Internal echo histogram examination has a role in distinguishing malignant tumors from benign masses in the breast.

We analyzed the histograms of reflecting ultrasound (US) from the internal areas of the masses of 50 lesions in the breast. The central average of gravity and the ratio between lower and higher width in the histograms were compared as the parameters. Statistical significance were found in both parameters between malignant tumors and benign masses (P<.001, P<.01). Therefore, analysis of histograms based on reflecting US was useful in making differential diagnoses of malignant tumors and benign masses in the breast.

Corneal dystrophies in Japan.

Recent advances in molecular genetics have increased our understanding of the role of genes. Four autosomal dominant corneal dystrophies (CDs); granular CD (GCD), Avellino CD (ACD), lattice CD (LCD), and Reis-Bücklers CD (RBCD) were mapped to the long arm of chromosome 5 (5q31). These four diseases were shown, in a Caucasian series, to result from different missense mutations in the TGFBI (BIGH3, keratoepithelin) gene. The same mutations were also detected in Japanese patients, from a different ethnic background. Gelatinous drop-like corneal dystrophy (GDLD), on the other hand, which was found in Japanese patients in 1914, is a rare autosomal recessive disorder characterized by corneal amyloidosis. Parents of the patients had a markedly higher frequency of consanguineous marriages than the general population. The gene responsible for GDLD, the membrane component, chromosome 1, surface marker 1 (M1S1) gene was mapped to the short arm of chromosome 1(1p). Four deleterious mutations in this gene were detected in Japanese patients. We review here additional studies on mutations of the TGFBI and M1S1 genes found in Japanese patients. In the TGFBI gene, nine different mutations were detected in Japanese patients with GCD, ACD, LCD, or RBCD. The codons R124 and R555 of the TGFBI gene were hotspots in Japanese patients, of whom many were ACD patients with the R124H mutation. New mutations responsible for LCD were detected in the TGFBI gene of patients with LCD, in addition to the P501T mutation in LCD type IIIA found earlier. These studies showed a clear genotype/phenotype correlation associated with the TGFBI gene. In the M1S1 gene, the Q118X mutation was the most common alteration, and a founder mutation in Japanese GDLD patients, as previously reported. Ninety-two percent of the mutated alleles were the Q118X.

The expression of laminin-5 and ultrastructure of the interface between basal cells and underlying stroma in the keratoconus cornea.

PURPOSE: We investigated the expression of laminin-5 and integrins, and the ultrastructure of the interface between basal cells and the basement membrane in the keratoconus cornea. These findings were compared to those in normal central cornea and limbus. METHODS: Frozen sections of the normal cornea (center and limbus) and the keratoconus cornea were immunostained with monoclonal antibodies against three chains of laminin-5 and integrins. To investigate the ultrastructure of the interface between basal cells and the underlying stroma, we used transmission electron microscopy. RESULTS: As compared to those in the normal central cornea, immunostaining patterns of the three chains of laminin-5 were thick and irregular in the keratoconus cornea and the normal limbus. Using electron microscopy analysis, the same characteristic structure of the interface between basal cells and the underlying stroma was recognized in the keratoconus cornea and the normal limbus. The expression of integrin alpha(6)beta(4) was restricted to the basal aspect of basal cells in the normal cornea. In the keratoconus cornea, however, integrin alpha(6)beta(4) was expressed in all aspects in basal and suprabasal cells. CONCLUSION The expression patterns of laminin-5 and the ultrastructure of the interface between basal cells and the basement membrane in the keratoconus cornea were similar to those in the normal limbus.

Six different mutations of TGFBI (betaig-h3, keratoepithelin) gene found in Japanese corneal dystrophies.

PURPOSE: To investigate mutations of the human transforming growth factor beta-induced gene (TGFBI), transforming growth factor-beta-induced gene product (betaig-h3, keratoepithelin), in Japanese patients with Avellino corneal dystrophy (ACD), lattice corneal dystrophy (LCD), granular corneal dystrophy (GCD), and Reis-Bücklers corneal dystrophy (RBCD). METHODS: Genomic DNA was extracted from the peripheral blood of 75 patients and 7 unaffected relatives from 60 families with ACD, 34 patients and 8 unaffected relatives from 21 families with LCD, 4 patients and 4 unaffected relatives from 4 families with GCD, and 4 patients and an unaffected relative from 3 families with RBCD. Fifty normal volunteers served as controls. Exons 4, 11, and 12 of the TGFBI gene were amplified by polymerase chain reaction and were directly sequenced. RESULTS: Six different heterozygous missense mutations were detected in codons R124, L518, L527, and R555 of the TGFBI gene in the 117 patients from 88 families. A R124H mutation was detected in the patients with ACD. A R124C mutation was detected in the patients with LCD type 1 (LCD1), L518P was in atypical LCDI, and L527R in LCD with opacities deep in stroma. A R555W mutation was detected in the patients with GCD. A R555Q mutation was detected in the patients with RBCD. CONCLUSIONS: We conclude that codons R124 and R555 of the TGFBI gene are also hot spots in Japanese patients with ACD, LCD, GCD, and RBCD. Many Japanese patients with CD had ACD with R124H mutation. GCD with R555W mutation was rare.

Intraocular Lens Calculation for Cataract Treated with Photorefractive Keratectomy Using Ray Tracing Method.

Purpose: Conventional methods (such as the SRK-II formula) do not accurately calculate the power of the intraocular lens (IOL) after refractive surgery. Therefore, we compared a new formula including a ray tracing method to the conventional method for foldable IOL lens implantation.Method: Foldable IOLs (MA 60 BM) were implanted in 26 patients (32 eyes) using the phakoemulsification technique. The power of the IOL was measured preoperatively using the SRK-II formula in all cases. From the results of postoperative refractive errors of these cases, the power of IOL calculated by the ray tracing method was compared to the SRK-II formula. Cataract patients first treated with photorefractive keratectomy (PRK) received IOL implants using our ray tracing method and their postoperative refraction was measured.Results: The average postoperative refractive error was 1.32 D in SRK-II formula, 0.95 D in the ray tracing method with Ray 1 used and 0.89 D with Ray 2 used. Postoperative refraction of both eyes first treated with PRK was -1.00 D.Conclusion: The average postoperative refractive error was reduced in the ray tracing method using Olsen's predicted ACD (Ray 2) compared to SRK-II formula. This new tracing method appears to be useful for determination of IOL power and it may be applied for IOL calculation for cataract surgery after refractive surgery.

Secondary keratoconus with corneal epithelial iron ring similar to Fleischer's ring.

BACKGROUND: Fleischer's ring is considered to be a characteristic of keratoconus, but we have seen a ring similar to Fleischer's ring in patients with secondary keratoconus, in which the cornea becomes thinner secondarily for undetermined reasons. CASES: We report 6 cases of secondary keratoconus with a corneal epithelial ring similar to the Fleischer's ring pattern. OBSERVATIONS: In these 6 cases (2 men and 4 women), the causes of secondary keratoconus were trachoma in 2 cases, trauma in 2 cases, keratitis in 1 case and unknown etiology in one case. All showed thinning of the cornea and a corneal iron ring similar to Fleischer's ring pattern. The corneal button obtained after keratoplasty in 1 case showed the deposition of hemosiderin in the corneal epithelium after staining with Prussian blue. At the same time we confirmed the existence of iron in the corneal epithelium by x-ray ultimate analysis. CONCLUSIONS: All 6 patients we encountered had a past history of corneal disease in their childhood except for 1 case with unknown etiology. Primary keratoconus is also considered to develop by the early teens at the latest. These facts led us to an assumption that the occurrence of some abnormalities in the cornea during the growth period may result in iron deposition in the epithelium and thinning of the stroma. In light of these facts, abnormalities of the iron metabolism must be thoroughly investigated in considering the etiology of keratoconus.

Trial for new intraocular lens power calculation following phototherapeutic keratectomy.

PURPOSE: To determine an equation to calculate the intraocular lens (IOL) power for eyes that have undergone laser phototherapeutic keratectomy (PTK). METHODS: The Gullstrand series was used to determine the power and radius of curvature of a convex-plane IOL, which will alter the focal point from the cornea to the conjugate point on the retina using the ray tracing method. RESULTS: The radius of curvature of the anterior corneal surface (R), axial length (AXL), the predicted postoperative anterior chamber depth (ACD), and lens thickness (LT) were used in the following formula to calculate the refractive power of the IOL to be used: K = R/7.7, DC = 337.5/R, VC = lOOO/DC x 1.336 where VC is the posterior vertex focal length, A(1) = -(VC - ACD), B(1) = AXL - 0.5 x K - ACD - 0.103LT, S = l/A(1) + l/B(1), K is the proportional expression for anterior corneal curvature, DC = anterior corneal refractive power, A(1) = distance from anterior surface of IOL to posterior vertex focal point, B(1) = distance from the second principal point of IOL to the retina, S = 1/focal length of IOL in air. Using this equation, the power (in diopters) of the IOL in liquid was determined to be 1000/(l/S). 1. 336. In eyes that have undergone PTK, the keratometric value prior to cataract surgery is not used. Instead a value, R', is introduced. R' is defined as (R - 376/1376. dT), where R is the radius of corneal curvature prior to PTK and dT the amount of corneal tissue removed. The corneal thickness after cataract surgery, CT', was defined as CT - dT, where CT is the corneal thickness prior to PTK. CONCLUSION: The new equation appears to be useful for determining the IOL power, although it is important to select a lens that has the accurate predicted anterior chamber depth.

Q118X mutation of M1S1 gene caused gelatinous drop-like corneal dystrophy: the P501T of BIGH3 gene found in a family with gelatinous drop-like corneal dystrophy.

PURPOSE: To analyze BIGH3 and M1S1 genes in two Japanese brothers with gelatinous drop-like corneal dystrophy and five unaffected family members. METHODS: DNA was extracted, and each part of the two genes was amplified and directly sequenced. RESULTS: On the BIGH3 gene, a heterozygous P501T mutation was found in the elder brother and three unaffected family members. On the M1S1 gene, both brothers with gelatinous drop-like corneal dystrophy showed a homozygous Q118X mutation, whereas all unaffected members were heterozygous. CONCLUSIONS: The Q118X mutation of M1S1 gene caused gelatinous drop-like corneal dystrophy. Although the P501T of the BIGH3 gene found in this pedigree was precisely the one reported for lattice corneal dystrophy IIIA, no clinical feature was shown, even in the 85-year-old father. This fact shows that the P501T mutation for LCDIIIA has low penetrance.

The functions of exogenous and endogenous laminin-5 on corneal epithelial cells.

Recent evidence suggests that the basement membrane not only separates basal cells from Bowman's layer, but also has a crucial role in the proliferation, differentiation and migration of corneal epithelial cells. The basement membrane is composed of a mixture of matrix components including collagens, laminins and heparan sulfate proteoglycans. In these extracellular matrixes, laminin is a major component of the basement membrane. Of 11 laminin isoformes, laminin-5 is a variant, composed of three nonidentical subunits alpha3, beta3, gamma2 and is a major component of the corneal basement membrane. However, little is known about the interactions of laminin-5 with corneal epithelial cells. In this study, we investigated the functions of laminin-5 on SV-40 transfected human corneal epithelial cells (HCE cells). We also revealed different functions between exogenous and endogenous laminin-5 on HCE cells. Laminin-5 is synthesized initially as a 490 kDa molecule that undergoes specific processing to cleavaged isoforms after being secreted. The alpha3 subunit is processed from 200-190 kDa to 160 kDa/145 kDa. The gamma2 subunit is processed from 150 kDa to 105 kDa/80 kDa. The beta3 subunit (140 kDa) is not processed. Exogenously added laminin-5 (soluble form) in this study was purified from a serum-free, conditioned medium of a human gastric carcinoma cell line STKM-I. This soluble laminin is a processed isoform containing alpha3 (160 kDa), beta3 (140 kDa) and gamma2 (105 kDa) chains. On the other hand, immunocytochemical analysis showed that HCE cells themselves secreted laminin-5 endogenously. Western blotting analysis revealed that HCE cells initially produced unprocessed isoform containing 190 kDa alpha3, 140 kDa beta3 and 150 kDa gamma2 chains and that after being secreted, the alpha3 chain was processed to 160 kDa/145 kDa and the gamma2 chain was processed to 105 kDa. Initially we investigated the functions of exogenous (processed) laminin-5 on HCE cells. Exogenously added laminin-5 strongly promoted cell adhesion via alpha3beta1 integrin, cell spreading, assembly of hemidesmosomes and mildly inhibited cell migration. Next we estimated the effect of endogenous (unprocessed) laminin-5 on HCE cells. Using an anti laminin-5 monoclonal antibody (mAb) or anti integrin alpha3beta1 mAbs, the blocking of the interaction between endogenously secreted laminin-5 and HCE cells caused strong inhibition of cell migration. Integrin alpha3beta1 and alpha6beta4 were expressed in HCE cells. These integrins are receptors of laminin-5. But, anti integrin alpha6beta4 mAbs did not have any blocking ability against cell migration. These results indicated that endogenous (unprocessed) laminin-5 has a crucial role in cell migration on HCE cells via alpha3beta1 integrin. In conclusion, structural differences between exogenous (processed) and endogenous (unprocessed) laminin-5 regulated their functions on HCE cells. Exogenously added laminin-5 strongly promoted cell adhesion, cell spreading and assembly of hemidesmosomes. Endogenously secreted laminin-5 had a crucial role in cell migration. In the future, processed soluble laminin-5 could be a useful drug for the prevention of recurrent corneal erosion, and unprocessed soluble laminin-5 could be applied for the treatment of prolonged corneal epithelial defects.

[Intraocular lens calculation for cataract treated with photorefractive keratectomy using ray tracing method].

PURPOSE: Conventional methods (such as the SRK-II formula) do not accurately calculate the power of the intraocular lens (IOL) after refractive surgery. Therefore, we compared a new formula including a ray tracing method to the conventional method for foldable IOL lens implantation. METHOD: Foldable IOLs (MA 60 BM) were implanted in 26 patients (32 eyes) using the phakoemulsification technique. The power of the IOL was measured preoperatively using the SRK-II formula in all cases. From the results of postoperative refractive errors of these cases, the power of IOL calculated by the ray tracing method was compared to the SRK-II formula. Cataract patients first treated with photorefractive keratectomy (PRK) received IOL implants using our ray tracing method and their postoperative refraction was measured. RESULTS: The average postoperative refractive error was 1.32 D in SRK-II formula, 0.95 D in the ray tracing method with Ray 1 used and 0.89 D with Ray 2 used. Postoperative refraction of both eyes first treated with PRK was--1.00 D. CONCLUSION: The average postoperative refractive error was reduced in the ray tracing method using Olsen's predicted ACD (Ray 2) compared to SRK-II formula. This new tracing method appears to be useful for determination of IOL power and it may be applied for IOL calculation for cataract surgery after refractive surgery.

Leu518Pro mutation of the beta ig-h3 gene causes lattice corneal dystrophy type I.

PURPOSE: To describe a Japanese family with lattice corneal dystrophy type I, which segregates with a novel mutation, Leu518Pro of the beta ig-h3 gene. METHODS: DNA was extracted from leukocytes in four members (three affected and one unaffected) of a Japanese family with lattice corneal dystrophy type I. Exon 12 of the beta ig-h3 gene was amplified and analyzed with a molecular biologic method. Clinical data were also collected. RESULTS: Three generations of this family have been positively diagnosed with lattice corneal dystrophy, indicating autosomal dominant inheritance. We found a heterozygous point mutation that segregates with the disease phenotype. It was a single base-pair transition (CTG to CCG, Leu to Pro). CONCLUSION: Although it is extremely rare compared with the Arg124Cys mutation of the beta ig-h3 gene, Leu518Pro mutation of the beta ig-h3 also causes lattice corneal dystrophy type I.

[The effect of neurotransmitters on rabbit cornea].

PURPOSE: To ascertain the effect of neurotransmitters added to the culture medium of rabbit corneal epithelium and stromal cells. METHOD: The corneal epithelium and stromal cells were cultured in RCGM medium. Three neurotransmitters were added to the medium : substance P, acetylcholine, and vasoactive-intestinal peptide (VIP). RESULTS: Proliferation of epithelial cells significantly increased after incubation for 24 hours with substance P (p < 0.05). There was no change in proliferation after addition of acetylcholine or VIP. The extension of epithelial cell layer increased after addition of substance P but not after addition of acetylcholine or VIP. No change was induced in proliferation of stromal cells or extension of the stromal cell layer after addition of any one of the three substances. CONCLUSION: Substance P stimulates the proliferation of corneal epithelial cells when added to the culture medium.

The ultrastructure of the lens capsule abnormalities in Alport's syndrome.

The ultrastructure of lens capsule abnormalities in Alport's syndrome is reported. An anterior lens capsule from a 29-year-old patient with lenticonus who was affected by Alport's syndrome was obtained at the time of surgery. The histopathologic findings showed the thickness of the anterior lens capsule was decreased and there were many vertical capsular dehiscences localized at the inner part of the lens capsule. Almost every dehiscence was limited to the inner two thirds of the capsule. One should be cautious in attempting intraocular lens implantation into the lens capsule of patients with Alport's syndrome, because the lens capsule may be fragile in this disease.

A new L527R mutation of the betaIGH3 gene in patients with lattice corneal dystrophy with deep stromal opacities.

Mutations in the betaIGH3 gene on chromosome 5q31 cause five distinct autosomal dominant corneal dystrophies: granular Groenouw type I, Reis-Bücklers', lattice type I and IIIA. and Avellino corneal dystrophies. We present here a new mutation of the betaIGH3 gene in patients with late-onset lattice corneal dystrophy manifest as a deep stromal opacity. To test the previously reported R124C, R124H, P501T, R555W, and R555Q mutations of the betaIGH3 gene, 30 patients and 11 normal relatives from 16 independently ascertained families with lattice corneal dystrophy, 49 patients and 12 normal relatives from 40 independently ascertained families with other corneal dystrophies, and 40 unrelated normal volunteers, were analyzed. A L527R (CTG/CGG) mutation of the betaIGH3 gene was found in 6 unrelated patients with lattice corneal dystrophy. A retrospective review of the patients' records showed that the opacities were deep in the stromal layer and of late onset. The mutation was a heterozygous single base-pair transversion from T to G of the second nucleotide position of codon 527. This caused the substitution of arginine for leucine. These six patients did not have mutations in codons 124, 501, or 555. The L527R mutation was not detected in the other corneal dystrophies or 40 normal volunteers. Although phenotypic variations in the size and shape of the deposits were found, all patients with the L527R mutation showed deposits deep in the stromal layer. We conclude that there are now at least six different mutations that have been detected in the betaIGH3 gene on chromosome 5q31 and that lead to corneal dystrophy.

[Trial of new intraocular lens power calculation following phototherapeutic keratectomy].

We reviewed the SRK-II method and introduce a new equation to calculate the intraocular lens (IOL) power for eyes which underwent laser phototherapeutic keratectomy (PTK). The Gullstrand series was used to determine the power and the radius of curvature of planoconvex IOLs which alter the focal point from the cornea to reach the conjugate point on the retina. The radius of anterior corneal curvature (R), axial length (AXL), predicted postoperative anterior chamber depth (ACD), and lens thickness (LT) were employed in the following formula to calculate the IOL refractive power: K = R/7.7, DC = 337. 5/R, VC = 1,000/DC*1.336 where VC is the posterior vertex focal length. A1 = -(VC-ACD), B1 = AXL-0.5* K-ACD-0. 103 LT, S = 1/A1 + 1/B1; this determined the diopter (D) of IOL in liquid to be (D) = 1,000/(1/S)* 1.336. In eyes which underwent PTK, the keratometric value prior to cataract surgery was not applied. Instead, R' defined as R-dT, where R is the radius of corneal curvature prior to PTK and dT the amount of corneal tissue removed, was introduced. Further, the corneal thickness before cataract surgery (CT') was defined as CT-dT where CT is the corneal thickness prior to PTK. Although it is important to select a lens that has an acurate predicted anterior chamber depth, the new equation appears to be more useful than the SRK-II formula.

Surgery for abdominal aortic aneurysms associated with malignancy.

Of 148 patients treated for abdominal aortic aneurysms (AAA), 33 (22%) also had cancer. According to the classification of Szilagyi, there were 13 patients in group I, 19 in group II, and 1 in group IV. In group I, the mean interval between the cancer and AAA operations was 7 years (range 1-14 years). Aneurysmectomy was performed in 9 patients, wrapping in 2, and no operation in 2. In group II, a two-stage operation was performed in 8 patients, a single-stage operation in 4, only surgery for cancer in 4, and no operation in 3. Of 4 patients undergoing single-stage operations, 3 had colorectal cancer, and there were no postoperative complications such as graft infection or anastomotic breakdown. In group I, 6 of 13 patients died, but there were no cancer deaths. In group II, 9 of 19 patients died, 6 from progressive cancer. The group IV patient also died of cancer. These results suggest that if a patient can tolerate surgery for both diseases, a single-stage operation is preferable.

Homozygotic patient with betaig-h3 gene mutation in granular dystrophy.

PURPOSE: This study investigated patients with granular dystrophy and identified a homozygotic patient and his family with a mutation in the betaig-h3 gene. METHODS: Genomic DNAs were extracted from leukocytes of the peripheral blood of the proband, his parents, and his grandmother. All had granular dystrophy. Genomic DNAs from 50 unrelated normal volunteers were used as controls. Exon 4 of betaig-h3 gene was amplified and analyzed by direct sequence. Clinical data were collected. RESULTS: A single-base-pair transition was detected. This was a substitution of G to A of the second nucleotide position of codon 124 in the betaig-h3 gene that led to a replacement of histidine for arginine (Arg124His, CGC-->CAC). This mutation was the precise one previously reported for Avellino dystrophy. Although the proband was homozygotic for the mutant alleles, his grandmother, and parents were heterozygotic for these alleles. No sequence modification in the codon 124 from 50 nonaffected control individuals was detected. Clinical findings of the proband were severe. Keratectomies were performed for both his eyes 5 times for a 24-year period. His grandmother and parents showed mild clinical symptoms, had a few annular granules in the subepithelial stroma, and maintained good visual acuities. CONCLUSION: Arg124His mutation of the betaig-h3 gene was found in a pedigree with granular dystrophy. This mutation was the precise one previously reported for Avellino dystrophy. This fact shows an existence of Avellino form in Japanese. Homozygotic patient for mutant gene showed severe symptoms and an early onset.

Multihormone-producing islet cell tumor of the pancreas associated with somatostatin-immunoreactive amyloid: immunohistochemical and immunoelectron microscopic studies.

Pancreatic islet cell tumors, especially insulinomas, are often associated with amyloid deposition in the tumor tissue. Biochemical analysis has demonstrated that the amyloid protein from insulinoma is derived from islet amyloid polypeptide (or amylin) that is produced by tumor cells originating from beta cells of the islet of Langerhans. We examined a case of malignant pancreatic islet cell tumor with amyloid deposition in the tumor tissue using immunohistochemistry and double-labeling immunogold electron microscopy. The tumors were composed of cells producing multiple hormones, including somatostatin, gastrin, amylin, insulin, calcitonin gene-related polypeptide, and calcitonin. Amyloid deposits reacted with antisomatostatin antiserum but not with other antisera, including antiamylin. The present study demonstrated for the first time that amyloid associated with islet cell tumors is not always derived from amylin and can come from somatostatin.

Arg124Cys mutation of the betaig-h3 bene in a Japanese family with lattice corneal dystrophy type I.

To characterize severe lattice corneal dystrophy, we analyzed the betaig-h3 gene, clinical features, histological findings, and genotype-phenotype correlation in an affected Japanese family. Deoxyribonucleic acid was extracted from leukocytes in 16 members (12 affected and 4 unaffected) of a Japanese family with lattice corneal dystrophy type I. Exon 4 of the betaig-h3 gene was amplified and analyzed using molecular biological methods. Clinical and pathological data were also collected. We found a heterozygous point mutation that causes the disease phenotype. It was a single base-pair transition leading to an amino acid substitution (CGC-->TGC, Arg124Cys). The phenotypic variation within families was not recognized. The affected members in the pedigree demonstrated severe visual disturbance in the third decade and required keratoplasty. Histopathological examination revealed amyloid deposits consisting of short and thin amyloid fibers and lattice corneal dystrophy type I. The heterozygous Arg124Cys mutation reported in Caucasian lattice corneal dystrophy caused severe lattice corneal dystrophy consisting of short and thin amyloid fibers in a Japanese family. Based on our study of many members of the family, we are able to construct the natural course of this disorder from its earliest clinical findings through its late manifestations.