[Home oxygen therapy (HOT) in patients with pulmonary tuberculosis sequelae--comparison between patients medically treated and those surgically treated]

In Japan there are about 40,000 patients under home oxygen therapy (HOT), of whom about 30 to 40% are pulmonary tuberculosis sequelae (TBS). These patients can be divided into three groups depending on the treatments they had, Group 1: those who had medical treatments only, Group 2: those who had artificial pneumothorax, and Group 3: those who had thoracoplasties or other surgical treatments. The purpose of this study was to observe the distributions and possible differences in the survival rates among these groups. The study included 1537 patients with TBS under HOT followed at National Hospitals and Sanatoriums nationwide in Japan. In 819 patients the treatments were specified and of those 354 were in Group 1, 29 in Group 2, and 436 in Group 3, so that the proportion of surgically treated patients in PTS was estimated between 28.4% (436/ 1537) to 53.2% (436/819). The ages at the onset of tuberculosis, at the start of HOT and the intervals in between were 36.6, 66.2 and 29.8 in Group 1, and 26.8, 65.5, and 38.1 in Group 3 respectively. Though the ages at the start of HOT were the same, those at the onset of tuberculosis were about ten years younger in Group 3 than in Group 1. Comparing Group 1 and 3, the survival rates after the initiation of HOT (Kaplan-Meier method) was better in Group 2 (surgically treated) than in Group 1 (medically treated). It is speculated that the reason could be a better preservation of the function of the remaining lung in the surgically treated and a higher incidence of obstructive impairments in the medically treated patients.

Frontonasal flap for reconstruction of complete alar defects

BACKGROUND

It is difficult to reconstruct a satisfactory ala. Axial frontonasal flap has been common in reconstruction of nasal tip. We modified this flap to reconstruct nasal ala.

OBJECTIVE

A modified axial frontonasal flap was applied for reconstruction of complete unilateral alar defects in two patients.

METHODS

Skin from an intact nasal tip covered the alar defect. The resulting defect in the nasal tip was covered with dorsal skin from the nose. Extended mucosa or a hinged nasolabial flap was used to line the mucosal side of the reconstructed ala.

RESULTS

The outcome judged by shape, and texture, was satisfactory. This technique can be employed under field block.

CONCLUSION

The modified frontonasal flap is one of the ideal techniques to reconstruct an entire nasal ala.

Binding assay of low density lipoprotein to Asp-hemolysin from Aspergillus fumigatus

Binding activity of Asp-hemolysin to low density lipoprotein (LDL) was measured. LDL binds to Asp-hemolysin with an affinity as high as the LDL receptor. The apparent Kd, determined by Scatchard plot analysis, was 8.9 x 10(-9) M [125I]LDL. Asp-hemolysin is thus identified as a novel LDL-binding protein.

A facilitatory effect on the induction of long-term potentiation in vivo by chronic administration of antisense oligodeoxynucleotides against catalytic subunits of calcineurin

A rise in Ca2+ concentration at postsynaptic sites provides an initial step in inducing both the long-term potentiation (LTP) and long-term depression (LTD) in the CA1 region of the hippocampus. LTP induction requires the activation of Ca(2+)-sensitive protein kinases following the rise in Ca2+. By contrast, the activity of protein phosphatase(s) appears to be critical to induce LTD. Here we demonstrate that inhibition of the synthesis of calcineurin A alpha and A beta, catalytic subunits of Ca2+/calmodulin- (CaM) dependent protein phosphatase, reduces the threshold of induction for commissural-CA1 LTP in anesthetized rats. In rats administered antisense oligodeoxynucleotides (ODNs) against calcineurin A alpha and A beta intraventricularly for 7 days, a brief tetanic stimulation to the CA3 region, which in the control case was below threshold for the induction of LTP, now produced a long-lasting increase in both the EPSP slope and the amplitude of population spike recorded from the commissural-CA1 pathway. Western blot analysis of calcineurin showed that the threshold reduction was accompanied by a selective decrease in the protein levels in the hippocampus. Thus our study provides direct evidence that calcineurin per se has an antagonizing role in LTP induction. Complementary experiments with the selective calcineurin inhibitor, FK506, also showed the reduction of LTP threshold in a dose-dependent manner. These results, together with previous studies, support the hypothesis that the quantitative phosphorylation level of critical intracellular proteins determines whether the synaptic efficacy will increase or decrease after the activity-dependent rise in postsynaptic Ca2+.

A case of Ki-1 positive anaplastic large cell lymphoma transformed from mycosis fungoides

A case of cutaneous Ki-1 positive anaplastic large cell lymphoma which developed in the plaque stage of mycosis fungoides was described. A 73-year-old woman who had suffered from pruritic scaly eruptions over her entire body for more than two decades was admitted because of an ulcerated tumor measuring 45 x 55 x 15 mm and several satellite tumors on the buttock. All tumorous lesions were resected without recurrence to date. Histochemical study revealed that the tumor consisted of large anaplastic cells which were Ki-1 (CD30)-positive and LCA-negative. Some of the erythematous plaques contained LCA-positive, small-sized atypical lymphocytes. In other plaques which developed two years later, there were large Ki-1-positive atypical cells. In the specimens obtained from the tumor and the plaque, the same pattern of T-cell receptor gene rearrangements was detected. These findings indicate that both Ki-1 positive anaplastic cells in the tumor and atypical lymphoid cells in the plaques were derived from the same T cell clone.

Regulation of insulin-like growth factor-binding protein-4 protease activity by estrogen and parathyroid hormone in SaOS-2 cells: implications for the pathogenesis of postmenopausal osteoporosis

The cellular mechanisms involved in the accelerated bone loss occurring in association with estrogen deprivation as seen following the menopause are not fully understood. Insulin-like growth factor-I (IGF-I) is the local regulator of osteoblasts and one of its binding proteins, insulin-like growth factor-binding protein-4 (IGFBP-4), binds to IGF-I and suppresses biological activity. Previous studies have shown that the binding activity of IGFBP-4 in the conditioned medium of parathyroid hormone (PTH)-treated SaOS-2 osteoblastic-like cells is enhanced twofold and that this PTH-enhanced IGFBP-4 binding activity is abolished by 17 beta-estradiol. Levels of IGFBP-4 in the conditioned medium have been reported to be regulated not only at the level of production but also at the level of degradation which is catalyzed by a protease that specifically cleaves IGFBP-4. We have, therefore, studied the effects of 17 beta-estradiol and PTH on IGFBP-4 protease activity using SaOS-2 cells. SaOS-2 cells produce a protease that specifically cleaves IGFBP-4 into two fragments of approximately 18 and 14 kilodaltons. IGFBP-4 protease activity in the conditioned medium from PTH-treated cells was suppressed, while this PTH-induced suppression of protease activity was reversed by the addition of 17 beta-estradiol to the cultures. IGFBP-4 proteolytic activity was stimulated by IGF-I or IGF-II added exogenously and was inhibited by EDTA or protease inhibitors. IGFBP-4 proteolyzed in the conditioned medium from cells treated with PTH and 17 beta-estradiol was less effective at inhibiting IGF-I-stimulated [3H]thymidine incorporation into DNA compared with that proteolyzed in the conditioned medium from PTH-treated cells. The simplest explanation is that 17 beta-estradiol suppressed the inhibitory effect of PTH on osteoblastic activity by inhibiting the PTH-induced suppression of IGFBP-4 protease activity.

The vestibular nerve: its course to the anterior and lateral ampullae

The course of the ampullary nerve to the anterior and lateral ampullae was studied using 25 human temporal bones. Sudan Black B staining was applied to decalcified temporal bones in order to stain nerve fibers. After removing the external and middle ear, each temporal bone was divided into four blocks by three parallel planes, making an angle of 45 degrees to the long axis of the stapes footplate or a line along the stapedial tendon. Two planes were in contact with the anterior and posterior margin of the oval window, respectively. The third plane passed through the capitulum of the stapes. Distances from the upper margin of the oval window, to the distal and proximal part of the ampullary nerve, to the facial nerve, and to the utricular macula were measured in the third plane. The thickness of the thinnest part of the wall of the facial canal facing the stapes was also measured. A new surgical approach to the ampullary nerve is discussed.

The regulation of L-proline transport by insulin-like growth factor-I in human osteoblast-like SaOS-2 cells

The effect of insulin-like growth factor-I on amino acid transport was studied by measuring the uptake of tritiated L-proline in the cultured human osteoblast-like SaOS-2 cells. The uptake of L-proline was supported by both transport system A, ASC and Gly and by Na+-dependent amino acid transport system A, and by Na+-independent system L. The initial rate of total L-proline uptake as a function of concentration showed saturation and obeyed Michaelis-Menten kinetics with Michaelis constant (Km) and maximum velocity (Vmax) values of 1.87 mM and 8.89 nmol x (mg protein)-1 x (3 min)-1, respectively. Na+-dependent L-proline uptake was significantly stimulated by insulin-like growth factor-I in a time- and concentration-dependent manner. Kinetic analysis showed that insulin-like growth factor-I enhanced transport activity by increasing the Vmax of transport without significant changes in the affinity (Km) of the carrier for the substrate. The increase in transport activity was significantly reduced by cycloheximide. The stimulated increment above basal L-proline uptake was completely inhibited by alpha-(methylamino) isobutyric acid, suggesting that only system A was affected by insulin-like growth factor-I. Na+-dependent L-proline uptake was also stimulated by insulin-like growth factor-II and insulin-like growth factor-I analogues. The insulin-like growth factor-I-stimulated L-proline uptake was inhibited by one of its binding protein, insulin-like growth factor binding protein-4, in a concentration-dependent manner.

Free composite graft for lip reconstruction after tumor excision

This paper represents 10 patients for whom lip defects following excision of malignant tumors were reconstructed by the free composite graft technique using the opposite side of the lip. Usually, for upper lip reconstruction, a switch flap or Zisser-Madden method is commonly used. For lower lip reconstruction, the methods of the double cross-lip flaps or the rotation flap are most frequently used. However, we recommend the free composite graft technique for selective patients, since this method is simpler than the other techniques and the results are excellent both cosmetically and functionally.

Detection of genes in Escherichia coli sequences determined by genome projects and prediction of protein production levels, based on multivariate diversity in codon usage

We used principal component analysis to develop measures (called Z-parameters in this study) which reflect the diversity of codon usage in Escherichia coli genes. Protein production levels for 1500 CDSs (protein-coding sequences) identified by E.coli genome projects in Japan and the US were estimated from a correlation equation between Z1 and cellular protein content obtained through analysis of the genes experimentally characterized. Through the profile analysis of Z1 for E.coli sequences obtained by the Japanese Project, we predicted an additional 36 CDSs that had not been annotated in the International DNA Database. Thirty-one out of the 36 CDSs could be assigned to presumptive protein genes through a BLASTX search for recent protein databases in the Genome Net in Japan. Detailed examination of the Z1-parameter profile led us to assess sequencing errors which cause frame-shift.

Synchronous gene expressions during embryogenesis of Oncorhynchus masou (Yamame)

In order to detect periods of synchronous gene expressions during embryogenesis of Oncorhynchus masou (Yamame), we analyzed the peptide constituents of the embryos by means of two-dimensional electrophoresis. New kinds of peptides were mainly detected in three periods, i.e. between the 12th and 13th day, between the 20th and 21st day, and between the 30th and 31st day after fertilization. Hatching occurred between the 34th and 37th day. These indicate that these three periods, which corespond to (1) the shifting stage from maternal to nuclear events in gene expression, (2) the development of external organs such as fins, and (3) the preparative stage for hatching, respectively, may be critical stages in gene expression.

[The changes of complement activities in sera of mice after subcutaneous administration of beryllium chloride]

We studied changes of the complement pathway activities and the content of C3 in sera of mice, administered BeCl2 (containing 5 micrograms of Be per mouse) or CuCl2 (containing 5 micrograms of Cu per mouse) by a single subcutaneous injection. The value of the classical complement pathway activity (CH50) of the Be group 3 days after administration was significantly higher than that of the control group (P < 0.001). It was significantly lower than in the control group after 7 days (P < 0.001). On the other hand, the CH50 value of the Cu group 3 hr after administration tended to increase, however, it was significantly lower than in the control group after 7 days (P < 0.01). The change of the alternative complement pathway activity (ACH50) value of the Be group was similar to the change of the CH50 value of the group. The ACH50 value of the Cu group 3 days after administration tended to increase but it was the same as the ACH50 value of the control group after 7 days. The C3 contents of both the Be and Cu groups 3 days after administration were significantly higher than in the control group (P < 0.001). The aspartate aminotransferase (AST) activity of the Be group 7 days after administration was significantly higher than that of the control group (P < 0.01). By contrast, AST activity of the Cu group 3 hr after administration was significantly higher than in the control group (P < 0.05). The value of the alanine aminotransferase (ALT) activity of the Be group was low (P < 0.01), but that of the Cu group was high (P < 0.05), 3 hr after administration. These values of both groups after 7 days, however, were significantly higher than in the control group (P < 0.05). The AST/ALT ratio in mice was very high at 3 hr, and it remained high by 7 days after Be injection. On the other hand, the ratio of the Cu group was almost constant for 7 days after Cu injection. Thus, these values changed with relative expedition after Be injection. Therefore, we confirmed that measurements of complement activities and the content of C3 were valuable indices for assaying acute effects of Be on mice.

Physiological role of insulin-like-growth-factor-binding protein-4 in human folliculogenesis

Insulin-like growth factor (IGF)-I and IGF-II, and their binding proteins (IGFBPs) have been demonstrated to play important roles in follicular development as intraovarian regulators. Previous studies have demonstrated that the follicular fluid of atretic follicles contains high levels of IGFBP-2 and IGFBP-4, which are known to inhibit the action of IGFs. In this study, we identified IGFBP-4 protease activity in the follicular fluid of developing but not atretic follicles. To elucidate the regulation mechanism of IGFBP-4 proteolytic activity in the ovary, cultured luteinized granulosa cells (GCs) were incubated with various hormones, and proteolyzed IGFBP-4 in the medium was analyzed. IGFBP-4 proteolytic activity was increased when GCs were incubated with IGFs, estradiol or follicle-stimulating hormone (FSH) but not with testosterone. We also showed that IGFBP-4 inhibited IGF-1-induced estradiol release by GCs while proteolyzed IGFBP-4 did not. These results suggest that human luteinized GCs produce IGFBP-4 protease, and that FSH and IGFs may stimulate folliculogenesis by modulating IGFBP-4 degradation in the ovary.

Placental tyrosine transport and maternal phenylketonuria

Brush border and basal plasma membrane vesicles prepared from normal human placental syncytiotrophoblast have been used to study L-tyrosine transport across placenta in an attempt to investigate the aetiology of the fetal damage found in maternal phenylketonuria. The results suggest that competition for transport with a grossly raised L-phenylalanine concentration at the basal surface of the trophoblast is responsible for the suppressed delivery of L-tyrosine to the fetus across the placenta.

[A comparative study of caregivers of the elderly with dementia between 1982 and 1991]

The purpose of this study is to clarify the changes of the caregivers'status with comparison of two cross-sectional studies. The subjects were 658 (primary, in 1982) and 705 (secondary, in 1991) group members of "The Association of Families Caring for Elderly Persons with Dementia". The summary of results are as follows: 1) The mean life span of a person suffering dementia was found to be longer in 1991 than 1992. 2) In 1991, about 30 percent of the patients in all age groups were hospitalized and about 70 percent of the patients were treated at home. These facts indicated that the medical facilities had expanded their capacities during the 9 year period for receiving the elderly with dementia. 3) Family members who wished to live independently supported the idea that care should be given by a decreased number of individuals within the family. In that sense, the family's power of caregiving was decreased. 4) The range of main caregivers' informal social-support-network was remarkably expanded. 5) The more the service were expanded, the more the service were utilized by the caregivers. However, the quality and the quantity of the services provided are still not sufficient to meet the caregivers' need. 6) In balance, the difficulties caregivers used to face, seemed to be decreased in 1991.

Lipo-PGE1, prostaglandin E1 incorporated in lipid microspheres, protects injury of the liver caused by warm ischemia reperfusion

Effects of Lipo-PGE1, prostaglandin E1 incorporated in lipid microspheres on liver injury caused by ischemia reperfusion were investigated. Lipo-PGE1 (10 micrograms/kg or 3 micrograms/kg) or vehicle was gradually injected twice via portal vein 5 min prior to induction of ischemia and reperfusion. Rats died within 2 d after liver ischemia of 90 min from the group receiving injection of vehicle alone. Lipo-PGE1 had its most profound effect on the survival of animals subjected to liver ischemia followed by reperfusion when given in two doses, one prior to ischemia, and another prior to reperfusion. Lipo-PGE1 markedly suppressed both the increases in plasma PCOOH (phosphatidyl-choline hydroperoxide) levels and the leakage of GOT, GPT, and LDH from the liver during the ischemia reperfusion. These findings suggest that Lipo-PGE1 may have therapeutic applications in treatment of hepatic injury.

Effects of estrogen and parathyroid hormone on osteoblastic activity via regulating the binding activity of insulin-like growth factor binding protein-4 in SaOS-2 cells: implications for the pathogenesis of postmenopausal osteoporosis

The cellular mechanisms involved in the accelerated bone loss occurring in association with estrogen deprivation as seen following the menopause have not been fully understood. Insulin-like growth factor-I (IGF-I) is the local regulator of osteoblasts and one of its binding protein, insulin-like growth factor binding protein-4 (IGFBP-4), binds to IGF-I and suppresses its biological activity. We have therefore studied the effects of 17 beta-estradiol and parathyroid hormone (PTH) on binding activity of IGFBP-4 and osteoblastic activity using SaOS-2 osteoblastic cells. DNA and collagen synthesis were enhanced by IGF-I or 17 beta-estradiol and suppressed by PTH in a concentration dependent manner. The inhibitory effect of PTH on DNA and collagen synthesis was abolished by the presence of IGF-I or 17 beta-estradiol. The binding activity of IGFBP-4 was stimulated 2-fold by 10 nM PTH, while this PTH-induced IGFBP-4 production was completely inhibited by the addition of 17 beta-estradiol. The stimulated DNA and collagen synthesis by IGF-I or 17 beta-estradiol were inhibited by IGFBP-4 in a concentration dependent manner. The simplest explanation is that 17 beta-estradiol suppressed the inhibitory effect of PTH on osteoblastic activity by inhibiting the PTH-induced increment of IGFBP-4 binding activity in SaOS-2 cells.

[Studies on the bone metabolisms in either after natural menopause or surgical menopause: implications of IGF-IGFBP system for postmenopausal osteoporosis]

It is well established that accelerated bone loss occurs in association with estrogen deprivation as seen following the natural menopause and in premenopausal women undergoing surgical oophorectomy (i.e., surgical menopause). We have measured serum levels of bone biochemical markers after both natural menopause and surgical menopause. Circulating levels of insulin-like growth factor-I (IGF-I), which is considered to be the local regulator of osteoblast activity and one of its binding protein, insulin-like growth factor binding protein-4 (IGFBP-4) which binds to IGF-I and suppress its biological activity, were also measured. Bone mineral density measured by dual energy X-ray absorptiometry was decreased more rapidly after surgical menopause. A concomitantly higher rate of bone turnover as assessed by bone biochemical markers was observed after surgical menopause, and thus the levels of procollagen type I C-peptide, pyridinoline and deoxypyridinoline were increased. The serum levels of IGF-I were significantly reduced after natural menopause compared with that after surgical menopause. The levels of IGF-I were correlated with bone mineral density after natural menopause (r = 0.62, p < 0.001), but no significant correlation was observed between these two variables after surgical menopause. The binding activity of IGFBP-4 was significantly greater after surgical menopause than after natural menopause. A stronger inverse correlation existed between the binding activity of IGFBP-4 and bone mineral density after surgical menopause (r = -0.90, p < 0.001) compared to that after natural menopause (r = -0.29, p < 0.05). The simplest explanation is that whereas the loss of bone depends upon the decreased level of IGF-I after natural menopause, after surgical menopause it depends upon the increased level of IGFBP-4.

A case of subacute necrotizing fasciitis

We report a 48-year-old woman who developed necrotizing groin fasciitis with insidious onset. Before she visited us, she had been unsuccessfully treated with several kinds of antibiotics by other doctors for one month, because of a small ulcer covered by blackish necrotic tissue. She was referred to us because of high fever, an ulcer on the left labium majus, and a cellulitis-like lesion with severe pain on the lower abdomen. Methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus intermedius, and Bacteroides uniformis were isolated from the wound. After aggressive debridement on the eighth day after admission of the whole indurated area and the fascia of the underlying muscle, healthy granulation tissue covered the defect, and the wound was finally closed with a skin graft Long-term administration of antibiotics along with insufficient and delayed surgical treatment were considered to have caused the full development of this disease.