Complete hydatidiform mole in a triplet pregnancy coexisting two viable fetuses: case report and review of the literature

We report a rare case of a complete hydatidiform mole with two or more coexisting fetuses where both infants survived without complications. A male infant weighing 1258 g and a female infant weighing 880 g were delivered without complications and discharged 95 days after the birth. The analysis of DNA microsatellite polymorphisms indicated that the mole was of paternal origin and probably homozygous. The mother suffered from multiple pulmonary metastasis of the hydatidiform mole which was detected 3 days after the surgery and was successfully treated with methotrexate. A complete hydatidiform mole with two or more coexisting fetuses produces a dilemma between immediate termination and pregnancy continuation. Although the present case resulted in a favorable outcome, a review of the 14 reported cases suggests that the high fetal loss rate (90%) must be a consideration in the decision regarding management of such a pregnancy.     

Integration of a transposon into the Gli3 gene in the Pdn mouse

ABSTRACT  The phenotype of the genetic polydactyly/arhinencephaly mouse (Pdn/Pdn) is similar to Greig cephalopolysyndactyly syndrome (GCPS), whose responsible gene is GLI3. Suppression of Gli3 gene expression has been observed in the Pdn/Pdn and integration of retrotransposon in Gli3 gene in the Pdn mouse has been reported. Thus, the responsible gene for Pdn/Pdn is thought to be Gli3 , but the site of mutation within the gene has not been demarcated.
In the present study, we demonstrated that 5442 bp of early retrotransposon was inserted into intron 3 of Gli3 gene in the Pdn mouse (Gli3^Pdn). This transposon had almost the same sequence as MMY17106 (EMBL). It had 317-bp long terminal repeat at both ends followed by the identical 6-bp target duplication sequence, GAGACT. Forward and reverse PCR primers were constructed in intron 3 near the insertion point, and a forward primer in the transposon was also constructed. These primers allowed us to discriminate +/+, Pdn /+ and Pdn/Pdn embryos by the PCR products. Morphological determination of the genotypes in the Pdn mouse embryos is impossible before day 12 of gestation. Quick discrimination method of genotypes developed in the present study allows us to investigate the early dysmorphogenetic mechanisms in the brain and limbs in the Pdn/Pdn embryos. Then, the dysmorphogenetic mechanisms in the Pdn/Pdn may be extrapolated to those in GCPS.     

New anterolateral thigh perforator flap with a short pedicle for reconstruction of defects in the upper extremities

Three cases of successful transfer of a new free anterolateral thigh (ALT) perforator flap for coverage of soft-tissue defects in the hand and upper arm are described. This new flap has a thin superficial fatty layer, no fascial component, and is vascularized with a perforator of the descending branch of the lateral circumflex femoral system. The free flap is nourished by anastomosing of the perforator or the proximal small segment of the descending branch. The advantages of this flap are no need for deep dissection, minimal time for flap elevation, minimal donor site morbidity, preservation of the main trunk of the lateral circumflex femoral system, possible thinning of the flap with primary defatting, possible application as a flow-through flap, and a concealed donor scar. This flap is suitable for coverage of defects in the fingers, hands, and arms.     

Serial measurement of serum S-100B protein as a marker of cerebral damage after cardiac surgery

BACKGROUND: We used serial measurements of serum S-100B protein to evaluate the time course of serum S-100B protein concentration after cardiovascular surgery and to determine the clinical relevance of its concentration and cerebral damage. METHODS: We assessed neurologic function in 149 patients undergoing cardiovascular surgery with cardiopulmonary bypass. The patients were classified into three groups according to their early postoperative outcome: those without complications (group A), those having unconsciousness or convulsion or both but no hemiplegia (group B), and those having unconsciousness and hemiplegia either with or without convulsion (group C). Serum S-100B protein concentrations were measured with a commercially available immunoluminometric assay, Sangtec 100 LIA, at seven time-points: before cardiopulmonary bypass, at the end of cardiopulmonary bypass, and at 5, 12, 24, 48, and 72 hours after cardiopulmonary bypass. RESULTS: At 5 hours after cardiopulmonary bypass, the S-100B values in groups B and C were significantly higher than the value in group A. Although the S-100B level decreased in group C during the first 5 hours after cardiopulmonary bypass, it increased thereafter (12 through 24 hours) and continued at a high level until the final measurement at 72 hours. At 12 hours after cardiopulmonary bypass, S-100B was significantly higher in group C than in group B. This late increase in S-100B was associated with radiologically detected abnormalities and cerebral damage. CONCLUSIONS: Serial measurement of serum S-100B protein in the initial 12 hours after cardiopulmonary bypass can be used to predict early postoperative brain injury.     

Efficacy of a detector tube method in formaldehyde measurement

In order to determine the efficacy of a detector tube method in formaldehyde (HCHO) measurement, we performed a chamber experiment and a field study. The experiment clearly showed that the value obtained by the detector tube method was significantly correlated to that obtained using an active-DNPH method, and was not influenced by the coexistence of toluene, xylene or carbon monoxide, but was by acetaldehyde. In the field study, we investigated 171 rooms in 81 houses. Indoor air was simultaneously sampled for 30 minutes by both an active-DNPH method and the detector tube method. The mean HCHO concentration in the 171 rooms was 0.110 +/- 0.089 ppm determined by the active-DNPH method and 0.12 +/- 0.10 ppm by the detector tube method. Regression analysis showed that the two measures closely correlated with a regression equation Y=1.057 X + 0.002 (r=0.912, p<0.0001), where X is the HCHO concentration determined by the active-DNPH method and Y is that determined by the detector tube method. The mean acetaldehyde concentration in the 171 rooms was 0.024 +/- 0.018 ppm using the active-DNPH method, and no correlation was found between acetaldehyde concentrations using the active-DNPH method and the values obtained by the detector tube method. Therefore, this study clearly showed that the detector tube method is not only simple and fast but also precise in measuring HCHO in indoor air.     

Hange-koboku-to, a Kampo medicine, modulates cerebral levels of 5-HT (5-hydroxytryptamine), NA (noradrenaline) and DA (dopamine) in mice

Cerebral monoamine systems play important pathogenic roles in various psychiatric and neurologic diseases, such as depression, anxiety and swallowing disturbance. Hange-koboku-to, a Kampo (Japanese herbal) medicine, has been successfully used for the treatment of these disorders. To elucidate the mechanisms underlying its clinical efficacy for these disorders, the effects of Hange-koboku-to (500 mg/kg, p.o.) on the cerebral monoamine systems were examined. Regional levels of 5-HT (5-hydroxytryptamine), NA (noradrenaline), DA (dopamine) and their metabolites in mouse brain were measured using a high-performance liquid chromatography system. Hange-koboku-to increased the 5-HT and NA levels and decreased 5-HIAA (5-hydroxyindole-3-acetic acid), thus decreasing 5-HT and NA turnover (metabolites/monoamine ratio) in the hypothalamus. The levels of DA, DOPAC (3,4-dihydroxyphenylacetic acid) and HVA (4-hydroxy-3-methoxy-phenylacetic acid) were all increased, resulting in a decreased DA turnover in the striatum. Since decreased 5-HT turnover has been observed after administration of various antidepressants, Hange-koboku-to-mediated reduction of 5-HT turnover may be related to the clinical efficacy of this Kampo medicine on certain psychiatric disorders. Furthermore, the beneficial therapeutic effects of Hange-koboku-to on swallowing disturbance may be related to the increased cerebral DA level brought about by this Kampo medicine.     

Optic disc measurements with computerized image analysis in experimental chronic glaucoma

We quantitatively analyzed morphological changes of the optic disc of ten Japanese monkey eyes exposed to sustained intraocular pressure (IOP) elevation by repeated argon laser application to the trabecular meshwork. Using a computerized image analyzer (Topcon IMAGEnet), we measure the cup-disc ratio (CDR), disc area (DA), cup volume/disc area (CV/DA), and rim area/disc area (RA/DA). The duration of IOP elevation was 48.4 +/- 0.8 (mean +/- SD) weeks, and the mean IOP during the experiment was 26.3 +/- 2.6 mmHg [the mean IOP during the experiment/pre-treatment IOP was 2.05 +/- 0.55 (IOP ratio)]. In advanced glaucomatous eyes (the duration of IOP elevation of approximately one year), comparing pretreatment, the CV/DA increased 4.96 times, the vertical CDR increased 1.78 times, the horizontal CDR increased 1.69 times, the DA increased 1.42 times, and the RA/DA decreased 0.54 times. A significant positive correlation was found between the IOP ratio and, both the vertical CDR (gamma = 0.65) and the CV/DA (gamma = 0.68). These results suggested that the development of glaucomatous optic disc cupping correlated with the degree of IOP elevation in monkey eyes. Using this computer image analyser, the longitudinal quantitative follow-up of disc changes of experimental glaucoma may be useful for understanding the mode of human glaucomatous optic nerve damage.     

A study on the appropriate fixation for the procedures for the better preservation of cellular antigenicity and morphology of the blood smear in immunocytochemistry: an improvement of the immunostain technique using alkaline-phosphatase (ALP) as a labeling enzyme

The authors previously reported a new coloration method which utilized hexazotized newfuchsin as a coupler for the immuno-enzyme-cytochemistry. This procedure used alkaline-phosphatase (ALP) as the labeling enzyme. The insolubility of the reaction product to organic solvents made it possible to prepare permanent slides. However, this suffered from several drawbacks, due to the fixation procedures, in the preservation of better morphology and antigenicity of the cell. The present study was undertaken to overcome such problems by modifying the fixation procedure. The study utilized twenty monoclonal and polyclonal antibodies commonly used in immunohematological staining. Various fixative solutions and timing of fixation were evaluated. The results indicated that; 1) the best fixative solution was a mixture of buffered paraformaldehyde (PFA) and acetone (10 ml 40% PFA solution, 10 ml pH 6.6 0.02 M phosphate buffer, 20 ml distilled water, 60 ml acetone, with pH adjusted to 6.6-7.4 with HCl) and 2) the fixation should be performed just before the immunostain. The results further showed that unstained smear slides, when freshly air dried and stored in a desicator, could maintain various differentiation antigens (CD2, 3, 4, 5, 8, 10, 14, 15, 16, 19, 25, L26, HLA-DR) for at least 4 weeks without any change in the immuno-reactivity. Thus, we conclude that this improved fixation procedure is an optimum fixative and should be used in routine application of the immunostain method for blood smears.     

The contribution of nitric oxide to diuretic and natriuretic effects of renal kinins in normotensive rats.

We have reported that diuresis and natriuresis due to increase in renal kinins induced by the neutral endopeptidase 24.11 (NEP) inhibitor were attenuated by nitric oxide (NO) synthase inhibitor. To further clarify the water-sodium excretory mechanism of renal kinins, we estimated NO2+NO3 (NOx) and cGMP in plasma and urine with and without a specific NEP inhibitor, thiorphan. P-aminohippuric acid (PAH) and inulin were injected into male Sprague-Dawley rats. Vehicle (n = 8) or thiorphan (30 mg/kg, n = 10) was injected after the control period. Mean blood pressure (MBP), plasma and urinary PAH, inulin, NOx and cGMP, urinary volume (UV) and urinary sodium excretion (UNaV) were measured before and after injection of the reagents. MBP, renal plasma flow and glomerular filtration rate were not affected by thiorphan. Plasma NOx and cGMP with thiorphan did not differ from the vehicle, while urinary NOx and cGMP increased. None of the variables were affected by vehicle. UV and UNaV were higher with thiorphan than with vehicle. Positive correlation was found between urinary deltaNOx and deltacGMP. Each urinary deltaNOx and deltacGMP was significantly correlated to both deltaUV and deltaUNaV. Urinary NOx and cGMP were increased while maintaining correlations to UV and UNaV, but plasma NOx and cGMP were not affected by thiorphan. This implies that the mechanism of water-sodium excretion induced by NEP inhibitor is mediated by renal NO. Therefore, renal NO may contribute to the diuretic and natriuretic effects of renal kinins.     

Primary orbital malignant lymphoma: a clinicopathology study of 17 cases

We investigated the clinicopathologic characteristics of 17 patients (13 men and 4 women) with primary orbital malignant lymphoma using the Working Formulation. Most of the cases belonged to the low-grade malignancy group, and more women than men were in the histologically high-grade malignancy group. The phenotype of the tumor cells was investigated immunohistochemically. All cases showed the monoclonal feature of a B-cell lineage. All patients received chemotherapy with or without radiotherapy. Of 16 subjects, 15 achieved a complete remission; none of these patients has had a recurrence since the completion of the initial therapy (range of follow-up from 16 months to 10 years). One patient died. Offprint requests to: H.K. Mishima