Tissue plasminogen activator levels after single intracisternal injection in patients with subarachnoid hemorrhage

Tissue plasminogen activator (tPA) levels were investigated in the cisternal fluid of patients with subarachnoid hemorrhage treated with single intracisternal injection of recombinant tPA during radical surgery for ruptured aneurysms. Seven patients received different doses of tPA: two of 400 microg/ml, three of 500 microg/ml, one of 700 microg/ml, and one of 800 microg/ml in a total amount of 20 ml distilled water at pH 7. Cerebrospinal fluid samples were taken directly from the cisternal fluid at 15-minute incubation after injection, immediately after irrigation during surgery, and by lumbar tap 2 days after surgery. Cisternal tPA levels decreased to about 60% of the mean injected doses after 15-minute incubation. Simple linear regression analysis showed these tPA levels after incubation correlated with the initial doses. After copious irrigation with Ringer solution at pH 8, tPA levels decreased rapidly without correlation with the initial doses. After spinal drainage for 2 days, tPA levels further decreased by an order of 10(-4) to 10(-6) from the initial dose. These values were still greater than normal controls. The final values of tPA levels were not related to the initial dose. None of the patients suffered from systemic or wound complications. Cisternal tPA injection with increased doses and irrigation may be beneficial for the selective rapid removal of blood clots with controllable safety.     

The relationship between the concentration of dextran sodium sulfate and the degree of induced experimental colitis in weanling rats

BACKGROUND: Although a dextran sodium sulfate (DSS)-induced colitis is commonly used as an ulcerative colitis (UC) model in adult rodents, there are no studies using this model in young animals. We examined differences in the severity of DSS-induced colitis as a function of the concentration of DSS administered and sought to establish a DSS-induced colitis model in young rats. METHODS: We administrated different concentrations of DSS solution (2%, 3%, and 4%) to 4-week-old weanling rats and compared their clinical findings, colonic histologic findings, mucosal leukotriene B4 (LTB4) production, and mucosal blood flow with control weanling rats and 8-week-old adult rats given 4% DSS for induced colitis. RESULTS: Clinical symptoms, such as diarrhea and rectal bleeding, histologic findings, and disturbance of mucosal microcirculation in weanling rats given 4% DSS were significantly more severe than those in adult rats given the same treatment. Three of 10 rats given 2% DSS had no bloody stool and 2 of 10 rats given 4% DSS died during the experimental periods. Clinical symptoms, hemoglobin levels, histologic damage scores, mucosal LTB4 production, and mucosal blood flow became more severely deranged as the concentration of DSS increased from 2% to 4%. CONCLUSION: These findings suggest that we can adjust disease severity in UC model for young children by giving different concentrations of DSS to weanling rats.     

Inhibitory effects of hyssop (Hyssopus officinalis) extracts on intestinal alpha-glucosidase activity and postprandial hyperglycemia

It has been known that Hyssopus officinalis (hyssop) is a herb that grows in the wild and is a source of natural antioxidants. We previously reported that a-glucosidase inhibitors, (2S, 3S)1-O-beta-D-6'-O-cinnamoylglucopyranosyl-3-(3", 5"-dimethoxy-4"-hydroxyphenyl)-1,2,3-propanetriol and (2S, 3S)1-O-beta-D-glucopranosyl-3-(3", 5"-dimethoxy-4"-hydroxyphenyl)-1,2,3-propanetriol, from the dry leaves of hyssop, were isolated. This study examined the alpha-glucosidase inhibitory effects of hyssop extracts on intestinal carbohydrate absorption in rat everted gut sac and carbohydrate-loaded hyperglycemia in mice. In the everted gut sac experiment, 10 mM sucrose- and 5 mM maltose-treated increases in glucose concentration in the serosal compartment were inhibited in the presence of 0.5 and 1.0 mg/ mL hyssop extracts, although a 10 mM glucose-induced increase in serosal glucose was not inhibited by the extracts. Additionally, hyperglycemia in sucrose- and maltose-loaded mice was significantly suppressed at an early stage, within 30 to 60 min by oral pre-administration of 300 and 100 mg/kg hyssop extracts, respectively. These findings suggest that hyssop extracts inhibited the digestion of complex carbohydrates, but not that of absorbable monosaccharide, and might be a useful supplemental food for hyperglycemia.     

Correlation between electroencephalography and heart rate variability during sleep

It is known that autonomic nervous activities change in correspondence with sleep stages. However, the characteristics of continuous fluctuations in nocturnal autonomic nerve tone have not been clarified in detail. The study aimed to determine the possible correlation between the electroencephalogram (EEG) and autonomic nervous activities, and to clarify in detail the nocturnal fluctuations in autonomic nerve activities. Overnight EEGs and electrocardiograms of seven healthy males were obtained. These EEGs were analyzed by fast Fourier transformation algorithm to extract delta, sigma and beta power. Heart rate and heart rate variability (HRV) were calculated in consecutive 5-min epochs. The HRV indices of low frequency (LF), high frequency (HF) and LF/HF ratio were calculated from the spectral analysis of R-R intervals. The sleep stages were manually scored according to Rechtschaffen and Kales' criteria. Low frequency and LF/HF were significantly lower during non-rapid eye movement (NREM) than REM, and were lower in stages 3 and 4 than in stages 1 and 2. Furthermore, delta EEG showed inverse correlations with LF (r = - 0.44, P < 0.001) and LF/HF (r = - 0.41, P < 0.001). In contrast, HF differed neither between REM and NREM nor among NREM sleep stages. Detailed analysis revealed that correlation was evident from the first to third NREM, but not in the fourth and fifth NREM. Delta EEG power showed negative correlations with LF and LF/HF, suggesting that sympathetic nervous activities continuously fluctuate in accordance with sleep deepening and lightening.     

Correlation of Clinicopathologic Features of Resected Hepatocellular Carcinoma with Hepatitis C Virus Genotype

Clinicopathologic findings in patients with hepatocellular carcinoma complicating hepatitis C virus and outcomes after liver resection were compared between different viral genotypes. One hundred and forty-seven patients with both anti-hepatitis C virus antibody and hepatitis C virus RNA in their sera underwent curative resection for hepatocellular carcinoma in our department between 1991 and 1997. Of these patients, 115 were infected with hepatitis C virus genotype 1b (group 1), and 32 were infected with 2a or 2b (group 2). Clinicopathologic findings and outcomes after operation were compared between the two groups. Alanine aminotransferase activity was significantly higher in group 2 than in group 1. Genotypes did not differ concomitantly with histopathologic features of the carcinoma or adjacent hepatic tissue. Although the tumor-free survival rate did not differ significantly between the two groups, recurrence was not detected during the period beyond 3 years following operation in group 2, while recurrences arose during that period in 16 group 1 patients, most of whom continued to manifest active hepatitis. In 7 of these 16 patients, the recurrent tumors were histologically multicentric in origin. The cumulative survival rate was significantly lower in group 1 than 2. Multivariate analysis indicated that genotype 1b was an independent risk factor for short survival. Patients infected with genotype 1b may have a relatively high risk of ongoing hepatocarcinogenesis and more aggressive progression of associated liver dysfunction, resulting in a poorer outcome than with other genotypes.     

Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum

BACKGROUND: Indications for the treatment of osteochondritis dissecans of the humeral capitellum have remained unclear. The aims of this study were to analyze the outcomes and to determine the most useful classification for the choice of treatment. METHODS: The cases of 106 patients with osteochondritis dissecans of the capitellum were studied retrospectively. At the time of the initial presentation, the mean age of the patients was 15.3 years. The capitellar growth plate was open in eighteen patients and closed in eighty-eight. Thirty-six patients were treated nonoperatively. Fifty-five patients underwent fragment removal alone, twelve underwent fragment fixation with a bone graft, and three underwent reconstruction of the articular surface with use of osteochondral plug grafts from the lateral femoral condyle. The mean follow-up period was 7.2 years. The outcomes in terms of pain in the elbow, return to sports, and radiographic findings were analyzed and compared. RESULTS: An osteochondritis dissecans lesion with an open capitellar physis and a good range of elbow motion resulted in a good outcome. Continued elbow stress resulted in the worst outcome in terms of pain and radiographic findings. In patients with a closed capitellar physis, surgery provided significantly better results than elbow rest (p < 0.01). Fragment fixation or reconstruction provided significantly better results than fragment removal alone (p < 0.05). The results of removal alone were dependent on the size of the defect in the capitellum. The outcome in terms of pain was closely associated with sports activity and radiographic findings. CONCLUSIONS: We believe that osteochondritis dissecans of the capitellum can be classified as stable or unstable. Stable lesions that healed completely with elbow rest had all of the following findings at the time of the initial presentation: an open capitellar growth plate, localized flattening or radiolucency of the subchondral bone, and good elbow motion. Unstable lesions, for which surgery provided significantly better results, had one of the following findings: a capitellum with a closed growth plate, fragmentation, or restriction of elbow motion of > or =20 degrees . For large unstable lesions, fragment fixation or reconstruction of the articular surface leads to better results than simple excision. LEVEL OF EVIDENCE: Prognostic Level II.     

Malignant parotid gland tumors and facial nerve paralysis

Summary During the last three decades, 586 cases of parotid gland tumor have been extirpated in our clinic. The tumors were malignant in 170 cases and, of these, facial nerve paralysis was observed at first examination in 59 patients. This paper deals with the retrospective study of these cases and is chiefly concerned with the histological types and facial nerve paralysis.     

Persistent expression of Aurora-A after neoadjuvant hormonal therapy as a predictor of a poor clinical outcome in patients undergoing radical prostatectomy for prostate cancer

OBJECTIVES: To characterize the changes in the expression of Aurora-A protein in prostate cancer before and after androgen-withdrawal therapy, and to assess the prognostic significance of the Aurora-A expression in patients undergoing radical prostatectomy (RP) after neoadjuvant hormonal therapy (NHT). PATIENTS AND METHODS: The study included 97 patients with clinically localized prostate cancer who received NHT followed by RP. Paired needle biopsy and corresponding RP specimens obtained from these patients were analysed for the expression of Aurora-A protein by immunohistochemical staining. These findings were then evaluated in relation to several clinicopathological factors. RESULTS: There were various levels of Aurora-A protein expression in most prostate cancer tissues before NHT; however, the Aurora-A expression in RP specimens after NHT was significantly down-regulated compared with that in corresponding needle-biopsy specimens. The expression level of Aurora-A in biopsy specimens was significantly associated with the biopsy Gleason score, but not with other factors available before RP. The Aurora-A expression in the RP specimens correlated significantly with the preoperative value of the serum prostate specific antigen and pathological stage, but not with any other clinicopathological factors examined. Furthermore, cell proliferative activity in the RP specimens, measured by Ki-67 immunostaining, was proportional to the expression of Aurora-A. The biochemical recurrence-free survival in patients with a persistent Aurora-A expression in RP specimens was significantly lower than that in those with a weak Aurora-A expression, but the expression level of Aurora-A was not an independent predictor of biochemical recurrence. CONCLUSIONS: Despite the lack of any independent significance, the expression level of Aurora-A in prostate cancer tissue after NHT, which might inversely reflect the therapeutic effect of NHT, could therefore be a useful variable for predicting biochemical recurrence in patients undergoing RP.     

Relationship between high sensitive C-reactive protein and coronary plaque component in patients with acute coronary syndrome: Virtual Histology study

OBJECTIVES: Elevated circulating C-reactive protein (CRP)is commonly observed in patients with acute coronary syndrome(ACS), suggesting enhanced inflammation in vulnerable plaques. However, few data are available on the relationship between the levels of CRP and the histological composition of coronary plaque. We investigated the relationship between plasma high sensitive CRP level and coronary plaque component with Virtual Histology intravascular ultrasound (VH-IVUS). METHODS: Twenty eight patients with ACS and 37 patients with non-ACS were enrolled in the study. Plasma high sensitve CRP levels were measured before catheterization. A total of 125 lesions (ACS; 24 culprit lesions, 30 non-culprit lesions, non-ACS; 34 culprit lesions, 37 non-culprit lesions)underwent IVUS volumetric investigation, and the volume of plaque and media were calculated. Spectral analysis of IVUS radiofrequency data was performed with VH software, and plaque and media were classified into fibrous, fibro-fatty, dense calcium, and necrotic core elements. RESULTS: Although the plasma high sensitive CRP level in patients with ACS was higher than that in those with non-ACS (0.26 +/- 0.2 vs 0.15 +/- 0.17 mg/dl, p < 0.05), necrotic core volume was not different between the two groups(11.7 +/- 7.3 vs 12.3 +/- 7.2mm3/cm, p = 0.71). There was a positive correlation between high sensitve CRP and necrotic core volume in patients with ACS, not only in culprit lesions (p = 0.0004, r2 = 0.564) but also in non-culprit lesions (p = 0.0008, r2 = 0.473), whereas patients with non-ACS showed no correlations. CONCLUSIONS: IVUS spectral analysis revealed that elevated plasma high sensitve CRP level was correlated with necrotic core volume in patients with ACS, both in culprit and non-culprit lesions, suggesting enhanced vascular inflammation.     

Predicting obesity in early adulthood in Japanese women

Aim:   We analysed the body measurements of Japanese women to determine which factors may forecast adult obesity and also performed a comparative study of the utility of body mass index (BMI), which is used widely in Western Europe, and percentage of overweight, which is used in Japan.
Methods:   Subjects included 244 Japanese women who were born between 1983 and 1986. Using a questionnaire, we investigated anthropometric values from birth to present and parents' present anthropometric data, and analysed factors that correlate with current BMI data.
Results:   (i) BMI after 10 years of age and BMI increase between ages 7 and 8 years correlated with BMI in adulthood. The carrying over rate of overweight increased with age. Meanwhile, percentage of overweight after 13 years onwards correlated with BMI in adulthood. (ii) Adult BMI positively correlated to both parents' BMI.
Conclusions:   (i) For a Japanese woman, BMI in childhood is a good indicator of young adult BMI, and has the possibility of becoming an important parameter to monitor obesity progression. (ii) Therefore, attempts to control obesity in elementary school girls are necessary. (iii) Parents' weights may potentially influence obesity in adulthood; however, further examination of other confounding factors is necessary.