Fat and fish intake and asthma in Japanese women: baseline data from the Osaka Maternal and Child Health Study.

OBJECTIVE: It remains controversial whether the intake of n-3 polyunsaturated fatty acids and fish is preventive against asthma. This cross-sectional study investigated the relationship between fat and fish intake and the prevalence of asthma using baseline data from a prospective study. DESIGN: The subjects were 1002 pregnant Japanese females. A diet history questionnaire was used to assess dietary habits. Current asthma and asthma after age 18 were defined as present if subjects had been treated with medications at some time in the previous 12 months and after reaching the age of 18, respectively. RESULTS: Fish consumption was independently associated with a decreased prevalence of asthma after age 18 and current asthma. A significant inverse relationship was observed between the ratio of n-3 to n-6 polyunsaturated fatty acid intake and the prevalence of current asthma, but not asthma after age 18. Intake of total fat, saturated, monounsaturated, n-3 polyunsaturated and n-6 polyunsaturated fatty acids, cholesterol, meat, eggs or dairy products was not evidently related to either outcome for asthma. CONCLUSION: Our results suggest that fish consumption and the high ratio of n-3 to n-6 polyunsaturated fatty acid intake may be associated with a reduced prevalence of asthma in young female Japanese adults.

Radical resection for intrinsic midbrain pilocytic astrocytoma: report of two cases.

BACKGROUND: Intrinsic midbrain glioma has been one of the most challenging therapeutic tasks in neurosurgery due to its prognosis and risks associated with surgical procedures. It is known that the prognosis of pilocytic astrocytoma is relatively good if radical resection can be achieved without severe complications. In order to remove pilocytic astrocytoma within the midbrain radically, we used microsurgical techniques. METHOD: Two patients with intrinsic pilocytic astrocytomas located at the midbrain were operated on. The subtemporal approach was used with a point of entry on the lateral surface of the midbrain just behind the cerebral peduncle. Major vessels were preserved, followed by resection of the intrinsic tumor making the cleavage between tumour and midbrain. FINDINGS: In both patients, intrinsic pilocytic astrocytoma was grossly totally removed with minimal permanent morbidity. They have been able to maintain independent activities in their daily lives without tumor recurrance. CONCLUSIONS: Surgical cure can be accomplished in some cases of midbrain pilocytic astrocytoma, even if the lesions are intrinsic to the midbrain. To remove the tumor totally without further neurological deficits, it is necessary to select a safe access or entrance point to the tumor, and to demarcate the gliotic plane between tumour and midbrain. A long-term follow up with a larger number of patients is needed to establish the significance of radical resection for intrinsic midbrain pilocytic astrocytoma.

Demonstration of the reentrant circuit of verapamil-sensitive idiopathic left ventricular tachycardia: direct evidence for macroreentry as the underlying mechanism.

The exact reentrant circuit of verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) remains unclear. This case report demonstrates the reentrant circuit of ILVT. A 20-pole electrode catheter was placed along the left posterior fascicle during electrophysiologic study. ILVT was reproducibly induced by programmed ventricular stimulation. During the tachycardia, sequential diastolic potentials bridging the entire diastolic period were observed in the recordings from the electrodes positioned from left ventricular mid-septum to inferoapical septum. The slow conduction zone appeared to be composed of a false tendon in this patient. Entrainment of the ILVT from the right ventricular outflow tract at a different pacing cycle length revealed that a dominant conduction delay occurred at the proximal site of the slow conduction zone. Entrainment studies from several sites on the left ventricular septum confirmed that these sites where sequential electrical activity was recorded were included within the reentrant circuit. However, the left posterior fascicle itself seemed to be a bystander. This report provides the direct evidence of macroreentry as the underlying mechanism of this ILVT, adjacent to the left posterior fascicle.

In vitro translation.

The two most frequently used systems for in vitro translation are the rabbit reticulocyte system and the wheat germ extract. These systems are useful for mRNAs isolated from cells, tissues, and capped or uncapped mRNA produced in vitro by transcription of cDNA. In a combined system, mRNA can be transcribed and translated in a single reaction. In addition these systems can be used for translation reactions with biotinylated amino acids; this allows capture of the newly synthesized protein using streptavidin immobilized on agarose.

Interleukin-16 in synovial fluids from cases of various types of arthritis.

OBJECTIVES: To examine the characteristic relationship between interleukin-16 (IL-16) and clinical data in various types of arthritis. METHODS: We measured IL-16 levels of the synovial fluids (SF) of patients with various types of arthritis, which included rheumatoid arthritis, traumatic arthritis, pseudogouty arthritis, gouty arthritis, and osteoarthritis, by an enzyme immunosorbent assay, and examined their correlations with clinical parameters. RESULTS AND CONCLUSIONS: Higher levels of IL-16 in synovial fluid from patients with rheumatoid arthritis, traumatic arthritis, and pseudogouty arthritis, compared to those with osteoarthritis, and gouty arthritis were indicated. Also, synovial IL-16 levels in patients with rheumatoid arthritis correlated significantly, especially with synovial matrix metalloproteinase-3 levels. But the IL-16 levels of both synovial fluid and peripheral blood did not correlate with conventional inflammatory parameters such as C-reactive protein, erythrocyte sedimentation rate, or rheumatoid factor. Although the function of IL-16 in inflammatory arthritis has not yet been defined, these data indicated some essential features of IL-16.

Levels of rheumatoid factor isotypes, metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 in synovial fluid from various arthritides.

When synovial effusion is the only symptom, it is often difficult to make an exact diagnosis of the arthritic disease. To distinguish various types of arthritis with synovial effusion, we measured the levels of matrix metalloproteinase-3 (MMP-3, Stromelysin), tissue inhibitor of metalloproteinase-1 (TIMP-1) and rheumatoid factor (RF) isotypes in synovial fluid (SF) from patients with rheumatoid arthritis (RA), osteoarthritis (OA), pyogenic arthritis (PA), pseudogouty arthritis (PG), gouty arthritis (GA) and traumatic arthritis (TA). SF was aspirated from the knee joint or the ankle joint. Levels of IgG-, IgM- and IgA-RF isotypes were measured by ELISA. Levels of MMP-3 and TIMP-1 in SF were simultaneously determined by a one-step EIA system. Levels of IgG-RF, IgM-RF and MMP-3 in SF from RA patients were significantly higher than those in OA, PA, PG, GA and TA. However, IgA-RF in SF from RA patients, when compared with PA and GA, did not show a significantly increased level. In addition, TIMP-1 in SF from RA, when compared with PA and TA, also has not shown a significantly increased level. Therefore, in addition to analysing clinical data, measurements of IgG-RF, IgM-RF and MMP-3 in SF may contribute in distinguishing RA from other arthritic diseases.

[Autologous blood transfusion in surgery of urologic malignant tumor].

BACKGROUND: Autologous blood transfusion has been widely endorsed, because of the adverse effects attributed to homologous blood transfusion. So we employed autologous blood transfusion to avoid homologous blood transfusion in operation of urological malignant patients. We reviewed our experience with autologous blood transfusion in 48 patients. METHODS: A total of 48 patients underwent operation with 400 to 1,200 ml preoperative autologous blood donation, in 41 patients with administration of erythropoietin and 7 patients without erythropoietin. The details of operations are radical nephrectomy in 18 cases (2 cases were bilateral), radical nephro-ureterectomy in 2 cases, retroperitoneal lymph node dissection (RPLND) in 2 cases, radical prostatectomy in 12 cases and radical cystectomy in 14 cases. RESULTS: The volume of surgical blood loss were 381 +/- 522 ml in nephrectomy (1,158 +/- 202 ml in bilateral case), 517 +/- 5 ml in radical nephro-ureterectomy 636 +/- 574 ml in RPLND, 665 +/- 291 ml in radical prostatectomy and 1,123 +/- 417 ml in radical cystectomy. Only three cases needed homologous blood transfusion. CONCLUSION: We can avoid homologous blood transfusion in 94% of patients. Autologous blood transfusion is recommended as safe and convenient.

Diagnostic value of technetium-99m methoxyisobutyl isonitrile (99mTc-MIBI) scintigraphy in detecting thyroid cancer metastases: a critical evaluation.

Technetium-99m methoxyisobutyl isonitrile (99mTc-MIBI) scintigraphy has recently been used in clinical application for detecting thyroid cancer metastases, its role being considered supplementary to serum thyroglobulin (Tg) measurements and radioactive iodine (131I) whole-body scans (WBS). The present retrospective study was designed to elucidate the role of 99mTc-MIBI scans in localizing metastatic lesions by assessing sensitivity and specificity of the scan results obtained in a group of 68 thyroidectomized thyroid cancer patients. Presence or absence of thyroid cancer was judged with other diagnostic modes including serum Tg measurements, 131I WBS, bone scans, chest x-rays, computed tomography (CT), ultrasonography, histopathology, and evolution of disease during follow-up. All scans were read on lesion basis for detecting neck, lung, and bone metastases and also on region basis, namely head-neck, chest, and abdomen-pelvis-extremities (ab-p-ex) areas. The sensitivity of detection was 94.4% (17/18) for neck, 78.4% (40/51) for lung, and 92.8% (64/69) for skeletal lesions. Positive predictive value (PPV) and negative predictive value (NPV) were 96.3% (26/27) and 97.7% (43/44) for head-neck; 94.7% (71/75) and 50.0% (12/24) for chest; 100.0% (25/25) and 93.1% (54/58) for ab-p-ex regions, respectively. For all scan sites taken together, PPV and NPV were 96.1% (122/127) and 86.5% (109/126), respectively. In conclusion, the present study reveals that 99mTc-MIBI can be proposed as a first-line diagnostic agent for the follow-up protocol of thyroid cancer patients, although the ability to detect small lung metastases is somewhat limited.

Clinical use of percutaneous intramuscular electrodes for functional electrical stimulation.

OBJECTIVE: To evaluate the clinical use of the percutaneous intramuscular electrode in functional electrical stimulation (FES). DESIGN: Randomized and controlled study. SETTING: A referral center and institutional practice providing outpatient care. PATIENTS: Seventeen patients (12 men, 5 women) who had implanted percutaneous intramuscular electrodes for more than 1 year were examined. The average follow-up time after implantation of electrodes was 2.2 years (range, 1yr to 4yr 10mo). Overall, there were 327 electrodes (83 upper extremities and 244 lower extremities). INTERVENTION: The indwelling electrode was composed of helically coiled Teflon-coated rope stranded from 19 hard drawn wires of SUS 316L stainless steel (SES 114). MAIN OUTCOME MEASURES: The rates of breakage, movement, and infection, and the number of electrodes that needed reimplantation were evaluated. RESULTS: Only one electrode broke (0.3%) in the iliopsoas muscle at 12 weeks after implantation. Eight electrodes (2.4%) were removed because of loss of sufficient contraction force caused by movement of the electrodes. Movements occurred at 9 weeks in 6 electrodes and at 5 months in two. The failure rate of electrodes in the lower extremities was 3.7%. No failures occurred in the upper extremities. Ten electrodes (3.1%) required reimplantation. Although ten superficial infections (3.1%) were seen around the site of electrode insertion, no removals of electrode were needed. All electrodes in one patient were removed, however, because of generalized methicillin-resistant Staphylococcus aureus infection complicated with renal disease. Electrodes were reimplanted after improvement of the infection. CONCLUSIONS: The ultrafine percutaneous intramuscular electrode was considered practical for long-term FES use.

Calcium supplements increase bone mineral density in women with low serum calcium levels during long-term estrogen therapy.

In order to clarify whether the long-term effect of estrogen on bone mineral density (BMD) is reinforced by low dose calcium supplements, 600-800 mg of calcium lactate was administered to postmenopausal or oophorectomized women who had been undergoing unopposed estrogen therapy for at least 2 years and whose serum calcium level was suppressed to below the normal range. To patients whose serum calcium levels had been within the normal range, the same dose of estrogen alone was continued. Changes in lumbar spine BMD before and after calcium supplementation was measured by dual-energy X-ray absorptiometry. Lumbar spine BMD decreased by -0.37% for 2 years in women treated with estrogen alone, while that of women treated with estrogen and calcium increased by 2.78% (P = 0.003). These results indicate that low dose calcium supplements potentiate the effect of estrogen in women with decreased serum calcium during long-term hormone replacement therapy.

Concentrations of pyridinoline and deoxypyridinoline in joint tissues from patients with osteoarthritis or rheumatoid arthritis.

OBJECTIVE: To assess the usefulness of pyridinoline (Pyr) and deoxypyridinoline (Dpyr), intermolecular crosslinks of collagen, as markers in the evaluation of arthritis, by studying their distribution in tissues from knee joints. METHODS: Joint tissues (cartilage, bone, synovium) were obtained during operation from 10 patients with osteoarthritis (OA) and 10 patients with rheumatoid arthritis (RA). Synovium was also obtained from 10 non-arthritic (NA) subjects. Hydroxyproline was measured in hydrolysed tissue samples and converted to an equivalent collagen content. The amounts of Pyr and Dpyr crosslinks measured in the hydrolysed samples using a fluorescence technique were expressed as mumol/mol of collagen. RESULTS: Pyr and Dpyr were distributed in all three tissues, but in different amounts. The ratio of the contents of Pyr and (Pyr:Dpyr) was 50:1 in cartilage, 3:1 in bone, and 25:1 in synovium. OA cartilage had a greater Dpyr content than the RA cartilage, but there was no other significant difference in the contents of Pyr and Dpyr and the ratio Pyr:Dpyr in the joint tissues from patients with OA or RA. In synovium, there was no significant difference between the contents of Pyr and Dpyr and the Pyr:Dpyr ratio among OA, RA, and NA tissues. CONCLUSION: Both Pyr and Dpyr were located in cartilage, bone, and synovium. A significant amount of Pyr and Dpyr in these joint tissues, especially in synovium, may contribute to the urinary excretion of those crosslinks that is observed in arthritis.

Species specificity of anticoagulant activity of activated human protein C: involvement of factor V as well as protein S.

Activated protein C (APC) possesses species specificity in its anticoagulant activity. Human APC exerts only weak activity in rat plasma compared with that in human plasma. The present study was undertaken to estimate the difference in interaction of human and rat factors with human APC and to assess the cause of the species specificity. Human or rat protein S (PS), factor V, or factor VIII was used to supplement human plasma depleted of each respective factor, and the anticoagulant activity of human APC was measured in term of the elongation of activated partial thromboplastin time (APTT). The activity of human APC in rat PS- or factor V-supplemented plasma was weaker than that in the human PS- or factor V-supplemented plasma. Furthermore, using purified human and rat factor V, human APC showed weaker inactivation of rat factor V than human factor V. Equal anticoagulant activity was observed in human or rat factor VIII-supplemented plasma. And there was a little difference in the interaction of APC with its inhibitors in human or rat plasma during a few minutes of incubation as judged by measurement of residual activity by an enzyme capture assay. From these results factor V as well as PS seems to play a major role in the species specificity of APC.

Tumoricidal cytokines enhance radioiodine uptake in cultured thyroid cancer cells.

UNLABELLED: We explored whether the stimulation of iodine uptake by interferons seen in rat thyroid cell line is reproducible in human thyroid cancer and thus applicable to enhance the efficacy of radioiodine therapy. METHODS: Surgical specimens from 12 papillary and 2 follicular adenocarcinomas were minced and seeded in culture trays. After 14-16 days in a medium supplemented with 5% calf serum, we measured cellular uptake of 125I during a 40-min incubation period. RESULTS: In 8 of 12 papillary and all 2 follicular carcinomas, interferon-gamma significantly stimulated iodine incorporation. The four nonresponder tumors had lower basal iodine uptake and relatively less differentiation of histologic features. The effect was dose dependent (0-100 U/ml), and the average maximum increase in responding cases was 35.1% over basal values. Tumor necrosis factor-alpha alone did not alter uptake, but at 300 U/ml it further enhanced the effect of interferon-gamma in the two follicular tumors. In addition to the pure cytokines, supernatant from lymphocyte culture conditioned with a bacterial immunostimulator also boosted radioiodine trapping in thyroid cancer cells. CONCLUSION: These in vitro results warrant animal experiments to test potential usefulness of tumoricidal cytokines in radioiodine therapy.

[Study of hepatic arterial infusion chemotherapy for prophylaxis of liver metastases of colorectal cancer after hepatic resection].

We examined the significance of hepatic arterial infusion chemotherapy (HAIC) for prophylaxis of liver metastases of colorectal cancer after hepatic resection using an implantable port. Fifty-five patients operated at the hospital from August 1988 to December 1994 were divided into two groups consisting of 23 patients with HAIC group: (HAIC (+)), and 32 patients without HAIC group: (HAIC (-)) retrospectively. The cumulative survival rates and recurrent rates of cancer free in remnant liver of HAIC (+) were improved, compared with HAIC (-). This suggests that HAIC was effective in improving the prognosis and preventing recurrence in remnant liver.

Changes in the basal ganglia and thalamus following reperfusion after complete cerebral ischaemia.

We report specific changes bilaterally in the basal ganglia and thalamus following reperfusion after complete cerebral ischaemia. A 69-year-old man, resuscitated after cardiac arrest, showed symmetrical low-density lesions in the head of the caudate nucleus and lentiform nucleus on CT. MRI revealed methaemoglobin derived from minor haemorrhage in the basal ganglia and thalamus, not evident on CT. We suggest that this haemorrhage results from diapedesis of red blood cells through the damaged capillary endothelium following reperfusion.

Specific changes in human brain following reperfusion after cardiac arrest.

BACKGROUND AND PURPOSE: Very few reports are available on serial changes in human brain after cardiac arrest. The primary objective of this study is to investigate sequential neuroradiological changes in patients remaining in a persistent vegetative state following resuscitation after cardiac arrest. METHODS: We repeatedly studied eight vegetative patients resuscitated from unexpected out-of-hospital cardiac arrest using computed tomographic (CT) scanning and high-field magnetic resonance (MR) imaging at 1.5 T. RESULTS: In seven of the eight patients, CT scans obtained between days 2 and 6 features symmetrical low-density lesions in the bilateral caudate, lenticular, and/or thalamic nuclei. These ischemic lesions were persistently of low density on serial CT scans. In these seven patients, MR images demonstrated what were thought to be hemoglobin degradation products derived from minor hemorrhages localized in the bilateral basal ganglia, thalami, and/or substantia nigra. Diffuse brain edema in the acute stage and diffuse brain atrophy in the chronic stage were consistent neuroradiological findings. No abnormal enhanced lesions were demonstrated by CT scans. CONCLUSIONS: The most characteristic findings on high-field MR images were symmetrical lesions in the bilateral basal ganglia, thalami, and/or substantia nigra with specific changes suggestive of minor hemorrhages that were not evident on CT scans. We speculate that these minor hemorrhages result from diapedesis of red blood cells in these regions during the reperfusion period through the endothelium disrupted by ischemia-reperfusion insult.

[Intraoperative liquid embolization of an arteriovenous malformation in the basal ganglia and thalamic region].

Total three patients with arteriovenous malformation (AVM) in basal ganglia or thalamic region were treated by intraoperative liquid embolizations. These procedures were decided because of repeated hemorrhagic episodes. In the case with AVM in the head of the caudate nucleus which was fed by several anterior perforating arteries originated from anterior cerebral artery (A1 portion) and middle cerebral artery (M1 portion), frontotemporal craniotomy was performed. After the microsurgical dissection of these feeders, one of the feeders lenticulostriate artery, was cannulated with a small-caliber polyethylene catheter, 0.6 mm in outer diameter and 0.3 mm in inner diameter. A small amount of isobutyl 2-cyanoacrylate (IBCA) was injected through the catheter. Same procedure was carried out one month later. Postoperative angiograms revealed about 90% loss of AVM. In two cases with AVM which involved almost entire thalamus, subtemporal craniotomy was done. Feeding vessels which originated from posterior communicating artery and posterior cerebral artery (PCA) were carefully dissected under the operative microscope and one of them was prepared for cannulation with small catheter. When the small amount of IBCA was injected, proximal PCA and internal carotid artery were temporarily occluded. In both cases intraoperative embolization was carried out twice. Postoperative angiograms revealed that the size of AVM was decreased to 20% in one and 40% in the other. Although temporary postoperative deterioration of neurological deficits such as hemiparesis and visual disturbance was slightly noted in all cases, no hemorrhagic episode was experienced for 6 months, 1.5 and 2 years in each after embolization.