Scintigraphic changes in bone metastasis from prostate cancer after hormonal therapy--comparison with tumor markers and bone X-ray

Bone scintigraphy is often performed to assess the response to systemic therapy of bone metastasis from prostate cancer. We examined the changes in bone scintigraphic findings and the agreement with AIP, AcP, or other tumor markers measured in the follow-up of patients with known bone metastasis after hormonal therapy. Out of 32 patients, 22 (69%) showed improved scintigraphic findings on the first follow-up bone scintigraphy after hormonal therapy. However, 7 out of 22 patients who showed improvement on the first follow-up scintigraphy, deteriorated thereafter. Changes in the scintigraphic findings were closely correlated with those in the measured tumor markers except for patients with small bone metastasis. Though there were no significant differences in the agreement ratios of the 6 tumor markers evaluated, AIP might be a practical and acceptable indicator. Bone X-ray findings did not change at all in almost half of the cases though the scintigraphic findings showed improvement or deterioration.

Transitional changes in immunophenotypic subpopulations of human peripheral blood CD34+ cells expanded in vitro

We determined the appropriate incubation period to expand human peripheral blood (PB) CD34+ cells for clinical application and the role of recombinant human (rh) interleukin-3 (rhIL-3) in the expansion and differentiation of these cells. The cells were purified up to 40 +/- 16% and transitional changes in immunophenotypic subpopulations in suspension culture were examined following stimulation with three different combinations of rh colony-stimulating factors (rhCSFs): 1) rhIL-3 alone, 2) rhIL-6, rhSCF, rhG-CSF, plus rhGM-CSF, and 3) the four CSFs plus rhIL-3. With all three CSF combinations, the total cells increased continuously after day 5 until day 14, and a combination of the five CSFs always gave rise to the highest number of total cells. Immunophenotypic analysis of the expanded cells showed that with all three CSF combinations CD34+ cells reached a maximal rate on day 5 and then decreased in an inverse correlation between the logarithm of CD34 positive rate and the duration of suspension culture. The maximum expansion of CD34+ cells and PB progenitor cells (PBPC) with rhIL-3 alone, the four CSFs, or the five CSFs was observed on day 5, 10, or 7, respectively. The combination of the five CSFs was identified as the most potent stimulus for expansion of PBPC and CD34+ cells, as it increased non-erythroid PBPC 89 +/- 69-fold, with a range of 24 to 204-fold on day 7. However, differences in the expansion rate of these cells on days 5, 7, and 10 were not statistically significant. The majority of purified CD34+ cells coexpressed CD38 (91 +/- 3%) but were negative for CD33 (85 +/- 4%), and one-half coexpressed CD13. With all three combinations of CSFs, the mature CD34+ cells that coexpressed CD38, CD33, or CD13 expanded in parallel with the total CD34+ cells, while an increase in relatively immature CD34+ cells, which do not express CD38, CD33, or CD13, was only statistically significant with the five CSFs. Thus, rhIL-3 played a critical role when combined with the four CSFs by increasing both mature and immature CD34+ cells.

[Effects of byakushi and ogon on the hepatic drug metabolizing enzymes in rats]

The effect of single or daily oral administration of hot water extracts (HWE) from Byakushi or Ogon on rat hepatic drug-metabolizing enzymes were investigated in vivo. Enzymes were measured for 3 to 72 hr after single oral administration of HWE at the dose of 1.0 g/kg or 5.0 g/kg. Administration of 1.0 g/kg of Byakushi and 5.0 g/kg of Ogon inhibited aniline hydroxylase activity, while 5.0 g/kg of Byakushi inhibited it in the early phase, but increased it in the late phase. Byakushi inhibited aminopyrine N-demethylase activity, while 5.0 g/kg of Ogon increased it. Byakushi and Ogon decreased the amount of cytochrome P-450. Byakushi and Ogon increased the amount of cytochrome b5. Byakushi increased cytochrome c reductase activity 3 hr after administration and decreased it 6 and 12 hr after administration. In contrast, 1.0 g/kg of Ogon decreased cytochrome c reductase activity, and 5.0 g/kg increased it 6 hr after administration and decreased it 12 hr after administration. At 24 hr after the last administration to animals treated with a regimen of once a day administration of the HWE (0.1 or 1.0 g/kg) of Byakushi or Ogon for 14 days, the enzymes were measured. Byakushi decreased aminopyrine N-demethylase activity, the amount of cytochrome P-450, and cytochrome c reductase activity. Ogon decreased cytochrome c reductase activity. Byakushi altered the composition of cytochrome P-450 isozyme after daily administration.

Choledochocele with obstructive jaundice: a case report and a review of the Japanese literature

A case of a 57-year-old farmer with a rare type of choledochal cyst (choledochocele; Alonso-Lej's type III) is described. The patient was admitted because of obstructive jaundice and acute biliary infection. Abdominal computed tomography scan showed a cystic lesion in the head of the pancreas, and endoscopic retrograde cholangiopancreatography disclosed cystic dilatation of the terminal portion of the common bile duct. It was suspected that the choledochocele could swell and compress the common bile duct, causing obstructive jaundice and acute cholangitis; therefore, it was surgically resected. We also reviewed 61 cases of choledochocele reported in Japan; the findings were similar to those reported in the English literature.

Adrenal adenomas: characteristic hyperintense rim sign on fat-saturated spin-echo MR images

PURPOSE

To determine whether adrenal adenomas can be differentiated from metastases on fat-saturated magnetic resonance (MR) images.

MATERIALS AND METHODS

Twenty-eight adrenal adenomas and 20 metastatic lesions were imaged at 1.5 T by means of fat-saturated T1- and T2-weighted and gadolinium-enhanced T1-weighted sequences. The authors evaluated visually whether structures of high signal intensity (hyperintense rim sign) could be observed in the outer margin of the adrenal masses.

RESULTS

Twenty-six of 28 adrenal adenomas revealed the hyperintense rim sign on at least one kind of fat-saturated image, compared with only one of 20 metastases. The sensitivity of the hyperintense rim sign as suggestive of adrenal adenoma was 92%, specificity was 95%, and overall accuracy was 94%.

CONCLUSION

The hyperintense rim sign is characteristic of adrenal adenomas. Thus, adrenal adenomas can be differentiated from metastases by means of this new imaging sign on fat-saturated MR images.

[Chronic cold agglutinin disease accompanied with an increase of CD20+/CD5+ cells; a case report]

A 61-year-old male complained of acrocyanosis and dark urine when exposing to cold temperatures. This had continued for several years. His physical examinations showed neither lymphadenopathy nor hepatosplenomegaly. Laboratory findings were as follows; RBC 305 x 10(4)/microliters, Hb 10.3 g/dl, reticulocytes 4.32%, platelets 27.3 x 10(4)/microliters, WBC 7,400/microliters with 50% lymphocytes, and a high cold agglutinin titer (2,048-fold) with anti-I specificity. Bone marrow smear preparations showed erythroid hyperplasia and increase of lymphocytes (52%). Immunophenotypic analysis showed an increase of CD20+/B-lymphocytes in peripheral blood (32.6%) and in bone marrow, and 94% of these cells co-expressed CD5. Most B-lymphocytes expressed surface IgM-lambda, suggesting a monoclonal proliferation of B-lymphocytes. At this point we diagnosed cold agglutinin disease (CAD) because there was no evidence of lymphoma, and the absolute number of peripheral blood lymphocytes was lower than the criteria of chronic lymphocytic leukemia (CLL) proposed by the International Workshop (1989). However, there still remains the possibility of the transitional form between "idiopathic" CAD and B-CLL or lymphoma.

[Fluctuation of HCV quasi-species population during interferon therapy; analysis by single strand conformation polymorphism]

We investigated the fluctuation of hepatitis C virus (HCV) quasispecies during interferon therapy by single strand conformation polymorphism (SSCP) analysis. In 13 of 16 interferon ineffective patients, the predominant HCV population was replaced with other quasispecies during the treatment. Especially, in 9 patients, a part of the HCV quasispecies, pre-existing before interferon therapy, became predominant after the therapy. These results indicate that sensitivity to interferon differs among HCV quasispecies and that interferon selects resistant HCV strains. Existence of such HCV quasispecies seems to be associated with interferon treatment failure.

Inhibitory activity on DNA gyrase and intracellular accumulation of quinolones: structure-activity relationship of Q-35 analogs

Q-35, 1-cyclopropyl-6-fluoro-1,4-dihydro-8-methoxy-7-(3- methylaminopiperidine-1-yl)-4-oxyquinoline-3-carboxylic acid, has excellent activity against gram-positive bacteria and inhibits S. aureus gyrase at concentrations more than 10-fold lower than those of other quinolones. In this paper, the effect of the C-7 and C-8 substituents of Q-35 on the inhibitory activity of gyrase purified from S. aureus, M. luteus, E. coli, and P. aeruginosa are described. In addition, intracellular accumulation of Q-35 was examined. The 50% inhibitory concentrations (IC50) of Q-35, 8-fluoro- Q-35, and 8-hydro-Q-35 on DNA gyrase purified from S. aureus were 2.5, 7.8, and 68 micrograms/ml, respectively. The IC50 on gyrase from P. aeruginosa were 11, 5.2, and 17 micrograms/ml, respectively. It is concluded that the introduction of a methoxy group into the 8 position of the quinolone leads to greater antibacterial activity against gram-positive bacteria. The concentrations of Q-35 which accumulated in S. aureus and E. coli were almost equal to ciprofloxacin, but in P. aeruginosa, Q-35 was lower than ciprofloxacin.

[A case of dissection of the right aortic arch, with consideration on the development of its major branches and ductus arteriosus]

In the present study, we reported a case of the right aortic arch which was found in the course of dissection at Juntendo University in 1993 from a cadaver of a 92-year-old female. The present case possessed as its terminal branch the right subclavian artery. The ascending aorta arose from the left ventricle and ran upwards, curved dorsally and became the right aortic arch. The arch passed on the right side of the trachea and esophagus, curved right posteriorly and became the thoracic aorta which descended on right side of the vertebral column. The aortic arch sent off the left brachiocephalic artery, the right common carotid artery and the right subclavian artery in this order and connected with the pulmonary artery by the right ligamentum arteriosum. The present case represents the 11th report of dissection of a right aortic arch in Japan which was type M according to the classification system of Adachi-Williams-Nakagawa. Type M is subdivided into three subtypes depending on the pattern of the ligamentum arteriosum. The right ligamentum arteriosum has been found in three cases including the present study. We critically discussed previous explanations and theories on the developmental processes of the right aortic arch and its variable major branches and ductus arteriosus.

[Diagnosis of sinus venosus atrial septal defect by transesophageal color Doppler and two-dimensional echocardiography]

Diagnosis of sinus venosus atrial septal defect based on transthoracic color Doppler and two-dimensional echocardiography is often difficult. We recently experienced two cases of sinus venosus atrial septal defect which were correctly diagnosed using transesophageal color Doppler and two-dimensional echocardiography. Transthoracic color Doppler flow imaging did not demonstrate the atrial septal defect or the shunt flow across the defect in either case. Transesophageal two-dimensional echocardiography visualized a defect in the upper most portion of the interatrial septum in one case, and transesophageal color Doppler flow mapping detected a left-to-right shunt across the defect in both cases. Transesophageal color Doppler flow mapping also demonstrated the flow signal of the right upper pulmonary vein into the right atrium near its junction with the superior vena cava in each case. The diagnoses of sinus venosus atrial septal defect and combined partial anomalous pulmonary venous return were confirmed by surgery in both cases. Transesophageal color Doppler and two-dimensional echocardiography are very useful in diagnosing sinus venosus atrial septal defect and combined partial anomalous pulmonary venous return.

[Change in mitral valve area after percutaneous transvenous mitral commissurotomy: prediction of mitral valve restenosis]

Factors indicating changes in mitral valve area after single-balloon percutaneous transvenous mitral commissurotomy (PTMC) were evaluated in 53 patients receiving PTMC by follow up for 3-48 months (mean 18 +/- 12 months) using serial transthoracic echocardiography to measure mitral valve area by planimetry. The echocardiographic scores of the mitral commissures and mitral valve, and other clinical variables were assessed. Mitral valve area showed an immediate increase from 1.1 +/- 0.3 to 1.8 +/- 0.3 cm2 (p < 0.01). There was a small but significant decrease in mitral valve area at follow-up to 1.6 +/- 0.4 cm2 (p < 0.01). Restenosis (a decrease in mitral valve area of more than 25% from immediately after PTMC to follow-up) occurred in nine patients (17%). There was no significant correlation between clinical or echocardiographic features and an increase in mitral valve area immediately after PTMC. The total echocardiographic score of the mitral commissures correlated with the decrease in mitral valve area at follow-up (r = 0.42, p = 0.002). Multiple regression analysis showed the total echocardiographic score of the mitral commissures was the best indicator of a decrease in mitral valve area at follow-up (p = 0.0059). Six of nine patients with restenosis had a commissure score of more than 3, while only five of 44 patients without restenosis had a commissure score of more than 3 (p < 0.01). Mitral valve area increases significantly immediately after PTMC, and decreases significantly at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Recombinant human interleukin-4 inhibits the production of granulocyte-macrophage colony stimulating factor by blood mononuclear cells

The effect of recombinant human (rh) interleukin-4 (rIL-4) on human blood BFU-E was investigated using two populations of cells: platelet-depleted low-density mononuclear cells (FH,Pl- cells), as unpurified cells, and highly purified BFU-E. When FH,Pl- cells were cultured with rh-erythropoietin (rEp), rIL-4 inhibited BFU-E growth in a dose-dependent manner. However, the addition of rIL-4 did not affect rh-interleukin-3 (rIL-3) supported BFU-E growth. Limiting dilution analysis (LDA) of FH,Pl- cells showed that rIL-4 suppressed endogenous production of burst-promoting activity (BPA) by accessory cells. Highly purified BFU-E were used as target cells to measure BPA in the conditioned medium (CM) that was prepared by FH,Pl- cells. When 100 purified BFU-E were cultured in 0.5 ml clots with 20% (vol/vol) of the CM, the number of BFU-E colonies was increased by the CM. The increase was significantly reduced by the addition of the CM prepared in the presence of rIL-4, but anti-IL-4 blocked the effect of rIL-4. The concentration of IL-3 and granulocyte-macrophage colony-stimulating factor (GM-CSF) in CM was determined by an enzyme-linked immunoadsorbent assay (ELISA). The spontaneous production of GM-CSF but not IL-3 was detected, and this was significantly decreased in the presence of rIL-4. Anti-GM-CSF but not anti-IL-3 inhibited CM supported BFU-E growth, indicating that the main BPA in the CM is GM-CSF and that rIL-4 suppresses the spontaneous production of GM-CSF by accessory cells. From these studies, we conclude that rIL-4 has a unique mechanism as a negative regulator on erythropoiesis through the inhibition of BPA production by blood mononuclear accessory cells.

[A case with AML (M4EO) accompanied by recurrent reactive histiocytosis which showed spontaneous remission]

A 30-year-old female was admitted to our hospital complaining of high fever and fatigue. Laboratory findings showed as follows; WBC 41,500/microliter (40% of blasts), Hb 8.5g/dl, platelets 4.4 x 10(4)/microliter. Cytochemical staining of blasts was positive for peroxidase and non-specific esterase with NaF inhibition. Chromosome analysis showed 46, XX, inv (16p+,q-). AML with eosinophilia was diagnosed. During myelosuppression after remission induction therapy, she developed high fever, and did not respond to transfusions. Marrow smears showed the presence of phagocytic histiocytes consisting of 18% total nuclear cells. A diagnosis of reactive histiocytosis (RH) was made. She recovered spontaneously, but suffered two episode of recurrence during subsequent chemotherapy. Reactive histiocytosis is characterized by proliferation of histiocytes which phagocyte blood cells in immunodeficient cases, e.g. a myelosuppressive state after chemotherapy. RH causes high fever and prolonged myelosuppression. It is considered to be one of the poor prognostic factors in AML during chemotherapy, and spontaneous recovery is rare. In this report, the effect of hydrocortisone on histiocytes derived from patient marrow was also investigated in vitro.

Galactosylation of cyclodextrins and branched cyclodextrins by alpha-galactosidases

Transgalactosylated derivatives of cyclodextrins (CDs) and glucosyl and maltosyl CDs (G1- and G2-CDs) were synthesized by alpha-galactosidases from coffee bean and Mortierella vinacea (M. vinacea). The structures of the transfer products were analyzed by FAB-mass, 13C-NMR and methylation. Coffee bean alpha-galactosidase transferred a galactosyl residue not only to side chains of G1-CDs and G2-CDs, but also directly to CD rings. M. vinacea alpha-galactosidase transferred a galactosyl residue only to side chains of G2-CDs.

[Relationship between early peaking of serum myosin light chain 1 level and washout phenomenon of creatine kinase in acute myocardial infarction]

To investigate the serum levels of myosin light chain 1 (MLC1) during the acute phase of myocardial infarction, the MLC1 and creatine kinase (CK) levels were measured in samples from 59 consecutive patients with acute myocardial infarction. The serum concentration of MLC1 increased rapidly, reaching an early peak in 22 of the 59 patients (the MLP + group). Fifteen patients showed rapid increases in MLC1 levels without an early peak (the MLP - group). Serum MLC1 levels remained within normal limits (the MLN group) 10 hours after the onset of symptoms in the remaining 22 patients (but in eight of these serum MLC1 levels were abnormal 16-39 hours after the onset of symptoms). Serum level curves of CK showed a single episode of acute myocardial infarction in all patients. The patterns of MLC1 levels correlated with the washout phenomenon of CK (p < 0.001) and the maximum MLC1 level (p < 0.05). The ratio of serum MLC1 level during the early phase to the maximum level (EMR) decreased in the order of groups MLP+, MLP-, MLN (0.54 +/- 0.28, 0.31 +/- 0.22, 0.13 +/- 0.09, respectively). The EMR was correlated with the washout phenomenon of CK (p < 0.001), but not with the maximum MLC1 level which might reflect the size of the infarction. The patterns of neither MLC1 nor EMR were correlated with the administration of urokinase or the patency of the infarct-related artery at the early phase (within 10 hours of onset).(ABSTRACT TRUNCATED AT 250 WORDS)

Separation and characterization of five positional isomers of trimaltosyl-cyclomaltoheptaose (trimaltosyl-beta-cyclodextrin)

Trace amounts of trimaltosyl-cyclomaltoheptaoses (trimaltosyl-beta-cyclodextrins, trimaltosyl-beta CDs) were found in a mixture of maltosyl-cyclomaltoheptaoses (maltosyl-beta-cyclodextrins, maltosyl-beta CDs) prepared from maltose and cyclomaltoheptaose (beta-cyclodextrin, beta CD) through the reverse action of Klebsiella pneumoniae pullulanase. Five positional isomers of trimaltosyl-beta CD were isolated by high-performance liquid chromatography (HPLC) on a reversed-phase column and a graphitized carbon column. For the structural analysis of 6(1), 6(2), 6(3)-, 6(2), 6(5)-, and 6(1), 6(3), 6(5)-tri-O-maltosyl-beta CDs, an enzymic method using glucoamylolysis, followed by hydrolysis with Bacillus subtilis saccharifying alpha-amylase, was applied. Although 6(1), 6(2), 6(4)- and 6(1), 6(2), 6(6)-substituted isomers were indistinguishable by this method, these isomers were distinguished clearly by digestion of branched oligosaccharides produced from each isomer by the aforesaid method, with B. stearothermophilus neopullulanase or with glucoamylase. The resulting hydrolysates were analyzed by HPLC on an amino derivatized column and by fast-atom bombardment spectrometry (FABMS). The chromatographic behavior and spectral data (13C NMR and FABMS) of five positional isomers of trimaltosyl-beta CD are described.

Radioimmunoscintigraphy of CEA/CA 19-9 producing tumors with I-131 labeled monoclonal antibodies

A total of 7 (4 males and 3 females) patients were included in this retrospective study to determine the sensitivity of radioimmunoscintigraphy with I-131 labeled anti CEA/CA 19-9 monoclonal antibodies. Out of 7 patients 2 had ascending colon cancer, one had sigmoid colon cancer, one had rectal cancer and one had adenocarcinoma in the CBD and the remaining two had metastatic tumor (one in the lungs and the other in the liver). Whole body as well as spot images showed a 72% (5/7) positive scan. But post operative specimen counts and imaging showed a high tumor to non-tumor ratio and a good tumor to non-tumor contrast of activity of I-131 labeled monoclonal antibody. We did not find any relation between CEA/CA 19-9 levels and scan findings. A case of liver metastasis was also detected by this radioimmunoscintigraphy.

Chemical structures of hetero-oligosaccharides produced by Arthrobacter sp. K-1 beta-fructofuranosidase

The structures of hetero-oligosaccharides obtained by the action of transglycosylation of Arthrobacter sp. K-1 beta-fructofuranosidase, using sucrose as the fructosyl donor, and several mono- and di-sacchrides as the acceptors were investigated. The main transfer products to most reducing mono- and di-sacchrides were non-reducing oligosaccharides with a fructosyl residue linked to a hemiacetal hydroxyl group. In the presence of L-sorbose, the enzyme produced 2-O-beta-D-fructofuranosyl-alpha-L-sorbopyranoside as the major product. With D-galactose or L-arabinose, the enzyme produced not only non-reducing oligosaccharides, but also reducing oligosaccharides, which were identified as 3-O-beta-D-fructofuranosyl-D-galactopyranose and 4-O-beta-D-fructofuranosyl-L-arabinopyranose, respectively. When a non-reducing sugar such as methyl alpha-glucoside was used as an acceptor, the product formed had a fructosyl residue linked at the C6 hydroxyl group.

Preparation of 6(1),6n-di-O-(tert-butyldimethylsilyl)-cyclomalto-octaoses

Four positional isomers of 6(1),6n-di-O-(tert-butyldimethylsilyl)- cyclomalto-octaose (n = 2-5) were prepared by reaction of cyclomalto-octaose (1, cG8) with tert-butyldimethylsilyl chloride in pyridine, and were isolated by high-performance liquid chromatography. The regiochemical determination of those positional isomers was performed by comparison with authentic compounds, prepared from 6(1),6n-di-O-trityl-cG8s (n = 2-5).

Acceptor specificities of alpha-mannosidases from jack bean and almond, and transmannosylation of branched cyclodextrins

Jack bean alpha-mannosidase had a wide acceptor specificity and could transfer mannosyl residues to various acceptors such as D-fructose, L-arabinose, maltose, lactose, and sucrose. The structures of the transferred products of branched cyclodextrins (CDs) (glucosyl-beta CD, maltosyl-alpha CD, and maltosyl-beta CD) were found to be alpha-D-mannosyl-(1-->6)-alpha-D-glucosyl-(1-->6)-beta CD, alpha-D-mannosyl- (1-->6)-alpha-D-glucosyl-(1-->4)-alpha-D-glucosyl-(1-->6)-alpha CD and alpha-D-mannosyl-(1-->6)-alpha-D-glucosyl-(1-->4)-alpha-D-glucosyl-(1--> 6)- beta CD, respectively. Almond alpha-mannosidase also produced the same transmannosylated products of branched CDs.

Change in bone mineral density in patients with hyperthyroidism after attainment of euthyroidism by dual energy X-ray absorptiometry

Because of the previous controversial findings in studies of bone mineral density in patients with hyperthyroidism with older methodologies, we assessed bone mineral density in 15 Japanese patients with Graves' disease (8 males and 7 females) before and after treatment using dual energy X-ray absorptiometry (DEXA). Bone mineral density of the lumbar vertebrae and the femur, and thyroid function, and several metabolic parameters were measured before treatment and again after patients achieved a euthyroid state following treatment with methimazole for 4 to 20 months (mean 10.6 months). The bone mineral density of patients was calculated as the percentage of the mean value (%BMD) in an age- and sex-matched control group, and correlations between the changes in bone mineral density and metabolic parameters before and after treatment were investigated. The %BMD of vertebrae in patients with Graves' disease before treatment was 89.7% of that found in the normal population. When patients became euthyroid after treatment, %BMD increased significantly to 94.9%, although it still remained below the control level. TSH receptor antibody, osteocalcin, and alkaline phosphatase were elevated before treatment, but decreased significantly after treatment. The change between pre- and posttreatment TSH receptor antibody was negatively correlated with the change in bone mineral density. In conclusion, these findings suggest that bone mineral density is decreased in patients with Graves' disease and that successful treatment of hyperthyroidism results in a significant increase in bone mineral density within a short period of time. Furthermore, TSH receptor antibody is a useful marker of changes in bone metabolism in this group of patients.