Unilateral acute posterior multifocal placoid pigment epitheliopathy

A 24-year-old woman complained of paracentral scotomas in her left eye. Her visual acuity was good bilaterally. Multifocal, creamy, yellow-white lesions were seen at the level of the pigment epithelium and choroid in the left fundus. Fluorescein angiography showed blockage at the early phase and hyperfluorescence at the late phase in the left eye. The right fundus remained normal during the follow-up period of 1 year. We believe that unilateral acute posterior multifocal placoid pigment epitheliopathy, as found in our patient, may be uncommon.

Modulation of TCR-mediated signaling pathway by thymic shared antigen-1 (TSA-1)/stem cell antigen-2 (Sca-2)

Thymic shared antigen-1 (TSA-1) is a glycosyl-phosphatidylinositol (GPI)-anchored differentiation Ag expressed on murine lymphocytes, and is identical to stem cell Ag-2 (Sca-2). Using newly established mAb against TSA-1/Sca-2, we have previously shown that surface TSA-1 expression is induced upon activation in T cells, and that anti-TSA-1 inhibits IL-2 production induced by anti-CD3 stimulation in T cell hybridomas. In the present study, we have analyzed the functional role of TSA-1 during T cell activation using normal T cells, T cell hybridomas, and transfected Jurkat cell lines that expressed either GPI-anchored or transmembrane form of TSA-1. Anti-TSA-1 inhibited IL-2 production from normal T cells stimulated with soluble anti-CD3 plus accessory cells. Anti-TSA-1 exhibited the inhibitory effect on T cells, but not on accessory cells, because anti-TSA-1 inhibited IL-2 production in Jurkat cells transfected with TSA-1 cDNA, but not in control transfectant. A transmembrane form of TSA-1 was expressed in Jurkat cells by fusing the extracellular portion of TSA-1 to the transmembrane and cytoplasmic regions of the class 1 Db. The analysis using this transfectant revealed that anti-TSA-1-mediated inhibition of IL-2 production did not require the GPI anchor of TSA-1. Finally, in addition to the inhibition of IL-2 production, tyrosine phosphorylation of CD3 zeta-chains observed following TCR stimulation, one of the important early activation events, was markedly reduced by anti-TSA-1. These results imply that TSA-1/Sca-2 plays an important regulatory role in the TCR signaling pathway of activated T cells in addition to its role in T cell differentiation.

Modulation of TCR-mediated signaling pathway by thymic shared antigen-1 (TSA-1)/stem cell antigen-2 (Sca-2)

Thymic shared antigen-1 (TSA-1) is a glycosyl-phosphatidylinositol (GPI)-anchored differentiation Ag expressed on murine lymphocytes, and is identical to stem cell Ag-2 (Sca-2). Using newly established mAb against TSA-1/Sca-2, we have previously shown that surface TSA-1 expression is induced upon activation in T cells, and that anti-TSA-1 inhibits IL-2 production induced by anti-CD3 stimulation in T cell hybridomas. In the present study, we have analyzed the functional role of TSA-1 during T cell activation using normal T cells, T cell hybridomas, and transfected Jurkat cell lines that expressed either GPI-anchored or transmembrane form of TSA-1. Anti-TSA-1 inhibited IL-2 production from normal T cells stimulated with soluble anti-CD3 plus accessory cells. Anti-TSA-1 exhibited the inhibitory effect on T cells, but not on accessory cells, because anti-TSA-1 inhibited IL-2 production in Jurkat cells transfected with TSA-1 cDNA, but not in control transfectant. A transmembrane form of TSA-1 was expressed in Jurkat cells by fusing the extracellular portion of TSA-1 to the transmembrane and cytoplasmic regions of the class 1 Db. The analysis using this transfectant revealed that anti-TSA-1-mediated inhibition of IL-2 production did not require the GPI anchor of TSA-1. Finally, in addition to the inhibition of IL-2 production, tyrosine phosphorylation of CD3 zeta-chains observed following TCR stimulation, one of the important early activation events, was markedly reduced by anti-TSA-1. These results imply that TSA-1/Sca-2 plays an important regulatory role in the TCR signaling pathway of activated T cells in addition to its role in T cell differentiation.

Phylogeny of symbiotic methanogens in the gut of the termite Reticulitermes speratus

The phylogeny of a symbiotic methanogen inhabiting the gut of a lower termite. Reticulitermes speratus, was analysed without cultivation. The small subunit ribosomal RNA gene (ssrDNA) and a 640-bp portion of the gene encoding subunit A of methyl coenzyme M reductase (mcrA) were amplified from a mixed-population DNA of the termite gut by polymerase chain reaction and cloned. The nucleotide sequence of the ssrDNA and the predicted amino acid sequence of the mcrA product were compared with those of the known methanogens. Both comparisons indicated that the termite symbiotic methanogen belonged to the order Methanobacteriales but was distinct from the known members of this order.

A monoclonal antibody against a murine CD38 homologue delivers a signal to B cells for prolongation of survival and protection against apoptosis in vitro: unresponsiveness of X-linked immunodeficient B cells

A novel monoclonal antibody (mAb) was established in an attempt to look for a cell-surface molecule that delivered a signal regulating apoptotic cell death of B cells. Because spleen cells in resting culture die from apoptosis, mAb were looked for that were able to prolong spleen cell survival in vitro. This screening selected mAb CS/2. CS/2 not only prolonged spleen cell survival in vitro, but also protected spleen cells from apoptotic cell death brought about by irradiation or dexamethasone. Moreover, stimulation of spleen cells with CS/2 mAb induced changes of cells to blastoid morphology, and a significant uptake of [3H]thymidine ([3H]TdR). The antigen recognized by CS/2 mAb (CS/2 Ag) was expressed on preB cells, B cells, and Mac-1+ cells. The cells surviving in vitro culture or irradiation in response to ligation with CS/2 mAb were mostly B cells expressing the CS/2 Ag. In addition, B cells from X-linked immunodeficient (XID) mice did not respond to CS/2 mAb. These results indicate that CS/2 mAb is agonistic to B cells, and that XID mice are deficient in this CS/2 mAb-mediated activation pathway. Determination of the amino-terminal 24 amino acid residues revealed that the CS/2 Ag appears to be identical to the CS/2 mAb is directed against a murine CD38 homologue, and suggest a possible role of the murine CD38 homologue in controlling apoptotic cell death of B cells.

Holmium: yttrium-aluminum-garnet laser for endoscopic lithotripsy

OBJECTIVES

To evaluate the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for endoscopic lithotripsy on patients diagnosed with urinary tract calculi.

METHODS

Thirty-eight procedures utilizing transurethral ureterolithotripsy or percutaneous nephroureteral lithotripsy were evaluated: 5 renal calculi, 31 ureteral calculi (most in the upper ureter), 1 ureteropelvic junction calculus, and 1 bladder calculus. These were mainly in cases that, after being treated with extracorporeal shock-wave lithotripsy (ESWL), were contraindicated for further ESWL. Laser parameters included energy of 0.5 to 1.0 J/pulse and pulse rate of 5 to 10 Hz.

RESULTS

Composition of calculi was determined in 26 procedures. The Ho:YAG laser was effective for fragmenting all types of calculi. Patient outcome evaluated at 6 weeks after treatment showed that 33 of 38 procedures (87%) were effective. Residual calculi in 4 of the 5 unsuccessful procedures were less than 5 mm in size and judged to be able to pass spontaneously. In the remaining procedure, the calculus was passed spontaneously 3 months after treatment. No severe damage to tissues or adverse effects to the body were observed due to the Ho:YAG laser.

CONCLUSIONS

On the basis of these results, we determine that this wavelength is effective for lithotripsy in addition to its previously reported usefulness for soft tissue applications, and, thus, is a cost-effective and highly useful clinical device.

Oxidized cholesterol modulates age-related change in lipid metabolism in rats

For three weeks, male Sprague-Dawley rats at either four weeks (young) or eight months (adult) of age were pair-fed one of the purified diets free of or containing either 0.2% of oxidized cholesterol mixture (cholesterol oxidation products) or 0.2% of cholesterol. Although the food intake was similar, dietary oxidized cholesterol lowered body weight gain in young rats, but did not increase relative liver weight, in contrast to the enlargement seen with dietary cholesterol. Oxidized cholesterol, compared to cholesterol, tended to reduce the activity of hepatic 3-hydroxy-3-methylglutaryl CoA reductase and cholesterol 7 alpha-hydroxylase, particularly the latter in aged rats, and prevented the rise in the concentration of liver cholesterol at both ages. It also tended to increase the activity of hepatic delta 6 desaturase, particularly in young rats. Moreover, oxidized cholesterol in relation to cholesterol influenced liver and serum lipid concentrations in different ways, and increased lipid peroxidation at both ages. The ratio of splenic CD4+/CD8+ T-lymphocytes increased with age, but the influence of cholesterol and oxidized cholesterol was comparable. Thus, oxidized cholesterol may specifically disturb growth and age-related changes in the lipid metabolism in rats.

Do structural changes of T cell receptor complex occur in tumor-bearing state?

T cells in tumor-bearing mice and cancer patients were recently shown to be devoid of CD3-zeta chain, a signal-transducing invariant chain in T cell receptor (TCR) complex, and p56lck tyrosine kinase. In the present study, we investigated the structure and function of TCR complex in T cells from BALB/c mice bearing CSA1M fibrosarcoma. The expressions of TCR chains and p56lck in a T cell-enriched population from spleen were analyzed. Almost complete loss of CD3-zeta and p56lck was observed in the preparation from tumor-bearing mice as assessed by immunoblotting analysis using whole cell lysates, whereas the amounts of other TCR chains were relatively unchanged. However, these changes were due to the increase of contaminating Mac-1+ cells in the spleen of tumor-bearing mice because: 1) the removal of Mac-1+ cells led to the restoration of CD3-zeta and p56lck; and 2) CD3-zeta was clearly present when the preparation was solubilized with ionic detergent. Fc receptor gamma chain detected in the preparation from tumor-bearing mice disappeared along with the removal of Mac-1+ cells. These observations were further supported by the finding that addition of Mac-1+ cells from tumor-bearing mice to normal T cells resulted in loss of CD3-zeta, leaving CD3-epsilon largely intact. When T cells from tumor-bearing mice were highly purified by depletion of Mac-1+ cells, these T cells contained normal amounts of CD3-zeta at mRNA, protein, and surface levels, and expressed the properly assembled TCR complex on their cell surface. Moreover, stimulation of the TCR in these T cells by anti-TCR antibodies resulted in a comparable Ca2+ mobilization to that observed in normal T cells. These results suggest that no structural changes occur in TCR complex in our tumor-bearing mice, and that complete depletion of Mac-1+ cells in important to assess the structure of TCR complex.

A case of mitral regurgitation whose nocturnal periodic breathing was improved after mitral valve replacement

Nocturnal periodic breathing (PB) is often observed in patients with congestive heart failure (CHF). We investigated the sleep architecture polysomnographically in a 54-year-old man with CHF due to mitral regurgitation before and after surgical treatment. We found that the overnight frequency of central dominant sleep apnea decreased from 154 to 56, and the lowest nocturnal oxygen saturation increased from 66% to 85% postoperatively. These improvements in the manifestations of PB might be attributed to the improved hemodynamics after successful valve replacement.

MR in temporal lobe epilepsy: early childhood onset versus later onset

PURPOSE

To study the relationship between the MR findings and the clinical features in temporal lobe epilepsy in childhood (less than 10 years of age).

METHODS

MR studies were performed with a 1.5-T imager on 38 temporal lobe epilepsy patients receiving drug therapy at the psychiatric department. These patients were divided into two groups according to their age at onset (10 years or less, 11 years or more). The two groups were compared in terms of the MR findings and clinical features.

RESULTS

The 11 younger-onset patients included 5 with a high-signal area attributed to mesial temporal sclerosis. Clinically, all of these 5 patients had a history of "complex" febrile convulsions, which sharply distinguished them from the older-onset group.

CONCLUSION

The analysis suggests that complex febrile convulsions in infancy can be associated with high-signal areas on MR attributed to mesial temporal sclerosis.

Primary malignant melanoma of the biliary tract

Primary malignant melanoma of the biliary tract is an obscure entity, with only four previously reported cases. We report two cases involving the common bile duct. A 43-year-old male who underwent a right hepatectomy and excision of the extrahepatic biliary tree for a lesion at the bifurcation of the common bile duct. He remains alive and well 11 months after resection. The second patient is a 45 year old male with obstructive jaundice due to an ampullary lesion. Pancreaticoduodenectomy was performed with no signs of metastatic disease. He is 6 years following resection without evidence of disease. This is an unusual cause of obstructive jaundice and a definitive search for a possible extra-biliary primary should be pursued. In appropriately selected patients without evidence of metastatic disease, resection can potentially afford long-term survival if these lesions are true primary lesions and not metastatic from an undefined primary. However, given the high metastatic potential of melanoma it is unclear whether resection of these lesions results in cure or just effective long-term palliation.

Regulatory mechanisms for production of IFN-gamma and TNF by antitumor T cells or macrophages in the tumor-bearing state

Spleen cells from BALB/c mice bearing a syngeneic tumor (CSA1 M) 2 to 3 wk after inoculation with CSA1 M cells produced IL-2, IFN-gamma, and TNF upon in vitro cultures. This was previously demonstrated to be a result of collaboration between tumor-primed CD4+ T cells and APCs binding CSA1 M tumor Ags in vivo. The IL-2- and IFN-gamma-producing capacities decreased with the progress of tumor-bearing stages. This was parallel to the levels of IL-2 and IFN-gamma mRNAs expressed by cultured spleen cells. In contrast, comparable levels of TNF mRNA were expressed by all groups of cultured cells. However, large amounts of TNF were secreted by the cells from early but not from late tumor-bearing mice. TNF was produced mainly by the non-T cell fraction upon stimulation with CD4+ T cell-derived IFN-gamma. Therefore, the reduced TNF production by whole spleen cells from late tumor-bearing mice was restored by addition of rIFN-gamma to their cultures. Reciprocally to the progressive decrease in the production of IFN-gamma/TNF, the capacities of tumor-bearing mice to produce TGF-beta and IL-6 increased along with tumor growth. TGF-beta suppressed production of IL-2, IFN-gamma, and TNF, but not of IL-6. Moreover, IFN-gamma/TNF production was negatively regulated by IL-6. Taken together with the fact that the growth of CSA1 M cells is completely inhibited by the combination of TNF and IFN-gamma, these results demonstrate that the tumor-bearing state induces an abnormal cytokine network under which the production of antitumor cytokines is negatively regulated.

Regulatory mechanisms for production of IFN-gamma and TNF by antitumor T cells or macrophages in the tumor-bearing state

Spleen cells from BALB/c mice bearing a syngeneic tumor (CSA1 M) 2 to 3 wk after inoculation with CSA1 M cells produced IL-2, IFN-gamma, and TNF upon in vitro cultures. This was previously demonstrated to be a result of collaboration between tumor-primed CD4+ T cells and APCs binding CSA1 M tumor Ags in vivo. The IL-2- and IFN-gamma-producing capacities decreased with the progress of tumor-bearing stages. This was parallel to the levels of IL-2 and IFN-gamma mRNAs expressed by cultured spleen cells. In contrast, comparable levels of TNF mRNA were expressed by all groups of cultured cells. However, large amounts of TNF were secreted by the cells from early but not from late tumor-bearing mice. TNF was produced mainly by the non-T cell fraction upon stimulation with CD4+ T cell-derived IFN-gamma. Therefore, the reduced TNF production by whole spleen cells from late tumor-bearing mice was restored by addition of rIFN-gamma to their cultures. Reciprocally to the progressive decrease in the production of IFN-gamma/TNF, the capacities of tumor-bearing mice to produce TGF-beta and IL-6 increased along with tumor growth. TGF-beta suppressed production of IL-2, IFN-gamma, and TNF, but not of IL-6. Moreover, IFN-gamma/TNF production was negatively regulated by IL-6. Taken together with the fact that the growth of CSA1 M cells is completely inhibited by the combination of TNF and IFN-gamma, these results demonstrate that the tumor-bearing state induces an abnormal cytokine network under which the production of antitumor cytokines is negatively regulated.

Lens aplasia: a new mutation producing lens abnormality in the mouse

One female with bilaterally closed eyelids was observed in a breeding colony of BALB/c mice in our laboratories. This eye abnormality was considered to be heritable because offspring with the same abnormality were produced from the mating of this female with a normal male littermate. From the results of various crosses made to determine the mode of inheritance, this abnormality is considered to be attributable to a mutation on a single autosomal recessive gene. Histologic observations of 30-day-old and adult mutant mice revealed various eye abnormalities such as microphthalmia, aphakia, absence of the anterior chamber, dystrophy of the cornea and vitreous body, and retinal disorganization. Observations of fetal eye development from days 9 to 17 of gestation, indicated that the eye developed normally until the start of invagination of the lens placode at day 10. However, formation of the lens vesicle progressed abnormally to form a mass of cells without a cavity at day 11; this mass was reduced in size at day 12 and had vanished by day 13 or 14 of gestation. Also abnormal development was observed in the cornea, vitreous body, or retina after day 12 of gestation. Complementary mating between mice homozygous for this mutation and homozygous aphakia mice, which have similar modes of inheritance and lens development, produced no F1 newborns with abnormal eyes. From these results, the present mutation is considered to be a new one. Because lens development in this mutant is disrupted at an early stage and the anlage vanishes soon after, we propose the name lens aplasia, with the suggested symbol "lap."(ABSTRACT TRUNCATED AT 250 WORDS)

Retinopathy and subconjunctival haemorrhage in patients with chronic viral hepatitis receiving interferon alfa

A total of 43 patients (86 eyes) with chronic viral hepatitis were examined prospectively before and after the start of interferon therapy. Of 37 non-diabetic patients, 23 (group A1) did not have retinopathy or subconjunctival haemorrhage, 11 (group A2) developed retinopathy, and three (group A3) exhibited subconjunctival haemorrhage during the treatment. In most eyes, the retinopathy disappeared after therapy was stopped. Of six diabetic patients, three (group B1) developed retinopathy and three (group B2) showed progression of existing retinopathy. Thrombocytopenia was not associated with the retinopathy in any patient. The patients' good visual acuity remained unchanged, even after retinal changes appeared. Ophthalmologists should be aware that retinopathy and subconjunctival haemorrhage may develop in patients with chronic viral hepatitis receiving interferon therapy.

Recurrent subconjunctival hemorrhages in patients with Fuchs' heterochromic iridocyclitis

We examined two women who had keratic precipitates, minimal intracameral cells and flare, diffuse iris stromal atrophy, posterior subcapsular cataract, and vitreous opacities in their left eyes. No ocular pain, photophobia, or posterior synechia was noted. Their right irises appeared brown. Heterochromia was evident in both patients. Recurrent subconjunctival hemorrhages were also in their affected left eyes. It is possible that subconjunctival hemorrhages in our patients may be associated with Fuchs' heterochromic iridocyclitis.

Cervical cytology and conservative management of cervical neoplasias during pregnancy

To elucidate the clinical significance of cervical cytology during pregnancy, 7,725 pregnant women were examined. Abnormal cytologic findings were recorded in 65 cases (0.8%). Colposcopically directed punch biopsies revealed cervical dysplasia and carcinoma in 27 cases (0.35%). The incidences in a massive examination for 714,119 women in Osaka Prefecture were 1.1% and 0.25%, respectively. Cytologic findings of the patients with cervical neoplasia during pregnancy agreed well (76%) with their histologic findings. Colposcopically, the squamo-columnar junction was visible in many cases, and white epithelium was most commonly observed during pregnancy. Pre- and postpartum follow-up study revealed that progression from dysplasia was seen only in two (20%) of 20 cases. Laser conization was performed on six women during pregnancy, and four were microinvasive carcinoma, all of which underwent normal vaginal delivery without any complication from conization. These results suggest that routine cervical cytology must be performed during pregnancy, and cytologic and colposcopic diagnosis may supply enough data to avoid unnecessary biopsies. Moreover, laser conization is recommended as an excellent diagnostic and therapeutic procedure for women with microinvasive carcinoma during pregnancy.

HLA antigens in a Japanese family with Behçet's disease

BACKGROUND

Familial Behçet's disease is rare.

METHODS

HLA antigens in a Japanese family with Behçet's disease were examined.

RESULTS

The affected patients had HLA B51, and unaffected family members also had the same antigen.

CONCLUSION

It is likely that not only HLA B51 but also other factors may be involved in the pathogenesis of Behçet's disease in Japanese patients.

Reversible proliferation arrest of rat 3y1 fibroblasts and selective killing of simian-virus transformed derivation of 3y1 by short-chain Fatty-acids

We examined the effect of saturated fatty acids with carbon number from 2 to 10 on proliferation and survival of rat untransformed fibroblast 3Y1 cells and its transformed derivation induced by Simian virus 40 (SV-3Y1). Acetic acid (C2) had no effect on proliferation of these cells. Among medium-chain fatty acids (C6-C10), caproic acid (C6) showed the lowest proliferation inhibitory effect. Caprylic (C8), pelargonic (C9), and capric acid (C10) exerted killing activity to both 3Y1 cells and SV-3Y1 cells, and the toxicity increased with the elongation of their alkyl chains. The toxicity was a little greater to 3Y1 cells than to SV-3Y1 cells. In contrast, short-chain fatty acids caused reversible proliferation arrest in 3Y1 cells at 25 mM in propionic (C3), 5 mM in butyric (C4) and 10 mM in valeric (C5) acids. These short-chain fatty acids arrested 3Y1 cells not only in the GI phase but also in the G2 phase of the cell cycle. To SV-3Y1 cells, however, these short-chain fatty acids were cytotoxic. The cytotoxicity to SV-3Y1 cells was the greatest in butyric acid among short-chain fatty acid tested. These results suggest that short-chain fatty acids exert ploliferation-arresting activity against normal cells while exerting killing activity to the transformed cells.

Breast reconstruction

Breast reconstruction after mastectomy is becoming more common despite the general trend toward breast conserving therapy with lumpectomy and radiation. Reconstruction at the time of mastectomy can be done safely and eliminates the disadvantages associated with a second operation under general anesthesia. There are also some psychologic benefits to immediate reconstruction. Autologous reconstruction with flap tissue usually is preferred by the authors. In a woman with small breasts or when autologous tissue is not available, a prosthetic reconstruction is an acceptable choice. The authors prefer the use of textured saline implants in a submuscular position. Nipple and areola reconstruction is performed at least 3 months later as an outpatient procedure under local anesthesia. In 216 consecutive patients with immediate reconstruction, the patients with autologous reconstruction with transverse rectus abdominis or latissimus dorsi flaps ranked their level of symmetry as well as their level of overall satisfaction significantly higher than did the patients with prosthetic reconstruction. Similarly, the surgeons ranked the results from the autologous reconstructions higher. In the patients who underwent autologous reconstruction, 6% had necrosis of a significant portion of the flap. Prosthetic reconstructions were complicated by infections, hematomas, and chest-skin necrosis, resulting in removal of the implant in a total of 8% of the patients in this group. Thirty-four percent of the patients received adjuvant chemotherapy, and the reconstructive surgery did not result in a delay of the onset of this treatment. The authors conclude that breast reconstruction is a safe procedure with an acceptable morbidity when done either as an immediate or a delayed procedure. Patient satisfaction rates are high, particularly with autologous reconstructions.