[A study of falls among elderly living in the community]

This study was conducted to mainly investigate the causes of falls among elderly living in the community and also to clarify the status of the elderly one year after they experienced falls. Subjects who had lived in Koga city, Ibaraki prefecture were chosen. An average age of the subjects (n = 132) was 73.7 +/- 6.4 years. Self administrated questionnaire was employed. The main results were obtained as follows. 1) The average of the falls of a subject for the past one year was 1.75 +/- 2.40 times. About 70 percent of the falls occured outdoor. About 70 percent of the causes of the falls were extrinsic. 2) The higher injuries frequency occured among those who got medical treatment. Diuretic and hypotensive drugs occupide the major two kinds of all. 3) The physical symptoms such as pains, fatigues, walking problems, as well as less active behavior characterized those who experienced the fall-caused external injuries. The falls triggered off deteriorating the elderly's healthy physical status. It was suggested that nursing intervention was very important to prevent falls among elderly in the community to maintain their quality of life (Q.O.L).

A case of fatal infectious mononucleosis presenting with fulminant hepatic failure associated with an extensive CD8-positive lymphocyte infiltration in the liver

We describe a fatal case of infectious mononucleosis presenting with fulminant hepatic failure associated with extensive CD8-positive lymphocyte infiltration and diffuse karyorrhexis in the liver. Immunohistochemical analysis of mononuclear cells showed that Leu-2a (CD8)-positive lymphocytes were heavily distributed in the portal areas and the sinusoidal spaces, but Leu-3a (CD4)-, Leu-14 (CD22)-, or My 4 (CD14)-positive cells were undetectable in sections of the liver. Southern blot hybridization studies disclosed the presence of Epstein-Barr virus DNA fragments in the liver tissue. The unusual pathologic and immunologic responses observed in this case could not simply be explained by severe Epstein-Barr virus infection. Some superimposed factors should be considered.

Stability of liposomes in vitro and their uptake by rat Peyer's patches following oral administration

To evaluate the usefulness of liposomes as a carrier for the targeted delivery of antigens to gut-associated lymphoid tissue, liposomal stability and uptake by rat Peyer's patches were investigated. Liposomes composed of distearoylphosphatidylcholine, phosphatidylserine, and cholesterol (DSPC-liposome), or dipalmitoylphosphatidylcholine, phosphatidylserine, and cholesterol were stable in acidic solution (pH 2.0), diluted bile, and pancreatin solution. Following the oral administration of liposomes to rats, rhodamine B-PE incorporated in the lipid phase of DSPC-liposomes was preferentially taken up by Peyer's patches in the lower ileum. The uptake of rhodamine B-PE from DSPC-liposomes larger than 374 nm in mean diameter was high. Orally administered DSPC-liposomes of a large diameter thus appear to serve effectively as a vehicle for delivering antigens to Peyer's patches.

Contribution of N-acetyl-beta-D-galactosamine-specific lectin to Fc receptor-mediated phagocytosis by mouse peritoneal macrophages

The contribution of lectin-like receptors on the cell surface of mouse peritoneal macrophages to the process of phagocytosis of IgG-coated sheep red blood cells (SRBC) through Fc receptors has been investigated. Phagocytosis was activated by conditioned medium containing modified vitamin D3-binding protein (DBP) prepared by the incubation of foetal calf serum (FCS) with lysophosphatidyl-choline-treated splenic non-adherent cells. Fc receptor-mediated phagocytosis of opsonized SRBC was specifically inhibited by the addition of N-acetyl-beta-D-galactosamine. The binding of modified Gc globulin, human DBP, to peritoneal macrophage was only inhibited by the addition of N-acetyl-beta-D-galactosamine, and was dependent on N-acetyl-beta-D-galactosamine concentration. In the presence of cycloheximide, activated phagocytosis was reduced to control levels. By Scatchard plot analysis of binding studies, the number of Fc receptors of macrophages which were activated by conditioned medium increased 3.6-fold in comparison to that of control macrophages. These findings suggest that lectin-like receptors having a specificity to N-acetyl-beta-D-galactosamine are involved in activating the process of Fc receptor-mediated phagocytosis of opsonized SRBC by macrophages, and that modified DBP promotes the synthesis of Fc receptors through the N-acetyl-beta-D-galactosamine-specific lectin on macrophage surface.

Immunophenotypic and molecular analysis of a case of lymphocytic interstitial pneumonia

A case of lymphocytic interstitial pneumonia was studied immunophenotypically and with molecular methods in order to clarify its lymphocytic clonality. The patient, a 43 year old Japanese female, underwent lobectomy for a suspected malignant lymphoma as no clear diagnosis could be made from the biopsy specimen. An ill-demarcated, yellowish and elastic firm lesion measuring 60 x 35 x 20 mm in size was located in the peripheral part of the middle lobe of the right lung. Histologically, the alveolar, peribronchial-vascular and subpleural interstitia within the lesion were thickened markedly with severe cellular infiltration largely composed of small lymphocytes with germinal centers. Immunostaining revealed immunoglobulin (Ig) kappa and Ig lambda-bearing cells to be evenly distributed, suggestive of polyspecificity. Immunoglobulin gene analysis further demonstrated the unrearranged germ-line DNA but no rearranged band. These results strongly indicated a reactive process rather than a neoplastic nature for the lesion.

Uptake of phosphatidylserine liposomes by rat Peyer's patches following intraluminal administration

Uptake of the nonabsorbable marker 6-carboxyfluorescein was investigated both free and encapsulated in liposomes as a function of their surface charge and hydrodynamic diameter in rat Peyer's patch and nonpatch tissue. Significant uptake of the marker occurred only when encapsulated in liposomes consisting of at least 25 mol% phosphatidylserine and was highest in Peyer's patches. 6-Carboxyfluorescein encapsulated in liposomes equal to or greater than 374 nm was preferentially taken up by Peyer's patches. There was a trend to higher uptake in lower intestinal segments. These findings were supported by fluorescence microscopic observations. Uptake by Peyer's patches was specific for negatively charged liposomes as judged from competition studies.

Subacute panencephalitis associated with chronic graft-versus-host disease

A unique form of subacute panencephalitis developed in a child with aplastic anemia 8 months after an allogeneic bone marrow transplantation (BMT). It was characterized by parenchymal infiltration of CD3 lymphocytes, a marked increase in the number of microglia strongly expressing HLA-DR antigens in both the gray and white matter, and diffuse degeneration of the cerebral white matter. The onset of neurological symptoms coincided with the development of chronic systemic graft-versus-host disease (GVHD). Cellular infiltrates in the CNS lesions were exclusively CD3 lymphocytes intermingled with a small number of monocytes labeled with CD68. There was a preponderance of cells of the CD45RB phenotype. The pathological changes in visceral organs were consistent with those of chronic GVHD. In addition, scrutiny of immunohistochemistry disclosed sparse infiltration of CD3 lymphocytes and diffuse gliosis in the cerebral white matter of another child with chronic GVHD who died 9 months after allogeneic BMT. These cases are suggestive of a potential risk of CNS involvement in GVHD.

Enhancement of systemic and mucosal immune responses following oral administration of liposomes

The effects of liposomes on the systemic and mucosal immune response were investigated using bovine serum albumin (BSA) in BALB/c mice. Following three oral administrations of varied formulations at 1-week intervals, serum BSA-specific IgG levels were increased significantly by BSA encapsulated in liposomes and moderately by a mixture of liposomes and BSA. Serum and salivary BSA-specific IgA levels were elevated by BSA-encapsulating liposomes only. Liposomes thus activate not only the systemic immune response but also the mucosal immune response following their oral administration. However, no increase in salivary IgA levels was observed by intraperitoneal or subcutaneous injection of BSA-encapsulating liposomes. The production of IgA is closely related to the oral administration of liposomes encapsulating antigens. Liposomes thus function as carriers of oral vaccines against various infections of the mucosal surface.

[Postoperative recurrence form of Crohn's disease: comparison between perforating and non perforating types]

Postoperative recurrence rate and recurrence form were analyzed in two clinical forms of Crohn's disease at primary resection, one of which was perforating and the other was non perforating. Forty four patients with Crohn's disease were included in this study, 18 of them were perforating type and 26 were non perforating type. Crude recurrence rates were 39% (7/18 cases) in perforating type group and 54% (14/26 cases) in non perforating type group, which were not significantly different. Cumulative recurrence rates 5 years after initial operation were 58% in perforating type group and 47% in non perforating group without statistically significance. The recurrence form was perforating type more frequently in perforating type group (86%) than non perforating group at primary resection (29%) with statistically significance (p = 0.013). Postoperative recurrence form had a tendency to be similar to the form at primary resection. It was suggested from this study that Crohn's disease had two different disease entities; perforating and non perforating types and that postoperative recurrence should be examined carefully from the view of primary resection.

[A case of testicular choriocarcinoma achieving pathological complete response by "COMPE" chemotherapy, consisting of cisplatin, vincristine, methotrexate, peplomycin, and etoposide]

We report a case of pure choriocarcinoma of the left testis in a 27-year-old male. He consulted a physician with left back pain in August, 1990. Intravenous pyelography (IVP) revealed left hydronephrosis. Abnormal computerized tomography (CT) revealed para-aortic lymph node swelling. The chest X-ray revealed bilateral multiple coin lesions. The genital examination revealed a left testicular nodule 8 mm in diameter. Left high inguinal orchiectomy was performed. Histopathological diagnosis was pure choriocarcinoma. After 4 courses of the PVB (cisplatin, vinblastine, bleomycin) therapy, tumor regression rate of the pulmonary metastases was 41.9%. He was transferred to our hospital on December 3, 1990 and was admitted 3 days later. "COMPE" chemotherapy, consisting of cisplatin, vincristine, methotrexate, peplomycin, and etoposide, was administered. After seven courses of "COMPE" chemotherapy, he achieved a partial response (the regression rate of the pulmonary metastases and the retroperitoneal lymph node metastasis were 78.8% and 69.1%, respectively) and the residual masses in the lungs and the retroperitoneum were removed. Necrosis and xanthogranulomatous fibrosis were found in the resected material. The patient showed no evidence of disease one year after thoracotomy.

The body surface QRST isointegral maps in infants with right ventricular overload

Electrocardiographic criteria for right ventricular (RV) hypertrophy in infants generally exhibit low sensitivity in terms of diagnostic accuracy. We studied the QRST isointegral map (QRST-Imap) of body surface potential distribution for the diagnosis of RV overload in patients less than 2 years old. Patients with atrial septal defect (ASD), pulmonary stenosis (PS) and tetralogy of Fallot (TOF) were examined (RV overload group) and the findings of their QRST-Imaps were compared to those of age-matched healthy infants (NOR). QRST-Imaps in RV overload showed abnormal findings, with two maxima or a rightward shift of the maximum with increased amplitude, in contrast to one maximum at the left anterior chest with a single dipole pattern in the NOR group. ASD patients had two maxima with a decreased integral value between them. In PS, two maxima were also observed, with increased integral values of the right maximum as the RV systolic pressure was elevated. TOF patients showed a single maximum shifted to the anterior median line with increased amplitude. These results indicate that the findings of QRST-Imaps are of value in detecting the presence and pattern of RV overload in infants.

Primary squamous cell carcinoma of the breast in a pregnant woman: report of a case

Although reports on primary squamous cell carcinoma of the breast have been increasing in number, the morbidity rate of the disease is comparatively low. Its onset in pregnant women, especially, is quite rare. We herein report a case of primary squamous cell carcinoma of the breast in a pregnant woman. A 33-year-old woman was admitted with a lump in the right breast and an abnormal bloody nipple discharge. The breast mass was 5.6 x 5.4 cm in size, and both ultrasonogram and CT scanning showed that it consisted of a cystic tumor for the most part. A large amount of bloody cystic fluid was aspirated by fine-needle aspiration; squamous cell carcinoma of the breast was suspected by a cytological study on the fluid. Twelve days after an induced abortion was performed, a modified radical mastectomy was carried out. Histological findings of the resected specimen demonstrated that the tumor was squamous cell carcinoma which had been well differentiated with partial keratinization and cancer pearls. Noninvasive ductal carcinoma was also observed in a very small region of the specimen, which indicated that the tumor was probably originally adenocarcinoma which later transformed into squamous cell carcinoma.

Familial genetic defect in a case of leukocyte adhesion deficiency

Leukocyte adhesion deficiency (LAD) is an inherited immunodeficiency disorder caused by CD18 subunit abnormality dependent defective expression of beta 2 integrins on the surface of leukocytes. On analysis of the CD18 molecular defect in a female Japanese patient with a severe deficiency LAD phenotype, neither CD11a nor CD18 molecules could be detected on the patient's EBV-transformed B lymphoblastoid cell line. The mRNA of the patient's B cells was normal in size, but was diminished in quantity, to approximately half normal levels. Sequencing of the CD18 cDNA of the patient revealed a C605 to T transition, resulting in a Pro178-->Leu substitution. This was heterozygous in the genomic DNA, and shown to be of maternal origin by family study. Only a few transcripts from the other allele without the Pro178-->Leu mutation were detectable. Northern blot analysis revealed reduced CD18 mRNA levels, not only in the patient, but also in the father and brother. These results indicate that our case is a compound heterozygote with two different mutant alleles: one causing a single amino acid substitution and the other causing defective expression of mRNA.

Primary scirrhous carcinoma of the nipple with symptoms simulating Paget's disease: report of a case

We report herein an extremely rare case of primary scirrhous carcinoma of the nipple, being of particular interest in that the patient presented with symptoms very similar to those of Paget's disease. The carcinoma cells were detected by aspiration biopsy cytology rather than by touch smear, although both were performed to differentiate this lesion from Paget's disease and other diseases of the nipple. Thus, we recommend that both touch smear and aspiration biopsy cytology should be performed for all patients presenting with symptoms such as those observed in this case to rule out the possibility of scirrhous carcinoma of the nipple or Paget's disease.

Three monoclonal antibodies against human LFA-1 alpha and beta chains with different biological activities

Three murine monoclonal antibodies (MAbs) directed against human lymphocyte function-associated antigen-1 (LFA-1, CD11a/CD18), designated as MAY.017, MAY.035, and MAY. 044, were newly generated. The hybridomas were screened for their ability to inhibit a phorbol ester-stimulated aggregation of Epstein-Barr virus-transformed B-lymphoblastoid cell line (B-LCL). The MAbs bound to peripheral blood leukocytes, T cell lines, B cell lines, and some of myeloid/monocytic lines, but not to B-LCL derived from a patient with leukocyte adhesion deficiency. MAY.035 immunoprecipitated a complex of proteins with molecular masses of 155 kDa and 95 kDa, while MAY.017 and MAY.044 did a complex of 130 kDa, 155 kDa and 95 kDa proteins. MAY.035 was shown as to recognize the alpha chain of LFA-1 (CD11a), and both MAY.017 and MAY.044 the beta chain of the beta 2 integrin family (CD18). All the three MAbs inhibited lymphocyte proliferative responses to mitogens or alloantigens. MAY.017 blocked cytolytic activity mediated by natural killer cells.

[A study of falls experienced by institutionalized elderly]

This study was conducted to determine what factors are related to falls, conditions contributing to falls and the associated injuries. Subjects who had lived in 3 institutions for the elderly in the western region of Shizuoka Prefecture were chosen. Subjects (n = 181) had an average age of 76.4 +/- 7.8 years, and all were interviewed regardless of their history of falls. For those who had experienced falls further interviews were conducted. The following results were obtained: 1) There were 64 subjects (35.4% of the subjects) who had experienced falls, some having experienced multiple falls (for a total count of 89 falls). 2) The frequency of falls of differed by sex or age was significantly. The frequency of females was significantly higher than that of males. The frequency for those in their 70's was lower than in other age groups. 3) At the time of experiencing falls the majority of subjects had hypertension, eye symptoms, insomnia, paralysis, functional restrictions, were going up or down stairs, working, and had difficulty reading characters in newspapers, had experiences of stumbling or need of medical attention within for the past 2 years. Results of this study showed that, while the use of tranquilizers or hypnotics were not statistically significant, they were closely connected to and increase in falls among the aged. 4) In the causes of falls, intrinsic factors figured in 34 (34.0%) cases, and the extrinsic factors in 66 (66.0%). 5) Both falls and fall-caused external injuries were higher among females than males. Furthermore, female subjects mainly suffered contusions and fractures while male subjects mainly suffered abrasions.

Mass screening for neuroblastoma in Miyagi Prefecture

In Japan, aiming at early and preclinical detection of neuroblastoma in infancy a mass screening program for the tumor has been implemented nationwide using urinary tests for catecholamine metabolites, vanillylmandelic acid (VMA) and homovanillic acid (HVA) (Sawada 1990; Sawada et al. 1991). In this report, the results obtained from the screening program in Miyagi Prefecture for the last 6 years are described. The detection rate of neuroblastoma by mass screening was 1:8,377 among 125,652 infants tested in Miyagi Prefecture. All but one patients survived after removal of the primary tumor and none or minimal chemotherapy.

Allogeneic bone marrow transplantation for malignant hematologic disorders in children

In the present study we carried out allogeneic bone marrow transplantation (BMT) in 14 leukemia children with high risk prognostic factors. Six patients with acute nonlymphocytic leukemia (ANLL), four with acute lymphocytic leukemia (ALL), two with chronic myelogenous leukemia (CML), and two with myelodysplastic syndrome (MDS). Among these patients, six with ANLL, two with ALL, one with CML and one with MDS were alive in complete remission 8 to 58 months post-BMT. Four patients died of relapse (one with ALL, and one with MDS), and chronic GVHD (one with ALL and one with CML). In six patients recombinant granulocyte colony stimulating factor (rG-CSF) was used to shorten the period of granulocytopenia. The mean time of recovery to granulocyte count of 500/mm3 was 13.2 days in the rG-CSF+ group, being 15.9 days faster than that in the rG-CSF- group. In light of these results, allogeneic BMT is shown to be a choice of treatment for leukemia children with high risk prognostic factors and rG-CSF may be an effective reagent to prevent infectious episodes in BMT.

Surgical treatment of pulmonary metastases from uterine cervical cancer. Operation method by lung tumor size

Between 1959 and 1986, 32 patients with pulmonary metastatic tumors from squamous cell carcinoma of the uterine cervix underwent pulmonary resection. The method of pulmonary resection was correlated with the pathology of the metastases. In 20 patients with pulmonary metastatic lesions 3 cm in diameter or larger, secondary lymph node involvement was observed in 65% and microscopic satellite lesions around the main metastatic lesion were seen in 50%. On the other hand, in none of 12 patients having metastatic lesions smaller than 3 cm was there accompanying lymph node involvement, and microscopic satellite lesions were observed in only one patient among them. Consequently, we concluded that wedge resection with a disease-free margin of 2 cm or a little more from the tumor edge was appropriate for lesions smaller than 3 cm in diameter, and lobectomy with lymph node dissection was necessary for lesions 3 cm in diameter or more.

Plasminogen with type-I mutation is polymorphic in the Japanese population

A functionally inactive plasminogen (PLG) variant designated as PLG M5 is polymorphic in the Japanese population and has a feature common to PLG with type-I mutation that has a codon 601 missense mutation in exon 15 (GCT for Ala-->ACT for Thr). This study was conducted to clarify whether the type-I mutation of PLG is present in PLG M5 and polymorphic in the Japanese population. Direct sequencing of the amplified DNA from the PLG gene in a heterozygote for PLG M5 revealed that the sequence of the exon 15 in the gene for PLG M5 is identical with that in the PLG gene with type-I mutation. In addition, the amplified DNA from the PLG gene in 12 heterozygotes for PLG M5 reacted with the probe for the type-I mutation in dot blot hybridization with an allele-specific oligonucleotide probe. The heterozygote for PLG with type-I mutation was found in 2.2% of 360 unrelated healthy subjects. These data indicate that the type-I mutation of PLG is present in PLG M5 and polymorphic in the Japanese population. The data also suggest that the PLG M5 is identical with PLG Tochigi and Kagoshima.

[Comparative study of CABG following PTCA and PTCA following CABG]

Forty-five cases of PTCA with prior CABG and 14 cases of CABG with prior PTCA were studied on their pathogenesis and results. Ninety-four PTCA procedures were performed electively after CABG on 45 patients and 145 lesions. Lesion success rates were 95.8% in stenosis and 55.6% in occluded vessel. The mortality was none and no emergent surgery was needed. Causes of PTCA following CABG included the progression of coronary artery disease (13.1%), graft stenosis (15.0%), graft occlusion (31.0%), incomplete revascularization (13.8%), restenosis after the initial procedure (26.2%). Especially percentage of the progression of coronary artery disease was increased with a lapse of time, and it was 31.7% in PTCA group over 3 years after CABG. Fourteen patients with prior PTCA were received CABG because of unsuccessful PTCA (50.0%), progression to LMCD (21.4%), restenosis (21.4%), and PTCA complication (7.1%). Both interventions were appropriate and useful to reduce the recurrent ischemia and cardiac events with each other. Myocardial revascularization should not be considered either PTCA or CABG, but PTCA and CABG. In conclusion the strategy that much more benefits can be obtained from supplementary use of PTCA and CABG makes it possible to reduce the mortality and morbidity associated with intervention.

Genetic differences in steroid-induced protein synthesis in vivo of the liver and magnum in immature chicks (Gallus domesticus)

1. The present study was conducted to investigate whether or not the rate of steroid-induced protein synthesis measured in vivo in the liver and magnum was different between chicks from different genetic backgrounds. 2. Both protein deposition and synthesis in the liver were enhanced after the administration of beta-estradiol with or without testosterone. In the magnum, the combined administration of beta-estradiol and testosterone resulted in significantly higher protein deposition and synthesis than did beta-estradiol alone. 3. After the administration of beta-estradiol and testosterone, protein deposition in the liver and magnum was lower in broiler than in layer and dual-purpose chicks. Protein synthesis in the magnum tended to be highest, though not significantly, in layer, followed by dual-purpose and broiler chicks in decreasing order. 4. Steroid-induced protein deposition in the liver was not changed between chicks genetically selected for low and high albumen contents. In contrast, steroid-induced protein synthesis in the magnum was significantly higher in high-albumen birds than low-albumen chicks. 5. It was concluded that genetic traits for high egg production were well reflected in increased protein deposition and synthesis in the liver and especially in the magnum of immature female chicks stimulated by steroid hormone treatment.