucosa and middle ear effusion, systematic histological and immunohistochemical studies have not been performed.

OBJECTIVES

To clarify the pathogenesis of middle ear diseases, we carried out immunohistochemical studies on middle ear specimens, particularly focusing on the characteristics of accumulated eosinophils.

METHODS

Middle ear specimens obtained from eight adult patients and from 17 controls were immunohistochemically stained using monoclonal antibodies against EG1, EG2, mast cell tryptase, IgA and IgE. The concentration of eosinophil cationic protein (ECP) in middle ear effusion samples was also measured.

RESULTS

In the asthmatic patients, severe round-cell infiltration was observed in the submucosa and most of the EG1-positive cells were also EG2-positive. In the control patients, the mucosa showed a fibrotic change with a few inflammatory cells, and EG1- or EG2-positive cells were quite few. The expression of IgE was found not only on the surface of mast cells but also within the plasma cells in the asthmatic patients, and the number of IgE-positive cells was about twice as high as that of mast cells. A significantly higher concentration of ECP was noted in middle ear effusion obtained from the asthmatic patients than that from the control patients.

CONCLUSION

Most of the eosinophils in the middle ear mucosa and middle ear effusion were activated, resulting in degranulation and release of ECP, and local IgE production occurs in the middle ear mucosa, indicating that the intractable inflammation is closely associated with IgE-mediated late phase response with eosinophil accumulation.

Hemodynamics in the left gastric vein after endoscopic ligation of esophageal varices combined with sclerotherapy

BACKGROUND AND METHODS

We examined the changes in portal hemodynamics after endoscopic variceal ligation (EVL) combined with endoscopic injection sclerotherapy (EIS) in relation to post-treatment relapse. The present study included 93 patients who underwent EVL-EIS combination therapy. Portal hemodynamics were examined by Doppler ultrasonography and percutaneous transhepatic portography (PTP).

RESULTS

Therapy with EVL-EIS resulted in the complete disappearance of varices in 89 of 93 patients. Cumulative relapse-free rates (Kaplan-Meier method) were 75.8 and 50.2%, respectively, 1 and 3-5 years after treatment. At the end of treatment, the flow in the left gastric vein was examined by Doppler ultrasonography. In 50 of 63 patients, the flow remained hepatofugal. In 23 of these patients, PTP was performed at the end of treatment; selective left gastric venography did not reveal any palisade zone vessels or varices. However, fine blood vessels were seen around the lower esophagus in nine patients, only the paraesophageal vein was found in 10 patients and these two findings were present in four patients, indicating that collateral blood flow remained in the lower esophagus in 13 of 23 patients. These findings suggest that frequent relapse of varices results from insufficient blockage of blood flow from the left gastric vein to the lower esophagus. However, in patients with a patent paraesophageal vein, long-term effects obtained by EVL-EIS combination therapy were satisfactory.

CONCLUSIONS

The pattern of the development of collateral left gastric veins represents important hemodynamic changes that predict the long-term prognosis of patients after treatment.

Grey-scale contrast enhancement in rabbit liver with DMP115 at different acoustic power levels

The contrast enhancement effect of ultrasound (US) contrast agent DMP-115 (YM454, Definity) in rabbit liver at two acoustic transmit power levels was studied. A total of 12 rabbits with healthy livers and 7 rabbits with VX-2 tumors were used. Grey-scale ultrasonograms in both fundamental (3.75 MHz) and harmonic (2.5/5.0 MHz) imaging modes were performed at a frame rate of 26 Hz under baseline acoustic power (MI = 0.6) or lower acoustic power (MI = 0.2). The contrast enhancement depended on the contrast agent dose and the acoustic power. The video intensity change was higher in the portal vein under the baseline acoustic power and higher in the liver parenchyma under the lower acoustic power. The contrast-enhanced US observation of the VX-2 tumor in the arterial phase correlated well with the angiographic and histopathological appearance of the tumor. In the parenchymal phase, the borderline of the tumor could be clearly delineated from the surrounding liver parenchyma. Continuous fundamental and harmonic grey-scale imaging with DMP115 has the capability of making peripheral circulation images of liver parenchyma and tumors.

EUS changes predictive for recurrence of esophageal varices in patients treated by combined endoscopic ligation and sclerotherapy

BACKGROUND

Recurrence of varices is still common after endoscopic treatment of esophageal varices. In this study, predictive signs of variceal recurrence were investigated by ultrasonic (US) miniature probe in patients treated by combined endoscopic ligation and sclerotherapy.

METHODS

Detectability of vessels by US miniature probe was evaluated first in rats. In 41 patients treated by combined therapy, the esophagus and the cardia region were examined by US miniature probe. In 25 patients examined by percutaneous transhepatic portography, the relationship between US miniature probe and percutaneous transhepatic portography findings was evaluated.

RESULTS

The smallest vessel detected by US miniature probe was 0.3 mm in diameter in the study using intra-abdominal vessels of rat. After variceal eradication, US miniature probe showed intramural vessels in the cardia that were classified as follows: grade I, a few vessels (19 patients, 46%); grade II, uniformly scattered vessels (11, 27%); grade III, abundant vessels resembling a honeycomb (11, 27%). As the sonographic grade increased, the rate of variceal recurrence increased. As the venographic grade of staining in the distal esophagus increased, the esophageal wall became thicker and the sonographic grade at the cardia increased.

CONCLUSIONS

Endosonographic evaluation of the distal esophagus and cardia is predictive of variceal recurrence.

Inactivation of a hepadnavirus by electrolysed acid water

Glutaraldehyde is used as a disinfectant for endoscopes, but is an irritant and so should be replaced by an alternative. Electrolysed acid water (EAW) has a bactericidal effect, and an endoscopic washing device using EAW has been developed in Japan. To investigate the effect of EAW on the infectivity of viruses, we treated duck hepatitis B virus (DHBV), which has similar properties to hepatitis B virus, with EAW, and determined the number of remaining infectious virus particles in a bioassay system. One-day-old Pekin ducks were inoculated with duck serum containing 10(5.5) ID(50) DHBV; the serum had previously been incubated with 100 volumes of EAW or ion-exchanged water at room temperature for 7 min. DHBV infection was indicated by detection of viral DNA in duck serum samples 1-8 weeks after inoculation. Treatment of serum with EAW diminished DHBV infectivity whereas treatment with ion-exchanged water did not. The virus load was estimated to have been reduced to 10(1)-10(3) ID(50) during the first 1 min and to <10(0.5) ID(50) in the next 6 min of incubation when compared with the control. Thus, EAW directly inactivates DHBV and its clinical application is recommended.

Differentiation of mitral cell dendrites in the developing main olfactory bulbs of normal and naris-occluded rats

The morphological differentiation of mitral cell dendrites during embryonic and early postnatal development was examined in the main olfactory bulb of rats to determine a possible role of afferent activity in the development of the dendrites. Mitral cells and olfactory nerve fibers were labeled with 1,1'-dioctadecyl-3,3,3', 3'-tetramethylindocarbocyanine perchlorate (DiI) and fluorescein-conjugated lectin (Ulex europeus agglutinin-I), respectively. Morphogenesis of mitral cell dendrites proceeded as previously described (Malun and Brunjes [1996] J. Comp. Neurol. 368:1-16); that is, undifferentiated dendrites with radial orientation were transformed into a single primary dendrite having a glomerular tuft and secondary dendrites extending tangentially into the external plexiform layer. Quantitative examinations in both pre- and postnatal rats revealed that the differentiation of primary dendrites, including tuft formation, increases in diameter and decreases in branching, started before birth, whereas differentiated secondary dendrites were only observed in postnatal animals. Mitral cells with more than two primary dendrites were found after embryonic day 21. The proportion of the mitral cells with differentiated dendrites increased postnatally. At postnatal day 10, almost all mitral cells had fully differentiated dendrites, and mitral cells with multiple primary dendrites were no longer seen. No significant change was found during development in the number of stem dendrites that arose directly from the cell body. Unilateral naris occlusion started on postnatal day 1 retarded differentiation of primary and secondary dendrites, and increased the proportion of mitral cells with multiple primary dendrites. These finding revealed that differentiation of mitral cell primary dendrites precedes that of secondary dendrites, and suggested that the differentiation of secondary dendrites proceeds in an activity-dependent manner.

Enhanced color flow images in small hepatocellular carcinoma

BACKGROUND

Features of enhanced color flow images in small hepatocellular carcinoma (HCC) are not fully elucidated. The purpose of this study was to clarify the characteristic vascular images in small HCC observed by enhanced color Doppler.

METHODS

Enhanced color Doppler using the contrast agent Levovist was performed on 13 patients with HCC smaller than 30 mm. Enhanced color flow appearance was compared with angiographic findings. Time-intensity changes after injection of the contrast agent were analyzed in HCC nodules.

RESULTS

Significant improvement in the detection of color flow signals was obtained in small HCC using Levovist, from 33% in precontrast to 92% in postcontrast (p < 0.005). Three patterns of enhanced color flow images, which were related to the angiographic findings, were observed. The time-intensity curve was classified into two types by "time to peak" and "time on plateau" and was associated with the patterns of enhanced images.

CONCLUSION

Enhanced color flow imaging promises to be a useful method for evaluating tumor vascularity noninvasively and to contribute to the elucidation of the hemodynamics in small HCC.

GABAergic neuron-to-astrocyte signaling regulates dendritic branching in coculture

Effects of neurotransmitters on dendritic morphology were analyzed in cocultures of neurons and astrocytes from the neonatal rat olfactory bulb by means of immunocytochemical staining and morphometry. About 70% of the neurons gamma-aminobutyric acid (GABA)-immunoreactive on day 7 of the coculture. Morphometric analysis of neurons having no contact with other neurons revealed that incubation of the coculture with either a sodium channel blocker, tetrodotoxin, or GABAA receptor antagonists such as bicuculline or picrotoxin resulted in a decreased number of dendritic branch points as compared to neurons in control cultures, while the same treatment did not affect radial dendritic outgrowth or the number of primary dendrites. Application of a GABAB receptor antagonist, phaclofen, or an AMPA-type glutamate receptor antagonist, 6-cyano-7-nitroquinoxaline-2,3-dione, had no detectable effect on dendritic morphology. Incubation of the coculture with a GABAA receptor agonist, muscimol, enhanced branching and reversed the inhibitory effect of tetrodotoxin. Branching was also enhanced by increasing extracellular K+. The inhibitory effect of tetrodotoxin or bicuculline and the stimulatory effect of muscimol or elevated K+ were abolished when neurons were grown on a monolayer of dead astrocytes, indicating that the morphoregulatory action of GABA requires living astrocytes to operate. Astrocytes pretreated with muscimol before the addition of neurons supported branching better than those without pretreatment. These results suggest that various aspects of dendritic growth are regulated by distinct mechanisms, and that neuron-to-astrocyte signaling mediated by GABA promotes dendritic branching.

[Enhanced color flow findings in small hepatocellular carcinoma]

Features of enhanced color flow images of small hepatocellular carcinoma (HCC) were studied to elucidate their usefulness in evaluating tumor hemodynamics. Enhanced color Doppler using the contrast agent "SH/TA508" was performed on 16 patients, 13 with HCC, 1 with regenerative nodule, and 2 with hemangiomas, in whom the size of the tumor were smaller than 30 mm. Enhanced color flow appearance was compared with angiographic findings. Significant improvement in the detection of color flow signals was obtained in small HCC using SH/TA508, from 33% in pre-contrast to 92% in post-contrast (p < 0.005). Three patterns of enhanced color flow images, which were related to the angiographic findings, were observed. Enhanced color flow imaging promises to be a useful method for evaluating tumor vascularity noninvasively, and to contribute to the elucidation of the hemodynamics in liver tumor.

White ball appearance in endoscopic ligation of bleeding esophageal varices

BACKGROUND

Endoscopic variceal ligation is useful in the control of bleeding from esophageal varices. However, confirmation of ligation precisely at the site of bleeding is usually difficult when treating massive variceal bleeding. Characteristic endoscopic findings that appeared when ligation was performed at the site of bleeding are reported in this article.

METHODS

Emergency endoscopic variceal ligation was performed in 14 patients with active bleeding from esophageal varices. Endoscopic findings after variceal ligation at the site of bleeding were compared with those at sites without bleeding.

RESULTS

Active bleeding ceased just after endoscopic ligation at the site of bleeding in all patients. After ligation of the bleeding site of the varix, an unusual white-colored ball-like appearance (white ball appearance) was observed in all patients. This finding was markedly different from the purple-colored ball-like appearance that is usually observed after ligation of a varix at a site without bleeding.

CONCLUSIONS

White ball appearance was a characteristic finding that appeared after ligation of a varix at the site of bleeding. This finding may be useful in the confirmation of successful ligation of a varix at its bleeding site.

Neuronal regulation of astrocyte morphology in vitro is mediated by GABAergic signaling

The addition of isolated neurons to monolayers of cultured astrocytes induced a morphological change in the astrocytes that came into contact with the added neuronal cell bodies or neurites. The change, which included an increase in the complexity of cell shape, took at least 3 days to become detectable and was enhanced in proportion to the number of attached neurons. Astrocytes that did not make contact with any neurons had a less complex contour, comparable to those in control cultures with no neurons added. Treatment of neuron-astrocyte cocultures with a sodium channel blocker, tetrodotoxin, suppressed the neuron-induced morphological changes in astrocytes. A GABAA-receptor antagonist, bicuculline, mimicked the inhibitory effect of tetrodotoxin. In cultures without added neurons, morphological alteration of astrocytes was also observed when cultures were incubated for 1 or more days with exogenous GABA together with a GABA-uptake inhibitor, 4,5,6,7-tetrahydroisoxazolo[4,5-c]pyridin-3-ol. The effect of exogenous GABA was mimicked by treatment with a GABAA-receptor agonist, muscimol, and blocked by bicuculline treatment. These results suggest that GABA released from neurons with their activity serves as a signal from neurons to astrocytes that triggers the morphological change in astrocytes through the activation of GABAA receptors.

Genetic analyses of the interactions of the IS1-encoded proteins with the left end of IS1 and its insertion hotspot

Insertion sequence IS1 specifies the InsA, delta InsA-B'-InsB and InsA-B'-InsB protein species. These three proteins have the identical alpha-helix-turn-alpha-helix motif that is likely to be responsible for DNA binding. In fact, InsA binds to the ends of IS1, and regulates gene expression and transposition of IS1. delta InsA-B'-InsB and/or InsA-B'-InsB has been thought to possess a transposase-like activity. Here, I examined the actions of these proteins in vivo on the promoter (pinsL) in the left end of IS1. InsA repressed pinsL-driven gene expression, both in cis and in trans. delta InsA-B'-InsB inhibited it efficiently only when pinsL was located near the construct where delta InsA-B'-InsB is expressed. Furthermore, it has been shown that the possible -10 sequence of pinsL is required for delta InsA-B'-InsB to act on, but the -35 sequence where InsA binds specifically, is not. InsA-B'-InsB appeared not to work on a nearby pinsL. The cis-action of delta InsA-B'-InsB is consistent with the previous observation that the IS1 transposase acts preferentially in cis. Interestingly, delta InsA-B'-InsB acted on a nearby P3 promoter in the IS1 insertion hotspot, and on another promoter outside the hotspot. delta InsA-B'-InsB may generally interact with the regions in or around promoters owing to their low DNA helix stability. Note that IS1 transposes preferentially into A + T-rich DNA segments, and that DNA is unwound from the -10 region of a promoter in transcription. The cis-preference of delta InsA-B'-InsB would result in an overall reduction of transposition of IS1 and its defective copy in a cell, allowing stable existence of the element in its bacterial host.

Synthesis and phospholipase A2 inhibitory activity of thielocin B3 derivatives

We prepared several types of derivatives of thielocin B3, a very potent naturally occurring inhibitor for human nonpancreatic secretory PLA2 (sPLA2-II), and conducted a structure-activity relationship study to identify potent sPLA2-II inhibitors with the aim of developing antiinflammatory drugs. The total number of aromatic rings is critical for sPLA2-II inhibition, and the best result was obtained in the case of six rings. The structure of the central part of the inhibitors was not specific, and potent inhibitors were found among the sulfide, sulfone, ether, methylene, and amino derivatives. Although a diester of the terminal carboxylic acid lost its inhibitory activity, having both of the carboxylic acids was not necessary for expression of activity, as illustrated by a glycine derivative with the benzyl ester group 36. Among the newly synthesized derivatives, 18, 20, 29, and 36 showed very potent human sPLA2-II inhibitory activity comparable to that of natural thielocin B3. Their IC50 values are in the range 0.069-0.14 microM, and they are a class of compounds showing the most potent sPLA2-II inhibition to date.

[Recent progress in the diagnosis of gastroesophageal varices]

Recent advances in the diagnosis of gastroesophageal varices are reviewed in this paper. Endoscopy, angiography, ultrasound, and ultrasound Doppler are now employed in the diagnosis of varices. As for endoscopic diagnosis, new criteria for the evaluation of gastroesophageal varices have been applied. Angiography is now not only used to demonstrate the varices and collateral circulations in portal hypertension but also used in the embolization therapy for large gastric varices or intractable esophageal varices. Ultrasound and color Doppler are now widely used in the diagnosis of portal hypertension because of its noninvasiveness and conveniency. Furthermore, in its use in endoscopy, varical vessels and blood flow in the wall of the esophagus and the stomach can be directly demonstrated. Recent advances in these diagnostic modalities will made it possible to diagnose gastroesophageal varices and evaluate the pathophysiology in patients with portal hypertension more precisely.

Response of blood flow to vasopressin in the collateral left gastric vein in patients with portal hypertension

BACKGROUND/AIMS

A problem in pharmacotherapy for bleeding varices in portal hypertension is non-responders. The aim of this study was to elucidate the features of hemodynamic response to vasopressin in the gastroesophageal collateral vein in patients with esophageal varices.

METHODS

Flow velocity in the portal and the collateral left gastric vein was measured with an echo-Doppler flowmeter before and during infusion of vasopressin, 0.2 U/min, in 41 patients with cirrhosis and esophageal varices.

RESULTS

The decrease in flow velocity in the left gastric vein with vasopressin (-29 +/- 25%) was significantly smaller than that in the portal vein (-56 +/- 20%). There was no or only minimal change in flow velocity in the left gastric vein in 39% of the patients, especially in those with large-size varices. In 28 patients examined by portal catheterization, changes in flow velocity in the left gastric vein were correlated with portal pressure, and portal pressure in non-responders was significantly higher than that in responders (non-responders: 363 +/- 49, responders: 312 +/- 41 mmH2O, p < 0.05).

CONCLUSIONS

It was concluded that hepatofugal blood flow in the gastroesophageal collateral is not readily reduced by vasopressin. However, as the study was performed in a stable condition without variceal bleeding, whether these hemodynamic features will apply during acute variceal bleeding in patients who are known to have a poor hemodynamic response to vasopressin remains to be elucidated.

Effect of thielocin A1 beta on bee venom phospholipase A2-induced edema in mouse paw

Several investigators have reported that inactivation of secretory phospholipase A2 purified from bee venom with p-bromophenacyl bromide, an irreversible inhibitor, before injection resulted in attenuation of the subsequent inflammatory reaction in the mouse paw edema model. Recently, thielocin A1 beta, a novel secretory phospholipase A2 inhibitor from fungi, was found to suppress histamine release from mast cells stimulated with secretory phospholipase A2. These observations led us to examine the effect of thielocin A1 beta against secretory phospholipase A2-induced paw edema. Thielocin A1 beta inhibited bee venom phospholipase A2 in a dose-dependent manner (IC50 = 1.4 microM). In addition, the inhibition of bee venom phospholipase A2 was noncompetitive (Ki = 0.57 microM) and reversible. Subplantar injection of bee venom phospholipase A2 produced a rapid but transient edematous response. Coinjection of thielocin A1 beta (1 microgram/paw) with bee venom phospholipase A2 resulted in a 44.7 +/- 4.6% reduction of edema formation. This anti-edema action was not enhanced by cyproheptadine (antihistamine/antiserotonin). These results suggest that thielocin A1 beta shows edema-reducing activity via inhibition of the phospholipase A2 activity which participates in histamine release by mast cells.

Isolation and biological activity of thielocins: novel phospholipase A2 inhibitors produced by Thielavia terricola RF-143

Thielocins A2 alpha, A2 beta, A3, B1, B2 and B3 were isolated as a novel family of phospholipase A2 inhibitors from the fermentation broth of Thielavia terricola RF-143 together with thielavins and thielocins A1 alpha and A1 beta. The most potent inhibitory activity (IC50 = 0.0033 microM) against rat group II phospholipase A2 was shown by thielocin A1 beta. Against human group II phospholipase A2, thielocin B3 (IC50 = 0.076 microM) was the most potent.

[Study of the changes in portal hemodynamics after endoscopic injection sclerotherapy with reference to the variceal recurrence]

Endoscopic injection sclerotherapy (EIS) combined with percutaneous transhepatic obliteration was performed in 63 cirrhotic patients with esophageal varices. In all patients, esophageal varices were completely disappeared after EIS. To investigate risk factors for recurrence of esophageal varices after EIS, hemodynamic changes in the portal system before and after EIS were studied by portal vein catheterization and ultrasonography. In patients in whom portal pressure rose after EIS, recurrence of varices was observed in high incidence (p < 0.05). Furthermore, variceal recurrence appeared frequently in patients with progressive splenomegaly after EIS (p < 0.05). During post-EIS course, new appearance or increase in size of non-variceal portosystemic collaterals was detected by ultrasonography in 22% of the patients. In these patients, variceal recurrence rate was low (p = 0.09). In patients with shunts around the splenic hilum, variceal recurrence rate was lower compared with the patients with paraumbilical vein (p < 0.05). Prognostic factors for variceal recurrence were analysed using multiple regression model. It was suggested that the absence of non-variceal portosystemic collaterals was the most risky factor. In conclusion, observation of portal hemodynamics is considered to be useful for the long-term management of patients with esophageal varices treated with EIS.

[Diffuse gastric mucosal redness in liver cirrhosis--with special reference to portal hemodynamics]

The clinicopathological characteristics of the diffuse gastric mucosal redness were studied in 235 patients with liver cirrhosis. Moreover, in 96 patients in whom percutaneous transhepatic portal catheterization was carried out, the relationship was studied between gastric mucosal lesions and portal hemodynamic aspect with reference to portal vein pressure and extrahepatic collaterals. Extrahepatic collaterals were divided into three groups, which related either of cephalad, caudal and peri-abdominal as the most prevalent extrahepatic collateral on portographic findings. The frequency of the diffuse gastric mucosal redness was increased with the elevation of portal vein pressure, and it was seen more frequently in patients with cephalad collaterals than in caudal. However, the diffuse gastric mucosal redness was seen less frequently in patients with cephalad collateral accompanied with the development of renal shunts. Multiple logistic model analysis showed significant correlation between the diffuse gastric mucosal redness and the development of cephalad collaterals. These results suggest that the gastric mucosal circulation in liver cirrhosis is strongly affected by the development of portosystemic collaterals in portal hypertension.