A qualitative study of Japanese patients' perspectives on post-treatment care for gynecological cancer.

The perspectives of cancer patients are important for designing a medically and economically effective follow-up program to help in the rapid recovery of patients. However, research focusing on the perspectives of Japanese gynecological cancer patients on follow-up programs is extremely scarce. In this study, we explored the perspectives and expectations of Japanese gynecological cancer patients with regard to post-treatment follow-up. Twenty-eight patients recruited through a gynecological cancer support group were included in focus groups 1-10 years post-treatment. Participants' accounts related to their perspectives on follow-up were coded and grouped into themes according to commonalities and differences. Seven themes emerged as follows: (1) living with uncertainty, (2) monitoring recurrence, (3) test content and frequency, (4) coping with "another illness", (5) provider communication and attitude, (6) holistic care, and (7) compromising with the reality of changed body. While these Japanese gynecological patients regarded follow-up as an opportunity for reassurance, they also wanted treatment for adverse effects and the opportunity to discuss their concerns. On the basis of the study findings, we conclude that during follow-up after cancer treatment, Japanese gynecological cancer patients not only prioritize recurrence management of cancer but also place a significant amount of importance on the management of symptoms and doctor-patient communication. However, these expectations for communication and care are often unmet. Thus, there is a need to fulfill the gap between the current follow-up programs and patients' expectations by reviewing and changing the hospital's policy that mainly focuses on the detection of recurrent diseases.

A double aortic arch with a deformed trachea accompanied by a subaortic left innominate vein.

During our dissection of a Japanese elderly female cadaver, a double aortic arch with a deformed trachea was found in the cadaver. The ascending aorta was bifurcated to form the left (anterior) and right (posterior) aortic arches. Encircling and compressing the trachea and esophagus, they confluenced into the descending aorta. We concluded that it was a case of the double aortic arch forming a vascular ring. In the vascular ring the trachea was deformed. In addition, the left innominate vein coursed under the aortic arches (subaortic left innominate vein, SLIV) and crossed the mediastinum posterior to the ascending aorta and anterior to the trachea.

Coincidence of a right retroaortic circumflex coronary artery and a right-sided aortic arch with a retroesophageal course of the left subclavian artery (arteria lusoria).

An anomalous branch of the right coronary artery was found in a 71-year-old male cadaver with a right-sided aortic arch. The anomalous artery arose from the proximal portion of the right coronary artery and ran in a retroaortic course, before reaching the posterior wall of the heart. It was recognized as the right-sided variation of the circumflex coronary artery. The aortic arch had as branches the left common carotid, right common carotid, right subclavian, and left subclavian arteries, in that order, and the descending aorta was located in the right thorax. The left subclavian artery arose from a Kommerell's diverticulum and ran behind the esophagus, and the left-sided ligamentum arteriosum was also connected at the diverticulum. Therefore, the right aortic arch was classified as type N according to Adachi-Williams-Nakagawa and type III-B1 in accordance with Stewart-Edwards. The Kommerell's diverticulum in this case seemed to press on the posterior wall of the esophagus.

Metabolic activation of heterocyclic amines and other procarcinogens in Salmonella typhimurium umu tester strains expressing human cytochrome P4501A1, 1A2, 1B1, 2C9, 2D6, 2E1, and 3A4 and human NADPH-P450 reductase and bacterial O-acetyltransferase.

We investigated roles of different forms of cytochrome P450 (P450 or CYP) in the metabolic activation of heterocyclic amines (HCAs) and other procarcinogens to genotoxic metabolite(s) in the newly developed umu tester strains Salmonella typhimurium (S. typhimurium) OY1002/1A1, OY1002/1A2, OY1002/1B1, OY1002/2C9, OY1002/2D6, OY1002/2E1 and OY1002/3A4, which express respective human P450 enzymes and NADPH-cytochrome P450 reductase (reductase) and bacterial O-acetyltransferase (O-AT). These strains were established by introducing two plasmids into S. typhimurium TA1535, one carrying both P450 and the reductase cDNA in a bicistronic construct under control of an IPTG-inducible double tac promoter and the other, pOA102, carrying O-AT and umuC"lacZ fusion genes. Expression levels of CYP were found to range between 35 to 550 nmol/l cell culture in the strains tested. O-AT activities in different strains ranged from 52 to 125 nmol isoniazid acetylated/min/mg protein. All HCAs tested, and 2-aminoanthracene and 2-aminofluorene exhibited high genotoxicity in the OY1002/1A2 strain, and genotoxicity of 2-amino-3-methylimidazo [4,5-f]quinoline was detected in both the OY1002/1A1 and OY1002/1A2 strains. 3-Amino-1,4-dimethyl-5H-pyrido[4,3-b]-indole and 3-amino-1-methyl-5H-pyrido[4,3-b]-indole were activated in the OY1002/1A1, OY1002/1B1, OY1002/1A2, and OY1002/3A4 strains. Aflatoxin B(1) exhibited genotoxicity in the OY1002/1A2, OY1002/1A1, and OY1002/3A4 strains. beta-Naphthylamine and benzo[a]pyrene did not exhibit genotoxicity in any of the strains. These results suggest that CYP1A2 is the major cytochrome P450 enzyme involved in bioactivation of HCAs.

Molecular cloning, DNA sequence, and expression of the gene encoding for thermostable pectate lyase of thermophilic Bacillus sp. TS 47.

The gene that encodes a thermostable pectate lyase (called PL 47), from Bacillus sp. TS 47, was cloned, sequenced, and expressed in mesophilic B. subtilis. The gene contained an open reading frame consisting of 1326 bp, which encoded 441 amino acids. The deduced amino acid sequence of the mature enzyme (416 amino acids with a calculated molecular mass of 47,262 Da), showed 52% similarity with PL (BsPel) from mesophilic B. subtilis SO113. The structure-based alignment of the deduced amino acid sequence of PL 47 with that of BsPel suggested that PL 47 might have a parallel beta-helix structure with three long loops. The amino acids making up PL 47 are richer in hydrophobic amino acids and glutamic acid than BsPel. The hydropathy profile of PL 47 indicated that the amino acid sequences around putative calcium binding sites are more hydrophobic than the same region of BsPel. The gene product expressed in B. subtilis as the host was stable up to 70 degrees C and the reaction was optimal around 70 degrees C, as well as native PL 47.

Use of genetically engineered Salmonella typhimurium OY1002/1A2 strain coexpressing human cytochrome P450 1A2 and NADPH-cytochrome P450 reductase and bacterial O-acetyltransferase in SOS/umu assay.

The major pathway of bioactivation of procarcinogenic heterocyclic aromatic amines (HCAs) is cytochrome P450 1A2 (CYP1A2)-catalyzed N-hydroxylation and subsequent esterification by O-acetyltransferase (O-AT). We have previously reported that an umu tester strain, Salmonella typhimurium OY1001/1A2, endogenously coexpressing human CYP1A2 and NADPH-P450 reductase (reductase), is able to detect the genotoxicity of some aromatic amines [Aryal et al., 1999, Mutat Res 442:113-120]. To further enhance the sensitivity of the strain toward HCAs, we developed S. typhimurium OY1002/1A2 by introducing pCW"/1A2:hNPR (a bicistronic construct coexpressing human P450 1A2 and the reductase) and pOA102 (constructed by subcloning the Salmonella O-AT gene in the pOA101-expressing umuC"lacZ gene) in S. typhimurium TA1535. In addition, as an O-AT-deficient strain, we developed the OY1003/1A2 strain by introducing pCW"/1A2:hNPR and pOA101 into O-AT-deficient S. typhimurium TA1535/1,8-DNP. Strains OY1001/1A2, OY1002/1A2, and OY1003/1A2 expressed, respectively, about 150, 120, and 140 nmol CYP1A2/l culture (in whole cells), and respective cytosolic preparations acetylated 15, 125, and > or = 0 nmol isoniazid/min/mg protein as the O-AT activities of cytosolic preparations, respectively. We compared the induction of umuC gene expression as a measure of genotoxicity and observed that the OY1002/1A2 strain was more sensitive than OY1001/1A2 strain toward the genotoxicity of 2-amino-1,4-dimethylimidazo[4,5-f]quinol ine(MeIQ), 2-amino-3-methylimidazo[4,5-f]quinoline (IQ),2-amino-3, 8-dimethylimidazo[4,5-f]quinoxaline (MeIQx),2-aminoanthracene, 2-amino-6-methyldipyrido[1,2-a::3,2'-d]i midazole,3-amino-1, 4-dimethyl-5H-pyrido[4,3-b]indole, and 3-amino-1-methyl-5H-pyrido[4, 3-a]indole. However, the genotoxicity of MeIQ, IQ, and MeIQx was not detected with the OY1003/1A2 strain. These results indicate that the newly developed strain OY1002/1A2 can be employed in detecting potential genotoxic aromatic amines requiring bioactivation by CYP1A2 and O-acetyltransferase.

Purification and characterization of an endo-polygalacturonase. From Aspergillus awamori.

An extracellular endo-polygalacturonase (PGase) produced by Aspergillus awamori IFO 4033 was isolated from the culture filtrate. The enzyme was purified to a homogeneous preparation with cation-exchange and size-exclusion chromatographies. Its properties were investigated, comparing them with that of recombinant pgx2 gene product, a PGase having protopectinase activity. This enzyme was a monomeric protein of 41 kDa, with an isoelectric point of pH 6.1. The characteristics of this PGase substantially coincide, with that of recombinant pgx2 gene product, and the PGase is assumed to be native pgx2 gene product. The production of PGase-X2 was confirmed to be regulated by ambient pHs.

Outbreak of human parvovirus B19 in hospital workers.

We report an outbreak of human parvovirus B19 (HPV B19) infection affecting five nursing staff, four hospital office workers and one physiotherapist and its possible transmission between hospital staff. We investigated the presence of the virus in serum specimens using a nested PCR assay to confirm HPV B19 infection. The viral genome was detected in serum specimens from a nurse with a rash and arthralgia and from three hospital office workers with a febrile illness. The DNA sequence of the PCR products from three staff members was identical. Our findings suggest that transmission of HPV B19 between hospital staff members occurred.

Purification and characterization of thermostable pectate lyase with protopectinase activity from thermophilic Bacillus sp. TS 47.

A strain of thermophilic bacterium, Bacillus sp., with pectolytic activity has been isolated. It produced an extracellular endo-polygalacturonate trans-eliminase (PL, EC 4.2.2.1) when grown at 60 degrees C on a medium containing polygalacturonate (PGA). The PL was purified by hydrophobic, cation exchange, and size exclusion column chromatographies. The molecular mass of the enzyme was 50 kDa by SDS-PAGE. The isoelectric point of the enzyme was pH 5.3. The enzyme had a half-life of 13 and 1 h at 65 and 70 degrees C, respectively, and showed optimal activity around at 70 degrees C and pH 8.0. It had protopectinase activity, besides PL activity, on lemon protopectin and cotton fibers. The first 20 amino acids sequence of the enzyme had significant similarity with that of PL from methophilic Bacillus subtilis, with 50% identity.

Development of a new genotoxicity test system with Salmonella typhimurium OY1001/1A2 expressing human CYP1A2 and NADPH-P450 reductase.

In order to develop a new tester strain detecting environmental promutagens and procarcinogens, we introduced two plasmids into Salmonella typhimurium TA1535; one contains the cDNAs of human cytochrome P450 (P450 or CYP) 1A2 and NADPH-P450 reductase and the other (pOA101) a umuC"lacZ fusion gene. The newly developed tester strain, S. typhimurium OY1001/1A2, was found to express P450 at a level of 0.15 nmol/ml in whole cell culture. Membrane fractions, when isolated from this tester strain, contained 0.04 P450 nmol/mg protein and a reductase activity of 170 nmol cytochrome c reduced/min/mg protein and were active in catalyzing CYP1A2-dependent 7-ethoxyresorufin O-deethylation and metabolic activation of heterocyclic aromatic amines to DNA-damaging products in a conventional tester S. typhimurium NM2009 strain, only when NADPH was added as a reducing equivalent. In the OA1002/1A2 strain, heterocyclic aromatic amines (e.g., IQ, MeIQ, and MeIQx) were found to be activated to reactive metabolites that cause induction of umuC gene expression in a dose-dependent manner, without addition of external NADPH. These results indicate that the newly established strain can be of use to detect mutagenic and carcinogenic potencies of environmental chemicals without addition of metabolic activation system.

Which vertebrae should be assessed in diagnosing osteoporosis by plain radiography? Comparative study of radiographic findings and bone mineral density measured by dual energy X-ray absorptiometry.

In 1990, the Ministry of Health and Welfare of Japan advocated a criterion for the diagnosis radiographic bone atrophy in lumbar vertebrae. We carried out a comparative study of this criterion (i.e. , radiographic bone atrophy grading) and bone mineral density measured by posteroanterior and lateral dual energy X-ray absorptiometry. We investigated the second to fourth lumbar vertebrae of 47 postmenopausal women (mean age, 67.2 years; range, 57-82 years), to determine which vertebra would most accurately indicate osteoporosis. A significant difference in bone mineral density (P < 0.01) was found between each grade of radiographic bone atrophy in all of the second, third, and fourth vertebrae examined. The highest correlation (r = 0.714) was found between the radiographic grades and the bone mineral density on lateral dual energy X-ray absorptiometry of the third lumbar vertebrae. Our visual determinations were dependable, radiographic and a examination of the third lumbar vertebra rather than that of other lumbar vertebrae was more helpful for the detection of radiographic bone atrophy. Plain radiographic film can provide a rough estimation of bone atrophy.

Biological Species of Armillaria in Japan.

Pairing tests with isolates of Armillaria in culture were used to identify species of Armillaria and their distribution throughout Japan. The existence of 10 intersterile groups of Armillaria was determined by pairing haploid single spore isolates obtained from 20 basidiocarps from a wide geographic distribution in Japan. Two to four haploid tester isolates from each intersterile group were then paired to biological and morphological species with haploid tester isolates from Europe and North America identified in previous studies. Japanese haploid tester isolates were then paired with 190 haploid or diploid isolates and compatibility reactions were used to identify these to species. Of the 10 intersterile groups identified in Japan, 7 were authenticated as A. gallica, A. nabsnona, A. ostoyae, A. cepistipes, A. mellea, A. sinapina, or A. tabescens. Three of the groups were not compatible with any of the tester species. The distribution and host relationships of the Japanese biological species are also discussed.

Medial medullary syndrome with contralateral face hypalgesia: a report of two cases.

Classically, patients with unilateral medial medullary syndromes show contralateral deep sensory loss, contralateral hemiparesis, and ipsilateral tongue paralysis. We encountered two patients with medial medullary syndromes showing hypalgesia of the contralateral face. Both patients had contralateral deep sensory loss and hemiparesis, but no hypoglossal nerve palsy, so it was difficult to establish a medial medullary syndrome from the clinical neurological signs alone. Magnetic resonance images showed that the infarcted areas were located in the ventromedial area of the upper medulla, probably involving the trigeminothalamic tract in the medial lemniscus. We reviewed the reported cases of medial medullary syndromes and summarized their clinical features as well as the topography concerned with the associated sensory disturbances.

[Spontaneous intracranial hypotension with severe headache and typical neuroradiological findings: report of two cases].

Intracranial hypotension causes the postural headache that sometimes follows lumbar puncture. When postural headache and associated symptoms occur after lumbar puncture, the diagnosis is usually obvious. However, similar symptoms may occur after minor trauma or without an obvious precipitating cause (spontaneous intracranial hypotension: SIH). SIH is rare, but is now increasingly recognized as a cause of postural headache. We encountered two cases of SIH showing typical neuroradiological findings. Case 1 is a 47-year-old man who was admitted with severe frontalgia. CT scan revealed vague visualization of bilateral Sylvian fissures and slit ventricles. Spinal fluid pressure was 6cm H2O in the lateral recumbent position. Cerebrospinal fluid (CSF) showed slight lymphocytic pleocytosis. We treated him as having viral meningitis. His headache improved gradually and he was discharged 2 weeks later with slight occipitalgia. One week after discharge, he complained of severe headache again and plain CT showed bilateral subdural hematoma. The subdural hematoma in both sides was evacuated and his headache improved after the operation. Follow-up CT scans two months later showed normalization of ventricle size and cisterns. Case 2 is a 52-year-old woman who was admitted with severe occipitalgia. CT scan on admission showed slit ventricles and the disappearance of the suprasellar cistern and the Sylvian fissure. Spinal fluid pressure was 3cm H2O. Gd-enhanced MRI showed remarkable meningeal enhancement and effacement of the optic chiasm suggesting brain sagging. Her headache improved 2 weeks later after strict bed rest and oral pain relief drugs. The follow-up MRI showed disappearance of abnormal meningeal enhancement and normalization of optic chiasma effacement. SIH is one of the important differential diagnoses of patients complaining of postural headache. Meningeal enhancement of gadolinium-enhanced MRI is an important finding to diagnose SIH. We have to consider SIH when diagnosing postural headache.

Antimutagenic activity of extracts from Japanese eggplant.

Using the Salmonella/microsome assay, the antimutagenic effects of specific components of the extracts from eggplant fruits were investigated. The eggplant fruit juice exhibited an antimutagenic activity against 3-amino-1-methyl-5H-pyrido[4,3-b]indole (Trp-P-2) induced mutagenicity. In some of the fractions extracted with several organic solvents (acetone, petroleum ether, ethyl acetate; and methanol), the activity was recognized. No mutagenicity or toxicity for Salmonella typhimurium TA98 in the presence of S9 mixture was observed with any of the extracts. It is suggested that there are multiple components of the activities that exist in the eggplant fruit. We isolated lutein from the 84% methanol (methanol/water, v/v) layer, pheophorbide or chlorophyllide from the 70% methanol layer and tannins containing sugar-moieties from the water layer. Pheophytin a and b, Mg-free derivatives of chlorophyll a and b, were isolated from the petroleum ether layer as possible antimutagens. The pheophytin a with S9 mix inhibited by 30-40% the mutagenicity of Trp-P-2.

Stereotactic evacuation of hypertensive cerebellar hemorrhage using plasminogen activator.

Treatment for hypertensive cerebellar hemorrhage still remains controversial as to whether direct surgical procedure is indicated or not. This is so even after the introduction of CT scan which easily demonstrates the location and size of the hematoma and the presence of hydrocephalus. In this paper, we present our experience of 20 patients with cerebellar hemorrhage treated by stereotactic evacuation using Komai's CT-stereotactic apparatus. All the patients had vertigo, cerebellar symptoms, dysfunction of brain stem or consciousness disturbance. The hematomas on CT scan were more than 28 mm in diameter. Acute obstructive hydrocephalus occurred in 90% of the patients with hematoma 40 mm or larger in size. The patients with consciousness disturbance were immediately operated on after the attack, and a drainage tube was placed in the hematoma cavity to drain cerebrospinal fluid and liquefied hematoma for one to eight days. On the other hand, when patients with hematoma around 30 mm in diameter complained vertigo for about two weeks, they also were operated on stereotactically. After the operation, their symptoms improved rapidly. The stereotactic operation could aspirate about 85% of the estimated hematoma volume and improved the hydrocephalus, except in one case in which the patient rapidly deteriorated to coma level with a large cerebellar hemorrhage and brain stem damage. This stereotactic evacuation of cerebellar hematoma using a plasminogen activator is effective for not only the removal of hematoma, but also for the treatment of secondary hydrocephalus following obstruction of the fourth ventricle by cerebellar hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of carotid superior cerebellar artery anastomosis associated with bilateral hypoplasia of the internal carotid artery represented as the rupture of posterior cerebral artery-posterior communicating artery aneurysm].

A rare case of a variant type of the persistent primitive trigeminal artery associated with bilateral hypoplasia of the internal carotid artery was reported. Left common carotid arteriography revealed a thin left internal carotid artery terminated at the ophthalmic artery. Right common carotid arteriography showed that a narrow internal carotid artery gave off several fine vessels to the cavernous portion, and terminated at the right superior cerebellar artery via the prominent persistent primitive trigeminal artery (PTA). Supraclinoid portions of the bilateral internal carotid arteries were not able to be found. Eventually the entire cerebral hemisphere was supplied by the vertebrobasilar system via the posterior communicating artery. The narrowed supraclinoid portion of the left internal carotid artery was confirmed by surgery of the left posterior cerebellar artery-posterior communicating artery aneurysm. This case may provide an important suggestion about the mechanism of the persistence of the primitive trigeminal artery. In an embryo, at the stage of 5-6mm embryo in size, the posterior communicating artery begins to develop and then PTAs begin to dwindle. If the C1- or C2- portion of the internal carotid artery is gradually occluded, the forebrain, which has to be supplied by the internal carotid system, must be supplied retrogradely by the basilar system via the posterior communicating artery. At this stage, however, the vertebral artery has not developed enough to supply the entire central nervous system. Therefore, the PTA can not regress and this results in the postnatal persistence of the primitive trigeminal artery.