Chance fracture of the lumbar spine in an amateur snowboarder: a case report.

"Chance fracture" is an unusual type of spinal fracture caused by flexion-distraction of the back. We describe herein a rare case of a male amateur snowboarder who suffered lumbar Chance fracture caused by a fall after freestyle jumping. Radiological findings of plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) showed a loss of vertebral height in the anterior L1 vertebral body with a horizontal splitting fracture extending across the vertebral body, bilateral pedicles, and lamina. On the basis of the aforementioned findings, the diagnosis of Chance fracture of the L1 vertebra was established. The fracture healed without any subsequent disabilities following conservative medical management with a thoracolumbar orthosis, and no impairments to activities of daily living were encountered, including job or sports performance. Although Chance fracture caused by a fall is rare, particularly in sports, the possibility of this fracture should be considered when diagnosing spinal injuries in snowboarders.

Relationship between serum levels of interleukin 6, various disease parameters and malnutrition in patients with esophageal squamous cell carcinoma.

Serum levels of interleukin 6 (IL-6) are correlated with the disease status and prognosis in cancer patients. IL-6 is also an important mediator of experimental cancer cachexia. We investigated the production of IL-6 and IL-6 receptors and expression of IL-6 mRNA by esophageal squamous carcinoma cells using immunohistochemical staining and in situ reverse transcription-PCR. We also measured levels of serum IL-6 using an ELISA in 50 patients with esophageal squamous cell carcinoma (ESCC) to determine the correlation between serum levels of IL-6 and clinicopathological factors IL-6 mRNA was expressed in the primary tumor. Esophageal squamous carcinoma cells produced both IL-6 and IL-6 receptor. IL-6 concentrations were significantly higher in the primary tumor than in the normal epithelium. The incidences of weight loss, tumor invasion to adjacent organs, and noncurative resection were significantly higher in ESCC patients with serum levels of IL-6 > or = 7 pg/ml (n = 13, group C) compared with patients with serum levels <7 pg/ml and > or = 3 pg/ml (n = 14, group B) and <3 pg/ml (n = 23, group A). Tumor size and C-reactive protein levels were significantly higher and albumin levels were significantly lower in group C. Results suggest that IL-6, which is produced by tumor cells, may be related to various disease parameters as well as to the nutritional status in patients with ESCC.

Purification, resolution, and reconstitution of rat liver branched-chain alpha-keto acid dehydrogenase complex.

Branched-chain alpha-keto acid dehydrogenase (BCKADH) was solubilized as an enzyme complex from rat liver mitochondria by sonic treatment. Dehydrogenase (E1) and dihydrolipoyltransacylase (E2) components of the complex were purified in an associated form and resolved into individual components in the presence of 1 M NaCl, while lipoamide dehydrogenase (E3) component was dissociated from the complex during purification. Analysis by gel electrophoresis in dodecyl sulfate revealed the E1 comprised two different subunits with apparent molecular weights of 36,000 and 45,500, presumably in an equal molar ratio, while E2 consisted of a single subunit with an apparent molecular weight of 51,000. The BCKADH complex was reconstituted by combining E1, E2, and E3, and the formation of the complex was confirmed by analysis by sucrose density gradient centrifugation. The reconstituted enzyme complex oxidized not only alpha-ketoisovalerate (KIV), alpha-ketoisocaproate (KIC), and alpha-keto-beta-methylvalerate (KMV), but also pyruvate and alpha-ketoglutarate. Apparent Km values were 10-12 microM for the branched-chain alpha-keto acids, 2.2 mM for pyruvate, and 2.5 mM for alpha-ketoglutarate.

Light and electron microscopic investigation of the process of healing of the naevus of Ota by Q-switched alexandrite laser irradiation.

Melanocytes in the naevus of Ota were destroyed by irradiation using the Q-switched alexandrite laser. This laser is highly selective and highly absorbed by melanosomes. Other cells and tissue components of the dermis remained almost intact. Melanosomes were vaporized or fragmented to subelectron microscopical size, or degenerated. If the irradiated energy was sufficient, melanocytes vanished and large vacuoles several times the size of dermal melanocytes formed at the sites. If it was too weak, dermal melanocytes were also vaporized, but vacuoles formed within them. Nuclei were no longer discernible. Following irradiation macrophages infiltrated the irradiated areas and scavenged degenerated melanosomes and cellular debris. Thus, discoloration of the skin was markedly reduced. Although a few melanocytes and melanophages remained, pigmentation cleared to a satisfactory level. Melanocytes and keratinocytes were also injured in the epidermis; however, the epidermis recovered completely. No scarring was observed.

Electron microscopic examination of oligocilia in naevus of Ota.

The structure of the cilia present in dermal melanocytes of 14 patients with naevus of Ota was examined by electron microscopy. Cilia and basal bodies were found in 10 and 9 lesions, and in 39 and 18 dermal melanocytes, respectively. In each case, 1-12 cells with a single cilium or multiple cilia were observed. In a total of 3 dermal melanocytes from 2 cases, two cilia per cell were observed. The cilia contained 7, 6, 5 and 4 pairs of doublet microtubules in the periphery and no central microtubule. Another pattern with several pairs of doublet microtubules in the periphery and one or two centrally located doublet microtubules were also observed. The latter were not bona fide central microtubules but one and two doublets, which seemed to be displaced to the centre from the periphery of the cilium.

Disulphates of 16-oxygenated ketonic C19 steroids as biliary metabolities of androsterone sulphate in female rats.

The chemical synthesis of 16beta-hydroxyandrosterone was described preparatory to studies of the disulphates of the 16-oxygenated ketonic C19 steroids present in the bile of female rats dosed with [3H]androsterone sulphate. The biliary metabolites were separated by chromatography on Sephadex LH-20 to afford monosulphate and diconjugate fractions. After solvolysis of the diconjugate fraction, the liberated steroids were separated by partition chromatography on Celite 545 and analyzed by gas chromatography-mass spectometry. In addition to 3alpha, 17beta-dihydroxy-5alpha-androstan-16-one isolated previously, 16beta-hydroxyandrosterone was identified as a disulphate.

Metabolism of testosterone sulfate in the rat: analysis of biliary metabolites.

Following intraperitoneal injection of a mixture of testosterone-7-3-H-17-sulfate and testosterone-4-14-C into male and female rats with bile fistulas, biliary metabolites were separated and purified by a combination of column chromatography, enzymic hydrolysis or solvolysis of the conjugate fractions and identification of the liberated aglycones. The injected steroids were extensively metabolized and excreted predominantly in the bile. The major portion of the 3H was excreted in the disulfate fraction in both sexes. Solvolysis of the disulfate revealed the sex-specific aglycone pattern: 5alpha-Androstane-3beta,17beta-diol was the major metabolite in the male rat, whereas 5alpha-androstane-3alpha,17beta-diol and polar steroids were found in the female. In marked contrast, testosterone was metabolized in a different way than testosterone sulfate. 14-C radioactivity was distributed in monoglucosiduronate, monosulfate, and diconjugate fractions. Analysis of the aglycones showed that polar steroids were the main metabolites in the male. In the female, testosterone was metabolized to polar steroids, androsterone, and 5alpha-androstane-3alpha,17beta-diol.

Specificity of lipoamide dehydrogenase for alpha-keto acid dehydrogenase complexes and the glycine cleavage system.

Rat liver lipoamide dehydrogenase (LipDH) was separated into three types on DE-32 column chromatography, but no difference was observed among them in either immunological reactivity or enzymatic properties. A reconstitution experiment of branched-chain alpha-keto acid dehydrogenase complex (BCKADH) revealed that the most anionic type of LipDH was the most effective for the enzyme complex while the three types of LipDH were the same in the affinity for BCKADH subcomplex. All three types of LipDH were equally effective in reconstituting pyruvate dehydrogenase complex, alpha-ketoglutarate dehydrogenase complex and the glycine cleavage system. However, either pyruvate dehydrogenase or alpha-keto-glutarate dehydrogenase complex appeared to involve a certain LipDH in vivo which was firmly integrated into and hardly dissociable from the complex. A broad specificity of LipDH was observed for the glycine cleavage system. When BCKADH reconstitution experiments were carried out with both LipDHs from various sources and purified rat liver BCKADH subcomplex, the effectiveness of animal LipDHs was proportional to the extent of their immunological reactivity to the anti-rat LipDH antibody. However, BCKADH activity was also restored by a certain bacterial LipDH which had no cross-reactivity with the antibody, and LipDHs from some bacterial species, which reacted well with the antibody, showed no effect for the reconstitution of BCKADH. Thus, the determinant(s) of LipDH for the integration into alpha-keto acid dehydrogenase complexes including BCKADH can be its tertiary and/or quarternary structure rather than its primary and secondary structures.

[Usefulness of LDH isozyme for monitoring the therapy of human breast cancer transplanted in nude mice].

Human breast cancer (Br-13) serially transplanted in nude mice in ascitic form was used in this experiment. Released isozyme of human lactate dehydrogenase (LDH) was detected in the blood of the Br-13 tumor-bearing nude mice, and the serum levels of the isozyme rose associated with the increase of neoplastic cell number in ascitic fluid. After Br-13 bearing nude mice were treated with single drug or a combination of cyclophosphamide, adriamycin and 5-fluorouracil, serum LDH levels were monitored and compared with the change of ascitic cells. When effective treatment was performed, serum LDH-5 levels increased transitorily 1 or 2 days after drug administration, then decreased and became undetectable. These changes indicate a good correlation with the extent of the cell damage and the increase of life span of the mice. In conclusion, monitoring of human LDH isozyme in serum of nude mice was a useful marker for evaluating the efficacy of experimental chemotherapy in nude mice.

[Clinical experiences with pepleomycin].

From experimental observations, Peplomycin was expected to be more active against a variety of tumors and to be less toxic for the lung than the parent compound. An intermittent dose(10mg. twice a week) of peplomycin was tested in patients with malignant lymphoma or squamous cell carcinoma who had failed conventional treatment. There were two cases of CR and five cases of PR in twelve cases with malignant lymphoma, and two cases of PR in fourteen cases with squamous cell carcinoma. Out of 26 cases treated with peplomycin, fever was seen in ten cases(38.5%) and pulmonary complication was seen in five cases (19.2%). These data obtained from peplomycin treatment were compared with the results obtained from our previous experiences with bleomycin. Response rate, spectrum and frequency of side reactions of peplomycin treatment were substantially identical with those of bleomycin treatment. However, remission duration and life span were much longer in peplomycin treatment. In this respect, peplomycin seems to be superior than bleomycin to a certain extent.

Unusual fracture of the humerus in a volleyball player: a case report.

We describe a case of a female high school volleyball player who suffered a humeral shaft fracture while executing a floater serve. Based on the patient's history, a stress fracture was initially suspected. However, plain radiographs showed no periosteal reactions, callus formation or osteosclerosis, and thus we could not make a definite diagnosis of "stress fracture". It is suggested that an instantaneous muscle force in addition to rotational forces applied by impact with the ball caused the fracture. Her fracture healed without any subsequent disabilities based on a conservative medical management with a plaster splint, and she returned to the volleyball team. The inaccuracy of her serve form in addition to her own muscular force might be involved in the mechanism of injury. Instruction on achieving appropriate serve form might help prevent such fractures.

Purification and characterization of human liver branched-chain alpha-keto acid dehydrogenase complex.

Human liver BCKADH complex was purified. On SDS-polyacrylamide gel electrophoresis, the purified enzyme complex gave three major bands having molecular weights of 51,000, 46,000, and 36,000, and one minor band with a molecular weight of 55,000. The minor band corresponded in molecular weight to lipoamide oxidoreductase which was purified separately. The purified BCKADH represented only approximately 20% of the maximum activity when assayed without addition of exogenous lipoamide oxidoreductase, indicating that lipoamide oxidoreductase component was readily dissociable from the complex. The BCKADH effectively oxidized all of KIV, KIC, and KMV, yielding apparent Km values in the range of 14-17 microM for those alpha-keto acids. Vmax values obtained were 0.86, 0.61, and 0.51 mumole NADH produced/min/mg of protein for KIV, KIC, and KMV, respectively, in the presence of excess amount of lipoamide oxidoreductase. This ratio of Vmax values was practically identical to those of specific activities obtained with respective branched-chain alpha-keto acids at each purification step. The enzyme complex also oxidized pyruvate and alpha-ketoglutarate to a lesser extent. Kinetic experiments gave Km values of 0.98 and 2.9 mM for pyruvate and alpha-ketoglutarate, respectively, with Vmax of 0.43 and 0.08 mumole NADH produced/min/mg of protein. NAD and CoASH were absolutely required for the reaction. Km values for NAD and CoASH were estimated to be 47 and 25 microM, respectively.

cDNA cloning of the chicken branched-chain alpha-keto acid dehydrogenase complex. Chicken-specific residues of the acyltransferase affect the overall activity and the interaction with the dehydrogenase.

Branched-chain alpha-keto acid dehydrogenase complex is a macromolecule comprising three catalytic components: a dehydrogenase (E1) with alpha(2)beta(2) structure, an acyltransferase (E2) and a dihydrolipoamide dehydrogenase (E3). In the mammalian complex, the E2 component with 24 identical subunits forms a structural core, to which multiple copies of E1 and E3 bind noncovalently. We isolated cDNA clones encoding E1 alpha, E1 beta and E2 subunits from a chicken-liver cDNA library and performed nucleotide sequencing. Amino-acid sequences deduced from the nucleotide sequences revealed that chicken E1 alpha and E1 beta chains had substantially homologous sequences with the corresponding mammalian polypeptides, except for the N-terminus. Chicken E2 conserved three functional domains, a lipoyl-bearing domain, an E1/E3 binding domain and an inner-core domain, but contrasted strongly with mammalian E2 in respect of containing 11 additional residues in two interdomain linkers: nine sequential residues in one linker and two residues in the other. Replacement of many residues was also observed in the chicken linkers. When E2 activity for catalyzing the overall reaction was measured by activity reconstitution in combination with E1 and E3, chicken E2 was markedly less effective than mammalian E2. The capability of chicken E2 for binding E1 was also reduced when determined by the binding assay using sucrose density gradient centrifugation. Chicken E1 was functionally as well as structurally indistinguishable from mammalian E1. Thus the reduced catalytic activity of chicken E2 must arise from its reduced E1-binding capacity, which results from the characteristic structure of interdomain linkers in chicken E2.

Autoantibodies of sera from patients with primary biliary cirrhosis recognize the alpha subunit of the decarboxylase component of human branched-chain 2-oxo acid dehydrogenase complex.

BACKGROUND/AIMS: The major antigens for anti-mitochondrial autoantibodies in primary biliary cirrhosis (PBC) are the lipoyl-containing components of 2-oxo acid dehydrogenase complexes. Autoantibodies against the E1alpha subunit of the pyruvate dehydrogenase complex (PDH) also have been found, but those against the E1alpha subunit of branched-chain 2-oxo acid dehydrogenase complex (BCKADH) have not been detected. We investigated the occurrence of BCKADH-E1alpha-specific autoantibodies by employing the purified human antigen. METHODS: The reactivities of PBC sera against purified antigens were assessed by ELISA and by immunoblotting analysis. The specificity of immunoreactivity was confirmed by absorption tests and affinity-purified antibodies. RESULTS: Fourteen out of 27 PBC sera reacted with BCKADH-E1alpha, and these same sera also reacted with BCKADH-E2. No PBC sera reacted with BCKADH-E1beta. The reactivity of PBC sera with BCKADH-E1alpha was removed only when the sera were pre-absorbed with this antigen. However, reactivities to BCKADH-E2 and PDH-E1alpha were retained. Affinity-purified antibodies to BCKADH-E1alpha reacted with BCKADH-E1alpha, but not PDH-E1alpha. Thus, it was confirmed that anti-BCKADH-Elalpha did not cross-react with either BCKADH-E2 or PDH-E1alpha. CONCLUSIONS: BCKADH-E1alpha-specific autoantibodies were found in the sera of PBC patients. The antibodies seem to occur subsequent to the anti-BCKADH-E2 antibody production, supporting the concept of intermolecular determinant spreading.

Regulation by induction of branched-chain 2-oxo acid dehydrogenase complex in clofibrate-fed rat liver.

The activity of branched-chain 2-oxo acid dehydrogenase complex increased 3.0-fold in liver of rats fed on 0.1%(w/w) clofibrate. Immunotitration experiments with antibodies against the constituent enzymes of the complex revealed that this increase resulted mainly from the increased amounts of only two(a decarboxylase and a lipoate acyltransferase) of three components of the complex and that the other component(dihydrolipoamide dehydrogenase) remained unchanged in its content, irrespective of clofibrate administration. The increases of both enzyme components were associated with increases in their mRNA levels which were estimated by in vitro translation with poly(A)+ RNA.