[Expression of neurotrophin and IL-1 beta mRNAs following spinal cord injury and the effects of methylprednisolone treatment]

Glucocorticoid has been clinically used for the treatment of acute spinal cord injury (SCI) to enhance the neurological recovery, but the relevance of the use of steroid is not fully discussed. Neurotrophins play important roles in normal development of central and peripheral nervous system. It is reported that traumatic insults to the brain alter the expression of these neurotrophins. These responses are considered to trigger a cascade of cellular protection and repair. First, we investigated the temporal and spatial expression patterns of neurotrophin and IL-1 beta mRNAs in the area of spinal cord lesion. Second, we examined if methylprednisolone (MP) affects the expression of these genes in SCI. Male Sprague-Dawley rats (250-300 gms) were laminectomized at T10. Spinal cord was crushed by clipping (holding force 60 gms, 1 sec). Rats were killed at 1, 6, 12, 24 h, and 72 h after the injury and the spinal cord was rapidly removed and frozen sections were cut. Second, the other group of rats were treated with MP (165 mg/kg) just after SCI and sacrificed at 6 h. The levels of neurotrophins and IL-1 beta mRNAs were evaluated by in situ hybridization histochemistry. IL-1 beta mRNA level was elevated at 1 h and 6 h and attenuated at 12 h. The increased level of BDNF and NT3 mRNAs were first observed at 6 h and the labeling was enhanced at 24 h and 72 h. In MP treated group, the levels of IL-1 beta, BDNF and NT3 mRNAs were attenuated compared with those of MP-untreated SCI group. Steroid hormone therapy diminishes the post-traumatic inflammatory cascades which produce edema and swelling and worsen neuronal injury. However, glucocorticoid may hinder the endogenous repair mechanism. Our data show that MP depress the production of BDNF and NT3 following SCI, which might be disadvantageous to the survival of spinal neurons.

The role of phospholipase A2 and nitric oxide in pain-related behavior produced by an allograft of intervertebral disc material to the sciatic nerve of the rat

STUDY DESIGN

To elucidate the pathomechanisms of radicular pain secondary to lumbar disc herniation.

OBJECTIVES

To evaluate whether intervertebral disc material applied to the sciatic nerve produces hyperalgesia, and if the hyperalgesia in influenced by inhibitors of phospholipase A2 and nitric oxide synthase.

SUMMARY OF BACKGROUND DATA

Previously, the authors reported that application of nucleus pulposus and anulus fibrosus material to the lumbar epidural space produces different forms of hyperalgesia (mechanical versus thermal), with different and distinct histologic changes. Additional pharmacologic studies showed that phospholipase A2 and nitric oxide are involved in the mechanisms that produce the mechanical and thermal hyperalgesia, respectively, N omega-nitro-L-arginine methyl ester and mepacrine are relatively selective inhibitors of nitric oxide synthase and phospholipase A2, respectively. However, it is not known what the relation is between the hyperalgesia produced and the activation and involvement of phospholipase A2 and production of nitric oxide, or why the application of nucleus pulposus and nucleus pulposus with anulus fibrosus produces different types of hyperalgesia.

METHODS

Experiments were performed in five groups of rats: The control group (no treatment), the sham group (exposure of the sciatic nerve only), the fat group (allografted fat on the sciatic nerve), the nucleus pulposus group (allografted nucleus pulposus) and the nucleus pulposus + anulus fibrosus group (allografted nucleus pulposus and anulus fibrosus). Withdrawal threshold and latency from mechanical pressure and a radiant heat to hind paws were measured preoperatively and postoperatively. After local sciatic nerve administration of N theta-nitro-L-arginine methyl ester or mepacrine into the operated site, sensitivities to noxious stimuli were reevaluated after treatment.

RESULTS

Only rats in the nucleus pulposus group showed evidence of mechanical hyperalgesia. However, injection of N theta-nitro-L-arginine methyl ester resulted in evidence of mechanical hyperalgesia in the nucleus pulposus + anulus fibrosus group. Mechanical hyperalgesia was produced in the nucleus pulposus group and after injection of N theta-nitro-L-arginine methyl ester in the nucleus pulposus+anulus fibrosus group, both of which returned to normal after mepacrine injection. There were no significant changes in sensitivity to thermal stimuli in any of the experimental groups.

CONCLUSION

It appears that phospholipase A2 and nitric oxide play important but different roles in pathomechanisms of radicular pain in lumbar disc herniation.

Histochemical demonstration of nitric oxide in herniated lumbar discs. A clinical and animal model study

STUDY DESIGN

This study was designed to localize the cells that produce nitric oxide in a lumbar disc herniation by histochemical method, including in situ hybridization.

OBJECTIVE

To clarify which cells in herniated lumbar discs produce nitric oxide.

SUMMARY OF BACKGROUND DATA

It was reported that herniated lumbar intervertebral disc specimens in culture are capable of producing nitric oxide.

METHODS

Surgical specimens from lumbar disc herniation were examined to determine nitric oxide synthase histologically using nicotinamide adenine dinucleotide phosphate diaphorase histochemistry. Allografts of intervertebral disc materials were placed on the epidural space at L6 level in the rat. Nitric oxide synthase was examined in the applied tissues using nicotinamide adenine dinucleotide phosphate diaphorase histochemistry and in situ hybridization histochemistry.

RESULTS

Nicotinamide adenine dinucleotide phosphate diaphorase (nitric oxide synthase) positive cells were observed in 2 (40%) of 5 herniated disc materials in patients. The positive cells were mainly in granulation tissue around intervertebral disc materials. In animal models, nitric oxide synthase-positive cells were observed in all specimens at 1 and 2 weeks postoperatively. Newly formed vessels and small round cells in granulation tissue around the grafted intervertebral disc showed positive reaction. In situ hybridization demonstrated the expression of inducible isoform of nitric oxide synthase messenger RNA (mRNA) identical to small round cells around the applied intervertebral disc.

CONCLUSION

Nitric oxide in a lumbar disc herniation is mainly produced by cells in granulation tissue around the herniated intervertebral disc.

[Bone metastases responsive to pamidronate therapy in breast cancer]

A 66-year-old woman with locally advanced and metastatic breast carcinoma received combination chemotherapy, which comprised mitomycinC (total 84 mg) and anthracyclines (total : epirubicin 350 mg and pirarubicin 450 mg). She had been alive without tumor progression for more than one year thanks to these chemotherapies. Nevertheless, she thereafter complained of severe bone pain due to progression of bone disease. Since morphine administration could not give her sufficient pain relief, we tried to treat her bone pain with pamidronate in a dose of 30 mg weekly or biweekly. The pamidronate markedly relieved her bone pain and improved osteolytic bone lesions. In conclusion, pamidronate therapy can be a promising therapeutic modality for bone-derived pain in terminal patients.

Flexibility in the scoliotic spine: three-dimensional analysis

The purpose of this study was to measure the three-dimensional geometry of scoliosis by using biplane radiographic photogrammetry and to evaluate the flexibility of the deformed spine. Thirty-one patients with idiopathic scoliosis underwent analysis. There was a significant correlation between the degree of the scoliotic angle in the frontal plane, kyphotic angle in the sagittal plane, and the rotational angle of the apical vertebra. Hypokyphosis was associated with a scoliotic angle > 40 degrees in the frontal plane. Similarly, hypokyphosis was related to increased rotation of the apical vertebra (p < 0.01). Although the scoliotic angle was decreased by traction in all cases, axial rotation was less corrected in those patients with scoliotic angle > 40 degrees. This suggests that the rotational stiffness at the apex is related to the degree of the rotational angle of the apical vertebra and to the degree of the frontal curve.

Regional blood flow in Dahl-Iwai salt-sensitive rats and the effects of dietary L-arginine supplementation

The purpose of the present study was to determine 1) whether different organs undergo similar increase in vascular resistance in Dahl-Iwai salt-sensitive (S) rats, and 2) the effects of chronic oral L-arginine supplementation on the regional hemodynamics in S rats. Male 6-wk-old S rats and salt-resistant (R) rats were maintained on an 8% NaCl chow for 4 wk. One group (S or R rats) was maintained on tap water and the other group (S/Arg or R/Arg rats) received tap water containing L-arginine at a concentration of 1.5%. Organ blood flow and cardiac output were measured with microspheres in the conscious condition. Mean blood pressure in S, S/Arg, R, and R/Arg rats was 159 +/- 5, 138 +/- 3, 111 +/- 4, and 112 +/- 4 mmHg, respectively. Urinary excretion of protein and albumin in S/Arg rats was significantly suppressed compared with S rats. Concerning regional hemodynamics, the flow rate of the kidney was lower in S rats than in R rats, but there were no differences between S and R rats in the flow rates of the brain, heart, lung, liver, spleen, intestine, skeletal muscle, and skin. Thus the renal blood flow was solely reduced in S rats on a high-salt diet. The flow rate of the kidney in S/Arg rats was maintained at a higher level compared with that of S rats. L-Arginine treatment tended to produce a recovery in the urinary excretion of guanosine 3',5'-cyclic monophosphate in S rats, but had no effect in R rats. Thus the supplementation of L-arginine prevented the increase in blood pressure in S rats on a high-salt diet and normalized the abnormality of renal hemodynamics accompanying salt-induced hypertension.

Role of nitric oxide in desmopressin-induced vasodilation of microperfused rabbit afferent arterioles

We have previously reported that desmopressin (dDAVP) increased the lumen diameter of norepinephrine (NE)-constricted isolated microperfused rabbit afferent arterioles. In this study, we examined the role of nitric oxide in dDAVP-induced vasodilation of afferent arterioles. We microdissected a superficial afferent arteriole from the kidney of a New Zealand white rabbit. Each afferent arteriole was cannulated with a pipette system and microperfused in vitro at 60 mmHg. dDAVP increased the lumen diameter of NE-preconstricted rabbit afferent arterioles dose-dependently. dDAVP-induced vasodilation was abolished by pretreatment with NG-nitro-L-arginine (L-NNA, 10(-4)M) (L-NNA + NE, 6.7 +/- 1.1 microns; L-NNA + NE + dDAVP, 7.3 +/- 1.4 microns, n = 8). dDAVP increased the lumen diameter of NE-preconstricted afferent arterioles pretreated with L-NNA and L-arginine (10(-2)M) (L-NNA + L-arginine + NE, 6.1 +/- 1.1 microns; L-NNA + L-arginine + NE + dDAVP, 8.7 +/- 0.9 microns*; *p < 0.05, n = 6). Aspirin-DL-lysine (10(-4)M) did not influence dDAVP-induced afferent arteriolar vasodilation (aspirin + NE, 6.4 +/- 0.8 microns; aspirin + NE + dDAVP, 9.6 +/- 1.3 microns *; *p < 0.05, n = 5). These results suggest that nitric oxide may be responsible for dDAVP-induced afferent arteriolar vasodilation.

Serotonin increases Na(+)-dependent Ca2+ efflux from bovine adrenal chromaffin cells in culture

The effect of serotonin (5-hydroxytryptamine, 5-HT) on Ca2+ mobilization in bovine adrenal chromaffin cells in culture was examined. 5-HT (10(-5) M) did not increase secretion of catecholamine, uptake of 45Ca2+ and levels of intracellular free Ca2+ ([Ca/+]i). However, 5-HT (10(-8)-10(-5) M) stimulated the efflux of 45Ca2+ from cultured bovine adrenal chromaffin cells in a concentration-dependent manner. Its stimulatory effect on 45Ca2+ efflux was inhibited by cyproheptadine (a 5-HT1A and 5-HT2 receptor antagonist) or mianserin (a 5-HT2 receptor antagonist). The increase in 5-HT-stimulated 45Ca2+ efflux was dependent on extracellular Na+ concentration, but not extracellular Ca2+ concentration. These results indicate that stimulation of the 5-HT receptors induces extracellular Na(+)-dependent Ca2+ efflux from bovine adrenal chromaffin cells in culture, probably by acceleration of Na+/Ca2+ exchange.

Potentiation of histamine-induced catecholamine secretion by ouabain in cultured bovine adrenal chromaffin cells is dependent on calcium and sodium influx

The effects of histamine on catecholamine secretion from cultured bovine adrenal chromaffin cells were studied in the presence of ouabain, an inhibitor of Na+-K+ ATPase. The purpose of this study was to determine whether Na+, as well as Ca2+, was involved in histamine receptor-mediated catecholamine secretion. Histamine (10(-8)-10(-5) M)-induced catecholamine secretion was markedly potentiated by addition of ouabain (10(-5) M) and was inhibited by a histamine-H1 receptor antagonist or incubation in a Ca2+-free medium. Histamine-induced 45Ca2+ influx was also potentiated by addition of ouabain. Ouabain alone or in the presence of histamine increased 22Na+ influx into the cells. In an additional set of experiments, cells were preincubated in the presence or absence of Na+ for 30 min (+/- histamine and ouabain), washed and then catecholamine secretion was measured following exposure to 2.2 mM Ca2+ for 15 min. Preincubation with histamine alone with or without Na+ had no effect of Ca2+-induced secretion of catecholamine. Preincubation with ouabain alone or with ouabain plus histamine produced a slight stimulation of catecholamine secretion in Na+-free medium and a large stimulation in Na+-containing medium. These results suggested that stimulation of the histamine-H1 receptor and inhibition of the Na+ pump both increase intracellular Na+ levels, resulting in increases in Ca2+ influx and catecholamine secretion.

Characteristics of compensatory hypertrophied muscle in the rat: I. Electron microscopic and immunohistochemical studies

BACKGROUND

Complex branched muscle fibers are frequently observed in the muscles of mdx mutant mice and/or in damaged muscles. To investigate whether the complex branched fibers were present in the compensatory hypertrophied muscles of rats, we examined the morphological changes in these muscles.

METHODS

We examined the hypertrophied plantaris (PLA) muscle of the Wistar male rats, prepared by surgical ablation of synergistic muscles. The muscle was examined using three-dimensional analysis with scanning electron microscopy, immunohistochemical detection of proliferating cells using 5-bromo-2'-deoxyuridine (BrdU) and histological and histochemical characterization. Studies were performed at 48 hours, 2, 4, 6, 10, and 15 weeks after surgical preparation.

RESULTS

The muscle hypertrophy ratio (muscle weight relative to the contralateral intact control side), gradually increased from 2 to 10 weeks, and the peak value (48.6%) occurred at the 10th week. The total number of fibers did not change significantly at any time interval. However, the number of branched muscle fibers increased significantly (P < 0.05) after 6 weeks, and accounted for about 2.5% of the total fibers at the 15th week. Most branched fibers showed complex features resembling the "anastomosing syncytial reticulum" described in myopathic animals. The fibers were observed mainly in the middle and distal portions of the PLA muscle. The proportion and distribution of proliferating cells in the entire PLA muscle corresponded with the distribution of the complex branched fibers. These results were also observed in muscle tissues prepared for histological and histochemical examination.

CONCLUSIONS

The presence of a large proportion of complex branched fibers in a limited segment of the compensatory hypertrophied muscle suggests that this hypertrophy model represents a pathological and/or pathophysiological hypertrophy model rather than a normal physiological process.

Characteristics of compensatory hypertrophied muscle in the rat: II. Comparison of histochemical and functional properties

BACKGROUND

We reported that numerous complex branched fibers (CBF) are present in the compensatory hypertrophied plantaris muscle prepared by surgical removal of the synergist muscles in the rat. To investigate the functional effects of these CBF, we examined the histochemical and contractile properties of this muscle.

METHODS

Compensatory hypertrophied plantaris (PLA) muscles were prepared by ipsilateral ablation of synergistic muscle in male Wistar rats. We compared the operated (OP), contralateral (CON-L), and nonoperated age-matched normal control (NOR-C) plantaris muscles. Contractile properties under urethane anesthesia and histochemical properties (myofibrillar ATPase staining) were examined at 6, 10, and 15 weeks after surgical preparation of the muscles.

RESULTS

The weight of the OP muscle was 48-55% higher than that of the CON-L muscle. The twitch-time-to-peak tension (TPT) and half-relaxation time (HRT) were slower in NOR-C < CON-L < OP. The shift to slower muscle characteristics was also associated with a similar order (NOR-C < CON-L < OP) of histochemical analysis. However, the fatigue resistance capacity of OP (time to 50% fall in tension from initial peak tension during 15-Hz twitch train) was less than that of CON-L, in contrast to the results of twitch, tetanus, and histochemical analysis. The order of NOR-C < CON-L < OP was not observed in the fatigue-resistance test.

CONCLUSIONS

Our results suggest that the presence of CBF may disturb the correlation between histochemical and functional properties of the whole muscle. In addition, the CON-L muscle clearly shifted to slower muscle characteristics, indicating that it was not similar to normal control muscle.

[A case of Pryce's type I pulmonary sequestration with hemoptysis and bruit]

A 20-year-old man was admitted to our hospital with the complaint of hemoptysis. A bruit was best heard at the lower portion of the left posterior chest. CT scan and MRI revealed clearly the existence of a large aberrant vessel from the descending thoracic aorta. Aorto- and pulmonary arteriography demonstrated that a large systemic artery from the descending thoracic aorta supplied the basilar segments of the left lower lobe, and to which there was no pulmonary artery supply. The pulmonary veins from these segments drained into the left atrium. The properative diagnosis was Pryce's type I pulmonary sequestration. A left lower lobectomy was performed. The aberrant vessel was 15 mm in diameter and was elastic walled. The systemic artery of the basilar segments revealed proliferation of media and obstructive changes. Some discussions were made about hemoptysis and bruit in 23 cases of Pryce's type I pulmonary sequestration in Japan.

Transcriptional regulation of the human alpha2(I) collagen gene. Combined action of upstream stimulatory and inhibitory cis-acting elements

This study identifies three regions of the human alpha2(I) collagen promoter involved in the binding of nuclear factors. These regions include sequences from -173 to -155 (footprint I), -133 to -119 (footprint II), and -101 to -72 (footprint III). A novel positive cis-element containing a TCCTCC motif was identified within footprint II. In addition, we demonstrated that a pyrimidine-rich region within footprint I is a binding site for a transcriptional repressor, and a CCAAT motif within footprint III is a binding site for a transcriptional activator. Comparative functional analysis of the cis-acting elements within the proximal 350 base pairs of this promoter, including previously characterized Sp1 binding sites at -300, indicates that constitutive activity of this promoter is regulated equivalently by the three positive cis-acting elements at -300, -125, and -80. Mutations in the repressor site at -160 increase constitutive activity by 4-6-fold. However, simultaneous mutations of the repressor site and the cis-regulatory element at either the -300 or -125 sites result in no increase in constitutive transcription activity suggesting interaction between the activators and repressor elements. In contrast, simultaneous mutation of the CCAAT motif and the repressor site results in about a 4-fold increase, suggesting that activation via the CCAAT motif may be independent of this repressor.

Pathomechanism of pain-related behavior produced by allografts of intervertebral disc in the rat

STUDY DESIGN

This study was designed to evaluate whether allografts of intervertebral disc materials produce hyperalgesia in the rat and whether an immune response, pH, or chemicals correlate with the induced hyperalgesia.

OBJECTIVE

To elucidate the pathomechanisms of radicular pain secondary to lumbar disc herniation.

SUMMARY OF BACKGROUND DATA

It has been reported that a low pH, an autoimmune reaction, or chemical radiculitis is likely responsible for radicular pain associated with lumbar disc herniation. In animal studies, it has been shown that hyperalgesia (an increased sensitivity to painful stimuli) involves activation of phospholipase A2 and nitric oxide synthase.

METHODS

Fat, nucleus pulposus, and anulus fibrosus were allografted into the epidural space at L6 in the rat. Withdrawal response thresholds to mechanical stimuli and withdrawal response latencies to thermal stimuli on the tail and pH in the applied tissues were measured after surgery. Interleukin-1, phospholipase A2, and nitric oxide synthase were examined in the applied tissues using immunohistochemistry, nicotineamide adenine dinucleotide phosphate-diaphorase histochemistry, and in situ hybridization.

RESULTS

Allografted fat did not produce hyperalgesia. Allografts of nucleus pulposus and nucleus pulposus plus anulus fibrosis showed evidence of mechanical and thermal hyperalgesia, respectively. There were no observed changes in pH over time. Although interleukin-1 was demonstrated in all applied tissues, phospholipase A2 was only observed around the applied nucleus A2 was only observed around the applied nucleus pulposus and nucleus pulposus plus anulus fibrosus. Nitric oxide synthase was only markedly increased around the applied tissues.

CONCLUSION

The nucleus pulposus and anulus fibrosus produce different forms of hyperalgesia (mechanical vs. thermal) associated with different and distinct immunohistochemical changes. It is possible that radicular pain of a lumbar disc herniation results from chemicals, such as phospholipase A2 and nitric oxide.

Cubital tunnel syndrome associated with calcium pyrophosphate dihydrate crystal deposition disease

Nine patients (11 elbows) presented with cubital tunnel syndrome that was complicated by calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. Their age ranged from 63 to 86 years, and 8 of the 9 patients were more than 70 years old. X-ray film examination demonstrated the presence of CPPD crystal deposition not only in the elbow but also in the knee, wrist, or spine in all patients. Medial epicondylectomy was performed in 8 patients (9 elbows), while 1 patient with both elbows affected was treated conservatively at his request. Thickening of the ulnar collateral ligament and synovium due to CPPD crystal deposition and degenerative joint changes induced protrusion of the floor of the cubital tunnel, resulting in ulnar neuropathy in these patients. The ulnar nerve was compressed between the protruded floor and fibrous band. Though various causes of cubital tunnel syndrome have been reported, findings of this study indicate that CPPD crystal deposition disease should also be considered a cause of this syndrome.

Autoantibodies to mitochondrial 2-oxo-acid dehydrogenase complexes in localized scleroderma

Sera from patients with localized scleroderma frequently produce cytoplasmic staining by indirect immunofluorescence, although the antigen remains to be determined. We studied the prevalence, antigen specificity and associated clinical characteristics of anti-cytoplasmic antibodies in localized scleroderma. Serum samples from 60 patients with localized scleroderma were examined by indirect immunofluorescence analysis and immunoblotting. By immunofluorescence analysis on HEp-2 cell substrate, seven of 60 (12%) patients were shown to be positive for anti-cytoplasmic antibodies. Among these, six patients with generalized morphea had anti-mitochondrial antibodies as shown by immunoblotting: they showed reactivity with the E2 component of pyruvate dehydrogenase complex (PDC), with protein X, and with the E2 component of alpha-oxo-glutarate dehydrogenase complex, while two of them showed reactivity with PDC-E1 alpha. One of these patients who was positive for anti-PDC-E1 alpha antibody showed laboratory abnormalities, suggesting the presence of primary biliary cirrhosis. The age of disease onset was significantly higher in these six patients than in those without anti-mitochondrial antibodies. Furthermore, five of them were classified into generalized morphea with multiple plaque lesions but without linear lesions (multiple plaque type). These observations suggest that major antigens for anti-cytoplasmic antibodies in patients with localized scleroderma are mitochondrial enzymes, 2-oxo-acid dehydrogenase complexes. Patients with anti-mitochondrial antibodies may comprise a unique subset of localized scleroderma designated multiple plaque type of generalized morphea of older onset.

[A case of recurrent breast carcinoma with metastatic foci in the lung and pleura treated successfully with biochemical modulation of 5-fluorouracil by low-dose cisplatin]

A 65-year-old female received nipple preserved total glandectomy for breast carcinoma. A 250 mg dose of epirubicin was administered as an adjuvant. After a three-year disease-free interval, breast carcinoma recurred in the lung and pleura. We then used biochemical modulation of 5-fluorouracil by low-dose cisplatin. One course of biochemical modulation resulted in eighty-three percent tumor regression and complete disappearance of the pleural effusion for over six months.

Comparison of methods to evaluate acute rejection in heterotopic heart transplantation in rats

We compared palpation and electrocardiograms (ECG) as methods of evaluation of acute rejections, and also studied the mode of expression of rejection from histological findings by means of a cervical heart transplantation model in LEW strain rats with (LEW x BN) F1 rats as donors. Evaluation by palpation mainly involved changes in the intensity of the beat of the transplanted heart. With this method, it was also possible to observe changes in the size of the graft, and to investigate these changes over time. Unlike with abdominal heart transplants, the time of cardiac arrest can be clearly determined without any influence from the heart rate of the recipient. But with the ECG evaluation method, it was possible to distinguish clearly between the waveforms of the graft and the recipient waveforms unlike with the conventional lead method. In histological findings, the time of transfer of infiltrating cells into the graft and the time of appearance of CD8 positive cells matched the times when changes occur in the intensity of the beat and in the heart rate seen with palpation. Unlike the palpation and ECG methods, however, these findings are not suitable for evaluation of the time of cardiac arrest of the graft. The graft survival time was 6.1 +/- 0.6 days (n = 73) by palpation and 8.5 +/- 1.8 days (n = 73) by ECG. Since the graft survival time was significantly longer in the ECG evaluation than in the evaluation by palpation (P < 0.001), it appeared better to use these methods independently rather than concurrently in consideration of their features. Histological examination appeared to be useful in experimental systems for clarification of the mode of expression of the acute rejection after its has occurred.

Antiubiquitin antibody in localised and systemic scleroderma

OBJECTIVE

To determine the presence of antiubiquitin antibody (AUbA) in localised scleroderma and systemic sclerosis, as it is frequently found in the sera of patients with systemic lupus erythematosus (SLE) and has also been shown to have a close relationship with antihistone antibodies that have an important role in scleroderma.

METHODS

Serum samples from patients with localised scleroderma (n = 48) and systemic sclerosis (n = 52) were examined by enzyme linked immunosorbent assay. Twenty samples from patients with SLE, 20 from patients with dermatomyositis, and 30 samples from healthy individuals were used as controls.

RESULTS

AUbA was demonstrated in 44% of patients with localised scleroderma and in 42% of those with systemic sclerosis. The presence of AUbA correlated with the presence of antihistone antibodies in both localised scleroderma and systemic sclerosis.

CONCLUSIONS

AUbA is frequently present in patients with localised scleroderma and systemic sclerosis. Induction of AUbA is closely associated with that of antihistone antibodies, suggesting that ubiquitinated histone may be the target in autoimmune responses of these disorders.

Clinical Outcome of Immediate Breast Reconstruction Using a Silicone Gel-filled Implant after Nipple-preserving Mastectomy

In order to evaluate the safety of silicone gel-filled implants for breast reconstruction in terms of cancer control, we reviewed 122 patients with postoperative state I and II breast cancer who were treated by nipple-preserving mastectomy and immediate breast reconstruction using a silicone implant, and compared them with 92 controls treated by nipple-preserving mastectomy alone. Twelve complications requiring surgical management occurred in the 122 reconstructions(9.8%). Two implants were replaced, and 10 implants were removed. These 10 cases were excluded from survival analysis. The mean Follow-up duration was 78 months in the 112 patients with breast reconstruction, and 55 months in the controls. There were no significant differences in the overall, disease-free, and locoregional disease-free survival rates between the two groups. In the reconstruction group, recurrence occurred in 14 patients. Five of them had locoregional recurrence alone, and are surviving free of disease following local resection. By the last follow-up, there was no incidence of secondary cancer at any site, including the contralateral breast cancer or connective tissue disease in the both group. Our results do not support the hypothesis of a detrimental effect of breast reconstruction using silicone gel-filled implants after mastectomy for breast cancer.