[Effect of aging on distortion product otoacoustic emissions]

The effect of aging on distortion product otoacoustic emissions (DPOAE) was investigated in 58 ears of 32 volunteers with normal hearing DPOAE levels to tones with a fixed frequency ratio (f2/f1 = 1.2) were measured with the CUBDIS system (MIMOSA Acoustics, USA). Age dependency of DPOAE level was clearly observed both in frequency plots (DP-gram) and input-output functions. In elderly persons, DPOAE levels for higher frequency primaries were significantly lower than in younger persons, when no remarkable change of audiometry threshold was noted. These results imply that the DPOAE level can be a sensitive indicator for age-related cochlear dysfunction.

CT-pathologic correlation in the tumor margins of lung cancer

A CT-pathologic correlative study concerning the nature of the tumor margin was performed in 22 lung cancer cases with solitary nodules in the peripheral lung field. Three of 14 adenocarcinoma cases showed an ill-defined margin and an adjacent subtle high attenuation area on CT, representing alveoli lined by tumor cells. In the other 11 cases, both ill- and well-defined margins were seen on CT. A well-defined margin of the mass represented alveoli filled entirely with mucinous material or tumor cells. In three of six squamous cell carcinomas an ill-defined margin in CT represented the infiltration of lymphatic cells surrounding the tumor and continuous spread of tumor cells from neighboring alveoli. A well-defined margin in the other cases and two small cell carcinoma cases represented alveoli filled entirely with tumor cells. CT was shown to be very useful in the assessment of the nature of the margin of the tumor.

Predicting factors for distant metastases in head and neck carcinomas: an analysis of 103 patients with locoregional control

PURPOSE

This study evaluated the ability of certain clinical and pathologic parameters to predict distant metastases (DMs) in patients with squamous cell carcinoma of the head and neck.

MATERIALS AND METHODS

A total of 103 patients with histologically proven squamous cell carcinoma of the head and neck were studied. None had persistent or recurrent disease above the clavicle. Of these patients, 48 (47%) had metastatic lymph nodes. The relationships of tumor stage, primary site, clinical growth pattern, tumor differentiation, regional node status, and extranodal spread (ENS) with DMs were evaluated.

RESULTS

Twenty-one (20%) of the 103 patients developed DMs as the initial treatment failure. The incidence of DMs was significantly higher in patients with neck metastases (40%) than in those without neck metastases (4%) (P < .001). The degree of histologic differentiation and the presence of ENS were also correlated with the subsequent occurrence of DMs. There was no statistical difference in the incidence of DMs based on sex, location, stage of the disease, and clinical growth pattern. On multivariate analysis, only pathologic nodal status and ENS proved to be independent cofactors of DMs. The most common site of DMs was the lungs (56%), followed by bone (16%) and skin (16%).

CONCLUSION

The presence of pathologically positive nodes is the most critical factor to influence the eventual development of DMs.

Cytokines in bronchoalveolar lavage fluid in patients with high altitude pulmonary oedema at moderate altitude in Japan

BACKGROUND

The precise mechanism of high altitude pulmonary oedema (HAPE) remains unclear. The purpose of this study was to evaluate the role of cytokines and P-selectin in the development of HAPE which occurred at moderate altitude in Japan.

METHODS

The following cellular and biochemical markers and chemotactic cytokines were measured in the bronchoalveolar (BAL) fluid from four patients with HAPE at 2857-3180 m in the Japanese Alps: total proteins, albumin, lactate dehydrogenase (LDH), and interleukin (IL)-1 alpha, IL-1 beta, IL-1 receptor antagonist (ra), IL-6, IL-8, IL-10, tumour necrosis factor (TNF)-alpha, and the soluble form of P-selectin.

RESULTS

At admission there were significant increases in the levels of total cells, especially macrophages and neutrophils, total protein, albumin and LDH when compared with 13 healthy individuals. Furthermore, the levels of IL-1 beta, IL-6, IL-8, and TNF-alpha were also considerably increased but returned quickly to the normal ranges or were not detected after recovery. The levels of IL-1 alpha, IL-10, and P-selectin did not change.

CONCLUSIONS

These results suggest that an inflammatory process almost identical with acute respiratory distress syndrome (ARDS) may occur in HAPE, but that these changes are transient and are not associated with any increase in P-selectin levels in the BAL fluid.

Effects of coffee cherry on the immune system in SHN mice

Previously, we found that chronic ingestion of the extract of coffee cherry (CC), the residue after the removal of coffee beans, induced a marked suppression of the development and the growth of spontaneous mammary tumours in a high mammary tumour strain of SHN mice. As a possible step to clarify the mechanism of this effect, the immunomodulating role of CC was examined in this study. CC treatment resulted in significant weight gain in the spleen. CC treated experimental mice showed a significant decrease in the proportion of immature (CD4+8+) thymocytes and an increase in the percentages of mature cells expressing helper/inducer (CD4+8-) or cytotoxic/suppressor (CD4-8+) phenotypes. The proportion of T cells expressing CD25, a lymphocyte activation marker, in the spleen and peripheral blood tended to increase in the CC treated group. The natural killer activity of the spleen cells was not affected by CC ingestion. These results have revealed that CC can enhance the differentiation of thymocytes and the activation of peripheral T lymphocytes.

[Rapidly deteriorating adult hydronephrosis due to an aberrant vessel: a case report]

Hydronephrosis due to ureteropelvic junction (UPJ) obstruction generally progresses gradually. We experienced a case of hydronephrosis due to UPJ obstruction deteriorating rapidly in an adult woman. In spite of percutaneous nephrostomy, 99mTc-DTPA renogram showed a non-functional pattern. A nephrectomy was done. Peri-operatively, the aberrant lower pole vessel was found to be obstructing the UPJ. The hydronephrosis deteriorated rapidly because the extrarenal pelvis dilated in the shape of box, became suspended from the aberrant vessel. Therefore, we believe that the box pelvis is one of the most important factors deteriorating hydronephrosis.

Immunohistochemical study of Cell Cycle Modulators in G(1)-S Transition in Clinical Breast Cancer Tissue

In the present study, we investigated immunolocalization of the modulators of G(1)-S transition by using monoclonal or polyclonal antibodies for each of the modulators in 65 cases of clinical breast cancer. Two prominent cyclin dependent kinase(cdk)-cyclin complexes, cdk4-cyclin D and cdk2-cyclin E, were proved to have different modes of mutual expression. cdk4-positive lesions were found to equal cyclin D-expressing lesions in 55 cases, while the former were more extensive than the latter in 9 cases. On the other hand, cyclin E expression was detected in all the cases examined and was more dominant than that of cdk2/cdc2 in as many as 40 cases whereas the reverse was seen in only 1 case. Interestingly, cdk4(P<0.01)and cyclin E(P<0.05)expressions showed an inverse relationship with the tumor size and the cancer stage. A similar tendency was also detected for two other positive modulators of G(1)-S transition, indicating that cell cycle progression must be regulated by the cancer itself once it has grown to a certain extent. p21, which has been regarded as a universal inhibitor of the cell cycle, was expressed in 43.1% of the cases examined and its immunoreactivity showed an inverse relationship with lymph node metastasis(P<0.05). It also tended to be absent more frequently in T3 or larger cancers and stage III cases. Moreover, two patients who died as a result of cancer and three patients with recurrence were all p21 negative, suggesting that p21 is prognosticably the most significant of all these modulators.

[Distance walked in 10 minutes, pulmonary function, and pulmonary hemodynamics during exercise, in patients with pulmonary emphysema]

We examined relationships among the distance walked in 10 minutes (10 MD), pulmonary function, and pulmonary hemodynamics during exercise on a bicycle ergometer, in patients with chronic pulmonary emphysema who had dyspnea of grade III to IV on the Hugh-Jones scale. The 10 MD did not correlate significantly with desaturation during the 10-minute walk, but it did correlate significantly with the percent of predicted maximum voluntary ventilation, and it correlated negatively with airway resistance. These findings indicate that ventilatory impairment is an important factor limiting 10 MD in these patients. Also 10 MD correlated significantly and positively with %DLco; and it correlated negatively with the index of pulmonary vascular resistance and with the ratio of the change in pulmonary arterial pressure to the change in cardiac index during exercise. (delta Ppa/delta CI). These findings indicate that impairment of pulmonary circulation may also limit the 10 MD and exercise tolerance in patients with chronic pulmonary emphysema.

[Radiosurgery of cavernous sinus meningiomas with gamma-knife]

The treatment results of cavernous sinus meningioma with gamma-radiosurgery are reported. There were 18 cases of cavernous sinus meningioma, including 2 males and 16 females, whose age ranged from 39 to 63 with an average of 51.0 years. As prior treatments, operative tumor resection or biopsy had been carried out in 14 cases, and the pathology was verified. The other 4 cases were diagnosed clinically with radiological studies. The mean tumor diameter was 28.3mm (17.7-35.0) during the radiosurgery. The maximum dose ranged from 22 to 36Gy (mean 28.0Gy), with the marginal tumor dose ranging from 11 to 18Gy (mean 13.9Gy). Irradiation to the near-by optic nerves was less than 10Gy. Follow-up period ranged from 12 to 50 months with a mean of 25.5 months. MRI showed a minor tumor shrinkage in 9 (50.0%) and no obvious change in 8 (44.4%), and tumor progression in 1 (5.6%), which required a 2nd radiosurgery. Neurologically facial pain and facial dysesthesia were well improved (7/13). However the ophthalmoparesis was usually unchanged and only 1 out of 11 (9.1%) improved after radiosurgery. Deterioration of neurological signs was rare. Symptomatic edema presenting neurological signs was not seen. In conclusion, radiosurgery with a gamma-knife is one of the useful alternatives to operative intervention in the treatment of cavernous sinus meningiomas, not only for tumor control, but also for relief from the symptoms.

Fatal differentiated thyroid cancer

Thirty-five patients who died of differentiated thyroid cancer were analyzed for factors affecting survival. The neck was the most common initial site of recurrence (62.0%). The lung was the most common metastatic site (56.7%). Major sites associated with death were locoregional recurrence (neck and mediastinum: 48.6%) and bone metastases (22.9%). By univariate analysis, local tumor extension, type of initial surgery, and residual tumor and/or existence of distant metastases at the initial operation were significant factors affecting survival. Stepwise multivariate analysis revealed that invasion of the esophagus and/or carotid artery shortened survival and that multiple surgeries extended survival. Our results suggest that to improve survival in patients with differentiated thyroid cancer, better locoregional control, including multiple surgical resection, is necessary.

Septal structure of incomplete interlobar fissures of the lung

RATIONALE AND OBJECTIVES

Some septal structures have been observed in the areas of incomplete interlobar fissures (IIFs) in resected lungs. We describe the anatomy of IIFs with or without the presence of septal structures.

METHODS

Twenty fused areas from 16 autopsy cases were examined histologically. Other septal structures outside the areas of IIFs also were examined.

RESULTS

In 10 of the 20 fused areas, there was a mixture of septal structures with and without defects. In the remaining 10, there were no septal structures. The septal structures consisted of two inner layers from both lobes. Other septal structures examined were the same as ones observed in the IIFs.

CONCLUSION

Linear shadows seen at interlobar fissures and on computed tomography scans do not necessarily depict the presence of complete interlobar fissures. The absence of linear shadows does not necessarily imply the absence of septal structures.

Effect of a computer-aided diagnosis scheme on radiologists' performance in detection of lung nodules on radiographs

PURPOSE

To evaluate the effect of a computer-aided diagnosis (CAD) scheme on radiologists' performance in the detection of lung nodules, and to examine a new method of receiver operating characteristic (ROC) analysis.

MATERIALS AND METHODS

One hundred twenty radiographs (60 normal and 60 abnormal with lung nodules of varying subtlety) were used. Sixteen radiologists (two thoracic, six general, and eight residents) participated in an observer study in which they read both conventional radiographs and digitized radiographs. The radiologists' performance was evaluated with ROC analysis with two different methods (independent testing and sequential testing) and a continuous rating scale.

RESULTS

Az (area under the best fit binormal ROC curve when it is plotted in the unit square) values obtained from ROC analysis with and without CAD output were 0.940 and 0.894, respectively, in the independent test and 0.948 and 0.906, respectively, in the sequential test. Findings with both methods indicated that the CAD scheme statistically significantly improved diagnostic accuracy, particularly for radiologists with less experience (P < .001). Reading time was not increased when CAD was used.

CONCLUSION

The CAD scheme can assist radiologists in the detection of lung nodules on chest radiographs.

Augmented very low frequency component of heart rate variability during obstructive sleep apnea

After documenting the presence of obstructive sleep apnea syndrome (OSAS) through polysomnographic monitoring, we performed simultaneous ambulatory recordings of electrocardiogram, oronasal airflow, and pulse oximetry on 12 OSAS patients with normal autonomic nervous function for a period of 24 hours. The power spectrum of heart rate variability was investigated before and during treatments using dental appliances. Freuquency domain analysis showed that the very low frequency component of heart rate (0.008-0.04 Hz) was increased in OSAS patients and that a very low frequency peak appeared during episodes of obstructive sleep apnea. The increase in very low frequency identification was synchronized with episodes of absence of air exchange or hypoxemia (decreased arterial oxygen saturation) that occurred repeatedly at a cycle length of 25-120 seconds in our subjects. Frequency domain analysis of heart rate variability before and during prosthetic mandibular advancement treatment showed that only the very low frequency was significantly decreased during prosthetic mandibular advancement treatment, whereas the other frequencies, i.e. high, low, and ultralow frequency component values, showed no significant changes. Time domain analysis of heart rate variability before and during prosthetic mandibular advancement treatment showed no significant changes in any of these parameters. Frequency domain analysis of heart rate variability during nocturnal sleep, especially investigation of very low frequency and very low frequency peak, can be a noninvasive low-cost approach to diagnose and even better monitor subjects undergoing treatment at home, particularly considering that R-R intervals can be extracted from pulse oximetry and that analysis software programs are already commercially available.

High-level expression of Bacillus thuringiensis phosphatidylinositol-specific phospholipase C by the Bacillus brevis host-vector system

We succeeded in hyperproduction of Bacillus thuringiensis phosphatidylinositol-specific phospholipase C (PIPLC), using a Bacillus brevis 47 expression system. The recombinant B. thuringiensis PIPLC was expressed under the control of the middle wall protein gene promoter in B. brevis expression vector pNU211. A large amount of recombinant PIPLC (0.4 g per liter culture) was secreted into the medium as a mature enzyme, and the enzymatic properties of purified recombinant PIPLC were similar to those of the enzyme from wild-type B. thuringiensis. This system provides a useful approach to the three-dimensional structure-function relationship of PIPLC.

A case-reference study on plasma fibrinogen concentrations and coronary atherosclerosis in Japanese

To examine contribution of plasma fibrinogen concentrations to coronary atherosclerosis in Japanese, a cross-sectional study was conducted from 1991 to 1993 for 169 myocardial infarction cases and 1 : 1 matched references. All cases had one to three coronary vessels with 50 percent or more stenosis. References were chosen out of Osaka residents who had no cardiac event by matching sex and age ((+)-3 years) with cases. Mean (SD) values of plasma fibrinogen concentration were 322 (81) mg/dl in men and 377 (77) mg/dl in women for cases, and were 282 (56) mg/dl in men and 277 (48) mg/dl in women for references; mean plasma fibrinogen was significantly higher in cases than in references for both men and women. Furthermore, mean plasma fibrinogen was progressively higher as the number of stenotic vessels increased for men, and similar trend was seen for women. The case-reference difference remained significant even after adjusting smoking status, hypertension, serum total cholesterol, serum HDL cholesterol. Although plasma fibrinogen concentration was reported lower in Japanese than in American Caucasians, plasma fibrinogen is suggested to be a risk factor for myocardial infarction among Japanese as so among Caucasians.

Regular and irregular dichotomies of bronchial branching in the human lung

RATIONALE AND OBJECTIVES

Typical models of the human bronchial tree depict regular branching. However, some anatomic studies also have revealed irregular dichotomies in the human lung. We therefore studied the patterns of bronchial branching in the human lung.

METHODS

We examined a normal right lung. Bronchial branchings were traced up to terminal bronchioles (TBs) in both regular and irregular dichotomies.

RESULTS

In 256 TBs in peripheral regions, the number of branchings varied from 11 to 23; the largest number was found in the S10c of the basal segment, and the average was 15. In 354 TBs in hilar regions supplied by irregular dichotomies, the number of branchings ranged from 9 to 15, with the average being 10. In secondary pulmonary lobules, bronchioles supplying the secondary pulmonary lobules reached TBs in two or three divisions.

CONCLUSION

Irregular dichotomies are too frequent to be neglected in the interpretation of radiologic and physiologic findings.

[Nutritional and biochemical studies on vitamin D and its active derivatives]

We have performed nutritional and biochemical studies on vitamin D and its active derivatives and the following results are obtained. 1. Since recent studies have revealed that dietary supplement of vitamin D (D2 and D3) and calcium is effective for preventing osteoporosis, a simplified routine method for determination of vitamin D in foods is established and applied to the assay on the contents of vitamin D in various kinds of Japanese foods. 2. A simplified routine method for simultaneous determination of vitamin D and its metabolites in the plasma and milk is established and applied to nutritional and clinical studies. 3. Physiological activities of two kinds of novel vitamin D3 derivatives, 22-oxa-1 alpha, 25-dihydroxyvitamin D3 (22-oxa-1,25(OH)2D3, OCT) and 2 beta-(3-hydroxypropoxy)-1,25(OH)2D3 (ED-71) have been studied. OCT, which has less calcemic and stronger cell differentiation activities than 1,25(OH)2D3, is a candidate for curing leukemia and other cancers without hypercalcemia. We have clarified that the property is due to its weak binding affinity for vitamin D binding protein and rapid turn-over in the body and rapid excretion into bile. On the other hand, ED-71, which has stronger effects on intestinal calcium absorption and longer bone turn-over than 1,25(OH)2D3, is a candidate for curing osteoporosis. We have clarified that the properties are due to stronger binding affinity for DBP and longer half-life than 1,25(OH)2D3.

Pyothorax-associated lymphoma. An unusual case with biphenotypic character of T and B cells

Pyothorax-associated lymphoma is known to develop in patients who received an artificial pneumothorax for pulmonary tuberculosis some 30 to 40 years previously. Such patients exhibit large, immunoblastic lymphoma cells and often have a B-cell phenotype. We present a patient with an artificial pneumothorax and such a late developing lymphoma but with the unique finding of aberrant T- and B-cell phenotypes. Southern blot hybridization using immunoglobulin gene JH and T-cell receptor beta chain receptors revealed germline configurations. Lymphomas developing in immunocompromised patients, such as those with acquired immunodeficiency syndrome, may show such unusual phenotypes. The unusual phenotypes found in this patient provide evidence that his pyothorax-associated lymphoma was related to an immunocompromised state.

Ultracytochemical localization of alkaline phosphatase (ALPase) activity in neutrophils of the rat lung following injection of lipopolysaccharide

Alkaline phosphatase (ALPase) activity in neutrophils was examined by enzyme ultracytochemistry at sites of experimentally induced acute inflammation in the rat lung and compared with those in non-inflammatory regions. Neutrophil accumulations in the lung were stimulated by intraperitoneal (IP) injection and intratracheal (IT) instillation of lipopolysaccharide (LPS), an endotoxin from Escherichia coli. Microsliced sections of fixed lung were incubated in a cerium-based reaction medium for the detection of ALPase activity. As cytochemical controls, sections were incubated in a substrate-free medium or in a medium containing 2 mM levamisole for inhibition of ALPase activity. Both IP and IT injections resulted in a significant accumulation of neutrophils in the lung, however, their histological distributions differed, the former stimulating high accumulations within the capillaries and interalveolar spaces, and the latter within the confines of the alveolar spaces. In neutrophils from controls and non-inflamed regions of the lung, ALPase activity was detected as an electron-dense reaction product localized predominantly to small spherical and tubular membrane-bounded cytoplasmic compartments. In the IP-injected rats, prominent ALPase activity was observed at their plasma membrane surfaces, most notably at sites of endothelial cell contact. Following IT instillation of LPS, neutrophils suspended in the alveolar spaces showed a reduced plasma membrane reactivity, however, at type I pneumocyte contact regions, enzyme activity was significantly increased. In all cases, ALPase activity was not detected at the endothelial plasma membranes. Some reaction, however, was seen on the microvilli of the type II surfactant-producing cells. These results indicate that ALPase activity of rat neutrophils in the lung can be increased by LPS injection and that its activity may also be related to the sites of cell-cell interaction and cell surroundings.

Regional differences of the effect of sigma receptor ligands on the acetylcholine release in the rat brain

We found that sigma receptor ligands differentially regulated the acetylcholine (ACh) neurotransmission in the rat brain. Acute administration of (+)-N-allylnormetazocine [(+)-SKF-10,047], a prototype sigma 1 receptor ligand, and 1,3-di(2-tolyl)guanidine (DTG), a non-specific sigma receptor ligand, increased the extracellular ACh level in the rat hippocampus. This increase of hippocampal extracellular ACh level elicited by (+)-SKF-10,047 was more potent than that elicited by DTG. On the other hand, the striatal extracellular ACh level was slightly affected by (+)-SKF-10,047. In addition, DTG did not affect the striatal extracellular ACh level. Our previous studies have shown that both (+)-SKF-10,047 and DTG increased the extracellular ACh level in the rat frontal cortex. Taking all these data into consideration, the regulation of ACh neurotransmission by sigma receptor ligands are different depending upon the brain region.