The relationship between cerebral white matter changes, mental function and blood pressure in normal elderly

The authors examined the relationship between cerebral white matter changes and mental function, blood pressure in 39 neurologically normal aged (21 males, 18 females, mean age 75.0 years) who had no latent lesions on MRI images. The severity of cerebral white matter changes was estimated by T1 value images on MRI and was measured in the bilateral frontal lobe on an axial slice at the level of the basal ganglia and in the bilateral anterior, middle, and posterior portions on axial slices at the level of the body of the lateral ventricle. Mental function was measured by the Hasegawa's dementia rating scale (HDS) and Kohs' block design test (Kohs' test). The severity of cerebral frontal white matter changes increased significantly with age (p less than 0.05). However there was no significant correlation between the severity of cerebral white matter changes and HDS, Kohs' test. The severity of frontal white matter changes correlated with the mean arterial blood pressure (p less than 0.02). These results suggest that the severity of cerebral white matter changes is not related with mental function in the normal elderly, and that the severity of frontal white matter lesions is related with mean arterial blood pressure.     

Platelet glutathione peroxidase activity in long-term total parenteral nutrition with and without selenium supplementation.

Selenium (Se) is not routinely included in total parenteral nutrition (TPN) solution; thus, patients receiving long-term TPN may be at risk of Se deficiency, which may cause fatal cardiomyopathy. Platelet glutathione peroxidase (GSH-Px) activity, as well as Se levels and GSH-Px activity in plasma and erythrocytes during prolonged TPN, was measured in six patients with chronic gastrointestinal disease. During the time course of TPN, Se administration was discontinued for 12 weeks, and then resupplemented for another 12 weeks. Before the study period, all Se indices had been maintained within the normal range. After discontinuation of Se supplementation, a significant decrease in platelet GSH-Px activity was observed after 1 week (from 64 +/- 7 [mean +/- SD] to 39 +/- 5 U/g of protein). After resupplementation, it increased after 1 week (from 44 +/- 9 to 65 +/- 10 U/g of protein). Plasma Se indices significantly changed within 3 weeks after withdrawal and reintroduction of Se (Se: from 136 +/- 28 to 75 +/- 14 and from 61 +/- 22 to 125 +/- 33 micrograms/L; GSH-Px: from 236 +/- 50 to 140 +/- 36 and from 128 +/- 32 to 220 +/- 64 U/L). Erythrocyte Se indices showed no significant changes during the study period. The results demonstrate that platelet GSH-Px activity is the most sensitive index of Se status in TPN patients.     

M protein and protein F act as important determinants of cell-specific tropism of Streptococcus pyogenes in skin tissue.

The pathogenic gram-positive bacterium Streptococcus pyogenes (group A streptococcus) causes numerous diseases of cutaneous tissue, each of which is initiated after the interaction of the bacterium with the cells of the epidermis. In this study, we show that different surface proteins of S. pyogenes play important roles in determining the cell-specific tropism of the bacterium in skin. Using streptococcal strains with defined mutations in the genes which encode surface proteins in combination with primary cultures of human skin and an in situ adherence assay which uses histological sections of human skin, we show that the M protein of S. pyogenes mediates the binding of the bacterium to keratinocytes, while a second streptococcal surface protein, protein F, directs the adherence of the organism to Langerhans' cells. Characterization of binding revealed that adherence was inhibited by purified streptococcal proteins and pretreatment of both host cells with the protease trypsin. Adherence was only slightly affected by the state of keratinocyte differentiation in vitro, but was considerably modulated in response to environmental conditions known to regulate expression of M protein and protein F, suggesting that the interaction between these bacterial cell-surface structures/adhesins and keratinocytes and Langerhans' cells may play an important role in streptococcal skin disease.     

Pheochromocytoma discovered in a pregnant woman: a case report]

A case of pheochromocytoma discovered at pregnancy is reported. The patient was a 27-year-old woman who had no symptoms before pregnancy. A sudden hypertensive attack occurred during vaginal examination at the 36th week of pregnancy. Magnetic resonance imaging (MRI) and ultrasonography showed a right adrenal mass. The level of catecholamine in blood and urine was beyond the normal limit. This patient was diagnosed as pheochromocytoma with pregnancy. Cesarean section was immediately done to avoid hypertensive crisis caused by spontaneous delivery. Blood pressure and blood volume were controlled by an alpha-blocker for one month after delivery, and, then the tumor was removed surgically. Pheochromocytoma with pregnancy is life-threatening for the mother and the fetus because of difficult diagnosis and complex clinical features. Early diagnosis and appropriate treatment are mandatory. Pathophysiological characteristics and the treatment of such specified statics are mainly discussed through our successful achievement.     

Body temperature monitoring in subjects with delayed sleep phase syndrome

To clarify the circadian aspects of delayed sleep phase syndrome (DSPS) in 4 patients with DSPS, we recorded polysomnograms and rectal temperature before and after chronotherapy. The time interval (2.7 h) between sleep onset and rectal temperature minimum before chronotherapy was shorter than the time interval after chronotherapy (5.3 h). Before chronotherapy, the period of rectal temperature rhythm was 24.7 h. After chronotherapy, the period of rectal temperature rhythm was 24.0 h. These findings lead to the conclusion that in DSPS there is a weakened mechanism of entrainment similar to that in non-24-hour sleep-wake syndrome.     

Serum estrone sulfate levels in patients with breast cancer

Estrone and estradiol-17 beta concentration in breast cancer tissue are reported to be an order of magnitude higher than those of circulating plasma in breast cancer patients. This high level of estrogen is provided by local production from estrone sulfate (E1-S) through the sulfatase pathway. Then serum E1-S level was determined using direct radioimmunoassay method in order to monitor the estrogen kinetics of post-operative breast cancer patients. Peri-operative sequential E1-S determination was carried out in 10 patients. Among them, extremely higher level, as compared with normal menstruating level of 625-2670pg/ml, was observed just after an administration of tamoxifen (three weeks after operation) in two of 5 pre-menopausal patients. In order to evaluate the effect of tamoxifen on serum level of E1-S in post-operative pre-menopausal patients, serum E1-S level in 42 post-operative outpatients was examined. Although there was no difference in the average level of E1-S in post-menopausal patients treated with or without tamoxifen, average E1-S level in pre-menopausal patients treated with tamoxifen as adjuvant therapy was significantly higher than that in patients without tamoxifen. These results suggests that the administration of tamoxifen to premenopausal patients should be reconsidered from a view point of the estrogen kinetics.