The human tumor-associated antigen RCAS1 in pregnancies complicated by pre-eclampsia.

The human tumor-associated antigen RCAS1 (receptor-binding cancer antigen expressed on SiSo cells) is considered to play a role in the escape of tumor cells from immune surveillance and, at the same time, participates in the inhibition of the maternal immune response during pregnancy. The aim of our study was to investigate the expression of tumor-associated RCAS1 protein in the placenta and amniotic membranes and to assess and compare its concentration in amniotic fluid, maternal and cord blood sera in pregnancies complicated by pre-eclampsia. Samples were obtained from women with pre-eclampsia (N=9), pre-eclampsia with IUGR (N=4), normotensive IUGR (N=7) and healthy term controls (N=25) after delivery. Placentas were studied by immunohistochemistry, Western blot analysis and real-time (RT)-PCR. For assessment of RCAS1 protein concentrations in biological fluids, ELISA was performed. RCAS1 mRNA expression in the placentas of pre-eclamptic patients was significantly lower than in controls (p<0.01). The maternal blood serum RCAS1 protein concentration in the pre-eclampsia cases was also significantly lower than in controls (p=0.0207). The other study groups did not differ significantly. This study reveals the possible role of the RCAS1 protein in the development of pre-eclampsia through an immunological pathway.

S100B protein expression in the amnion and amniotic fluid in pregnancies complicated by pre-eclampsia.

Our aim was to investigate the expression of S100B protein in the amnion and to assess the amniotic fluid concentration in pregnancies complicated by pre-eclampsia. Samples were obtained from women who developed pre-eclampsia (n = 7), pre-eclampsia with intrauterine growth retardation (IUGR) (n = 4), normotensive IUGR (n = 7) and gestational hypertension (n = 4) during pregnancy and healthy controls who delivered at term (n = 35). To determine the difference in the expression of S100B in the amnion, we performed immunohistochemistry, western blot analysis and RT-PCR. Using enzyme-linked immunosorbent assay (ELISA), we assessed the S100B concentration in amniotic fluid. The S100B mRNA expression in the amnion of pre-eclamptic patients and patients with pre-eclampsia with IUGR was significantly higher than that in the control. The amniotic fluid S100B protein concentration of the pre-eclampsia and normotensive IUGR cases was significantly higher than that of the control. This study shows that amnion could be a source responsible for the increased concentration of S100B in amniotic fluid. In pre-eclampsia, reactive oxygen species (ROS) are generated by oxidative stress. Some pathological conditions that develop during pregnancy and are related to hypoxic stress can affect the elevation of S100B concentration in the amnion.

An autopsy case of postencephalitic parkinsonism of von Economo type: some new observations concerning neurofibrillary tangles and astrocytic tangles.

An autopsied case of postencephalitic parkinsonism of von Economo type with a 71-year duration is reported. Several cases of postencephalitic parkinsonism of von Economo type have been reported in Japan but this is the first reported case from western Japan. The patient was a Japanese man who was 74 years of age at the time of death. He developed encephalitis of unknown etiology at the age of 3 years. The first symptom was antisocial behavior, which developed at 30 years of age. At the age of 40 years, the patient showed progressive parkinsonism. Neuropathological findings disclosed marked neuronal loss with gliosis in the substantia nigra, locus ceruleus, and raphe nuclei, as well as the appearance of neurofibrillary tangles in the aforementioned areas. There were also widespread tuft-shaped astrocytes (Tu-SA) in the central nervous system, including the thalamus. Tuft-shaped astrocytes are considered to represent non-reactive astrocytes because the distributions of neurofibrillary tangles (NFT) and Tu-SA are clearly different. Therefore, the primary astrocytic lesions in postencephalitic parkinsonism of von Economo type may be more widespread. Ultrastructurally, the Tu-SA consisted of straight filaments, 15 nm in width, which formed tight bundles. Ultrastructurally, NFF in this case revealed paired helical filaments but straight filaments, 15 nm in width, which were also found in the neurons of the substantia nigra.

Immunohistochemical expression of MMP-2, MMP-9, and TIMP-2 in neuroblastoma: association with tumor progression and clinical outcome.

BACKGROUND/PURPOSE: The matrix metalloproteinases (MMPs) are responsible for degradation of the extracellular matrix. The MMPs and their specific tissue inhibitor metalloproteinases (TIMP) have been associated with tumor cell invasion and metastasis in a number of adult tumors. This study was carried out to detect their expression pattern in neuroblastoma and to evaluate whether they have any association with tumor progression and clinical outcome. METHODS: Cryostat sections of tumor tissues were collected from 31 patients with neuroblastoma, and immunohistochemical staining of MMP-2, MMP-9 and TIMP-2 with specific antibodies was performed according to labelled streptavidin-biotin method. RESULTS: MMP-2 and MMP-9 were coexpressed in neuroblastoma and exhibited an intratumor variability of staining intensity. MMP-2 and MMP-9 staining were confined mostly to the peritumoral stromal tissues rather than tumor cells and found positive in 80.6% cases and 71.0% cases, respectively. MMP-2 and MMP-9 immunoreactivity had no association with mass screened cases or with age of the patients. Increased expression of MMP-2 in stromal tissues of neuroblastoma had significant association with advanced clinical stages (chi2 test, P < .05). However, the expression of MMP-9 in neuroblastoma had no association with clinical stages and prognosis. However, TIMP-2 staining was confined mostly to the neoplastic cell cytoplasm, stromal tissue, and to the endothelial cells and accounted for 58.0% positivity. Decreased expression of TIMP-2 also had significant relationship with advanced clinical stages (chi2 test, P < .05). Kaplan-Meier survival curve showed that either increased expression of MMP-2 or decreased expression of TIMP-2 had relationship with poor clinical outcome. CONCLUSIONS: In neuroblastoma, stromal tissues are actively involved in the complex interaction between MMP-2 and TIMP-2 in extracellular matrix degradation during tumor progression, and TIMP-2 expression is inversely correlated with the corresponding MMP-2. An early detection of their expression pattern by immunohistochemistry in neuroblastoma may provide prognostic informations in clinical practice.

Apical hypertrophy with massive myocardial fibrosis: comparison with electrocardiographic changes.

We report the case of a 48-year-old woman with apical hypertrophy with massive myocardial fibrosis. She was admitted to our hospital because of general malaise. Echocardiographic examination showed asymmetrical apical hypertrophy, and an electrocardiogram showed a giant negative T wave on V3-V6. Right ventricular endomyocardial biopsy revealed massive myocardial fibrosis. Apical hypertrophy can lead to disorders that vary in severity, including rare massive myocardial fibrosis.

p16INK4, pRB, p53 and cyclin D1 expression and hypermethylation of CDKN2 gene in thymoma and thymic carcinoma.

There have been few reports on genetic alterations in thymomas. To investigate the expression of p16INK4A, RB, p53 and cyclin D1 in thymomas, we first examined 36 thymomas (non-invasive type, 16 cases; invasive type, 20 cases) and 3 thymic carcinomas, using immunohistochemistry. Abnormal expression of p16INK4A, RB, p53 and cyclin D1 was observed in 18, 8, 10 and 7 cases, respectively. Only a subgroup of invasive thymomas and thymic carcinomas showed an inverse correlation between p16INK4A and RB expression. Subsequently, we examined the 36 thymomas and 4 thymic carcinomas for mutations in p53 and CDKN2 genes, using PCR-SSCP and direct-sequencing analyses. No mutation of these genes was detected in the thymomas and thymic carcinomas examined. A polymorphism in the 3' untranslated region of exon 3 of CDKN2 was detected in 5 cases of thymoma. We searched for hypermethylation in the promoter region of CDKN2, observing it in 4 thymomas and 1 thymic carcinoma. Our data suggest that, unlike other more common cancers, alteration of the p53 gene may not play a significant role in the tumorigenesis of thymoma. However, inactivation of p16INK4A and RB may play a role in the progression of thymoma and thymic carcinoma.

New p57KIP2 mutations in Beckwith-Wiedemann syndrome.

Beckwith-Wiedemann syndrome (BWS) is characterized by numerous growth abnormalities and an increased risk of childhood tumors. The gene for BWS is localized in the 11p15.5 region, as determined by linkage analysis of autosomal dominant pedigrees. The increased maternal transmission pattern seen in the autosomal dominant-type pedigrees and the findings of paternal uniparental disomy reported for a subgroup of patients indicate that the gene for BWS is imprinted. Previously, we found p57KIP2, which is a Cdk-kinase inhibitor located at 11p15, is mutated in two BWS patients. Here, we screened for the mutation of the gene in 15 BWS patients.

Mutation analysis of p53 gene in childhood malignant solid tumors.

Alterations of the p53 gene have been extensively investigated in a wide variety of human malignancies. However, data on childhood malignant solid tumors are still limited. Mutations of the p53 gene on exons 5 through 8 were examined in 82 childhood malignant solid tumors by the polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) method, and the nature of these mutations was confirmed by direct sequencing. The 82 tumors examined included neuroblastomas (n = 44), Wilms' tumors in = 13), hepatoblastomas (n = 11), rhabdomyosarcomas (n = 10), extraosseus Ewing sarcomas (n = 2), undifferentiated sarcoma of the liver (n = 1), and fibrosarcoma (n = 1). Two sarcoma samples were identified as having point mutations. One was a rhabdomyosarcoma with a missense mutation at codon 273, substituting histidine (His) for arginine (Arg). Another was an undifferentiated sarcoma of the liver with a missense mutation at codon 245, substituting serine (Ser) for glycine (Gly). No mutations were detected among neuroblastomas, Wilms' tumors, or hepatoblastomas. The two sarcomas with mutations were localized tumors. Both patients who had these tumors are disease free for 8 and 5 years after treatment, respectively. The overall incidence of p53 mutations was low (2.4%, 2 of 82). However, the incidence, when calculated for sarcomas, was higher at 14.3% (2 of 14). These data indicate that p53 mutations are generally uncommon in childhood malignant solid tumors examined. However, in some childhood sarcomas, p53 mutations appear to have a causative role in the development of these tumors.

Laparoscopic resection of mass-screened adrenal neuroblastoma in an 8-month-old infant.

We describe a case of successful laparoscopic resection of a left adrenal neuroblastoma (NB) detected by mass screening (MS) in an 8-month-old boy. Cases with MS NBs are supposed to be potential candidates for laparoscopic surgery in the pediatric age group.

Immunohistochemical assessment of the MIB-1 Labeling Index in human hepatoblastoma and its prognostic relevance.

BACKGROUND/PURPOSE: The MIB-1 monoclonal antibody has been raised against recombinant parts of the Ki-67 antigen, which is a cell cycle-related nuclear protein that is elevated in late G1 and S phases. The aim of the study was to analyze the expression pattern of MIB-1 in hepatoblastoma and to assess whether it provides any prognostic information in clinical practice. METHODS: Sections from formalin-fixed paraffin embedded tissues were collected from 18 patients who had hepatoblastoma and stained with MIB-1 antibody according to streptavidinbiotin method. A percentage score of positively stained nuclei, MIB-1 Labeling Index (LI), was determined and correlated with clinical variables. MIB-1 LI ranged from 0% to 39.5% with a mean value of 13.5%. Among them in 14 patients, who received preoperative chemotherapy, the authors analyzed the result of MIB-1 staining. RESULTS: Although there were no significant correlations between MIB-1 LI and age, sex, or histological type, a statistically significant correlation was found between clinical stage and MIB-1 LI. Mean MIB-1 LI was lower in patients with stage I and II than in those with stages III and IV (P < .05). Metastatic lesions showed higher MIB-1 LI than primary lesions, indicating that metastatic tumor cells have an increased rate of cellular proliferation. Kaplan Meier survival curve showed that patients with MIB-1 higher than 10% (n = 3) had a worse survival rate than those with lower than 10% MIB-1 LI (n = 11), whereas there was no significant difference because of the limited number of cases. Because high MIB-1 LI was correlated with clinical stage and poor survival rate, MIB-1 LI may be considered an important prognostic factor in hepatoblastoma. CONCLUSION: Although further studies, including larger series of patients, are required, the authors consider MIB-1 immunostaining an easy method to assess proliferative activity that provides useful prognostic information in hepatoblastoma.

An imprinted gene p57KIP2 is mutated in Beckwith-Wiedemann syndrome.

p57KIP2 is a potent tight-binding inhibitor of several G1 cyclin/Cdk complexes, and is a negative regulator of cell proliferation. The gene encoding p57KIP2 is located at 11p15.5 (ref. 2), a region implicated in both sporadic cancers and Beckwith-Wiedemann syndrome, a cancer-predisposing syndrome, making it a tumour-suppressor candidate. Several types of childhood tumours including Wilms' tumour, adrenocortical carcinoma and rhabdomyosarcoma exhibit a specific loss of maternal 11p15 alleles, suggesting that genomic imprinting is involved. Genetic analysis of the Beckwith-Wiedemann syndrome indicated maternal carriers, as well as suggesting a role of genomic imprinting. Previously, we and others demonstrated that p57KIP2 is imprinted and that only the maternal allele is expressed in both mice and humans. Here we describe p57KIP2 mutations in patients with Beckwith-Wiedemann syndrome. Among nine patients we examined, two were heterozygous for different mutations in this gene-a missense mutation in the Cdk inhibitory domain resulting in loss of most of the protein, and a frameshift resulting in disruption of the QT domain. The missense mutation was transmitted from the patient's carrier mother, indicating that the expressed maternal allele was mutant and that the repressed paternal allele was normal. Consequently, little or no active p57KIP2 should exist and this probably causes the overgrowth in this BWS patient.

Inversely correlated expression of p16 and Rb protein in non-small cell lung cancers: an immunohistochemical study.

Cdk4-mediated phosphorylation of Rb protein is inhibited by p16, a product of a possible tumor suppressor gene. We examined the expression of p16 and Rb protein by means of immunohistochemistry in 61 non-small cell lung cancers and have demonstrated an inverse relationship between the expression of p16 and Rb protein: 28/30 specimens that did not stain for p16 stained for Rb and 21/31 p16-positive specimens did not stain for Rb. Only 1 of the p16-negative specimens had a mutation of exon 2 of the CDKN2 gene. Our results indirectly support the theory that p16 expression is negatively regulated by the functional Rb protein.

Experimental study of alleviation of hypertension, diabetes and pain by radon inhalation.

Indications for treatment at the Misasa Hot Spring, a radon producing radioactive spring, include hypertension, diabetes mellitus and pain. To clarify its mechanisms of action on these conditions, we evaluated dynamic changes in blood components such as vasoactive substances after radon inhalation. Vasodilation, alleviation of diabetic symptoms and morphine-like analgesic effects were observed, suggesting that these changes constitute part of the mechanisms of the radon spring therapy on the above conditions.

Unfavorable DNA ploidy and Ha-ras p21 findings in neuroblastomas detected through mass screening.

BACKGROUND: Urinary mass screening has been available for 6-month-old infants throughout Japan since 1985. It is still controversial as to whether the program contributes to the detection of unfavorable neuroblastomas destined to present clinically when a patient reaches an older age. DNA diploidy and tetraploidy, low expression of Ha-ras p21, and an amplified N-myc gene status relate to an unfavorable prognosis. The authors examined these biologic indicators in neuroblastomas detected by urinary mass screening. PATIENTS AND METHODS: Seventy-eight neuroblastomas detected by mass screening were studied for DNA ploidy using DNA flow cytometry, Ha-ras p21 expression using immunostaining, and N-myc gene copy number using slot-blot or Southern blot hybridization methods. RESULTS: Of 73 tumors with analyzable DNA flow cytometric results, 18 (24.7%) had diploidy (n = 7) or tetraploidy (n = 11). Twenty-eight (40.0%) of 70 tumors examined showed low-to-absent expression of Ha-ras p21. DNA diploid and tetraploid status correlated significantly with the low-to-absent expression of Ha-ras p21 (P = 0.00021). Fourteen (20.0%) of the 70 patients had both of these two unfavorable prognostic markers. N-myc amplification was not detected in 41 of 41 tumors studied. All 78 patients were alive 8-92 months after completion of treatment. CONCLUSIONS: At least 20.0% of neuroblastomas detected by mass screening have unfavorable biologic prognostic markers. These patients may benefit from early detection and immediate treatment. However, the biologic features associated with a poor prognosis are not predictive of poor outcome in individual patients, and, therefore, should not be used to justify more intensive therapies.

[A case of congenital atrial flutter associated with atrial septal defect].

We report the case of a 8-month-old boy with atrial septal defect associated with congenital atrial flutter. He was operated on for ASD successfully. Atrial flutter in infants has been reported to be uncommon and to have a poor prognosis when associated with underlying cardiac disease. Therefore, early surgical intervention may improve the prognosis.

[Perioperative insertion of peritoneal dialysis catheter].

Silicon rubber peritoneal dialysis catheter (Tenkoff) was inserted perioperatively in neonates undergoing cardiac surgery and also in those patients in whom right-sided heart failure may occur. This method is easy and safe even in neonates. Post operative excessive fluid retention could be avoided using this method.