Structures of two kinds of mRNA encoding the chum salmon melanin-concentrating hormone.

The structures of two kinds of melanin-concentrating hormone (MCH) cDNA clones isolated from a chum salmon hypothalamus cDNA library were described. The MCH heptadecapeptide was present at the C terminus of a putative MCH precursor consisting of 132 amino acid residues. The two clones were 80% homologous with each other at the amino acid sequence level. Two genes, each directing one of the mRNAs was noted at about a single copy per haploid salmon genome. MCH genes were efficiently expressed as 0.9-kb poly(A)+RNA in salmon hypothalamus, and sequences hybridizable with salmon MCH cDNA were found in rat hypothalamus.

Venous drainage from the posterior aspect of the pancreatic head and duodenum.

Eighty-three pancreatic head and duodenum specimens, selected from 214 specimens, were dissected minutely to clarify the configurations of the posterior superior pancreaticoduodenal vein (PSPDv) with special reference to its topographical relationship to the common bile duct (CBD) and to whether an artery accompanied the PSPDv. The PSPDv frequently (71.1%) ran postero-inferior to the CBD without the accompaniment of an artery. Moreover, several tributaries draining the second and third portions of the duodenum sometimes (28.9%) joined together without arterial association and formed a stem, the so-called dorsal pancreatic vein. Variations of PSPDv were discussed in relation to the general vascular configuration of the small intestine.

[Combination chemotherapy of continuous infusion 5-fluorouracil and daily low-dose cisplatin in advanced gastrointestinal and lung adenocarcinoma].

Continuous intravenous infusion (c.v.i.) of 5-fluorouracil (5-FU) plus daily low-dose cisplatin (CDDP) was evaluated in 45 patients with advanced and recurrent unresected colorectal, lung, gastric and pancreatic adenocarcinoma. 5-FU was given at a dose of 320 mg/m2/day, c.v.i. for 4 weeks, and CDDP between 3.5 to 7 mg/m2/day, infused for one hour five times a week for 4 weeks. Patients received 1 to 3 cycles of treatment (average 1.5 cycle). Pancreatic cancer cases needed longer treatment periods (2.25 cycles). The response rate of colorectal cancer cases was 57.7% (15/26), pancreas cancer 40%, gastric cancer 62.5%, and lung cancer 66.7%. The overall response rate was 57.8%. No severe side effects occurred in any of these cases. These data indicate that this combination 5-FU + daily low-dose CDDP chemotherapy is effective in the treatment of advanced gastrointestinal and lung adenocarcinoma.

[Biochemical modulation of 5-FU--effect of low dose CDDP].

A pilot study of continuous or intermittent low dose 5-FU and cisplatin chemotherapy (low-dose FP therapy) was conducted at the Department of Surgery of Sapporo Medical University School of Medicine (Group A) and Sapporo Tsukisamu Hospital, and at the Department of Internal Medicine of the Kochi Prefectural Center Hospital (Group B). The cases with esophageal cancer, stomach cancer, pancreatic cancer, hepatocellular carcinoma or colonic cancer co-existing with their inoperable lesion(s) were considered in this chemotherapy. The rates of complete and partial response and of side effects were studied. Also, the effects of low-dose FP on the prognosis of the patients with pancreatic or colonic cancers were investigated. The procedure consisted of continuous 5-FU 320 mg/m2 i.v. with daily CDDP 2.5 mg/m2 i.v. for five days/week rescue was performed for at least four weeks as a rule. The rates of complete response and partial response were 64% (Group A) and 56% (Group B) in esophageal cancer, 62% (Group A and B) in stomach cancer, 48% (Group A) and 57% (Group B) in colonic cancer, and 8% (Group A) and 21% (Group B). The overall response rate was 57.8%. The frequencies of severe side effect(s) (grades 3 and 4) were within three to eight percent, and no death from side effect(s) was experienced. The effects of low-dose FP therapy on the prognosis of stage IV colonic cancer and stage IV b pancreatic cancer were studied retrospectively. It is suggested that this chemotherapy might contribute to the survival of patients with these two cancers. Otherwise, the chemotherapy of intermittent administration (day by day) of 5-FU 750 mg/m2 i.v. and CDDP 2.5 mg/m2 i.v. was selected in order to decrease the rate of side effects and their severity. The pilot study encountered no severe side effects, no cases with grade 4 side effect were experienced but the remission rates were mostly similar to that of sequential low-dose FP therapy. However, the side effect of low grade ones as symptoms in gastrointestinal tract were observed in more patients. We concluded that sequential or intermittent 5-FU/CDDP therapy might be fairly effective, and since the adjuvant chemotherapy of choice for advanced or recurrent gastrointestinal cancer, their FP therapy might be one of the adjuvant treatments.

[A case of hereditary spherocytosis--role of complement system in hemolysis (author's transl)].

A female patient, 27 years old, with the chief complaint of anemia and jaundice, was diagnosed as hereditary spherocytosis with a complication of cholelithiasis and was examined before and after the operation of cholecystectomy and splenectomy. The surgery was followed by an increase in red cells, decrease in reticulocytes and normalization of serum bilirubin level. Both prothrombin time and partial thromboplastin time were normal before and after the surgery. The serum level of complement 4 was 11.5 mg/dl before and 20 days after the surgery it rose to 37 mg/dl. Similarly the serum level of complement 3c was 30 mg/dl before and 72 mg/dl 4 days after the surgery. From these results it was inferred that red cells of the patient were liable to hemolysis by the action of the complement system which was favored by an intrasplenic hemostasis without incurring intravascular coagulation.

[A study of the nature of the nurse's recognition of problems in pediatric nursing and the expectation for a support system provided by a specialist of pediatric nursing--the study presents a comparison children units with mixed units of both children and adults].

The purpose of the research was to examine the nature of the nurse's recognition of problems in pediatric nursing, the method of solving the problems and the expectation of support by the pediatric nursing specialist. A questionnaire was sent to 1511 nurses who care for hospitalized children. The nurses were selected from 165 hospitals which had a children's unit and 172 hospitals which did not have a children's unit, but had a mixed unit of both children and adults. Each hospital selected had more than 300 beds. The nurse's recognition of problems in child care in both care setting was high. Recognition of problems regarding direct care for children on the children's unit was higher than that on the mixed unit. Indirect factors relating to pediatric nursing were higher on the mixed unit than on the children's unit. The expectation of support by the specialist was high and varied in kind. Nurses who responded to the questionnaire expressed a need to have a pediatric nurse specialist in their hospital or on their unit. The results indicated that a pediatric liaison nurse is required to support the various needs of the pediatric nurse.

[A report on the clinical practice in pediatric nursing--review of literature and students learning at St. Luke's College of Nursing].

The purpose of this report is to examine the educational methods for nursing practice within the pediatric outpatient clinic environment. According to changes to the regulations for the educating of nurses and midwives and the extended role of community nursing, the focus of nursing practice moved from inpatient to outpatient care. However, due to constant and ongoing changes in the way in which such clinics operate and provide health care, frequent examination of educational methods has become more and more necessary. As subjects for this report, students of St. Luke's College of Nursing were surveyed following their period of clinical training. These students learn the importance of studying the reaction and communication of the child, child-parent relationship, and family influences on children's health. Furthermore, they learn the importance of such clinics in their role of providing community health.

Catalase-negative peroxisomes: transient appearance in rat hepatocytes during liver regeneration after partial hepatectomy.

Using light microscopy enzyme cytochemistry to localize catalase activity in peroxisomes, a population of peroxisome-negative hepatocytes was detected in livers of rats during liver regeneration induced by two-thirds partial hepatectomy. However, examination by electron microscopy revealed that this population of hepatocytes contained peroxisomes with a delimiting membrane and a nucleoid, but no cytochemically demonstrable catalase activity within their matrix. Regenerating livers 6, 18, 24, 36, 48 and 72 hours, and 1 week after partial hepatectomy showed hepatocytes without catalase activity. However, their numbers varied, with the most numerous appearing at 24 hours after partial hepatectomy. Mitosis of catalase-negative hepatocytes were seen along with mitosis of hepatocytes containing the normal complement of catalase-positive peroxisomes. The catalase-negative hepatocytes did not show evidence of apoptosis or necrotic cell death. Lysosomal acid phosphatase activity and bile canalicular ATPase activity were present in hepatocytes with catalase-negative peroxisomes. Another population of hepatocytes with a small number of catalase-positive peroxisomes appeared and were more numerous at 36 hours after partial hepatectomy; ultrastructurally, these hepatocytes contained both catalase-negative peroxisomes, which appeared to undergo dissolution, and catalase-positive peroxisomes, which were smaller in size. After complete restoration of the liver, all hepatocytes displayed essentially uniform numbers of catalase-positive peroxisomes. These studies indicated that during liver regeneration there is a transient loss of catalase in peroxisomes of some hepatocytes. These cells proliferate and with time acquire new catalase-positive peroxisomes. The observations are discussed in relation to peroxisome biogenesis, hepatocellular carcinogenesis, and oxidative stress during liver regeneration.

Blast-like cell compartment in carcinogen-induced proliferating bile ductules.

Small non-epithelial cells with morphological features of blast-like cells are found within a proliferating intrahepatic biliary system after institution in rats of a diethylnitrosamine, 2-acetylaminofluorene, partial hepatectomy carcinogenesis protocol. Two to three days after the partial hepatectomy step of the carcinogen protocol, the small blast-like cells are evident beneath a layer of bile ductule epithelial cells that line the walls of the bile ductules. The basally located small cells are not exposed to the bile ductule lumen or to the surrounding basal lamina. They ranged in size from 3.0 to 5.0 microns, exhibit an undifferentiated phenotype, including a high nucleus-to-cytoplasm ratio and no to minimal differentiated cytoplasmic and surface structures. Mitosis of blast-like cells are evident, and their nuclei express proliferating nuclear cell antigen. The ductal blast-like cells do not express cytokeratin 19, oval cell antigen 270.38, or actin immunoreactivity, in contrast to bile ductule epithelial cells. The basal cells, as well as bile ductule epithelial cells, are negative for a panel of T and B lymphocyte surface markers in contrast to lymphocytes present in the connective tissue stroma surrounding the bile ductules and throughout the hepatic parenchyma. Within some segments of the biliary system, some of the ductal blast-like cells increased in size to approximately 10 microns and showed increased amounts of cytoplasmic organelles and plasma membrane filapodia but did not develop the polarized phenotype of bile ductule epithelial cells (ie, apical microvilli, desmosomes, connections to bile ductule cells, and exposure to duct lumen); however, their nuclear morphology was essentially similar to the smaller basal cells. We also found bile ductules to contain two types of polarized epithelial cells, one with the characteristic oval nucleus of the oval/bile ductule epithelial cells and the other, transitional epithelial cells with a rounder nucleus and prominent nucleoli. The transitional cells exhibit a similar apical-basal polarity and antigenic phenotype as the oval/bile ductule epithelial cells. However, transitional cells are larger and have an overall less dense cytoplasm than the bile ductule epithelial/oval cells, and some show apical microvilli changes and small catalase-positive peroxisomes. These observations indicate that a greater diversity of cell types exist within intrahepatic bile ductules of rats treated with carcinogens. Furthermore, the nonpolarized ductal blast-like cells undergo proliferation and are significantly different in phenotype from other hepatic cells previously reported as candidates for liver progenitor cells.

An experimental study on the effects of selected drugs on pancreatic regeneration after partial pancreatectomy.

This study was undertaken to determine the effect of the single and combined administration of caerulein, hydrocortisone, and FOY-305 (camostat) on the regeneration of the remnant pancreas after a 90% pancreatectomy in rats. After undergoing either a sham operation or a 90% pancreatectomy, the rats were administered the three drugs either singly or in combination. After the rats were killed, the pancreas was weighed and examined for tissue amylase activity, tissue protein content and total DNA content. The results were as follows: In the sham operation group, the caerulein among three drugs produced a significant trophic effect. The trophic effect in the combined administration group was greater than that in the single administration group. In the 90% pancreatectomy group, of the three drugs administered, hydrocortisone produced the most significant trophic effect. The trophic effect in the combined administration group was greater than that in the single administration group. These data suggest that the trophic effect of caerulein is significant in mature pancreatic cells while that of hydrocortisone is an immature one and that an additive effect of the three drugs was observed.

Hemobilia caused by a giant benign hemangioma of the liver: report of a case.

We report herein the extremely unusual case of a 39-year-old woman in whom a giant cavernous hemangioma caused hemobilia. Cavernous hemangioma is the most common benign neoplasm of the liver and rarely causes any clinical symptoms or signs, while hemobilia usually occurs secondary to accidental operative or iatrogenic trauma, vascular disease, inflammatory disorders, gallstones, or tumors of the liver. Although invasive or malignant hepatic tumors often result in a communication between the biliary tract and the blood vessels, only one case of hemobilia caused by a benign cavernous hemangioma has ever been reported, but with no details about the patient. Our patient presented to a local hospital with severe melena as the initial main symptom, where ligation of the right hepatic artery was performed. This failed to relieve her symptoms, and she was subsequently referred to our department where a right hepatectomy was performed. Histopathological examination revealed no malignancy combined with the tumor; however, the hemangioma was exposed to the bile duct in segment VIII, which was presumably the cause of the hemobilia. This patient remains in good health almost 6 years after her operation. To the best of our knowledge this is the first case report of hemobilia caused by a cavernous hemangioma, and is accompanied by a detailed analysis.

Neuroendocrine carcinoma of the extrahepatic biliary tract with positive immunostaining for gastrin-releasing peptide: report of a case.

We report herein the first documented case of gastrin-releasing peptide-positive neuroendocrine (NE) carcinoma of the extrahepatic biliary tract. An invasive tumor measuring 2.5 x 1.5 cm was located in the confluence portion of the cystic duct in a 70-year-old Japanese man. Histologically, the tumor was found to be composed of small polygonal cells which formed a solid and trabecular structure, and the frequencies of both mitoses and small necrotic areas were dominant. The tumor cells were immunoreactive to the NE markers chromogranin-A and neuron-specific enolase, as well as to carcinoembryonic antigen and gastrin-releasing peptide. Although a few cases of gastrin-releasing peptide-positive small-cell lung carcinoma have been documented, there have been no reports of gastrin-releasing peptide-positive NE carcinoma occurring in the gastrointestinal tract. We consider our case not merely to be of pathological interest, but also to have clinical and therapeutic implications.

Lack of survival benefit of extended lymph node dissection for ductal adenocarcinoma of the head of the pancreas: retrospective multi-institutional analysis in Japan.

It has not been established that extended lymph node resection is necessary for ductal adenocarcinoma of the head of the pancreas. According to the general rules for the study of pancreatic cancer, a multiinstitutional, retrospective clinical study was undertaken to investigate the efficiency of extended lymph node dissection for this malignancy. Altogether 501 patients underwent resection of the pancreas between 1991 and 1994 at 77 medical facilities; the surgical procedures, staging, lymph node dissection, curability, and survival rate were analyzed retrospectively. Eighteen of the patients died within 30 postoperative days, leaving 483 patients to be studied. The resection was curative microscopically in 94 patients, resulting in a 3-year survival of 29%. Macroscopically curative resection resulted in a 3-year survival of 14%; noncurative resection produced a 3-year survival of 6%. Although extended lymph node dissection was performed on 38 patients in stage I, 42 patients in stage II, 206 patients in stage III, and 1 patient in stage IV, there was no improvement in survival when the results were compared to those seen after standard or palliative lymph node dissection. The extent of lymph node dissection has not affected the prognosis for ductal adenocarcinoma of the head of the pancreas at any stage of the course of the disease. Excessive lymph node dissection in advanced cases does not necessarily lead to a favorable prognosis. The patients who undergo a radical operation with an adequate lymph node dissection have longer survivals.

Effects of basement membrane matrix on the culture of fetal mouse hepatocytes.

The effects of laminin, fibronectin and type IV collagen, all of which are major matrix components of the basement membrane, upon fetal mouse hepatocyte culture were studied. Among these matrices, laminin showed the greatest effect on DNA synthesis, cell proliferation, the secretion of alpha-fetoprotein and cell attachment. The effects of fibronectin and type IV collagen were slight with regard to the promotion of growth and cell attachment. However, there were no differences in the secretion of albumin into the media among the groups. These results suggest that laminin may be necessary for the cellular growth and functional maintenance of immature liver cells during normal development of the liver in vivo.