A case of posterior choroidal artery infarction]

The posterior choroidal artery supplies the lateral geniculate body, the posterior thalamus and the caudate body. Currently, a few cases of infarction in this arterial territory have been reported. This is a case of 59-year-old male, exhibiting left homonymous hemianopsia and left hemiparesis. Clinically it was impossible to make a diagnosis of infarction in this area. We were able to determine that it was a posterolateral choroidal artery infarction rather than an anterior choroidal artery infarction using 1.5 T-magnetic resonance imaging (MRI). The MRI scan clearly disclosed the areas of infarction, which included the lateral geniculate body, the posterior thalamus and the caudate nucleus body. Additionally, cerebral angiography revealed an occluded proximal portion of the right posterior cerebral artery (P2) and a patent right anterior choroidal artery. Anatomically, the areas surrounding the lateral geniculate body are supplied by both the anterior and the posterolateral choroidal arteries. However, the posterolateral choroidal artery infarctions are believed to be rare due to usual dominance of the anterior choroidal artery. Presently, with the use of MRI scanning, these areas can be easily visualized. Therefore, the posterolateral choroidal artery infarction can be diagnosed more easily. It is conceivable that more cases will be accurately diagnosed using this tool.     

Evaluation of image-diagnosing methods of enlarged parathyroid glands in chronic renal failure

Three noninvasive image-diagnosing methods, computed tomography (CT), scintigraphy with²⁰¹T1C1 and^99mTcO_h4 ^–, and ultrasonography (US), were preoperatively performed on 50 patients with chronic renal failure and secondary hyperparathyroidism who underwent total parathyroidectomy and parathyroid autograft. The detection rates of the 3 methods on the 191 excised parathyroid glands were compared according to weight and location. CT detected 57.1% of all glands and 78.6% of 103 glands weighing over 500 mg. Scintigraphy detected 51.8% and 75.7%, and US detected 42.4% and 53.4%, respectively. The detection rate of upper glands was best with CT at 58.9% and 89.1%; that of lower glands was best with scintigraphy at 65.3% and 80.4%. Although the combination of the 3 methods diagnosed 69.6% and 89.5%, CT and scintigraphy, the best 2 combinations, visualized 67.5% and 88.3%.

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Resumen Tres métodos diagnósticos no invasivos, la tomografía computadorizada (TC), la centelleografía con²⁰¹T1C1 y^99mTcO₄ y la ultrasonografía (US) fueron realizados preoperatoriamente en 50 pacientes con falla renal crónica e hiperparatiroidismo secundario sometidos a paratiroidectomía y autotransplante paratiroideo. Las tasas de detección de los 3 métodos fueron comparados sobre las 191 glándulas paratiroideas resecadas en relación a los pesos y a los sitios de ubicación. La TC detectó el 57.1% del total de glándulas y el 78.6% de aquellas glándulas (103) con pesos superiores a 500 mg. La centelleografía detectó 51.8% y 75.7%, y la US 42.4% y 53.4% respectivamente. La tasa de detección para las glándulas superiores fue optima con TC, con 58.9% y 89.1%; la de las glándulas inferiores fue óptima con centelleografía, con 65.3% y 80.4%. Aunque la combinación de los 3 metodos diagnosticó el 69.6% y 89.5%, la TC y la centelleografía, la mejor de las combinaciones, visualizó el 67.5% y el 88.3% respectivamente.

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Résumé Trois méthodes d'imagerie non invasives, la tomodensitométrie, la scintigraphie (avec T1C1²¹⁰ et TcO₄ ^99m), et l'ultrasonographie ont été pratiquées avant l'intervention chez 50 malades qui présentaient une insuffisance rénale chronique compliquée d'hyperparathyroïdisme secondaire et qui furent traités par parathyroïdectomie totale et autogreffe parathyroïdienne. Les taux de détection de ces 3 méthodes concernant 191 glandes parathyroïdes réséquées ont été évalués en fonction du poids et du siège des lésions. La tomodensitométrie a permis de découvrir 57.1% de toutes les glandes et 78.6% des glandes dont le poids dépassait 500 mg; la scintigraphie 51.8% et 75.7%; l'ultrasonographie 42.4% et 53.4%. Le taux de détection des glandes supérieures fut plus élevé avec la tomodensitométrie: 58.9% et 89.1%; celui des glandes inférieures le fut avec la scintigraphie: 65.3% et 80.4%. Si la combinaison des 3 méthodes permet le diagnostic dans 69.6% et 89.5% des cas la tomodensitométrie associée seulement à la scintigraphie donne des résultats très voisins, les taux respectifs étant de 67.5% et de 88.3%.

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Presented at the International Association of Endocrine Surgeons in Paris, September 1985.     

Effects of a new histamine H2-receptor antagonist, Z-300, on gastric secretion and gastro-duodenal lesions in rats: comparison with roxatidine.

We examined the effects of a new compound, N-[3-[3-(piperidinomethyl)phenoxy]-propyl]-2-(2-hydroxyethyl-1- thio)acetamido.2-(4-hydroxy benzoyl)benzoate (Z-300), on the histamine H2-receptor, gastric secretion in rats and dogs, and acute gastro-duodenal lesions or chronic gastric ulcers in rats. Roxatidine acetate hydrochloride (roxatidine), a known histamine H2-receptor antagonist, was used as a reference compound. The pA2 values for Z-300 and roxatidine for the isolated guinea pig atrium were 6.8 and 7.0, respectively. These agents at less than 10(-5) M did not affect the contraction of guinea pig ileum in response to carbachol. Z-300, administered either orally or parenterally, significantly inhibited the basal and histamine-stimulated gastric acid secretion in rats. Gastric acid secretion stimulated by histamine, pentagastrin or carbachol in Heidenhain pouch dogs was also significantly inhibited by the compound. The effect persisted for greater than 7 hr in the case of histamine-stimulation. Oral Z-300 significantly protected the gastric mucosa from water-immersion stress-, indomethacin-, aspirin- and HCl.ethanol-induced lesions and protected the duodenal mucosa against mepirizole- and cysteamine-induced ulcers. These effects on gastric secretion and lesion formation were, as a whole, stronger than those observed with roxatidine. Z-300, but not roxatidine, significantly accelerated the spontaneous healing of acetic acid ulcers induced in rats and prevented the delay in ulcer healing caused by indomethacin. The mechanism of action of Z-300 on acute lesions and chronic ulcers appears to be mostly related to its potent antisecretory and mucosal-protective activities.     

Clinical Pharmacokinetics of Anti‐angiogenic Photodynamic Therapy with Benzoporphyrin Derivative Monoacid Ring‐A in Dogs Having Naturally Occurring Neoplasms

The aim of this study was to examine the pharmacokinetics of clinically applied benzoporphyrin derivative monoacid ring‐A (BPD‐MA; Verteporfin^®), a second‐generation photosensitizer, during a trial of photodynamic therapy (PDT) in nine dogs having naturally occurring neoplasms. After injecting BPD‐MA at 0.5 mg/kg intravenously, its mean half‐life (t_1/2) was found to be 8.14 ± 5.34 h, mean clearance (Cl) 35.13 ± 9.62 ml/(h kg), the mean value of the volume of distribution (V_c) 0.08 ± 0.01 l/kg and the mean steady state volume of distribution (V_ss) 0.38 ± 0.31 l/kg respectively. With the exception of a transitional increase in serum alkaline phosphatase activity, no other clinical abnormalities were observed. The t_1/2 in dogs with naturally occurring tumours was longer than that in humans, but similar to that in rats. The values of Cl and V_ss in dogs having naturally occurring neoplasms were lower than those in humans. It is suggested that the pharmacokinetics of BPD‐MA in tumour‐bearing dogs would be helpful in determining the protocol of a short drug‐light interval PDT with BPD‐MA that mainly targets the tumour vasculature.     

Functional and phenotypic analysis of tumor-infiltrating lymphocytes isolated from human primary and metastatic liver tumors and cultured in recombinant interleukin-2

Tumor-infiltrating lymphocytes (TIL) were isolated from 40 of 51 consecutive human liver tumor samples (primary hepatocellular carcinoma, 16 of 18; metastatic, 23 of 29; benign, one of four). Functional and phenotypic characteristics of fresh and recombinant interleukin-2 (rIL-2)-expanded TIL were evaluated. The expansion of TIL from hepatic tumors in the presence of 1000 units/ml of rIL-2 was possible in 60% of cases. In comparison to TIL from metastatic liver tumors, TIL obtained from primary liver tumors expanded faster and better in rIL-2 cultures. Expanded TIL from primary tumors had significantly higher cytotoxicity against K562 targets, but not Raji targets, than those from metastatic tumors. Cytotoxicity against fresh autologous tumor targets was detected in seven of eight cultures tested. TIL from primary tumors retained antitumor reactivity significantly longer in culture. The optimal in vitro cytotoxicity was achieved between days 20 and 60 of culture in the presence of rIL-2. Antitumor activity was associated with the increase in these TIL cultures of a cell population expressing the Leu19 antigen with or without the CD3 antigen. The frequency of the CD3+Leu19+ population showed a bimodal distribution during culture: the first peak of CD3+Leu19+ cells occurred between days 30 and 60 and was associated with the increased antitumor activity; the second peak occurred after day 60 and was not associated with activity. These findings demonstrate that TIL from most human hepatic tumors can be successfully isolated, cultured in rIL-2, and enriched in Leu19+ effectors. In addition, these TIL upon IL-2 activation in vitro are capable of lysing fresh autologous and/or allogeneic tumor targets.     

A case of multiple cranial neuropathy after Campylobacter jejuni infection]

We report a patient who developed overlapping symptoms of ophthalmoplegia and oropharyngeal palsy after Campylobacter jejuni infection. A 15-year-old man had diarrhea and fever, and developed dysarthria, diplopia and ptosis two weeks later. He did not show ataxia, weakness or abnormal tendon reflexes in the extremities during the clinical course. In the acute phase of the disease, we found significant elevation of anti-GQlb and anti-GTla IgG antibodies in the serum, and high-dose intravenous immunoglobulin therapy remarkably ameliorated the symptoms. Our patient was atypical of Fisher syndrome or pharyngeal-cervical-brachial (PCB) weakness, and this is the first case of multiple cranial neuropathy associated with C. jejuni infection.     

Effect of a two-solution fluoride mouthrinse on remineralization of enamel lesions in vitro.

A previous study showed that a two-solution fluoride (F) rinse deposited significantly more loosely-bound F on the tooth surface than did a sodium fluoride (NaF) rinse with the same F concentration (12 mmol/L). In the present study, this experimental rinse was evaluated for its ability to cause remineralization of enamel lesions in an in vitro pH-cycling model. Caries-like lesions were formed in the enamel of extracted human molars by means of a pH 4 demineralizing solution. Fifty-one approximately 120-microns-thick sections containing lesions were randomly divided into (1) control, (2) NaF rinse, and (3) two-solution F rinse groups. With the cut surfaces protected, the control samples were immersed in a pH 7 remineralizing solution for 12 days, and twice daily the sections were also exposed to a pH 4 demineralizing solution for 30 min. Samples in the NaF group received an additional one-minute rinse with a NaF (12 mmol/L) solution twice daily. Samples in the two-solution rinse group received the rinse treatment with a 12 mmol/L F solution prepared by combination of a Na2SiF6 and phosphate-containing solution with a calcium solution just before use. The mineral contents of the lesions were assessed by quantitative microradiography. The results showed that (1) no significant de- or remineralization was detected in the controls; (2) a 46% decrease in mineral loss (delta Z) of the lesion was produced by the NaF rinses; and (3) a 94% decrease in delta Z and a 20-microns-thick, mineral-dense surface-coating were produced by the two-solution F rinse treatment.