Ultrasonic level diagnosis of lumbar disc herniation

Although the use of diagnostic ultrasound to measure the spinal canal has been proposed, the value of ultrasound for lumbar disc herniation has not been yet fully assessed. The purpose of this investigation was to evaluate the effectiveness of ultrasound in the level diagnosis of herniated nucleus pulposus. Prospective ultrasound examinations were performed on 80 consecutive patients with clinically suspected lumbar disc herniation. In 41 discs of those 40 patients with surgically confirmed lumbar disc herniation, there were 32 discs (78%) with true-positive ultrasound diagnoses, 37 discs (90%) with true-positive myelographic diagnoses, and 20 patients (50%) with true-positive neurologic diagnoses. Conversely, ultrasound diagnoses showed positive echogram in 24 (60%) of 40 nonoperative patients. These results suggest that ultrasound is of value as an aid for diagnosing the level of lumbar disc herniation.     

A case of primary pulmonary sporotrichosis

We report the first case of primary pulmonary sporotrichosis in Japan. A 53-year-old man was admitted to our hospital for further examination of the abnormal shadows on chest X-ray film. Six months before admission, he was admitted to another hospital because of alcoholic liver disease and diabetes mellitus. Since the initial chest film showed cavities with infiltration in the left upper lung field, he was treated with antituberculous drugs despite negative sputum cultures for mycobacterium. In spite of the medication, his chest X-ray film revealed another cavitary lesion, so he was referred to our hospital. He had been asymptomatic during this period. Chest X-ray on admission disclosed multiple cavities in the left upper lobe and a cavity in the right lower lobe. Repeated sputum specimens, bronchial washings and brushings for cytology and cultures were all negative. In an attempt to clarify the pathogen, percutaneous lung aspiration (PLA) was performed. The PLA sample yielded a positive culture of Sporothrix shenckii. After the diagnosis, S. schenckii was also cultured from sputa. A sporothrix skin test and yeast agglutination test for S. schenckii were positive. In the absence of a history for skin lesion, the patient was diagnosed as a primary pulmonary sporotrichosis. As iodide therapy was ineffective, he was started on a regimen of intravenous amphotericin B. However his renal function progressively deteriorated, so amphotericin B was discontinued. Now he receives miconazole intravenously and is still under careful observation. As far as we know, this is the first report of primary pulmonary sporotrichosis in Japan. The possibility of sporotrichosis should be considered in any cases of undiagnosed cavitary lung diseases.     

Mitotic index in gastric carcinoma of the scirrhous type

For the purpose of studying the clinical and pathological specificities of the scirrhous type in gastric carcinoma, 96 patients with gastric carcinoma were studied according to age, sex, stage, macroscopic types and mitotic index. Scirrhous carcinoma was diagnosed in 45 patients. There were higher incidences of scirrhous carcinoma in the younger generation and among women. In the scirrhous type, the percentage of stages III and IV was higher than that of stages I and II (p<0.005). In Borrmann's categories III and IV, patients with the scirrhous type were more numerous than those with the other types. Mitotic indices were 18.4±8.1 in scirrhous type, 52.8±13.5 in medullary type, 54.1±16.9 in intermediate type and 53.3±11.5 in non-cancerous gastric mucosa. The low rate of mitotic index in those with scirrhous carcinoma was statistically significant compared to those of other types and that of the non-cancerous mucosa (P<0.001). Mitotic index is apparently related to the extent and the degree of degeneration of interstitial connective tissue. The speed of the growth of the tumor mass in gastric carcinoma is not so closely related to the mitotic index, and relates to a greater extent the number of dissociated cells entering the digestive canal. This study was supported in part by Grants-in-Aid for Cancer Research from the Ministry of Welfare of Japan and the Imanaga Foundation.     

Abnormal benzodiazepine receptor function in the depressive-like behavior of diabetic mice

We previously reported that streptozotocin (STZ)-induced diabetic mice exhibited depressive-like behavior in the tail suspension test. In this study, we examined the involvement of benzodiazepine receptor functions in this diabetes-induced depressive-like behavior in mice. STZ-induced diabetes significantly increased the duration of immobility without affecting spontaneous locomotor activity. This increase was dose-dependently and significantly suppressed by a benzodiazepine receptor antagonist, flumazenil (0.1-1 mg/kg, i.v.). However, flumazenil (0.1-1 mg/kg, i.v.) did not affect the duration of immobility in non-diabetic mice. Furthermore, flumazenil (1 mg/kg, i.v.) had no significant effect on spontaneous locomotor activity in either non-diabetic or diabetic mice. The benzodiazepine receptor inverse agonist methyl beta-carboline-3-carboxylate (beta-CCM; 0.03-0.3 mg/kg, i.v.) dose-dependently and significantly increased the duration of immobility in non-diabetic mice, but not in diabetic mice. beta-CCM (0.3 mg/kg, i.v.) significantly suppressed spontaneous locomotor activity in non-diabetic mice, but not in diabetic mice. These results indicate that diabetic mice may have enhanced negative allosteric modulation by benzodiazepine receptor ligands, such as diazepam binding inhibitors, under stressful conditions, but not free-moving conditions, and this abnormal function of benzodiazepine receptors may cause, at least in part, the expression of depressive-like behavior in diabetic mice.     

Transformation of Skeletal Muscle from Fast- to Slow-Twitch during Acquisition of Cold Tolerance in the Chick

Although birds lack brown adipose tissue, a thermogenic organ found in mammals, they possess other thermogenic mechanisms. In the current studies, we examined the molecular mechanisms of avian thermogenesis by studying how chicks acquire cold tolerance. We found that the acquisition of cold tolerance corresponded with an increase in the redness of the skeletal muscle, suggesting an increase in slow-twitch muscle fiber. This was confirmed by histological analysis. In addition, in chicks acquiring cold tolerance, there was an enhanced expression of the chicken homologue of peroxisome proliferator-activated receptor-gamma coactivator-1alpha, a protein involved in adaptive thermogenesis in mammalian brown adipose tissue and in slow-twitch fiber formation in mammalian skeletal muscle. Subtraction and differential display techniques further showed that, when chicks acquired cold tolerance, the expression of genes associated with slow-twitch fibers increased, whereas those associated with fast-twitch fibers decreased. There was also an enhanced expression of mitochondrial oxidative genes. Together, these results suggest that transformation of skeletal muscle fiber from fast-twitch to slow-twitch is involved in the acquisition of thermogenesis in chicks.     

Combination of short-pulsed CO2 laser resurfacing and cultured epidermal sheet autografting in the treatment of vitiligo: a preliminary report

Cultured epidermal autografting has been employed in a variety of clinical treatments including vitiligo management. In this study, we successfully treated 2 patients with vitiligo using a short-pulsed CO2 laser and by grafting the autologous cultured epidermis. Small pieces of uninvolved skin (2 x 1 cm) were taken for cultivation from a pudendal or axillary area and were expanded into 2 pieces of epidermal sheets 100 cm. Before grafting, the lesions were abraded superficially using a short-pulsed CO2 laser with a computerized pattern generator. After successful grafting, repigmentation was visible within 1 to 2 months. One year after grafting, the skin color was almost the same as that of the surrounding normal skin. Thus, the combination of short-pulsed CO2 laser resurfacing and cultured epidermal grafting is a powerful option for treating an asymmetric and wide vitiliginous lesion.     

Stage-dependent effect of pancreatic transplantation on diabetic ocular complications in the Spontaneously Diabetic Torii rat

BACKGROUND: In terms of the temporal relationship between pancreas transplantation (PTx) and reversal of diabetic ocular complications, it has been difficult but important to determine a "point of no return." Thus, it is of great clinical interest to evaluate the efficacy of PTx on diabetic ocular complications. METHODS: A spontaneous type 2 diabetic model of Spontaneously Diabetic Torii (SDT; RT1) rats was used in the present study, and syngeneic PTx was performed. RESULTS: In the control SDT rats that received no treatment, hyperglycemia (>250 mg/dL) was developed from 25.2+/-3.9 weeks of age. Lens opacity was observed in all rats at 15 weeks after the onset of diabetes. Fluorescein angiography and immunohistochemistry detected the nonperfusion area and neovascularization in the retina at 5 weeks of diabetes. Daily insulin treatment could not prevent or reverse the ocular changes in our experiment. Fluorescein filling defect of the retinal vessels was observed at 10 weeks of diabetes. However, in the PTx rats, normoglycemia was achieved at all experimental time points. Diabetic cataract and retinopathy could have been prevented and improved if PTx had been performed at 5 weeks, but not at 10 weeks after the onset of diabetes. With PTx treatment, an inhibition of angiogenesis in the retina at 5 weeks after the onset of diabetes was demonstrated by immunohistochemistry. CONCLUSIONS: Our results indicate that the potential use of the SDT rat for diabetes study and the positive effect of PTx performed before the "point of no return" could prevent and cure diabetic ocular complications.