The Drosophila Bruton's tyrosine kinase (Btk) homolog is required for adult survival and male genital formation.

We isolated a Drosophila fickleP (ficP) mutant with a shortened copulatory duration and reduced adult-stage life span. The reduced copulatory duration is ascribable to incomplete fusion of the left and right halves of the apodeme that holds the penis during copulation. ficP is an intronic mutation occurring in the Btk gene, a gene which encodes two forms (type 1 and type 2) of a Bruton's tyrosine kinase (Btk) family cytoplasmic tyrosine kinase as a result of alternative exon usage. The ficP mutation prevents the formation of the type 2 isoform but leaves expression of the type 1 transcript intact. Ubiquitous overexpression of the wild-type cDNA by using a heat shock 70 promoter during the late larval or pupal stages rescued the life span and genital defects in the mutant, respectively, establishing the causal relationship between the ficP phenotypes and the Btk gene mutation. The stage specificity of the rescuing ability suggests that the Btk gene is required for the development of male genitalia and substrates required for adult survival.

Residual effects of hypnotics: triazolam, flurazepam, and nitrazepam.

The residual effects of three hypnotics were investigated by the method of 24-h polygraphy (EEG, EMG, and EOG). The drugs were triazolam 0.25 mg and 0.5 mg, flurazepam 15 mg and 30 mg, nitrazepam 5 mg and 10 mg, and placebo. The subjects were healthy volunteers, eight men and eight women with an average age of 34.3 years. The number of total polygraphic records was 77. Triazolam 0.25 mg and 0.5 mg, flurazepam 30 mg, and nitrazepam 10 mg showed definited sleep inducing and sleep maintenance effects in night recordings. Flurazepam 15 mg and 30 mg and nitrazepam 5 mg and 10 mg were followed by residual effects in morning, afternoon and evening recording periods on the day after the administrations of the hypnotics. However, no effects were seen on the day after the administration of triazolam 0.25 mg and 0.5 mg except for some slight residual effects in the morning. Thus triazolam 0.25 mg and 0.5 mg produces less residual effect than do flurazepam 15 mg and 30 mg, and nitrazepam 5 mg and 10 mg, and 24-h polygraphy is useful for measuring the residual effects of hypnotics.

Determination of alpha-amylase using 4-O-beta-D-galactopyranosylmaltotetraose (Gal-G4) as a substrate.

A new substrate, 4-O-beta-D-galactopyranosylmaltotetraose (Gal-G4) is applied for the determination of alpha-amylase in serum and urine in a coupled assay with alpha-glucosidase (EC 3.2.1.20), glucokinase (EC 2.7.1.2) and glucose-6-phosphate dehydrogenase (EC 1.1.1.49) as auxiliary enzymes. Gal-G4 having a 4-position of the non-reducing-end glucose residue modified by a beta-galactopyranose group is resistant for degradation by alpha-glucosidase as auxiliary enzyme. Moreover, this substrate is hydrolyzed at just one position by alpha-amylase in serum and urine. More than 99% of the products generated from Gal-G4 by alpha-amylase are identified 4-O-beta-D-galactopyranosylmaltose (Gal-G2), maltose, respectively. Glucose and maltose do not interfere the value of alpha-amylase activity at least up to 0.056 mmol/l (1 g/dl) glucose and 0.027 mmol/l (1 g/dl) maltose, respectively. We are now carrying out this work under the authority of The Enzyme committee of Japanese Society of Clinical Chemistry (JSCC) as a standard method for determination of alpha-amylase in clinical chemistry.

Shape of lens epithelial cells after intraocular lens implantation.

PURPOSE: To evaluate the morphological behavior of lens epithelial cells (LECs) after human cataract surgery with implantation of a poly(methyl methacrylate) (PMMA) or silicone intraocular lens (IOL). SETTING: Department of Ophthalmology, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan. METHODS: Morphological observations of LECs in the patients with IOLs were made by light and transmission electron microscopy. The LECs were from 4 areas: (1) the region below the anterior capsule, touching the IOL; (2) the area between region 1 and the equatorial region; (3) the equatorial region; and (4) the central equatorial region and of the posterior capsule not touching the IOL. Case 1 had implantation of a single-piece IOL with a PMMA optic and haptics. Case 2 had a 3-piece IOL with a PMMA optic and polypropylene haptics. Case 3 had a 3-piece IOL with a silicone optic and polypropylene haptics. Areas 1 and 4 could not be observed in Case 2. RESULTS: The major difference between the patient with a PMMA IOL (Case 1) and the patient with a silicone IOL (Case 3) was that among the 4 areas observed, collagen fibers were present only in area 1 in Case 1 but in areas 2 or 3 as well in Case 3. CONCLUSIONS: Fibrous collagen fibers appeared in regions in which LECs adhered and there was capsule contact with the IOL optic. In addition fibrous collagen fibers appeared in more areas in the eye with the silicone IOL than in that with the PMMA IOL, perhaps because IOLs with silicone optics move slightly while in the capsular bag.

Versatility of the free anterolateral thigh flap for reconstruction of head and neck defects.

OBJECTIVE: The anterolateral thigh flap has many advantages in head and neck reconstruction. However, it has not yet come into widespread use because of the anatomic variations of its perforators. Herein, we describe a safe operative technique related to the patterns of the perforators and discuss its wide versatility. SETTING: A national cancer center hospital. PATIENTS: Thirty-eight anterolateral thigh flaps were transferred. Confirmation and dissection of the flap pedicle were simultaneously performed with tumor resection. The design and elevation of the flap were carried out immediately after the tumor resection was completed. RESULTS: From the study of the anatomic variations of the perforators, septocutaneous patterns were recognized in 10 cases (26.3%) and musculocutaneous patterns in 28 cases (73.7%). All flaps were easily and safely elevated with our techniques. Thirty-six flaps survived. Partial necrosis was noted owing to excessive thinning procedure in one patient and total necrosis was noted owing to venous thrombosis at the anastomosis part in another patient. CONCLUSIONS: We found that the anterolateral thigh flap has numerous advantages. It is possible to perform the flap elevation and the tumor resection simultaneously. The flap is generally thin and is suitable for reconstruction of intraoral defects. Combined flaps with neighboring tissues and other, distant flaps can be used. Furthermore, since our technique minimizes the problems of confirmation and dissection of the perforators, we conclude that this flap can be successfully used to repair a variety of large defects of the head and neck.

A case of normotensive scleroderma renal crisis after high-dose methylprednisolone treatment.

A 68-year-old male was admitted for interstitial pneumonia associated with scleroderma. High-dose methylprednisolone was administered for treatment of the pneumonitis. Two weeks later, anemia, thrombocytopenia and progressive increase in BUN, creatinine and LDH were observed. Although the blood pressure remained normotensive, renal biopsy showed thrombosis of the polar arterioles and glomerular capillaries. The affected interlobular artery included concentric intimal thickening and thrombosis in the lumen. Our findings suggested that the antecedent use of high-dose corticosteroids is involved in precipitating normotensive renal crisis. Corticosteroids should be used in low doses and with great caution in scleroderma patients.

Hepatocellular carcinoma after radiofrequency ablation therapy: dynamic CT evaluation of treatment.

The aim of this study is to analyze the dynamic CT findings after radiofrequency (RF) ablation for hypervascular hepatocellular carcinoma (HCC). RF ablation was used for 22 tumors in 20 patients. Peripheral enhancement was noted in 89% of regions within 1 month in the arterial phase. In 1-3 months, peripheral enhancement remained at 56% and was reduced to 22% by 3-6 months. It is difficult to determine the therapeutic result within 3 months due to continued peripheral enhancement in the arterial phase.

Lens epithelial cells in postoperative aqueous humor.

The aqueous humor during or after cataract surgery often contains red blood cells (RBCs) from blood; inflammatory cells from white blood cells (WBCs); fibrin, pigment cells, and fibroblasts from either the iris or the ciliary body; lens epithelial cells (LECs); and corneal endothelial cells. Since LECs may be related to postoperative complications, including a fibrin reaction and a secondary cataract, confirmation of their presence postoperatively not only in the capsular bag, but also in the aqueous humor, is necessary for identifying these complications. Using aqueous humor obtained from pig eyes, I attempted to identify LECs immunohistochemically in the aqueous humor, following phacoemulsification (PEA) and aspiration of the cortex, and found the presence of cells that react to keratin antibody, the marker for epithelial cells. Although these cells could be lens, conjunctival, or corneal epithelial cells, they were found following PEA and aspiration of the cortex, and therefore are believed to be LECs.

The relationship between morphological changes of lens epithelial cells and intraocular lens optic material.

To examine the morphological changes of lens epithelial cells (LECs) occurring directly beneath and at regions contacting various intraocular lens (IOL) optic materials, human LECs were cultured on human anterior lens capsules and were further incubated upon placing above the cells lens optics made of polymethylmethacrylate, silicone, and soft acrylic material. Observations as to the morphological changes of LECs under phase-contrast microscope and scanning electron microscope were performed on the 14th day of incubation. Gatherings of LECs were observed at regions contacting the soft acrylic material under phase-contrast microscope, and gatherings of LECs were observed accurately at the same regions mentioned above under scanning electron microscope. On the other hand, LECs in contact with two other optic materials did not show morphological changes. The results suggest that LECs attached to and proliferated on not only the anterior lens capsules but also the soft acrylic IOL optics. The model used in this study may be useful in studying the relationship between cellular movement of LECs and IOL optic material.

Intracranial mycotic aneurysm caused by Aspergillus--case report.

A 75-year-old female with chronic renal failure diagnosed as Wegener's granulomatosis was receiving steroids and immunosuppressive agents when subarachnoid hemorrhage developed. Cerebral angiography showed a fusiform aneurysm arising from an angular branch of the left middle cerebral artery. Hemorrhage occurred and the aneurysm was excised by emergency surgery. Microscopic examination of the aneurysm revealed dense infiltration of hyphae identified as Aspergillus. She died of subsequent hemorrhage. Autopsy showed numerous Aspergillus hyphae in the lung. Fungal mycotic aneurysm should be considered in the differential diagnosis of an immunocompromised patient with subarachnoid hemorrhage.

An evaluation of the biocompatibility of intraocular lenses.

BACKGROUND AND OBJECTIVE: The degree of cell adhesion to intraocular lenses (IOLs) was studied through the cell culture system and the morphology of adhering cells was studied using a light electron microscope and a scanning electron microscope. MATERIALS AND METHODS: Human lens epithelial cells were used as materials. The IOL materials were classified into four groups: polymethylmethacrylate (PMMA), heparin surface modified PMMA, surface passivated PMMA, and silicone. RESULTS: PMMA showed greater adhesion than did the other materials. Cells hardly adhered to silicone. Use of a light electron microscope and a scanning electron microscope revealed that cells adhered uniformly to the surface of PMMA and were elongated, but did not adhere uniformly to IOLs of other materials. Only a few cells without the tendency of elongation were noted on the silicone the second day after culture. The 14th day after culture, the surfaces of IOLs, except those of silicone, were covered with cells. CONCLUSION: Such differences in the surface adhesion and morphology of cells adhering to the IOL surface are important in evaluating IOL biocompatibility.

[The effect of epidermal growth factor on the growth potential of epithelial cells from human lens].

The growth promoting effect of epidermal growth factor (EGF) was studied in cultures of epithelial cells from human normal and cataractous lenses. The growth potential of lens epithelial cells was measured by MTT assay. The concentration of EGF in culture medium were classified into 7 groups (0 ng/ml-10(3) ng/ml). When the concentration of EGF was 1 ng/ml, EGF induced the highest increase of growth potential epithelial cells compared with an EGF-free group.

[The existence of epidermal growth factor and basic fibroblast growth factor in human lens epithelial cells].

The aqueous humor supplies the lens with nutrition. Recently, the existence of epidermal growth factor (EGF) and basic fibroblast growth factor (b-FGF) has been confirmed in the human aqueous humor. For this reason, it was thought that the function of these growth factors was related to the physiological condition of the lens epithelial cells (LEC). Therefore, we looked for the existence of receptors for EGF, FGF, and the internalization of EGF and b-FGF using LEC from human cataractous lenses in immunohistochemistry. We confirmed the existence of receptors for EGF and FGF as well as the internalization of EGF and b-FGF. From these results. We inferred that the function of EGF and b-FGF was strongly related to the physiological condition of LEC.

[Severe cases of pulmonary tuberculosis required mechanical ventilation].

We report severe cases of pulmonary tuberculosis with respiratory failure who required mechanical ventilation. Of 99 patients with pulmonary tuberculosis admitted to Daido Hospital from November 1991 to November 1993, 6 patients had been mechanically ventilated. Four of these 6 patients were vagrants and had long delay from onset of the symptom to the admission. Chest X-rays of ventilated patients showed bilateral, extensive shadows consistent with those of typical pulmonary tuberculosis, and a large number of acid-fast bacilli were detected in their sputa. Though all ventilated patients except one HCV carrier had no underlying disease, they showed remarkable emaciation and malnutrition. They also showed weak PPD-skin reactions and reduced number of lymphocytes that suggested immunological disorders. Four cases have recovered, so we conclude that mechanical ventilation is necessary and useful for the treatment of severe cases of pulmonary tuberculosis.

[Clinical effects of intravesical instillation of polymyxin B in patients with acute cystitis].

The effectiveness of intravesical instillation of Polymyxin B was studied in 17 patients suffering from acute cystitis. The 17 patients, all female, had an average age of 42 years. The average duration between the onset of symptoms and the initial visit to the hospital was 4.6 days. The causative organisms were 15 strains of E. coli and 1 each of P. rettegeri and K. pneumonia, respectively. Improvement of symptoms was observed in 76% of the cases but pyuria was cleared in only 47% of the cases. Clinical results were excellent in 8 cases (47%), good in 6 cases (35%) and poor in 3 cases (18%). The overall effectiveness rate was 82%. No appreciable amount o Polymyxin B, was detected in the serum of 4 patients examined.

[A study of transrectal aspiration biopsy of the prostate].

We studied 35 needle aspiration biopsies of the prostatic cancer to evaluate the reliability for screening, as compared with the transrectal or transperineal needle biopsy of the same patients. Eight specimens were unsatisfactory for cytological study, only 77.4% of the 35 aspirations being cytologically evaluable. False negative aspiration biopsies occupied 22.7%. Histopathological evaluation was possible for all of the needle biopsies and the false negative rate was 5.7%. To examine how accurately aspiration biopsy or needle biopsy reflects the true histologic grade of prostatic cancer, both the cytologic grade of the aspirations and histologic grade of the biopsies were compared with the grade of the prostatectomy specimens. The aspiration biopsy was undergraded in 2 (11.8%) overgraded in 2 (11.8%) and correctly graded in 14 (82.4%) out of 17 cases. The needle biopsy was undergraded in 1 (3.2%), overgraded in 2 (6.5%) and correctly graded in 28 (90.3%) out of 31 cases. There was no significant difference in grading accuracy rate between cytology of the aspiration and histology of the needle biopsy. We conclude that the cytological grade is as reliable as needle biopsy, but aspiration biopsy is not a more efficient screening test for prostatic neoplasms than needle biopsy, considering the higher percentage of speciments unsatisfactory for aspiration and false negative in this small series.

[Clinical study concerning of latamoxef concentration in the obstructed urinary tract].

Urinary LMOX concentration was studied in 18 patients with unilateral ureteral obstruction. The concentration of LMOX in the urine from the mild obstructed kidney was 124 to 2,140 micrograms/ml and 10 micrograms/ml in the severely obstructed ones. The difference was probably due to the intensity and the duration of the obstruction. The patient with 99mTc-DMSA renal uptake of less than 3% also had a urinary LMOX concentration of less than 7 micrograms/ml. The above results seem to show that 7 micrograms/ml in urinary LMOX concentration is a significant figure for treatment of UTI. 99mTc-DMSA renal uptake and renal echogram were used to estimate the excretion rate of antibiotics into the urine.

[A case of anti-glomerular basement membrane antibody (AGBMA) nephritis associated with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)].

A 68-year-old patient visited our hospital, because of progressive renal failure. Laboratory data were serum creatinine 13.3 mg/dl, BUN 74.3 mg/dl, AGBMA 134U, MPO-ANCA 37% and CIC 1.6 g/dl. Hemodialysis was performed on admission and renal biopsy was conducted. Though the histological findings showed fibrocellular crescents and global sclerosis in many glomeruli, renal function was gradually ameliorated by administration of prednisolone (40 mg/day) and cyclophosphamide (50 mg/day). After 3 weeks of therapy, hemodialysis was withdrawn temporarily. Because of the complication of pneumocystis carini, prednisolone and cyclophosphamide were discontinued, and maintenance hemodialysis was resumed. In spite of progressed histological findings, hemodialysis was withdrawn at least temporarily through the use of pharmacological therapy. Thus, the presence of ANCA may indicate a relatively good prognosis of AGBMA nephritis.

[A case of Fabry's disease associated with lupus nephritis].

A 36-year-old woman was hospitalized because of nephrotic syndrome. On admission, laboratory studies revealed total protein 5.9g/dl, total cholesterol 381mg/dl, urine protein 2-4g/day, C3 68mg/dl(90-185mg/dl) and the immunological tests showed that antinuclear factor, anti-DNA antibodies and the LE cell phenomenon were positive. Renal function was within normal range. After admission, renal biopsy was done. Light microscopic finding showed diffuse membranous glomerulonephritis, and vacuolization of epithelial cells. Immunofluorescent microscopic finding showed a granular specific staining for IgG, IgM, C3 and C1q along the capillary loops. Electron microscopic finding showed subepithelial and subendothelial dense deposits, and visceral epithelial cell cytoplasm containing osmiophilic multilamellar lipoid bodies. In the studies of the enzyme activities, the patient's fibroblast extract demonstrated a partial deficiency of alpha-galactosidase, and urine ceramide trihexoside was positive. But the patient's leukocyte extract did not demonstrate a deficiency of alpha-galactosidase. So Fabry's disease associated with lupus nephritis was diagnosed. It seems that the case of Fabry's disease which is an X-linked disorder caused by deficiency of the lysosomal enzyme alpha-galactosidase, associated with lupus nephritis, is extremely rare.