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Paraspinal arteriovenous fistulas (AVFs), with the fistulas draining into the epidural veins alone, are relatively rare and few cases have been reported until now. We reported a case of cervical paraspinal AVFs draining only into the epidural venous plexus without reflux into the intradural venous system. The patient showed myelopathy due to direct compression of the spinal cord by a large varix. A 57-year-old man presented with gait disturbance. Neurological findings on admission revealed that tetraparesis, sensory disturbance of four extremitas below the C5 level and bladder bowel dysfunction. Magnetic resonance imaging and computed tomography at the cervical level disclosed remarkable compression of the spinal cord by a large venous pouch at the C6 level. Digital subtraction angiography (DSA) revealed paraspinal arteriovenous fistulas fed by bilateral C6 radicular arteries, the right ascending cervical arteries, and the right deep cervical artery in the right C6 intervertebral foramen. Three-staged transarterial embolization was performed by selective catheterization of the multiple feeders with n-butylcyanoacrylate, followed by transvenous embolization. During transvenous embolization, motor evoked potential (MEP) monitoring was performed. After retrograde catheterization of the epidural venous plexus, the large varix was occluded with Guglielmi detachable coils. The AV fistulas were completely occluded without any change in MEP monitoring during the procedure. The patient's gait improved well after the procedure and follow up DSA six months later showed no recurrence of the paraspinal AVFs.

Pancreatitis represents an extremely rare complication of typhoid fever. Herein we report the case of a 4-year-old Bangladeshi girl with acute pancreatitis caused by Salmonella typhi.

Background: Nontraumatic osteonecrosis of the femoral head (ONFH) is caused by disruption of blood flow. This disease often occurs in association with steroid treatment. The pathology of steroid-induced ONFH remains unclear, although abnormalities in lipid metabolism have been reported to be involved. In this study, we examined the differences of gene polymorphism frequencies of apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1), which are important proteins for lipid transport, as well as of lipid parameters, between ONFH cases and referent patients among those who were subjected to renal transplantation., Methods: Subjects were 158 cases who had undergone renal transplant, including 34 cases that were diagnosed as ONFH after renal transplantation and 124 cases that were not. Four single nucleotide polymorphisms including C7623T and G12619A for the ApoB gene and G75A and C83T for the ApoA1 gene were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and Taqman real-time PCR chemistry. Also, serum levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), ApoB, and ApoA1 were measured. Their relationship to ONFH was statistically evaluated., Results: A higher frequency of 7623TT or CT of the ApoB gene was observed in ONFH cases than in referent patients (P = 0.033), resulting in an elevated odds ratio that was statistically significant (adjusted odds ratio = 6.37, 95% CI = 1.53-26.5, P = 0.011). No significant relationship was observed between other genes and ONFH. Regarding lipid parameters, a higher value of ApoB/ApoA1 ratio was observed in cases (P = 0.045)., Conclusion: For the prediction of ONFH, it is useful to analyze ApoB C7623T and plasma ApoB/ApoA1 ratio before the administration of steroids.

Objective: This study sought to evaluate the efficacy and safety of a novel treatment regimen, intra-arterial cisplatin infusion plus external/high-dose-rate radiotherapy., Methods: Superselective intra-arterial infusion of cisplatin (100-120 mg) was performed concomitantly with external radiotherapy in four patients with locally advanced carcinoma of the tongue. A high-dose-rate brachytherapy boost was performed after combination therapy in all patients. Brachytherapy was performed after external radiotherapy, and the treatment schedule was twice daily, with a fraction of 600 cGy up to a total of 30-48 Gy., Results: All patients completed the therapy as scheduled. There were no vascular or neurological complications. Grade III acute radiation mucositis developed in all patients but this did not necessitate a treatment break. With a mean follow-up period of 35 months, loco-regional control was obtained for all patients., Conclusions: The combination of weekly administration of intra-arterial cisplatin plus external/high-dose-rate radiotherapy seems effective for advanced carcinoma of the tongue.

Drug resistance continues to be a serious problem in cancer therapy. We investigated whether indomethacin, which inhibited cyclooxygenases, would overcome doxorubicin resistance in K562/ADR leukemia cells. Indomethacin at 10 muM increased the cytotoxicity of doxorubicin, as well as vincristine in K562/ADR. Both multi-drug resistant protein1 (MRP1) and P-glycoprotein were overexpressed in K562/ADR cells when compared with K562 parent cells (K562/P). Expression of MRP1 mRNA and protein, but not P-glycoprotein, was significantly decreased in K562/ADR cells after indomethacin treatment. Indomethacin treatment increased 5(6)-carboxyfluorescein diacetate (CFDA) efflux, as well as decreased accumulation in K562/ADR cells. The activity of the MRP1 promoter decreased after indomethacin treatment in Hela cells. These data strongly suggest that the cyclooxygenase inhibitor, indomethacin, increased the cytotoxicity of doxorubicin with decreasing expression of MRP1 through inhibition of MRP1 promoter activity.

Total syntheses of serofendic acids A (1a) and B (1b) are described. The key strategic element of the approach involves the novel tin-free homoallyl-homoallyl radical rearrangement of 5 for the construction of bicyclo[2.2.2]octane ring system 4. In addition, the conversion of methyl atisirenoate 2 to serofendic acids A (1a) and B (1b) was achieved on the basis of the Michael reaction of sodium thiomethoxide.[reaction: see text]

It is well known that distal anterior cerebral artery (ACA) aneurysms are often associated with the anomalies of the ACA, of which azygos ACA and triple ACA have frequently been described. In this report, we present a rare case with a ruptured aneurysm arising from the bifurcation of the bihemispheric ACA, a rare anomaly of the ACA. A 63-year-old male suddenly developed severe headache, consciousness disturbance, and left hemiparesis, and was admitted to our hospital. Plain CT scans revealed subarachnoid clots that were densely distributed in the supracallosal cistern. Cerebral angiography demonstrated that the left pericallosal artery supplied blood flow to the bilateral parietal lobes through the bihemispheric arteries. A saccular aneurysm was found at their bifurcation. He underwent clipping surgery through interhemispheric approach. Postoperative course was uneventful. Special care should be taken not to occlude the bihemispheric arteries supplying to the bilateral parietal lobes during surgery.

Recently, there are increasing numbers of patients with occlusive carotid artery disease and coronary artery disease. Simultaneous or two-staged surgery for both lesions has been recommended for these patients to reduce the incidence of perioperative complications. However, therapeutic options for the patients with bilateral carotid artery stenosis and coronary artery disease have not been established. In this report, we describe two patients who successfully underwent carotid endarterectomy (CEA) and carotid artery stenting (CAS) on each carotid artery in parallel with coronary artery bypass grafts (CABG). A 49-year-old male with severe stenosis of the bilateral internal carotid artery (ICA) and heart failure underwent CAS on the right side. Next day, he successfully underwent CABG and CEA on the left side at the same time. A 62-year-old male with severe stenosis of the bilateral ICA and coronary artery disease underwent CAS on the right side and CEA on the left side with an interval of 7 days. Subsequently, CABG was performed uneventfully. No perioperative complication occurred in either patient. The results suggest that combination therapy of CAS and CEA would be a valuable option for patients with complex carotid/coronary artery diseases.

Purpose: The purpose of this study was to evaluate the efficacy of rapid superselective high-dose cisplatin infusion with concomitant radiotherapy for previously untreated patients with advanced head and neck cancer., Methods: Forty-three patients for whom surgery was contraindicated or who rejected radical surgery were given superselective intra-arterial infusions of cisplatin (100-120 mg/m2/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity and conventional extra-beam radiotherapy (65 Gy/26 f/6.5 weeks)., Results: Thirty-nine patients had stage IV disease, and the remaining four had stage III disease. During the median follow-up period of 21 months, the 3-year locoregional progression-free rates of all patients (n = 43) and patients with unresectable disease (n = 24) were 68.9% and 56.4%, respectively. In addition, the 3-year overall survival of all patients and patients with unresectable disease was 54.0% and 39.6%, respectively. Thirty-five patients (81.4%) experienced nonhematologic grade III to IV toxicity, including mucositis (n = 16), nausea/vomiting (n = 8), and neurologic signs (n = 2). No patient died as a result of treatment toxicity. There are 29 surviving patients without evidence of disease, all of whom are able to have oral intake without feeding-tube support., Conclusions: We confirmed the efficacy of superselective arterial infusion and concomitant radiotherapy, which can concentrate the attack of supradose cisplatin on locoregional disease. Even patients with unresectable disease can be cured. Further studies are needed to establish the indications, long-term outcome, and possible late side effects of this treatment., (Copyright 2004 Wiley Periodicals, Inc.)

Cellular resistance to chemotherapeutic agents is attributable to several mechanisms, including alteration of topoisomerase IIa gene expression. Our previous studies have shown that transient transfection with a vector containing either Drosophila or human topoisomerase IIalpha gene into drug-resistant tumor cells enhanced their drug sensitivity. Furthermore, we constructed a recombinant adenovirus, Ad-hTopoIIalpha, containing the human topoisomerase IIa gene that was able to selectively increase etoposide sensitivity in drug-resistant tumor cells. We also examined Ad-hTopoIIalpha for therapeutic efficacy in vitro using additional etoposide-resistant cell lines, including a mouse breast cancer cell line and a human leukemia cell line. The etoposide-resistant mouse breast cancer cell line FvP, which is derived from FM3A, and etoposide-resistant human breast cancer cell line, MDA-VP, which derived from MDA-P cells showed increased sensitivity to etoposide as well as increased expression of human Topoisomerase IIa mRNA, but this was not seen in FM3A and MDA-P cells. On the other hand, the etoposide-resistant human leukemia cell line K562/MX2 and the parental cell line K562/P did not show enhanced sensitivity against etoposide or an increase in human Topoisomerase IIa mRNA. Using a recombinant adenovirus containing beta-galactosidase gene (Ad-beta-gal), K562 cells were not transducted by the recombinant adenovirus, while both etoposide-sensitive FM3A cells and etoposide resistant FvP cells were transducted by recombinant adenovirus. Ad-hTOP2alpha and etopside treatment showed reduced inoculated tumor weight in the mice. We concluded that a recombinant adenovirus containing the human Topoisomerase IIalpha gene might be a powerful tool for overcoming drug resistance in breast cancer cells, but not in leukemia cells.

Background and Purpose: Blood flow of the internal jugular vein and intracranial venous sinuses is affected by respiratory state. The purpose of this study was to clarify the changes in flow velocity and direction and signal intensities of sigmoid sinuses on phase-contrast (PC) MR images obtained with regular breathing and with deep inspiratory breath holding., Methods: One hundred seven subjects without venous sinus abnormality were studied. Coronal 2D PC MR venography and axial 2D PC images with peripheral pulse gating were acquired with a 1.5-T MR unit, during regular breathing and deep inspiratory breath holding. The signal intensity changes of bilateral sigmoid sinuses on MR venograms and the changes of flow velocity and direction on the axial 2D PC images were analyzed., Results: Breath holding decreased signal intensities of the right and left sigmoid sinuses on MR venograms in 57 (53.3%) and 36 (33.6%) subjects, respectively. Increased signal intensity was observed in 12 (11.2%) and 33 (30.8%) subjects, respectively. In the flow analysis, retrograde flow was detected at the left sigmoid sinus in four subjects (3.7%) during regular breathing, which was normalized by breath holding. Flow velocities of the right and left sigmoid sinuses decreased during breath holding in 92 (86.0%) and 70 (65.4%) subjects, and increased in 15 (14.0%) and 37 (34.6%) subjects, respectively., Conclusion: The signal intensities of sigmoid sinuses were affected by breath holding in about 2/3 of the subjects. Breath-holding maneuver can be used to increase blood flow and signal intensities of dural venous sinuses on PC MR venograms.

There is increasing evidence that stenting is a useful strategy for internal carotid artery (ICA) stenosis in patients unfit for drastic surgery. However, it should be remembered that perioperative complications including seizure or intracerebral hemorrhage due to hyperperfusion are not so rare. The authors describe a case with severe ICA stenosis, who successfully underwent stenting as a result of intensive medical care for postoperative hyperperfusion. A 77-year-old man with a recent history of angina pectoris and transient ischemic attack was referred to our hospital. Cerebral angiography showed subtotal occlusion of the left ICA. SPECT/PET studies revealed a disturbed reactivity to acetazolamide and an increase in regional oxygen extraction fraction in the left hemisphere, suggesting a marked reduction in cerebral perfusion pressure. He successfully underwent carotid stenting. Intraoperative near-infrared monitoring showed an increase in the concentration of total and oxidized hemoglobin in the left frontal area after stenting. A SPECT study just after stenting also demonstrated hyperperfusion in the left middle cerebral artery territory. His blood pressure was carefully controlled to avoid "hyperperfusion syndrome" including headache, seizure and intracerebral hemorrhage. Follow-up SPECT/PET studies showed a normalization of hemodynamic and metabolic parameters. SPECT/PET studies are quite valuable to predict and prevent hyperperfusion syndrome after carotid stenting, and result in good clinical outcome.

A new triterpene acid, lucidenic acid P (1a), and two new triterpene acid methyl esters, methyl lucidenates P (1b) and Q (2b), were isolated and characterized from the fruiting body of the fungus Ganoderma lucidum. Their structures were elucidated on the basis of spectroscopic methods. In addition, eight known triterpene acids, lucidenic acids A (3a), C (4a), D(2) (5a), E(2) (6a), and F (7a) and ganoderic acids E (9a), F (10a), and T-Q (11a), and six known triterpene acid methyl esters, methyl lucidenates A (3b), D(2) (5b), E(2) (6b), F (7b), and L (8b) and methyl ganoderate F (10b), were isolated and identified from the fungus. All of the triterpenoids, with the exception of 7a, were evaluated with respect to their inhibitory effects on the induction of Epstein-Barr virus early antigen (EBV-EA) by 12-O-tetradecanoylphorbol-13-acetate (TPA) in Raji cells, which is known to be a primary screening test for antitumor promoters. All of the compounds tested showed potent inhibitory effects on EBV-EA induction (96-100% inhibition at 1 x 10(3) mol ratio/TPA).

Six new rearranged 3,4-seco-tirucallane-type triterpenoids (1-6) have been isolated from the diethyl ether extract of the pollen grains of sunflower (Helianthus annuus). These compounds were evaluated with respect to their inhibitory effects on the induction of Epstein-Barr virus early antigen (EBV-EA) induced by the tumor promoter 12-O-tetradecanoylphorbol 13-acetate (TPA) in Raji cells. All of the compounds tested showed potent inhibitory effects on EBV-EA activation (97-100% inhibition at 1 x 10(3) mol ratio/TPA).

We investigated risk factors for osteonecrosis of the femoral head (ONF) in renal transplant recipients, who are susceptible to the disease. Among 287 renal transplant recipients, 18 ONF patients with enough data were included, and 18 age- and sex-matched recipients without ONF were nominated as reference cases. Risk factors were analyzed using a conditional logistic regression method. There were no differences between the ONF patients and the reference cases regarding the types of immunosuppressant or the donor (living or cadaveric, father or mother, matching blood type and human leukocyte antigens). The daily oral steroid dosage (prednisolone 25.0 mg/day or more) and blood urea nitrogen level 2 months after transplantation were the only factors with relevance to the occurrence of ONF. We propose that oral steroid dosages should be low or reduced after renal transplantation, and acute rejection should be controlled with pulsed therapy.

With advanced organ transplantation technology, steroid-induced osteonecrosis of the femoral head (ONF) is one of the most troublesome complications. Steroid sensitivity varies among individuals, and the involvement of polymorphism of various genes relating to steroid metabolism is suggested. The present study investigated the relation between single nucleotide polymorphism (SNP) on the DNA sequence of cytochrome p(450) and ONF development. The subjects were 80 renal transplant patients. Genome DNA was obtained from the peripheral blood, and SNP analyses for CYP3A4, CYP2D6, and CYP2C19 were conducted using various methods: direct sequencing, polymerase chain reaction restriction fragment length polymorphism, and DNA Chip. The relation between ONF development and SNP was statistically analyzed. It is useful if the generating risk judged according to SNPs to prevention of steroid-induced ONF is possible. This time, SNPs, which are clearly related to ONF, were not accepted, although the possibility that SNP related to steroid metabolism is involved in ONF development is important. We think that it is necessary to examine this area more closely.

Background and Purpose: Our purpose was to evaluate the visualization of the artery of Adamkiewicz (AKA) and the anterior spinal artery (ASA) by using multi-detector row CT. Preoperative detection of the AKA and ASA is important for prevention of ischemic complications of thoracoabdominal aortic surgery., Methods: Data from contrast-enhanced CT of the abdomen of 19 consecutive patients with known or suspected liver disease were evaluated. The scanning range was set from the level of the diaphragm to the lower edge of the liver. After bolus injection of contrast material (100 mL of iohexol, 350 mgI/mL, 5 mL/s), arterial phase scans were obtained by using a four-channel multi-detector row CT scanner. The scanning parameters included a detector row configuration of 4 x 2 mm, a pitch of 5:1, a gantry rotation speed of 0.5 s, 120 kVp, and 150 mAs. Arterial phase coronal multiplanar reconstruction scans obtained parallel to the spinal cord were evaluated by two neuroradiologists. The detectability of ASA and AKA was analyzed., Results: The AKA was visualized on the scans of 13 of 19 patients (68%). The segmental level of AKA origin ranged from T10 to L2. The AKA originated from the left side in nine patients (69%) and the right side in four patients (31%). The ASA was visualized on the scans of all patients (100%). For 16 of the 19 patients, the ASA was detected in its full length from the cranial edge of the scan range. However, the ascending branch of the ASA distal to the junction of the AKA was not detected for the remaining three patients., Conclusion: The AKA and ASA can be visualized by using multi-detector row CT with the use of IV administered contrast material. Multi-detector row CT could be a useful tool in the evaluation of spinal vascular structures.

We radiographically investigated 36 hips in 34 patients with osteoarthritis of the hip who had undergone total hip arthroplasty. Their mean age was 59.2 years (range 36-79 years), and the mean follow-up period was 11.2 years (range 10-14 years). The long-term outcome and the chronological changes in the bulk autograft were examined. The acetabular component of the prosthesis was a Lord-type threaded cup with a smooth surface. At follow-up, bone absorption was minor in 17 joints, moderate in 11, and major in 8. The hips with graft coverage of >==20% (group A) had a significantly higher loosening rate than hips with coverage of <<20% (group B) ( P << 0.05). The cup position changed markedly in group A. Our findings indicate that graft coverage should be less than 20% when a bulk graft is used together with a smooth-surfaced cementless cup.

Bacillus circulans IAM1165 produces isoforms of beta-1,3-glucan-hydrolases. Of these enzymes, the 42-kDa enzyme BgIM degrades Aspergillus oryzae cell walls the most actively. A gene coding for a BgIM precursor consisting of 411 amino acid residues was cloned. The 27 N-terminal amino acid sequence of the precursor is a signal peptide. The 141 C-terminal amino acid sequence showed a motif of carbohydrate-binding module family 13. This domain bound to pachyman, lichenan, and A. oryzae cell walls. The central domain showed a bacterial beta-1,3-glucan-hydrolase motif belonging to glycosyl hydrolase family 16. By removal of the C-terminal domain in the IAM1165 culture, mature BglM was processed to several 27-kDa fragments that hydrolyze a soluble beta-1,3-glucan.