Sequential occurrence of hepatocellular carcinoma following Waldenström's macroglobulinemia: the pathogenetic role of chronic liver disease

We report a case of sequential occurrence of hepatocellular carcinoma (HCC) following Waldenström's macroglobulinemia (WM) in the course of chronic liver disease. The diagnosis of WM was made in a 55-year-old man with a history of alcohol abuse. He developed HCC in the course of WM, and hepatitis C virus (HCV) infection was detected by enzyme-linked immunosorbent assay. Recent reports suggest that persistent HCV infection is related to the pathogenesis of B cell malignancy. Chronic liver disease may be associated with the pathogenesis of the double malignancies in the present case.

Targeted cancer chemotherapy with arterial microcapsule chemoembolization: review of 1013 patients

To evaluate the feasibility of intraarterial infusion of microencapsulated anticancer drugs (chemoembolization), collective data on 1013 cancer patients were reviewed. Ethylcellulose microcapsules containing mitomycin C (median total dose 20 mg), cisplatin (60 mg) or peplomycin (40 mg) were given to tumor-feeding arteries by bolus infusion in 79% of the patients and by fractionated infusion in the others, as a palliative (71%) or preoperative measure (29%). The target sites were the liver (42%), kidney (24%), intrapelvic organs (18%), lung (4%), head and neck (3%), bone (1%) and others (9%), excluding the central nervous system and gastrointestinal tract. The incidence of overall adverse effects ranged from 0.2 to 54.9%, but grade 2-3 hematological, renal and hepatic toxicities, local pain, abdominal discomfort, cutaneous reaction, remote embolization and infection were < 10%. Nine patients (0.9%) in the early stages of trials suffered serious complications including treatment-related death in two with critical underlying diseases of the target organs. The remaining patients recovered from the adverse effects, except for grade 2 cutaneous reactions, within 2 months by routine palliative measures. A > or = 50% tumor reduction was seen in 28% of 427 evaluable tumors (42% for < 25-cm2 tumors and 20% for > or = 25-cm2 tumors) with a median treatment number of one. The response rate depended on both the tumor size and the treatment number (P < 0.05), but it was not affected by prior therapies. Mitomycin C microcapsules produced a higher response rate. Complete or partial remission of intractable pain and genitourinary gross hemorrhage was found in two-thirds of eligible patients. The results indicate that this treatment modality, though restricted by catheter technique, can be applied to various tumor lesions with an acceptable morbidity and prospective trials are justified to evaluate the potential role of such a targeted chemotherapy.

[Retrospective analysis on 21 patients with follicular lymphoma]

We retrospectively analyzed the clinical data of the 21 patients with follicular lymphoma admitted to our institution from 1977 to 1994. The frequency of follicular lymphoma was 9.1% in the 231 patients with non-Hodgkin's lymphoma. Overall survival rates at 1 year, 3 years, and 5 years were 90.2%, 78.2%, and 52.1%, respectively. The median follow-up of surviving patients and time to treatment failure (TTF) was 43 months and 30 months, respectively. The median time from disease progression to death was 171 days. In univariate analysis, factors associated with poor survival were stage IV (Ann Arbor staging system), anemia (hemoglobin level less than 10g/dl), bone marrow involvement, two or more extranodal sites, and failure in induction of complete remission (CR) in the entire course. Factors associated with short TTF were anemia, bone marrow involvement, and failure in induction of CR. In multivariate analysis, induction of CR affected survival and TTF independently.

Studies on the ileum-contracting mechanisms and identification as a complement C3a receptor agonist of oryzatensin, a bioactive peptide derived from rice albumin

Oryzatensin (Gly-Tyr-Pro-Met-Tyr-Pro-Leu-Pro-Arg) is an ileum-contracting and immunostimulating peptide derived from rice albumin. The mechanisms for the ileal contraction that it induces, consisting of rapid and slow components, were examined. The rapid contraction was mediated by histamine release and the slow contraction by a prostaglandin E2-like substance, judging from the effects of various pharmacological inhibitors and antagonists on ileal contraction and titration of histamine release. The contractile profile was very similar to that of human complement C3a(70-77), which is the COOH-terminal octapeptide of C3a and has, although less potent, qualitatively the same biological activities as C3a. Oryzatensin showed homology with C3a(70-77) and affinity for C3a receptors (IC50 = 44 microM) by radioreceptor assay. This is the first report of a food-derived bioactive peptide acting through complement C3a receptors.

Vasorelaxation by casomokinin L, a derivative of beta-casomorphin and casoxin D, is mediated by NK1 receptor

Casomokinin L (Tyr-Pro-Phe-Pro-Pro-Leu), a derivative of beta-casomorphin and casoxin D, showed endothelium-dependent vasorelaxing activity on the canine mesenteric artery (EC50 = 7 x 10(-8) M). This relaxing activity was partly blocked by 10(-5) M NAME (nitric oxide synthase inhibitor), and the inhibition by NAME was restored by addition of 10(-4) M arginine, suggesting the involvement of nitric oxide as an endothelium-dependent relaxing factor. The relaxing activity was blocked by 10(-8) M CP-99994 and 10(-7) M FK888 (NK1 antagonists), but not by 10(-6) M SR-48968 (NK2 antagonist). Casomokinin L binds to neurokinin NK1 receptors (Ki = 5.8 x 10(-5) M), and lowered blood pressure in SHR (0.1 mg/kg, i.v. and 3 mg/kg, PO). Thus, despite its only three residues in common with substance P, casomokinin L binds to NK1 receptors, relaxes the artery, and exerts an antihypertensive effect.

Potentiation of the antihypertensive activity of orally administered ovokinin, a vasorelaxing peptide derived from ovalbumin, by emulsification in egg phosphatidylcholine

Ovokinin, a vasorelaxing octapeptide derived from ovalbumin, significantly lowered the systolic blood pressure of spontaneously hypertensive rats (SHR) when orally administered as an emulsion in 30% egg yolk at a dose of 25 mg/kg, this effect being larger than that of the peptide administered as a solution at a dose of 100 mg/kg. Egg phospholipid, especially phosphatidylcholine, showed essentially the same effect as egg yolk. However, egg neutral lipid was ineffective. Soybean phospholipid was less effective than egg phospholipid in potentiating the antihypertensive activity of ovokinin.

Sonographic findings in muscle strain injury: clinical and MR imaging correlation

Both sonography and magnetic resonance imaging were performed in 57 patients with clinically suspected strain injury in lower extremity muscles. Sonography demonstrated normal findings in nine patients (16%), hyperechoic infiltration in 31 patients (54%), mass in nine patients (16%), and compound lesions of infiltration and mass in eight patients (14%). Clinically grade 2 lesions ranged from small infiltration to large compound lesions on both sonography and magnetic resonance imaging. Hyperechoic infiltration was not demonstrated on T1-weighted magnetic resonance images and with less than 50% cross-sectional muscle involvement. The mass and compound lesions were ascertained to be moderate or severe injury because the masses of the lesions had obvious hemorrhage or hematoma on magnetic resonance images.

N-glycosylation-defective receptor for erythropoietin can transduce the ligand-induced cell proliferation signal

Erythropoietin receptor (EPOR) contains a single N-linked sugar in an extracellular domain. It has been suggested that an erythroleukemia cell line with high sensitivity to EPO expresses a high molecular mass form of EPOR, which appears to be a highly N-glycosylated form responsible for EPO-mediated signal transduction [Sawyer and Hankins (1993) Proc. Natl. Acad. Sci. USA 90, 6849-6853]. To examine the role of the N-linked sugar chain, we prepared EPO-dependent cell lines expressing the wild-type EPOR and N-glycosylation-defective EPOR. There was little difference in the expression of EPOR on the cell surface, EPO binding kinetics, and EPO-induced cell proliferation between the clones expressing the mutant EPOR and those expressing the wild-type EPOR.

Methicillin-resistant Staphylococcus aureus: colonization and development of infection in patients with haematological disorders

A retrospective study of 53 patients with haematological disorders whose bacterial cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA), was performed to analyse the risk factors for MRSA infection, and the prognostic factors. Sixteen patients showed colonization by MRSA but never developed infection(C), 16 showed colonization and subsequent infection(C-I), while 21 had MRSA infection at the time of first culture (I). Poor performance status, thrombocytopenia, increased serum urea nitrogen and decreased serum cholinesterase were more prominent in (I) than (C) + (C-I). The risk factors associated with the development of infection from colonization were age and serum cholinesterase. In addition, lower respiratory tract infection as a type of infection, non-remission status of the haematological malignancy and an inappropriate antibiotic therapy were associated with a poor prognosis for MRSA infection.

[Geographical epidemiologic studies on factors associated with centenarians in Japan]

To explore factors associated with longevity, we studied geographic distribution of centenarians in Japan, based on 1990 the population census. We calculated the proportion of centenarians from ratio of number of centenarian to that of population aged 65 years or older. Centenarians in Japan consisted of number 4,152 persons. By prefecture, Tokyo had the most centenarians (383), followed by Okinawa (193) and Fukuoka (151) prefectures. Fukui had the least (24), followed by Akita (26) and Ishikawa (29) prefectures. The proportion of centenarians in Japan was 21.6 (per 100,000 populations) in 1990. By prefecture, the highest proportion lived in Okinawa (133.8), whereas the fewest were found in Akita (8.9). The relationship between geographic distribution of centenarians and environmental factors and nutritional factors were analyzed. Correlation coefficients between proportion of centenarians and mean temperature, high quality of welfare work and of medical services, and having much leisure time were positively significant. As for nutritional factor, correlation coefficients between proportion of centenarians and protein (% of energy) was positively significant, while intake of total energy was negatively significant.

The extracts from rat submandibular glands induce the erythroid differentiation of K-562 cells

The extracts from rat submandibular glands (SMGs) induced erythroid differentiation of K-562. The activity was non-dialysable and abolished by heat, trypsin or 2-mercaptoethanol. Follistatin, which neutralizes the erythroid differentiation factor (EDF), had no effects on this activity. Analysis by gel chromatography and polyacrylamide gel electrophoresis-isoelectric focussing showed that the characteristics of this substance were different from those of erythropoietin, TGF-beta 1, EDF, stem cell factor and insulin-like growth factor-1. These results suggest the presence of a novel substance in rat SMGs which induces erythroid differentiation of K-562.

[A case of optic neuropathy, recurrent transverse myelopathy and hypertrophic pachymeningitis associated with perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA)]

A 77-year-old woman developed recurrent transverse myelopathy of the thoracic cord about a year after acute retrobulbar optic neuropathy on the left. Neurological examination revealed paraplegia, total sensory loss down from the level of the sixth thoracic cord and sphincteric disturbances. Her clinical features resembled multiple sclerosis, but magnetic resonance imaging (MRI) of the brain and spinal cord revealed no evidence of demyelination or inflammation. MRI of the brain showed the tentorium cerebelli on the right of low signal in T1- and T2-weighted images with marked enhancement by gadolinium, indicating pachymeningitis. Characteristically, perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) together with antinuclear antibody was positive, whereas lupus anticoagulant and anti-cardiolipin antibody were negative. A high dose of corticosteroid including pulse therapy did not improve her symptoms. In the present case, the optic neuropathy, recurrent transverse myelopathy and hypertrophic pachymeningitis may have been caused by some common inflammatory processes related with p-ANCA.

[A case of late-onset tethered cord syndrome presenting with spastic paraparesis]

We report a patient with late-onset tethered cord syndrome who presented with slowly progressive spastic paraparesis. Final diagnosis was made with spinal MRI. A 55-year-old man developed disturbance in gait at 52 years. He had severe congenital scoliosis of the thoracic spine and skin anomaly and hypertrichosis in the midline of the sacral region. His feet revealed pes equinovarus and pes cavus. Deep tendon reflexes in the lower extremities were hyperactive with positive Babinski signs. Vibration sense was diminished in the lower extremities. He had sexual impotence but no vesical or rectal disturbances. The plain X-rays revealed scoliosis at the fourth and fifth thoracic vertebrae, multiple costal fusion from the fourth through the eighth ribs on the left, and spina bifida occulta at the lumbosacral vertebrae. On MRI, the conus was tethered downward at the level between the forth and fifth vertebral bodies, and a thickened filum terminale connected the conus with a coccygeal cyst. Tethered cord syndrome, though rare in adults, should be differentiated from other diseases which produce late-onset spastic paraparesis, and MRI of the lumbo-sacral region is very useful for its diagnosis.

[A case of adrenal angiosarcoma]

A 62-year-old male with slight fever, anorexia and easy fatigability was found to have a tumor in the left adrenal gland by computed tomogram of abdomen. Further study of angiogram suggesting neoplasm of the left adrenal gland, eventually he was underwent surgical extirpation. Histological study, combined with immunohistochemical staining, revealed that the tumor measuring 8 x 4 x 6 cm was an angiosarcoma. The patient died of pulmonary dysfunction 42 days after the operation. Autopsy was not done. In the literature, 7 cases of adrenal angiosarcoma have been reported; ours is the 8th case.

Site-directed mutation in conserved anionic regions of guinea pig liver transglutaminase

Transglutaminases (EC 2.3.2.13) catalyze the formation of epsilon-(gamma-glutamyl) lysine cross-links and the substitution of primary amines for the gamma-carboxamide groups of protein-bound glutamine residues. There are conserved anionic regions in transglutaminases, some of which are thought to be possible calcium-binding sites. By site-directed mutagenesis, three mutant forms of recombinant guinea-pig liver transglutaminase, in which some acidic amino acid residues in two conserved regions became nonionic, were expressed in Escherichia coli: TGM1, with Asp-231 and -232 changed to Asn; TGM2, with Glu-445, -448, -449, -450, and -452 changed to Gln; and TGM3, with the mutations of both TGM1 and TGM2. The size and level of synthesis of the mutant proteins were unchanged when monitored by immunoblotting. All mutants retained enzyme activity, and their apparent Km values for substrates during histamine incorporation into acetyl alpha s1-casein were similar to those of the wild-type enzyme, but their Vmax values were smaller. The deamidation rate of glutamine residues in the acetyl alpha s1-casein was unaffected, but the rate of protein cross-linking catalyzed by these mutants was very low. All mutations caused with the enzyme a decrease in the sensitivity to activation by calcium and an increase in the sensitivity to inhibition by GTP. These results indicated that the negative charges of some acidic amino acid residues in the two conserved anionic regions of transglutaminase are not essential for its activity but the loss of their negative charges affects some catalytic properties.

Isolation, characterization and expression of cationic peroxidase isozymes released into the medium of cultured tobacco cells

Three glycoproteins of 34, 38 and 40 kDa were isolated from the spent medium of suspension-cultured tobacco cells. The 38-kDa and 40-kDa proteins were highly cationic peroxidases with indistinguishable enzymic properties but their structural difference was confirmed by sequence analysis of the amino-terminal regions and the recognition specificity of monoclonal antibodies. The 34-kDa protein was a moderately cationic peroxidase with enzymic properties quite different from those of the 38-kDa and 40-kDa enzymes. They were undetectable in the spent medium during the cell-proliferation phase but became abundant in the medium during the cell-expansion phase. This was confirmed quantitatively with the 40-kDa protein using the 40-kDa-specific monoclonal antibody. The mRNA expression for 40-kDa protein was at a constant basal level in the cell-proliferation phase but increased in the cell-expansion phase.

Characterization of a human glycoprotein (erythropoietin) produced in cultured tobacco cells

Erythropoietin (Epo), a glycoprotein that regulates the formation of erythrocytes in mammals, was produced in cultured tobacco BY2 cells (Nicotiana tabacum L. cv. Bright Yellow 2) by introducing human Epo cDNA via Agrobacterium tumefaciens-mediated gene transfer. Epo was correctly processed and subsequently penetrated the plasma membrane of tobacco cells. However, it remained attached to the cell wall and was not released into the culture medium. Although Epo produced by tobacco cells was glycosylated with N-linked oligosaccharides, these carbohydrates were smaller than those of the recombinant Epo produced in mammalian cells. Epo produced in tobacco exhibited in vitro biological activities by inducing the differentiation and proliferation of erythroid cells. However, it had no in vivo biological activities. A lectin-binding assay indicated the lack of sialic acid residues in the N-linked oligosaccharides of Epo, suggesting that Epo was removed from the circulation before it reached erythropoietic tissues.

[Biochemical markers of multiple myeloma]

Biochemical markers of multiple myeloma (MM) including beta 2-microglobulin (beta 2MG), C-reactive protein, neopterin, fibronectin, lactate dehydrogenase (LDH), thymidine kinase, connective tissue components, osteocalcin, amylase, etc. are reviewed. To date, no reliable biochemical markers have been reported for the diagnosis of MM. beta 2MG and LDH are widely used to predict the prognosis of the patients with MM. The value of other parameters is however, controversial. The cytochemical diagnosis of MM, using acid phosphatase, beta-glucronidase and lysozyme are also mentioned. Furthermore, the significance of the assay of various hormones, ammonia, cobalamin and electrolytes in MM are discussed.

[The relationship between serum dehydroepiandrosterone sulfate levels and factors associated with cardiovascular diseases: a cross-sectional study in Japan]

To explore the relationship between serum DHEAS levels and blood pressure, obesity, smoking habits and drinking habits associated with onset of cardiovascular disease, we examined serum DHEAS levels in 90 males and 183 females, aged 35 to 62 years, who participated in a mass health examination conducted in a town of Aichi prefecture in 1992. The results were as follows. 1. Serum DHEAS levels were significantly higher in males than in females and decreased with age both sexes. 2. Age-adjusted serum DHEAS levels for both sexes decreased with blood pressure and BMI. 3. There were no apparent significance between age-adjusted serum DHEAS levels and smoking habits, whereas age-adjusted serum DHEAS levels were higher in groups of intake of ethanol volume 1-29 g/day than in the groups of intake of more than and less than ethanol volume 1-29 g/day. 4. Age-adjusted serum DHEAS levels were significantly decreased with the rise of sum of factors chosen as risk factor of cardiovascular disease disease in this study. It was suggested that serum DHEAS levels might be useful as an index of accumulation of risk factors of cardiovascular disease. Further studies should be performed to establish the possibilities as an index of genesis and prevention of cardiovascular disease.