A case of resected retroperitoneal metachronous solitary metastasis from caecal cancer.

Colorectal cancer metastasis to the retroperitoneum, especially solitary metastasis allowing curative resection, is rare. We report a case of complete resection of retroperitoneal metachronous solitary metastasis from caecal cancer without distant metastasis. An 80-year-old woman with caecal cancer underwent laparoscopic ileocaecal resection with regional lymph node dissection. According to the eighth edition of the TNM classification, the pathological diagnosis was stage IIA (T3N0M0). Six months following the surgery, computed tomography revealed a solitary mass of 2cm diameter, dorsal to the right kidney. A second procedure for the removal of the tumour was performed. The lesion was pathologically diagnosed as a metachronous solitary retroperitoneal metastasis from caecal cancer. The patient is surviving and free from recurrence 17 months following the second procedure.

Genes involved in oxidative phosphorylation are coordinately upregulated with fasting hyperglycaemia in livers of patients with type 2 diabetes.

AIMS/HYPOTHESIS: Mitochondrial oxidative phosphorylation (OXPHOS) plays an important role in the pathophysiology of type 2 diabetes. Genes involved in OXPHOS have been reported to be down-regulated in skeletal muscle from patients with type 2 diabetes; however, hepatic regulation is unknown. MATERIALS AND METHODS: We analysed expression of genes involved in OXPHOS from the livers of 14 patients with type 2 diabetes and 14 subjects with NGT using serial analysis of gene expression (SAGE) and DNA chip analysis. We evaluated the correlation between expression levels of genes involved in OXPHOS and the clinical parameters of individuals with type 2 diabetes and NGT. RESULTS: Both gene analyses showed that genes involved in OXPHOS were significantly upregulated in the type 2 diabetic liver. In the SAGE analysis, tag count comparisons of mitochondrial transcripts showed that ribosomal RNAs (rRNA) were 3.5-fold over-expressed, and mRNAs were 1.2-fold over-expressed in the type 2 diabetes library. DNA chip analysis revealed that expression of genes involved in OXPHOS, which correlated with several nuclear factors, including estrogen-related receptor-alpha or peroxisome proliferator-activated receptor-gamma, was a predictor of fasting plasma glucose levels, independently of age, BMI, insulin resistance and fasting insulin levels (p = 0.04). Surprisingly, genes involved in OXPHOS did not correlate with peroxisome proliferator-activated receptor-gamma coactivator-1alpha or nuclear respiratory factor 1. CONCLUSIONS/INTERPRETATION: Our results indicate that upregulation of genes involved in OXPHOS in the liver, which are regulated by different mechanisms from genes in the skeletal muscle, is associated with fasting hyperglycaemia in patients with type 2 diabetes.

A novel missense mutation in Van der Woude syndrome: usefulness of fingernail DNA for genetic analysis.

Van der Woude syndrome (VWS) is an autosomal-dominant oral facial disorder. To find a gene mutation in a Japanese family using fingernail DNA samples, we performed this study. We hypothesized that a gene mutation in IRF6 might be involved in VWS, and that fingernail DNA samples may be valuable for detecting such mutations. Linkage and haplotype analyses of the family mapped the disease locus to the 1q32-q41 region. Mutation analysis with an improved extraction method for fingernail DNA detected a novel missense mutation (1046A>T, E349V) in exon 7 of IRF6 in all the affected members of the family. Since the E349V change may disturb the hydrophobic core and affect regulatory activity of IRF6, it is most likely that the mutation is causative for VWS in this family. Fingernail DNA is thus useful for linkage and mutation analyses, since the fingernail can be easily obtained non-invasively, sent through the mail, and stored for a long period. We emphasize here the usefulness of fingernail DNA for the genetic analysis of a disease.

Patched homologue 1 mutations in four Japanese families with basal cell nevus syndrome.

AIM: To search for patched homologue 1 (PTCH1) mutations in four families with basal cell nevus syndrome (BCNS). METHODS: Mutation analysis of PTCH1 in unrelated Japanese families affected with BCNS was carried out by direct sequencing. RESULTS: Six novel PTCH1 mutations, 833G-->A in exon 6, 1415C-->A and 1451G-->T in exon 10, 2798delC in exon 17, 2918-2925dupAGTTCCCT in exon 18 and 3956C-->A in exon 23, were identified. CONCLUSIONS: Among the six PTCH1 mutations, two frameshift mutations (2798delC and 2918-2925dupAGTTCCCT) and one nonsense mutation (833G-->A) are predicted to lead to premature termination of PTCH1 protein translation. Three simultaneous mutations, 1415C-->A (A472D) and 1451G-->T (G484V) in exon 10, and 3956G-->A (R1319H) in exon 23, were found on one allele in only affected members in one family and none of them were found among 90 unrelated healthy Japanese. The three mutations on one chromosome may have resulted from errors in the recombinational repair process and this is the first report on the PTCH1 mutations due to such a mechanism.

Gold-nanoparticle-assisted oligonucleotide immobilisation for improved DNA detection.

Colloidal gold nanoparticles are investigated as a potential scaffold for the assisted immobilisation of probe oligonucleotides on silicon surfaces. A preliminary study is devoted to the examination of the immobilisation of DNA-modified gold nanoparticles as a function of time, concentration, salt and pH. The DNA-modified nanoparticles self-assembled onto solid surfaces in a three-dimensional self-assembled architecture. The functionalised surfaces are evaluated in diagnostic assays, where their potential to improve the efficiency of the hybridisation reaction is tested. The system utilising DNA-modified nanoparticles produced an enhancement in the hybridisation efficiency and the sensitivity limit by a factor 10 to 100 as compared to a conventional DNA immobilisation system on a planar surface.

Nephrotic IgA nephropathy associated with disseminated tuberculosis.

A 35-year-old woman who had been suffering from ascites more than 3 months after the delivery of her first baby, developed generalized edema, pyrexia, pleural effusion, and right lower abdominal pain. The laboratory data revealed 5.6 g of 24-hour urinary protein, increased ESR and CRP, a positive skin test for tuberculosis, and a positive culture fortuberculous bacilli from pleural effusion. A renal biopsy showed mild proliferative glomerulonephritis, IgA and C3 depositions along the capillary loop, in the mesangium and also in the focal tubular basement membrane, and scattered membranolysis of the glomerular basement membrane in addition to paramesangial and intramembranous electron-dense deposits. A positive culture of tuberculous bacilli led anti-tuberculous drugs resulted in the complete disappearance of proteinuria, inflammation, and various organ manifestations. As far as we know, the association of tuberculosis with glomerulonephritis is an uncommon occurrence. In addition to describing this case, we also discussed the role of tuberculosis in the pathogenesis of glomerulonephritis, and reviewed the pertinent literature.

[Studies on the relationship between serum albumin concentration and lipid peroxidation in the erythrocyte membrane of maintenance hemodialysis patients].

We conducted a study on the long-term prognosis of maintenance hemodialysis patients with and without diabetes mellitus(144 cases). As a result, significant differences were observed in the long-term prognosis over a 15-year period between those with a serum albumin concentration of more than 3.8 g/dl and those with a serum albumin concentration of less than 3.8 g/dl. The group with a serum albumin concentration of more than 3.8 g/dl showed a better prognosis than the group with a concentration of less than 3.8 g/dl. We investigated the levels of thiobarbituric acid-reactive substances (TBA-RS) in the erythrocyte membrane of maintenance hemodialysis patients(23 cases), pre-dialysis uremic phase patients(12 cases) and healthy controls(7 cases). TBA-RS in the erythrocyte membrane of pre-dialysis uremic phase patients was higher than that observed in the other groups. The TBA-RS in the erythrocyte membrane in the maintenance hemodialysis without diabetes mellitus group was lower than that in the pre-dialysis uremic phase group. The TBA-RS in the erythrocyte membrane in the maintenance hemodialysis without diabetes mellitus group thus indicated an inverse relationship with the serum albumin concentration, Kt/V and erythrocyte tocopherol contents. These results suggested that serum albumin protects against erythrocyte membrane lipid peroxidation, and that this function is related to hemodialysis. We thus conclude that hypoalbuminemia appears to increase the oxidative damage and acceleration of arteriosclerosis, while it also worsens the long-term prognosis of maintenance hemodialysis patients.

Hypoalbuminemia accelerates erythrocyte membrane lipid peroxidation in chronic hemodialysis patients.

BACKGROUND: Persistent hypoalbuminemia is a long-term poor prognostic factor in chronic hemodialysis patients. PATIENTS AND METHODS: We investigated the correlation between the degree of peroxidation of erythrocyte membrane lipids, erythrocyte alpha tocopherol content, erythrocyte glutathione peroxidase activity and serum albumin concentration in twelve patients with uremia not undergoing hemodialysis and fifteen patients on maintenance hemodialysis. RESULTS: The glutathione peroxidase activity in erythrocytes was higher in patients of uremia not undergoing hemodialysis than in chronic hemodialysis patients. A significant negative correlation was observed between the erythrocyte alpha tocopherol content and the degree of erythrocyte membrane lipid peroxidation in chronic hemodialysis patients. There was a statistically significant difference in the degree of erythrocyte membrane lipid peroxidation between patients with chronic hemodialysis-associated hypoalbuminemia and chronic hemodialysis patients having normal serum albumin levels. CONCLUSION: This study suggested that serum albumin inhibits peroxidation of erythrocyte membrane lipids and that hemodialysis induces recovery of serum reductivity. We conclude that persistent hypoalbuminemia worsens the serum antioxidant activity in chronic hemodialysis patients and may contribute to increased oxidative cell damage.

[Clinical psychopathologic study of aged chronic schizophrenics in residential homes for the elderly--relapsed and non-relapsed].

Residential homes for the elderly are expected to play an important role in the future as places for the social rehabilitation of inpatients with chronic schizophrenia in psychiatric hospitals. A study was performed to investigate the state of adjustment of schizophrenics currently staying in residential homes for the elderly from the viewpoint of clinical psychopathology. The subjects, consisting of 26 schizophrenics (10 males and 16 females) with a mean age of 76.0 years (SD = 5.4), were followed up mean 9.1 years (SD = 5.3). Background factors and clinical features of these subjects were compared in two groups divided according to relapsed (N = 16) or non-relapsed disease (N = 10). The results showed that there was a significant difference in the style of interpersonal relations (passive type and aggressive type). Passive type (N = 19) is autistic and meek. Aggressive type (N = 7) is uncooperative and has persecution mania towards any situation. All relapsed subjects were belonged to passive type. These subjects of the passive type who adjusted better than average during the stable phase experienced relapse more frequently than those of the aggressive type. And when they had a relapse, they revealed the same kind of symptoms as they had once revealed during their younger days, even though they usually seemed to be a better adaptation than the other group. In other words, their apparent stable condition represented unnatural adjustment that could also be described as overadjustment. The study revealed that persistent pathological anxiety underlies their adjustment, while the fundamental structure of schizophrenia, as indicated by the vulnerability of ego, remained unchanged even when they were elderly, and that their disease relapse as a result of any precipitating situation. All but 2 patients, including one who committed suicide and one who left the home due to exacerbated mental symptoms, were found to have adjusted to living in the home while under treatment. So adjustment prognosis of schizophrenia in the home is good.

[The effect of wound perfusion on the relief of postoperative pain].

The efficacy of wound perfusion (WP) with lidocaine for postoperative pain relief was studied in patients with median incision for cholecystectomy. Twenty four patients were divided into 3 groups according to the method of postoperative pain relief; group C, n = 8: intramuscular injections of penta-zocine 30 mg administered on demand, group WP, n = 8: WP with continuous lidocaine perfusion for 24 hours (plus pentazocine on demand); group EPI, n = 8: buprenorphine administered epidurally for 24 hours (plus pentazocine on demand). Pain scores at 0, 6, 12, 24, 48, hours after operation were examined. Arterial blood gas analysis, FVC and FEV1 were measured preoperatively and on the first postoperative day. Pain scores at 0 and 24 hours in group WP and EPI were significantly lower than those in group C. There were no significant differences in the scores between group WP and EPI at all the points. Analgesic requirement was significantly reduced in group WP and EPI compared with group C. FVC, FEV1 and PaO2 were significantly reduced postoperatively in every group but there were no differences among three groups. PaCO2 significantly increased postoperatively in group C and EPI. We conclude that the technique of wound perfusion with lidocaine is effective and safe for postoperative pain relief.

[Effect on cerebral blood flow of midazolam during modified neurolept-anesthesia].

Midazolam (0.2 mg.kg-1) was administered to ten patients undergoing neurosurgical operation and its influence on CBF was studied under modified NLA. Simultaneously, the plasma concentration of midazolam was measured. Heart rate and mean arterial blood pressure showed no significant changes after injection in comparison with the control. Cerebral blood flow (CBF) decreased for about 15-20% after 5 minutes, 10 minutes and 15 minutes in comparison with the control. However, 30 minutes later, CBF showed a trend to return to the control. This change in CBF is related to the changes of cerebro-vascular resistance. We applied cerebral oxygen extraction fraction (OEF) to evaluate cerebral metabolism. OEF was constant, showing no significant changes. It is concluded that cerebral oxygen consumption (CMRO2) has decreased together with the decrease in CBF. The plasma concentration of midazolam was 250-300 ng.ml-1 or greater after 5 minutes, 10 minutes and 15 minutes. We think that the sedative dose of midazolam can also sufficiently reduce CBF and CMRO2. The results suggest that midazolam is a safe and effective agent to use for anesthesia and provides adequate sedation for patients with intracranial hypertension.

[Anesthetic management of revascularization for moyamoya disease].

Anesthetic management during 85 STA-MCA anastomoses with or without encephalo-myosynangiosis for 64 patients with Moyamoya disease was evaluated retrospectively. Anesthetic agents included nitrous oxide-NLA (GONLA), nitrous oxide-halothane (GOF), nitrous oxide-enflurane (GOE), and their combinations. Slight hypercarbia (40 mmHg less than PaCO2 less than 50 mmHg) was essential to avoid cerebral ischemia. Several procedures to control heart rate by beta blockade or to control hypertension by nitroglycerin were required, because tachycardia and hypertension interfered with fine surgical procedure. During microsurgery HR of GONLA anesthetized patients was significantly lower. Postoperatively the patients anesthetized by GOE showed significantly lower PaCO2 compared with the GONLA anesthetized patients. So we recommend GONLA for anastomosis in patients with Moyamoya disease.

Studies on a new antibiotic M-92 produced by Micromonospora. I. Taxonomy of M-92 producing Micromonospora and antibiotic production therefrom.

An isolate (strain MCRL 0404) producing a new antibiotic, M-92, was identified as a new strain of Micromonospora for which the name Micromonospora verruculosa sp. nov. was proposed. A water-infusion of dried sea tangle and dried shiitake was utilized for the production of M-92. When this strain was fermented in the medium containing this infusion, M-92 accumulated in the mycelium at about 10 times that in the broth at the peak level.

Macrolide antibiotics M-4365 produced by Micromonospora. I. Taxonomy, production, isolation, characterization and properties.

A series of basic 16-membered macrolide antibiotics, M-4365 A1, A2, A3, G1, G2 and G3, were isolated from the culture broth of strain MCRL 0940 which is assigned to be a new species of Micromonospora and for which the name Micromonospora capillata sp. nov. is proposed. Among these antibiotics, M-4365 A2 and G2 showed strong inhibitory activity against Gram-positive and Gram-negative bacteria.