Severe Graves' ophthalmopathy accompanied by myasthenia gravis]

We report a 53-year-old woman with severe Graves' ophthalmopathy accompanied by uncontrolled myasthenia gravis. She presented remarkable exophthalmos, chemosis, and restriction of eye movement. Despite plasma exchange, steroid pulse therapy, local injection of steroid, and irradiation, ocular symptoms did not ameliorate. Since optic neuropathy was seen, orbital decompression surgery was performed in the left eye. Bilateral chemosis was improved after the surgery. Five years after surgery, there was no ocular palsy in the operated left eye, but in the contralateral eye. For the good prognosis of the eye movement, orbital decompression might be recommended in the severe Graves' ophthalmopathy accompanied by the optic neuropathy and/or ophthalmoplegia with proptosis.     

NEW DEVICE TO PERFORM COAGULATION AND IRRIGATION SIMULTANEOUSLY DURING ENDOSCOPIC SUBMUCOSAL DISSECTION USING AN INSULATION‐TIPPED ELECTROSURGICAL KNIFE

Background: Although bleeding is an unavoidable complication of endoscopic submucosal dissection (ESD), endoscopic hemostasis using an insulation‐tipped electrosurgical knife (IT) knife is impossible because an insulator is mounted at the tip of the knife. We have developed a new type of hood which could perform both coagulation and irrigation simultaneously. Methods: Our new device was fabricated by drilling a side hole in the cap portion of a conventional transparent hood followed by attaching a machined papillotomy knife to the exterior surface of the hole. Results: Our new hood was useful for hemorrhage during ESD using IT knife. Conclusions: With this method, endoscopic hemostasis using IT knife is easy, as hemostatic procedure can be performed under irrigation and coagulation using conventional endoscopy.     

The prognostic value of E-cadherin, α-, β- and γ-catenin in bladder cancer patients who underwent radical cystectomy

OBJECTIVES: To determine the value of the loss of expression of E-cadherin and cadherin associated molecules as useful markers for both prognosis and chemosensitivity in bladder cancer patients who have undergone radical cystectomy. PATIENTS AND METHODS: In 55 paraffin embedded specimens of radical cystectomy at our hospital from 1982 to 2000, the expression of E-cadherin, alpha-, beta- and gamma-catenin was examined by immunohistochemical staining. To evaluate the prognostic significance of these molecules, Kaplan-Meier survival curves were constructed and a statistical analysis was calculated by a log-rank test. A multivariate test (tumor stage, tumor grade, lymph node metastasis, configuration, the expression of E-cadherin, alpha-, beta- and gamma-catenin) was performed to detect prognostic markers. RESULTS: Normal expression was found in 33 cases (60.0%) for E-cadherin, 29 (52.7%) for alpha-catenin, 31 cases (56.4%) for beta-catenin, and 31 cases (56.4%) for gamma-catenin. The expression patterns for E-cadherin, alpha-, beta- and gamma-catenin were significantly correlated with each other (P < 0.01). Survival analysis showed a significant difference between normal and aberrant expression in each staining. A multivariate analysis revealed that the expression of alpha- catenin was an independent prognostic factor (P = 0.0191). In 23 patients that received adjuvant chemotherapy, there was a significant difference in survival between the normal and aberrant expression of alpha-catenin, but not other molecules. CONCLUSION: Alpha-catenin may not only be a good prognostic marker, but also one of key molecules that determine the chemosensitivities in patients with invasive bladder cancer.     

EFFECTS OF BKCa CHANNELS ON THE REDUCTION OF CYTOSOLIC Ca2+ IN cGMP-INDUCED RELAXATION OF GUINEAPIG TRACHEA

1. In order to examine the mechanisms of cGMP-induced relaxation in airway smooth muscle, the effects of atrial natriuretic peptide (ANP) and 8-brom cGMP on muscle tone were studied by measuring isometric tension, while the effects on cytosolic Ca²⁺ concentrations were studied by measuring the spectra of fura-2 loaded in guinea-pig tracheal strips. 2. Atrial natriuretic peptide and 8-brom cGMP caused a concentration-dependent inhibition of spontaneous tone in the guinea-pig trachea. The relaxant effects of these agents on spontaneous tone were markedly suppressed in the presence of iberiotoxin (IbTX), a selective inhibitor of large-conductance Ca²⁺-activated K⁺ (BKca) channels. Iberiotoxin (30 nmol/L) markedly affected the maximal effect induced by ANP and 8-brom cGMP and augmented EC₇₀ values for ANP and EC₅₀values for 8-brom cGMP approximately 27- and 17-fold, respectively. The inhibitory effects of IbTX on relaxation induced by these agents were diminished in the presence of 1 μmol/L nifedipine, an antagonist of voltage-operated Ca²⁺channels (VOCC). 3. The inhibitory action of ANP and 8-brom cGMP on spontaneous tone was not affected by the presence of 10 μmol/L glibenclamide, an inhibitor of ATP-sensitive K⁺ channels, and 100 nmol/L apamin, an inhibitor of small-conductance Ca²+-activated K⁺ channels. When these agents were applied to tissues precontracted by high (40mmol/L) K⁺, the relaxant effects of these agents markedly diminished. 4. The extracellular Ca²⁺-dependent contraction was inhibited in the presence of 0.3 μmoI/L ANP or 0.1 mmol/L 8-brom cGMP. Concentration—response curves to extracellular Ca²⁺ (0.03—2.4 mmol/L) were markedly diminished by exposure to these agents. The maximal effect induced by extracellular Ca²⁺ was affected by these agents. 5. Atrial natriuretic peptide caused an inhibition of spontaneous tone accompanied by a reduction in the intracellular Ca²⁺ concentration. In the presence of IbTX, the elimination of both muscle tone and cytosolic Ca²⁺ by ANP was suppressed. 6. We conclude that ANP and 8-brom cGMP activate BKca channels and that the inhibition of Ca²⁺ influx through VOCC, mediated by BKca channel activation, may be involved in cGMP-dependent bronchodilation.     

Effects of herbal medicine Dai-Kenchu-to on anorectal function in children with severe constipation.

AIM: We administered the herbal medicine Dai-Kenchu-To (DKT) to children with severe chronic constipation or with severe constipation after surgery for anorectal malformations. We then objectively assessed the effect of DKT on anorectal function by manometric study in addition to using a clinical scoring system. PATIENTS AND METHODS: Ten children with severe chronic constipation and 5 children with severe constipation after surgery for anorectal malformations were assessed. These 15 children received 0.3 g/kg/day of DKT for periods ranging from 3 months to 1 year. We objectively assessed their bowel function, sphincter function and rectal reservoir function by anorectal manometry and clinical scoring. RESULTS: In 10 children with severe chronic constipation, the clinical score after administration of DKT (7.2 +/- 0.8) improved significantly compared with that before administration of DKT (4.6 +/- 2.9) (p < 0.02). The threshold sensation volume and the maximum tolerable volume after administration of DKT significantly (p < 0.05; p < 0.01) decreased (128 +/- 63 ml vs. 69 +/- 18 ml; 229 +/- 99 ml vs. 144 +/- 47 ml), and rectal compliance after administration of DKT also significantly (p < 0.05) decreased (12.4 +/- 10.9 ml/cmH(2)O vs. 4.7 +/- 3.9 ml/cmH(2)O). CONCLUSION: The present study demonstrated that DKT had a favorable clinical effect on severe constipation in children, and anorectal manometry showed an improvement in their rectal reservoir functions. It appears that the results were secondary to DKT-stimulated peristalsis of the intestine, which promoted regular bowel habits.     

Muscarinic regulation of membrane ion channels in airway smooth muscle cells.

We have demonstrated that stimulation of airway smooth muscle by muscarinic agonists results in a coordinated modulation of two membrane ion channel proteins. Both channels are modulated in a similar way, although their effects on open-channel probability are opposite. The voltage-dependence of channel activity is shifted to more positive potentials in the case of KCa, and to more negative potentials in the case of the voltage-dependent calcium channels. Similarly, KCa channel dwell-time kinetics are shifted to short open lifetimes, whereas the long open state is favored for the large-amplitude voltage-dependent calcium channel. Although little is known about the molecular coupling of calcium channels, muscarinic inhibition of KCa channels is mediated through a pertussis toxin-sensitive guanine nucleotide binding protein.     

Influence of Coxsackie B4 virus on uptake and transport of colloidal carbon by glomerular mesangium

To evaluate the influence of Coxsackie B4 virus (Cox. B4 virus) on the clearing function of the mesangium, colloidal carbon and Cox. B4 virus were intravenously injected into five groups of female Swiss albino mice. Group I received carbon and no Cox. B4 virus; group II, carbon and live Cox. B4 virus; and group III, carbon and inactivated Cox. B4 virus; Group IV and V received live and inactivated Cox. B4 virus, respectively, first, followed by carbon. Semiquantitative analysis of the distribution of carbon particles within glomeruli revealed that in groups II and III disappearance of intracapillary carbon particles was delayed significantly, and that in group II mesangial transport of carbon particles in the direction of the vascular pole of the glomerulus was suppressed. In Groups IV and V, when the interval between carbon and virus injections was shorter than 24 hours, many carbon particles were observed within glomerular capillary lumina compared with Group I. The mechanism of suppressed mesangial uptake of carbon particles may be explained by change of the charge barrier of the glomerular capillary walls and the expansion of the subendothelial space observed after Cox. B4 virus injection. The suppressed mesangial transport of macromolecules appears to be intimately related to be effect of substances produced in viremia and to impairment by viral infection of the function of mononuclear cells infiltrating glomeruli. These results suggest that mesangial uptake and transport of carbon particles are suppressed in transient glomerular changes due to direct injury by the live virus. This means that the biologic property of Cox. B4 virus may be a very important determinant of the clearing function of the mesangium.     

Adherence of Pasteurella multocida or Bordetella bronchiseptica to the swine nasal epithelial cell in vitro.

The interaction of Bordetella bronchiseptica or Pasteurella multocida with swine nasal epithelial cells was studied in vitro. The mean number of B. bronchiseptica organisms adhered per cell was about three times as high as that of P. multocida (P less than 0.01), and the adherence was specifically inhibited by the homologous antiserum prepared with the whole-cell antigen of each bacterium. The poor affinity of P. multocida to the swine nasal mucosa as compared with that of B. bronchiseptica was also demonstrated in the cultured fragments of the nasal mucosa. When observed with a scanning electron microscope, B. bronchiseptica organisms colonized the fragments, whereas few P. multocida organisms adhered. Morphologically, the P. multocida-infected fragments had an essentially normal structure, whereas marked degeneration and marked desquamation of the epithelial cells and severe inflammatory reactions were observed in many areas of the B. bronchiseptica-infected fragments. These morphological observations were consistent with those for the nasal mucosa of P. multocida- or B. bronchiseptica-infected neonatal pigs (T. Nakai, K. Kume, H. Yoshikawa, T. Oyamada, and T. Yoshikawa, Jpn. J. Vet. Sci. 48:693-701, 1986; T. Oyamada, T. Yoshikawa, H. Yoshikawa, M. Shimizu, T. Nakai, and K. Kume, Jpn. J. Vet. Sci. 48:377-387, 1986). Cultured swine nasal fragments, however, were equally injured when they were incubated in a medium containing purified dermonecrotic toxin (DNT) preparations of B. bronchiseptica or P. multocida. Therefore, these DNT preparations can induce morphological damage closely resembling that induced in vivo. Hence, colonization of B. bronchiseptica and production of its DNT on the swine nasal mucosa appear to result in the production of mucosal damage. On the other hand, P. multocida seems to lack the ability to colonize normal swine nasal mucosa, thus resulting in no production or the slight production of DNT to such an extent as to produce mucosal damage. The present data support our previous hypothesis (Nakai et al.; Oyamada et al.) that B. bronchiseptica induces swine atrophic rhinitis, whereas P. multocida does not.     

The winged helix transcription factor Foxc1a is essential for somitogenesis in zebrafish

Previous studies identified zebrafish foxc1a and foxc1b as homologs of the mouse forkhead gene, Foxc1. Both genes are transcribed in the unsegmented presomitic mesoderm (PSM), newly formed somites, adaxial cells, and head mesoderm. Here, we show that inhibiting synthesis of Foxc1a (but not Foxc1b) protein with two different morpholino antisense oligonucleotides blocks formation of morphological somites, segment boundaries, and segmented expression of genes normally transcribed in anterior and posterior somites and expression of paraxis implicated in somite epithelialization. Patterning of the anterior PSM is also affected, as judged by the absence of mesp-b, ephrinB2, and ephA4 expression, and the down-regulation of notch5 and notch6. In contrast, the expression of other genes, including mesp-a and papc, in the anterior of somite primordia, and the oscillating expression of deltaC and deltaD in the PSM appear normal. Nevertheless, this expression is apparently insufficient for the maturation of the presumptive somites to proceed to the stage when boundary formation occurs or for the maintenance of anterior/posterior patterning. Mouse embryos that are compound null mutants for Foxc1 and the closely related Foxc2 have no morphological somites and show abnormal expression of Notch signaling pathway genes in the anterior PSM. Therefore, zebrafish foxc1a plays an essential and conserved role in somite formation, regulating both the expression of paraxis and the A/P patterning of somite primordia.