Reinvestigation on the buildup mechanism of alternate multilayers consisting of poly(L-glutamic acid) and poly(L-, D-, and DL-lysines).

The buildup mechanism of polypeptide multilayers prepared by the layer-by-layer deposition of a polyanion (poly(L-glutamic acid) (PGA)) and polycations (poly(L-lysine) (PLL), poly(D-lysine) (PDL), and copoly(DL-lysine)(PDLL)) was reinvestigated by using in situ ATR-IR spectroscopy. A difference spectral technique applied to analyze the spectra indicated that the deposition of both the PGA and PLL (PDL) layers accompanies the formation of secondary structures consisting mainly of the antiparallel pleated sheet (the beta-sheet) structure, and that the formation of the beta-sheet structure cannot always be explained in terms of polyanion/polycation complex formation or charge compensation between the polyanion and polycations, although it has been considered as a major process in the multilayer buildup process. Instead, the present paper proposes the following mechanism. During the deposition of the polyelectrolyte, a small amount of the beta-sheet structures are produced at the interface as a result of charge compensation between a polyelectrolyte and an oppositely charged polyelectrolyte in the multilayer. The beta-sheets act as nuclei from which further propagation of the structure takes place at the solution/multilayer interfaces. The driving force of the buildup process in the new mechanism is a kinetically favorable insolubilization of each polyelectrolyte in solution at the interfaces.

[A case of pulmonary Mycobacterium avium infection with a rapid-growing solitary node].

A 72-year-old man was admitted to our hospital because of an abnormal shadow on his chest radiograph. Computed tomography revealed a 3 cm solitary nodular opacity in the right S1. Bronchofiberscopy could neither give any specific histological findings nor bacteriological findings. This nodular shadow increased in size to 1.5 times that in the first chest radiograph. In addition, since there was no abnormal finding in the chest radiograph one year before, we performed partial pulmonary resection by video-assisted thoracoscopic surgery, taking into consideration the possibility that the solitary node was malignant. The pathological findings of the resected specimen were an epitheloid cell granuloma with Langhans giant cell and caseous necrosis. We could not detect any acid-fast bacilli or malignant cells. After surgery, M. avium was detected in a 6-week culture of the resected specimen. We treated the patient with RFP, EB and CAM for 6 months. Outpatient follow-up revealed no relapse.

Epidermal growth factor receptor expression correlates with poor prognosis in non-small cell lung cancer patients with p53 overexpression.

To determine whether cancer patients with tumor suppressor gene abnormality survive for a shorter time when their growth was stimulated by growth factors, we examined 290 non-small cell lung cancer (NSCLC) specimens for p53 and epidermal growth factor receptor (EGFR) protein expressions using immunohistochemical staining. The distribution of cases by pathological stage of tumor was 155 cases of stage I, 30 cases of stage II, 96 cases of stage III and 9 cases of stage IV. Pathological types were 142 adenocarcinomas, 127 squamous cell carcinomas, 17 large cell carcinomas and 4 other types of malignancy. Immunohistochemical staining was performed on the formalin fixed, paraffin-embedded materials with monoclonal antibodies DO-7 and clone EGFR.133. positive staining for EGFR was seen in 124 (42.8%) cases. More EGFR positive cases were found in squamous cell carcinomas than in non-squamous cell carcinomas (p=0.0121). Staining for p53 protein was observed in 147 (50.7%) specimens. Multivariate proportional hazard model analyses revealed EGFR protein expression as a risk factor in the patients with NSCLC (p=0.0240). Patients negative for both EGFR and p53 survived for a longer period of time (p=0.0427).

[Results of surgery in Mycobacterium avium complex pulmonary disease].

Recently, several studies have revealed the usefulness of surgical therapy for nontuberculous mycobacterial (NTM) disease. We have encountered and taken many opportunities for surgical therapy in Mycobacterium avium complex (MAC) disease. From April 1995 through March 1999, 14 patients with MAC disease underwent 16 pulmonary resections. NTM was diagnosed at our hospital in all subjects according to the criteria of the American Thoracic Society. There were 8 women and 6 men, with a mean age of 54 years. The most common indications for surgery were localized lesion (7 cases), severe symptoms (5 cases) and progressive disease (2 cases). Twelve patients were receiving multidrug chemotherapy, 10 of whom were also receiving clarithromycin. The mean period of preoperative chemotherapy was 17 months. Ten patients had a variety of symptoms, with some combination of cough, sputum, hemosputum, dyspnea, fever and anorexia. About 30% of the symptoms were improved after preoperative chemotherapy. The symptoms disappeared in all except one patient, who underwent pneumonectomy. After surgery, all patients attained a sputum-negative status. Nine patients underwent 11 partial resections, comprising 3 thoracotomies and 8 video-assisted thoracic surgeries (VATS). There was no operative mortality. Re-operation was performed in a patient with bronchopleural fistula after initial surgery. Currently, 2 months after the last operation, we have encountered no other severe complication and no relapse. Surgery may play an important role in treatment of MAC disease. We recommend partial resection with VATS for localized MAC disease.

[A case of traumatic dissecting aneurysm of the C1-2 portion of the internal carotid artery].

The authors report a case of traumatic dissecting aneurysm of the C1-2 portion of the internal carotid artery (ICA) in a 54-year-old woman. She suffered from traumatic SAH due to closed head trauma as a result of a motor vehicle accident. Twenty-five days after this accident, traumatic dissecting aneurysm of the C1-2 portion of the ICA that was caused by closed head trauma was ruptured and increased in size, as revealed by serial angiographic studies. In intraoperative finding, dissection involved the entire circumference of the C1-2 portion of the ICA. Clipping procedures were impossible, so internal carotid ligation and STA-MCA anastomosis was performed. To our knowledge, this traumatic dissecting aneurysm of the C1-2 portion of the ICA was the first case that presented with SAH. We discussed the mechanism of dissection of the ICA and operative strategy suitable for this aneurysm.

[Clinical significant of malassezia furfur specific IgE antibody in atopic dermatitis].

The clinical significance of AlaSTAT (DPC) Specific IgE for Malassezia furfur (Mf) was evaluated by testing the sera of 147 atopic dermatitis (AD) patients. Patients were from 0 to 52 years old, and the prevalence of positive assay results was analyzed by age, class of reactivity, and degree of face and body symptoms. Evaluations of rhinitis, seborrhea as complications and serum total IgE by RIST were included. The prevalence of Mf specific IgE positive sera was lowest in the 0-2 year age group, and increased swiftly in the 3-9 year age group. The older age is, the higher specific IgE antibody for Mf. The prevalence in the 0-2 year age group was significantly different from the other age groups. Although none of the positive results were above AlaSTAT class 2 in the 0-2 year age group, the positive result above AlaSTAT class 2 increased in the 3-9 year age group and was highest in the older age groups, reaching a peak prevalence at age 20 years. A group of age 20 years or older prevalence was significantly different from the 3-9 and 10-19 years old patients. The prevalence of positive did not correlate with face and body symptoms. Adults were more often Mf positive than children. An increasing prevalence of severe face symptoms in adults did correlate with the increased prevalence of Mf specific IgE in the in sera. The AlaSTAT class 3 and 4 results correlated with more severe face symptoms, and complications by seborrhea. The high AlaSTAT class results also corresponded to high total IgE values.

Primary pulmonary lymphoma: relationship between clinical features and pathologic findings in 24 cases. The Japan National Chest Hospital Study Group for Lung Cancer.

To elucidate the relationship between the clinical features and pathologic findings of primary pulmonary lymphoma, we reviewed 24 patients with this disease. The pulmonary lymphomas were divided into four groups: (1) B-cell lymphoma composed of small to medium-sized lymphoid cells (19 cases); (2) B-cell lymphoma composed of large lymphoid cells (three cases); (3) T-cell lymphoma (one case); (4) malignant lymphoma of lymphomatoid granulomatosis (LYG) type (one case). Radiographs of the first group revealed a predominance of infiltration associated with ill-defined tumor margins upon gross pathology, corresponding histologically to lymphangitic spread. Air bronchogram and pleural tail or abutment were additional radiographic features. Characteristics of the second group were a nodule or mass evident on radiographs and well-circumscribed tumor margins upon gross pathology. Lack of air bronchogram was an another radiographic feature in this group. Seventeen patients in these two groups underwent complete resection of the tumors and survived without recurrence, whereas four received chemotherapy after biopsy and survived with disease. These results indicate that primary pulmonary B-cell lymphoma is a low-grade malignancy and that complete resection is the only therapy which leads to cure. In a single patient with T-cell lymphoma, the radiographic and pathologic features of the tumor were indistinguishable from those in the first group, but the patient had an unfavorable prognosis. We consider that, from a prognostic viewpoint, it is important to determine the T- or B-immunophenotype of the tumor cells for diagnosis of primary pulmonary lymphoma. The only patient in this series with pulmonary lymphoma of LYG type showed distinctive clinicopathologic findings. We consider that this uncommon disease should be separated from other types of primary pulmonary lymphoma.

Prognostic significance of an interface pattern of central fibrosis and tumor cells in peripheral adenocarcinoma of the lung.

Fifty-nine surgically resected pulmonary adenocarcinomas were histologically classified into four types (A, B, C, and D) according to the pattern of invasion, ie, the extent of invasive tumor cell growth in the interface zone between alveoli replaced by cancer cells and the central region of fibrosis (so-called "scar"). In pattern A cancer cells proliferate along the alveolar walls without forming a frankly invasive lesion. In pattern B invasive lesions occupy less than 30% and in pattern C more than 30% of the fibrosing area. Pattern D refers to invasion of the bronchial lumen by cancer cells. The 59 tumors included 14 of pattern A, 12 of pattern B, 16 of pattern C, and 17 of pattern D. The 5-year survival rate for patients with pattern A tumors was 100%, and the rates for patients with pattern B, C, and D tumors were 64.2%, 30.0%, and 11.8%, respectively. Each difference between pairs of survival curves was statistically significant (P < .05). We found a correlation between the pattern of invasion and other prognostic factors. However, even in the cases evaluated as favorable by other prognostic factors (stage I, tumor less than 35 mm in diameter, negative for lymph node metastases, well-differentiated histology, negative for subpleural invasion, negative for vascular invasion) the survival curves became steeper going from pattern A to patterns B, C, and D. We conclude that the pattern of invasion is correlated with the prognosis of surgically treated patients. Our study may provide new histological criteria for the prognostic evaluation of pulmonary adenocarcinoma.

Significant role of an exocellular protease in utilization of heme by Vibrio vulnificus.

Clinical and environmental isolates of Vibrio vulnificus could grow in a synthetic medium supplemented with heme protein as the iron source. Protease-deficient mutants of the bacterium could not utilize any of the heme proteins in the synthetic medium, but the addition of purified V. vulnificus protease restored their growth. The protease digested all heme proteins tested and elicited heme liberation from the proteins. Furthermore, the induction of protease production by the heme proteins was demonstrated. These observations suggest that protease contributes to the efficient utilization of heme by V. vulnificus.

[Evaluation of pluronic F127 as a base for gradual release of anticancer drug].

The property of pluronic F127 (PLF) as a base for an anticancer agent, mitomycin C (MMC) was evaluated. A weighed amount of PLF and MMC were slowly added to cold water and mixed completely. The solution was warmed to 37 degrees C and MMC containing PLF gel was formed. The cumulative amount of MMC which was released from the gel during a 3-hour period was calculated. 5.5 percent of MMC was released from PLF-MMC gel which contained 20 or 25% PLF and 3.8% MMC from PLF-MMC gel containing 30% PLF. Intraperitoneal (i.p.) administration of large amount of PLF gel alone in rabbits or mouse revealed severe hepatorenal toxicity, and acute i.p. administered LD50 of PLF was supposed to be between 1.7 g and 5.0 g/kg body weight in mouse. Further evaluation of gradual releasing property of PLF is needed.

[Urinary and sexual dysfunction after rectal cancer operation].

Using a questionnaire, the urinary function of 68 patients and the sexual function of 81 patients were evaluated after rectal cancer operation. The patients with carcinoma of the rectum suffered from severe damage to the urinary system following Miles' operation (Miles) which included 85.7% of the male and 42.9% female. On the other hand, 31.8% male and 33.3% female suffered following anterior resection or pull through operation (AR). Following Miles 64.3% male and 71.4% female had developed urinary incontinence while 36.4% male and 33.3% female developed the same following AR. These results indicate that dysfunction of the urinary voiding system was more common in the males while the females experienced urinary incontinence. This difference may be due to the severity of the surgical intervention to the bladder neck and partly to the anatomical difference of pelvic floor and of urethra. The recovery was poor in the patients who had developed disorder of the urinary voiding system and unfortunately 84% patients following Miles and 75% patients after AR could not return to normal voiding even five years after operation. Urinary incontinence persisted after Miles and after AR in 77.8% and 31% patient respectively. Sexual activity was remarkably reduced following Miles. The males lost the power of erection and ejaculation, the females suffered due to the existence of artificial colostomy. In order to maintain the normal physiological activity of the urogenital system following operation, it is important to avoid any damage preferably to the bladder neck and urethra in case of males and to avoid artificial stoma in females.

[Functioning disorders after surgery of rectum cancer--(1). Functioning prognosis of defecation disorder following anus preserving operation].

Thirty-three anus-preserved rectal cancer patients with anterior resection or low anterior resection were asked about their postoperative defecation conditions with questionnaires after a more than one and half year postoperative period. Beforehand the residual anorectum length was defined by subtracting the length of the specimen AW and 1.5 cm as suturing width from the length of the anal verge through the anal tumor margin during romanoscopic examination. Involuntary soiling frequently occurred in the cases with a less than 9 cm residual anorectum, in the female cases and in the cases associated with lateral lymph node dissection. But these factors have no definite relation to the time of disappearance of involuntary soiling. Half of the cases were normalized in 2 years, and 80% in 3 years. Frequent bowel movement occurred in a high percentage of cases, especially in the cases with short residual anorectum or with lateral lymph node dissection. Frequency of defecation decreased from 8-9/day up to 6 months later, to 5/day up to one year later, and 2-3/day up to 6 years later. Improvement of the above-mentioned condition was slightly delayed in the less than 6 cm residual anorectum group and in females, but not in the lateral lymph node dissection group. Anastomosis insufficiency caused a delay in recovery from involuntary soiling.

[Electrophysiological atlas of human thalamus and adjacent structures.--Microcomputer assisted mapping of neurophysiological data and its application to stereotaxic surgery].

During stereotaxic surgery anatomical structures and their extent on trajectories were identified by neural noise (field potential) obtained by semi-microelectrode technique. Locations of anatomical structures (the white mater, caudate nucleus, thalamus, subthalamic field and nuclei in the subthalamic field) were fed into microcomputer (NEC PC-8001) as 3 dimensional correlates and stored in minifloppy disc system (NEC PC-8031). Data with satisfactory recordings from 48 trajectories from 30 patients (18 parkinsonism, 5 central pain, 7 others) entered this study. Microcomputer was so programmed that locations of the trajectories and electrophysiologically identified anatomical structures at that location in various coronal, sagittal and horizontal planes were displayed. Accumulation of this display from various groups of patients automatically created electrophysiological atlas. For comparison of thus created electrophysiological atlas with anatomical atlas display was made on various sections of the Schaltenbrand and Bailey's Atlas which were also stored in the mimifloppy disc system. Electrophysiological topography of the thalamus and adjacent structures was reasonably similar to anatomical topography with minor, but significant individual variations. In most cases the ventral border of the thalamus was located in the close vicinity of CA-CP line, however, in some cases the thalamus was located deep into the subthalamic field. This was thought to be due to the difficulty in identifying the ventral border of the thalamus by this technique and in such occasions other neurophysiological method for identifying the ventral border of the thalamus, i.e., thalamocortical evoked potential and other stimulation technique, were necessary. Medial aspect of the V. im. nucleus emitted neural noise of different characteristics which in current program was recognized as the subthalamic field. This implies that the medial and lateral aspects of the V. im. nucleus are cytoarchitecturally different and that it is possible to differentiate the medial and lateral aspects of the V. im. nucleus by this technique. The lateral thalamic border, i.e., thalamocapsular border, also showed relatively wide range of individual variations. When various parameters including age, sex, diagnosis and width of the 3rd ventricles were examined for possible cause of these variations, a tendency was noted that the thalamocapsular border was medially placed when the width of the 3rd ventricle was small. In this system it is possible to display sequentially electrophysiologically identified structures along any trajectory. This display method, which was called "tract study," was very usefull for comprehensive understanding of location of trajectory in relation to individually varying anatomical structures...