Na-K-ATPase activity in the guinea pig stria vascularis in experimentally-induced endolymphatic hydrops

The effect of endolymphatic hydrops on the Na-K-ATPase activity in the guinea pig stria vascularis was electron microscopically and enzyme cytochemically investigated one year after experimental induction. The morphological observations revealed intercellular dropsy in the basal infoldings of the marginal cells, and shrinkage and disappearance of intermediate cells. Moreover, shrinkage of the marginal cells, especially of the basal infoldings, was occasionally observed. In spite of these morphological alterations, the Na-K-ATPase activity was still detected on the plasma membrane of the basal infoldings of most marginal cells. No remarkable differences were found among the cochlear turns of the specimens examined. However, no reaction product was detected on the basolateral plasma membrane of severely degenerated marginal cells. The present results indicate that the Na-K-ATPase of the plasma membrane of the basal infoldings of the marginal cells plays an important role in the maintenance of the unique ion concentration of the endolymph even in the endolymphatic hydropic condition, and that the Na-K-ATPase activity is attenuated in severely atrophic cells.

Zinc supplementation alters thyroid hormone metabolism in disabled patients with zinc deficiency

OBJECTIVE

We examined zinc (Zn) status in relation to thyroid function in disabled persons, because the association between Zn deficiency and thyroid function remains controversial.

METHODS

After measuring serum free 3,5,3'-triiodothyronine (T3) and free thyroxine (T4) in 134 persons, TSH-releasing hormone (TRH) injection test and estimation of Zn status were conducted in persons with low free T3.

RESULTS

Thirteen had low levels of serum free T3 and normal T4. Patients with elevated levels of serum 3,3',5'-triiodothyronine (rT3) showed an enhanced reaction of serum thyrotropin (TSH) after TRH injection. Nine of 13 patients had mild to moderate Zn deficiency evaluated by body Zn clearance and increased urinary Zn excretion. After oral supplementation of Zn sulphate (4-10 mg/kg body weight) for 12 months, levels of serum free T3 and T3 normalized, serum rT3 decreased, and the TRH-induced TSH reaction normalized. Serum selenium concentration (Type 1 T4 deionidase contains selenium in the rat) was unchanged by Zn supplementation.

CONCLUSION

Zn may play a role in thyroid hormone metabolism in low T3 patients and may in part contribute to conversion of T4 to T3 in humans.

Shift in clinical features, histologic findings and antigen profiles from pemphigus vulgaris to pemphigus foliaceus--two case studies

We investigated antigen profiles of the sera from 2 cases of pemphigus vulgaris (PV) who subsequently developed pemphigus foliaceus (PF). Immunoblotting was carried out using normal human epidermal extracts as the antigen source. The sera during PV reacted exclusively with the 130-kD PV antigen and the sera during PF exclusively with the 150-kD antigen. Therefore, dermatologic, histologic and immunohistologic findings before and after this transition were clearly shown related to changes in serum reactivity with pemphigus antigens.

[The effects of calcium deficiency on aluminum accumulation in the tissues of rats treated by oral aluminum administration]

We carried out this investigation to elucidate the effect of calcium (Ca) deficiency (Ca (-)) on aluminum (Al) accumulation in tissues of rats treated by oral Al administration. Thirty-two four-week-old rats (65g) were divided into two groups; a normal (N) diet group and a Ca (-) diet group. The N diet group was fed the N diet for 45 consecutive days, and then divided into four groups. Group (G)-1 rats were fed normal diet (N) for 9 days, G-2, G-3 and G-4 rats were fed an Al-overloaded N diet (1mg Al/g diet) for 3, 6 or 9 days, respectively. The Ca (-) diet group was fed Ca (-) diet for 45 consecutive days, and then divided into four groups. G-5 rats were fed the Ca (-) diet for 9 consecutive days, G-6, G-7 and G8 rats were fed an Al-overloaded Ca (-) diet for 3, 6 or 9 days. We studied the accumulation of Al in Ca- deficient rats fed Al (Ca (-) + Al) for 3, 6, and 9 days, comparing that of the normal- diet rats fed Al (N + Al) for the same period. The Al concentration in the small intestine increased on the third day after Al, and then decreased to the normal level on the 6th day in both N + Al and Ca (-) + Al rats. However, that of the Ca (-) + Al rats increased significantly compared to N + Al rats on the 9th day.(ABSTRACT TRUNCATED AT 250 WORDS)

Two types of left ventricular wall motion abnormalities with distinct clinical features in patients with hypertrophic cardiomyopathy

During the long-term follow-up of patients with hypertrophic cardiomyopathy (HCM), some patients develop left ventricular (LV) wall motion abnormalities in the absence of fixed coronary artery disease. The purpose of this study is to clarify which clinical features in patients with HCM seem to influence gradual development of LV wall motion abnormalities over an extended period of time. The study investigates the incidence, mechanism and predictors of these abnormalities. In this retrospective study of 162 patients with HCM, followed-up for an average of 13.3 years, we focused our attention on 16 patients who gradually developed two different forms of LV wall motion abnormality. In 11 of these 16 patients, apical segmental dysfunction with midzone obstruction was recognized; the remaining five patients showed generalized hypokinesis, as seen in dilated cardiomyopathy. The 11 patients with apical segmental dysfunction presented with extensive apical hypertrophy reaching the midventricular level at first examination. The five patients with generalized hypokinesis showed a slight decrease in LV contractility and reduced localized antero-apical wall motion even at initial examination. None of the patients in either group developed the other group's features during their clinical course. These two groups had different initial manifestations and pursued different clinical courses, suggesting that the underlying mechanisms causing wall motion abnormalities are different.

[Evaluation of CEA, SLX and CA125 in active pulmonary tuberculosis]

Serum tumor markers (CEA, SLX, CA125) were evaluated in 123 patients with active pulmonary tuberculosis. The results were as follows: Elevated serum CEA, SLX and CA125 levels were found in 16.9%, 39.5% and 44.4%, respectively, of patients with active pulmonary tuberculosis. Markedly elevated serum CA125 levels were found in some cases. On chest X-ray films, the factors associated with elevation of serum tumor marker levels were examined. Serum CEA and SLX levels were correlated with the extent of disease. Pleural effusion had no influence on serum tumor marker levels. Serum SLX levels were higher in patients without a tuberculous cavity than in those with a tuberculous cavity. After therapy with antituberculous drugs, the mean values of serum SLX and CA125 levels significantly decreased. The decrease in mean value of serum CEA levels was not significant, but in 4 of 8 cases, elevated serum CEA levels were normalized after therapy. On the other hand, two cases with increased serum CEA or SLX level died of respiratory failure. These results suggest that to follow up patients with elevated serum tumor markers is useful for the evaluation of disease activity of pulmonary tuberculosis. Further elevation of serum tumor marker levels after antituberculous therapy may indicate the presence of cancer or deterioration of the disease.

[Adrenocorticotropin receptor in familial glucocorticoid deficiency]

Recent studies have revealed the presence of four subtypes for the melanocortin receptor (MC-R). Among these MC-Rs, MC2-R is considered to be an adrenocorticotropin (ACTH) receptor because its expression is almost localized in the adrenal cortex. Five Japanese patients with ACTH unresponsiveness were examined as to whether they have mutations in the putative ACTH receptor. Among these patients, there are two groups of siblings, each of which consists of two individuals. The coding region of the ACTH receptor gene was amplified by polymerase chain reaction and directly sequenced on both strands, however, no point mutation was found in any of the five patients, suggesting that familial glucocorticoid deficiency, caused by the mutated ACTH receptor, may be rare.

Restrictive cardiomyopathy with complete atrioventricular block and distal myopathy with rimmed vacuoles

Two-dimensional echocardiography, cardiac catheterization, electrophysiologic studies, and biopsies of cardiac and skeletal muscle were performed in a patient with complete atrioventricular block as the initial manifestation of restrictive cardiomyopathy. The patient also showed distal myopathy with rimmed vacuoles. Weakness of the distal leg muscles occurred several years after the initial cardiac manifestations and the patient developed congestive heart failure 1 year before the second admission. Endomyocardial biopsy showed patchy myocardial fibrosis without endomyocardial fibrosis or any other specific findings of myocardial disease. Histochemical examination of skeletal muscle showed the typical features of distal myopathy with rimmed vacuoles. In some patients with atrioventricular block as the initial manifestation of restrictive cardiomyopathy, the cardiomyopathy may be just 1 manifestation of a more generalized disorder affecting both cardiac and skeletal muscle.

Long-term prognosis in 990 medically treated Japanese patients with coronary artery disease

We performed a retrospective analysis of the fate of 990 medically treated Japanese patients with coronary artery disease. Patients were enrolled in this study between September 1973 and February 1984. They were confirmed to have significant coronary artery disease by coronary angiography. There were 924 males and 66 females with a mean age of 54.4 years. The mean duration of follow-up was 9.4 years with a range of 6.5 to 17.0 years. The 5-year and 10-year survival rates for the entire population were 92.1% and 84.4%. The 5-year and 10-year survival rates in patients with single- (SVD), double- (DVD), and triple-vessel disease (TVD) and left main trunk (LMT) disease were as follows: 96.0% and 91.9% for SVD, 93.8% and 87.5% for DVD, 83.2% and 68.3% for TVD, and 89.3% and 84.6% for LMT disease. This was the first large follow-up study of coronary artery disease in Japan. Its results suggest that the prognosis of Japanese patients with coronary artery disease is more favorable than that of patients in Western countries. In addition, the findings should provide a control data base for future studies in Japan and the West.

1 alpha,25-dihydroxy vitamin D3 modulation of HLA-DR mRNA induced by gamma-interferon in cultured epithelial tumor cell lines

Using three cultured epithelial tumor cell lines, we investigated and analyzed the effects of gamma-interferon (gamma-IFN) and 1 alpha,25-dihydroxy vitamin D3 (1,25-(OH)2D3) on the levels of HLA-DR (alpha) mRNA and HLA-DR (beta) mRNA by Northern blot analysis. After treatment with gamma-IFN alone, the levels of the mRNA increased. Treatment with both gamma-IFN and 1,25-(OH)2D3 at the same time resulted in a significant decrease in the levels of mRNA in K-TL-1, IK-TL-2, and M-TL cells as compared to those induced by gamma-IFN alone.

A case of postpartum hypopituitarism associated with empty sella: possible relation to postpartum autoimmune hypophysitis

A fifty-year-old woman was admitted to our hospital because of generalized edema, progressive symptoms of fatigue and weakness of ten years' duration. After an uneventful third delivery, 24 years before admission, she could not lactate and developed oligomenorrhea and then amenorrhea. Laboratory evaluation revealed panhypopituitarism and pituitary cell antibodies were positive. Both CT scans and MR images showed empty sella. This case is postpartum hypopituitarism without a preceding history of excessive bleeding and may be autoimmune hypophysitis.

Mild to moderate zinc deficiency in short children: effect of zinc supplementation on linear growth velocity

Twenty-one prepubertal, short Japanese children (11 boys) without endocrine abnormalities were identified as having mild-to-moderate zinc deficiency by zinc kinetics studies (zinc body clearance > or = 20 ml/kg per hour). Only one child had a serum zinc level < 65 micrograms/dl (cutoff level). A total of 10 children (5 boys) received 5 mg/kg per day of zinc sulfate for 6 months; 11 untreated children (6 boys) served as control subjects. During treatment, calorie intake (p < 0.01), growth velocity (p < 0.01), serum zinc, calcium, and phosphorus concentrations, alkaline phosphatase activity (p < 0.001), percentage of tubular reabsorption of phosphorus (p < 0.05), ratio of maximal tubular reabsorption rate for phosphorus to the glomerular filtration rate (p < 0.05), serum osteocalcin level (p < 0.01), and plasma insulin-like growth factor 1 (p < 0.05) were significantly increased, but urinary excretion of growth hormone was unchanged in the zinc-supplemented group. All these values were unchanged in the untreated children. We conclude that zinc supplementation is effective for inducing growth in short children with zinc deficiency, and that body zinc clearance tests facilitate detection of marginal zinc deficiency.

Effect of interleukin-6 on cell proliferation of FRTL-5 cells

We studied the effects of interleukin-6(IL-6) on DNA synthesis and cyclic AMP production in rat thyroid FRTL-5 cells. When cells were incubated with IL-6 in the presence or absence of IGF-I, cell proliferation was not observed. By contrast, IL-6 stimulated DNA synthesis in a dose dependent manner when TSH was added concomitantly. On the other hand, IL-6 did not modulate the cAMP accumulation in the presence or absence of TSH. These data demonstrate that, like IGF-I, IL-6 may be able to act as a growth factor through activation of a mitogenic signal transduction pathway different from A-kinase in FRTL-5 cells.

Functional regulation of GTP-binding protein coupled to insulin-like growth factor-I receptor by lithium during G1 phase of the rat thyroid cell cycle

The regulatory effects of lithium on the function of pertussis toxin-sensitive GTP-binding (G(i))-proteins located on the mitogenic pathway activated by insulin-like growth factor-I (IGF-I) in FRTL-5 cells were studied. Addition of GTP-gamma-S to the thyroid stimulating hormone-primed cell membranes resulted in a decreased affinity of IGF-I receptor binding, and the dissociation constant (Kd) increased from 0.46 nM to 3.1 nM. Moreover, IGF-I stimulated GTP-gamma-S binding to a 40-kDa protein, and pertussis toxin (PT) attenuated the stimulatory effect of IGF-I on the same protein. Lithium lowered the affinity of IGF-I receptor binding and the Kd (3.4 nM) was in the same range as that in the presence of GTP-gamma-S. The inhibitory effect of lithium was markedly abolished by pretreatment with PT. Lithium attenuated the amounts of ADP-rebosylation of the 40-kDa protein by PT. In addition, lithium stimulated Ca2+ entry, similar to that by IGF-I, and induced cell proliferation via a PT-sensitive step. These findings suggest that lithium may be capable of modulating the function of G(i)-proteins coupled to IGF-I receptors during the G1 phase of the FRTL-5 cell cycle.

[A case of endobronchial chondroma in a patient with atypical mycobacterial infection]

A case of endobronchial chondroma in a 74-year-old man with atypical mycobacterial infection is reported. Bronchoscopy was performed in order to exclude the possibility of malignancy. At bronchoscopic examination, a hemispherical polypoid tumor with smooth surface was found at the orifice of left B3 and was removed by transbronchial biopsy forceps. Histologically the tumor was composed of cartilage tissue. About 1 year after forceps resection, no growth of the tumor was seen in the left upper lobe bronchus on bronchoscopic examination. Endobronchial chondroma is relatively rare. We discuss the clinical features of 19 cases of endobronchial chondroma so far reported in Japan, including our case.

Genistein, a tyrosine kinase inhibitor, blocks the cell cycle progression but not Ca2+ influx induced by BAY K8644 in FRTL-5 cells

IGF-I, when added to TSH-primed FRTL-5 cells, induces a long lasting Ca2+ influx and then DNA synthesis. Ca2+ channel agonist, BAYK 8644, is capable to mimic these effects on cell proliferation. We studied the effect of genistein, a specific tyrosine kinase inhibitor, on BAY K8644- or IGF-I- induced cell cycle progression in FRTL-5 cells. Genistein inhibited DNA synthesis induced by BAY K8644 and by IGF-I. In contrast, Ca2+ influx stimulated by BAY K8644 was not inhibited. These data demonstrate that the signal transduction pathway induced by BAY K8644 or IGF-I may possibly involve genistein-sensitive process at the downstream step of Ca2+ entry.

Pigment production in murine melanoma cells is regulated by tyrosinase, tyrosinase-related protein 1 (TRP1), DOPAchrome tautomerase (TRP2), and a melanogenic inhibitor

Using antibodies that recognize either tyrosinase, tyrosinase-related protein-1 (TRP1), or tyrosinase-related protein-2 (TRP2, DOPAchrome tautomerase), the quantities of those melanogenic enzymes were analyzed in five melanoma cell lines that possess various degrees of melanin production. All cells except JB/MS-W increased melanin production four to 30 times after 4 d of melanocyte-stimulating hormone (MSH) treatment. Melanin production by JB/MS-W cells was always under background, with or without MSH treatment. There was a positive correlation between quantities and synthetic rates of those melanogenic enzymes and their melanin formation or DOPAchrome tautomerase activities. The activity of a heat-resistant melanogenic inhibitory factor was also analyzed. The results showed, surprisingly, that pigmented cells showed higher levels of melanogenic inhibitors activity. Tyrosinase activity was increased dramatically whereas the level of melanogenic inhibitor was remarkably decreased following MSH treatment. Interestingly, melanogenic inhibitor derived from JB/MS-W cells suppressed not only tyrosinase but also DOPAchrome tautomerase, another enzyme functional in melanin production. These results clearly suggest that melanin production is regulated by a subtle balance between the activities of these enzymes and other factors such as the melanogenic inhibitor.

Zinc kinetics in patients with bone demineralization due to physical immobilization

To examine the relationship between zinc (Zn) status and bone demineralization, a body Zn kinetics study was performed with 74 (37 male, 37 female) disabled persons ranging in age from 16 to 45 years. Three groups were classified according to degree of limited mobility: group 1 (n = 23), capable of walking; group 2 (n = 20), capable of crawling; group 3 (n = 31), bed-ridden, Serum Zn levels were similar in the three groups, whereas body Zn clearance and the distribution of Zn showed a pattern [group 1 < group 2 < group 3 (p < 0.01, p < 0.05)], with the reverse in cases of bone mineral density (BMD) [group 1 > group 2 > group 3 (p < 0.01)]. Renal handling of Zn did not different among the three groups. There was a negative correlation between Zn distribution volume and values of BMD (p < 0.005, gamma = 0.387). Thus, various organs, as well as the skeleton, are Zn deficient in immobilized patients.

Erythroderma, hair loss, and sinus histiocytosis with massive lymphadenopathy in a XYY-male

This paper presents a case of sinus histiocytosis with massive lymphadenopathy (SHML) presenting as erythroderma in an XYY-male aged 27. The patient had little or no scalp, axillary, or pubic hair. Histologically, lymph nodes indicated dilatation of the sinuses with proliferation of benign-appearing histiocytes possessing abundant clear cytoplasm, admixed with giant cells and pericapsular fibrosis. Infiltrating histiocytes in the lymph nodes were OKM-1 (CD11b) positive, which is characteristic of monocyte-granulocyte lineages. In the present case, the abnormal presence of erythroderma, hair loss, SHML, and a chromosomal abnormality, XYY, were thought to be incidental features.

[Three cases of lung cancer with calcification--demonstration by chest CT]

We report three cases of lung cancer with calcification shown on chest CT scans. Case 1 was a 63-year-old man with well differentiated squamous cell carcinoma of the lung. Chest CT scan showed pronounced central calcification within the tumor. Case 2 was a 57-year-old woman with small cell carcinoma of the lung. Chest CT scan showed diffuse amorphous calcification within the tumor. Case 3 was a 70-year-old man with lung cancer for which pathologic data was not available. Chest CT scan showed punctate and linear calcification of the cavity wall within the tumor. Microscopic examinations revealed dystrophic calcification in cases 1 and 2. Calcification has long been recognized as a distinguishing radiologic feature of a benign pulmonary mass, however, the presence of calcification within a tumor on chest CT scan does not exclude the diagnosis of lung cancer.

The role of metal allergy and local hyperhidrosis in the pathogenesis of pompholyx

Pompholyx (Dyshidrosis) is a disease of unknown etiology presenting as symmetrical, vesicular hand and foot dermatitis. To clarify the pathogenetic role of sweat and metal allergy, twenty five patients with pompholyx were examined with respect to their perspiration volume using equipment that continuously recorded the local perspiration volume. Patients were also examined for metal allergy by patch testing and oral challenge tests. The perspiration volumes were measured using recently developed equipment for continuous recording of local perspiration volume (Kenz-Perspiro oss-100). The perspiration volume of pompholyx patients was found to be 2.5 times higher than that of age-matched normal controls. Twenty percent of the patients showed sensitivity to chromate, 16% to cobalt, and 28% to nickel on patch testing. Six patients with positive results were challenged orally in a controlled trial with 2.5 mg nickel, 1 mg cobalt, or 2.5 mg chromium. Four of them (67%) showed vesicular reactions on their hands with challenge testing. These results indicated a sensitivity to metal compounds which, in combination with local hyperhidrosis, may contribute to the development of vesicular lesions in pompholyx.

[A case of adenocarcinoma of lung cancer with multiple brain metastasis and lymphangitis carcinomatosa responding well to chemotherapy with carboplatin, etoposide and ifosfamide]

A 75-year-old male who suffered from adenocarcinoma of lung cancer with multiple brain metastases, developed left hemiplegia. After diagnosis, he was treated with 4,000 cGy whole brain radiation, but soon after advanced lymphangitis carcinomatosa set in and his general condition deteriorated. He was administered carboplatin combination with etoposide and ifosfamide. Lymphangitis carcinomatosa disappeared, and the main tumor of lung and brain metastases were not growing. We recommended carboplatin for an old patient or one in poor condition, because it had less cytotoxicity and retained the same antitumor activity compared with cisplatin.

[Two cases of adult onset of Still's disease in the elderly]

Two cases of adult onset of Still's disease is in a 83-year-old and a 61-year-old women. Both cases complained of high fever, arthralgia, sore throat and maculae. Examinations on admission revealed leukocytosis and negative antinuclear antibody. Administration of prednisolone resulted in improvement of the clinical symptoms and laboratory data. In general, the onset of this disease is usually in early adulthood, but in these two cases the onset was at an advanced age. These results suggest that Still's disease of adult onset should be included in the differential diagnosis of fever of unknown origin, if the patient is elderly. In the treatment of the disease, proper attention to side effects of prednisolone and complications can be important.

Sex-determining region Y (SRY) in a patient with 46,XX true hermaphroditism

Using a polymerase chain reaction method, a search for Y-specific DNA sequences was made in samples derived from tissues of a 46,XX true hermaphrodite. We found a sequence of SRY in the ovotestis, skin and leukocytes. Other DNA sequences, which covered the pseudoautosomal boundary region, amelogenin gene and DYZ1 locus of Y-chromosome were not detected. The SRY gene detected in the patient by the polymerase chain reaction was not detected by Southern blot analysis, using the SRY fragment as a probe. These findings suggest that in the patient there is a mosaicism of cells with and without part of the Y chromosome, including the SRY sequence. As the SRY sequence was responsible for the development of the gonadal primordium to the ovotestis, SRY seems essential for gonadal differentiation in testis development.