Pruritic papular eruption of the acquired immunodeficiency syndrome

We report a case of acquired immunodeficiency syndrome with pruritic papular eruption. The patient, a hemophiliac, presented with generalized pruritic, skin-colored papules and nodules. The chronic lesions were excoriated and hyper-pigmented. The eosinophil count was elevated, but IgE was normal. The lesions and pruritus responded only to ultraviolet B phototherapy. While the mechanism is not known, ultraviolet B phototherapy may provide relief of AIDS-related pruritus.

Recombinant soluble CD59 inhibits reactive haemolysis with complement

Three soluble forms of membrane attack complex inhibitory factor (MACIF or CD59) were prepared using recombinant baculovirus-infected insect cells. They consisted of 70, 77 and 86 amino acids, starting from the amino terminus of naturally occurring CD59, and were designated recombinant (r) CD59 70, 77 and 86, respectively. All three rCD59 lacked a glycosyl-phosphatidylinositol (GPI) anchor, unlike membrane CD59 which has a GPI anchor at the anchor at the carboxyl terminus (77th amino acid). Their activities in inhibiting complement activation were assayed with C5b-7 intermediate cells and C8 and C9 components. The inhibitory activity of rCD59 70 was as high as that of rCD59 77 and twice that of rCD59 86. In addition, it was one-fourth and one-hundredth lower than the activities of urine and erythrocyte CD59, respectively. However, when assayed in the presence of human serum at a final concentration of 50% (v/v), the activities of both urine and erythrocyte CD59 were greatly decreased to to one-tenth of that of rCD59 70. Purified rCD59 70 molecules were all glycosylated, but rCD59 77 and 86 were mixtures of glycosylated and non-glycosylated molecules. The inhibitory activities of rCD59 77 and 86 were the same for the glycosylated and non-glycosylated forms. These results suggest that the soluble rCD59 provide a means for elucidating the biological roles of CD59.

[Occult CSF flow disturbance of patients with Alzheimer type dementia and vascular dementia--results from iotrolan CT-cisternography]

We report results of Iotrolan CT-cisternography on 41 demented patients (13 males and 28 females) to find "occult normal pressure hydrocephalus". These patients were suspected to have CSF flow disturbance from clinical symptoms and simple brain CT scan findings. Their average age, duration of dementia, and score of Hasegawa's dementia scale (HDS) were 76.2 years, 5.9 years, 9.5/32.5, respectively. Before performing CT-cisternography, clinical diagnosis for their dementia were vascular dementia in 18 patients, Alzheimer type dementia in 12, suspect of NPH in 5, and other diagnoses in 6. From the results of cisternography, we found 13 patients with CSF flow disturbance (contrast material remained in the ventricle more than 48 hours after injection), and 17 patients with normal CSF flow. The former showed lower scores of HDS, higher urinary incontinence scores and smaller areas of the interhemispheric fissure on CT scan than the latter. But the former showed no significant difference from the latter in the average age, duration of dementia and width of the ventricles.

Practical use of polymerase chain reaction for the diagnosis of steroid induced tuberculous lymphadenitis

Tuberculous lymphadenitis that had developed after treatment with systemic prednisolone was diagnosed using the polymerase chain reaction (PCR) combined with dot-blot hybridization. Although the patient had no history of tuberculosis or suggestive radiological findings, a DNA fragment specific for Mycobacterium tuberculosis complex strains was amplified from a paraffin-embedded biopsy specimen of a cervical swelling, which was compatible with tuberculous lymphadenitis on haematoxylin-eosin (HE) and Ziehl-Neelsen staining. This report demonstrates the practical use of PCR for diagnosis of extra-pulmonary tuberculosis in a case difficult to diagnose conventionally.

[Gastrocytoplasty in pediatric patients--initial clinical experience with 5 cases]

Gastrocytoplasty was undertaken for 5 patients with bladder dysfunction and incontinence caused by neurogenic bladder in 3 cases, bladder exstrophy in 1 case and trauma in 1 case respectively. The age of the patients ranged from 5 years through 14 years at the operation. Decreased renal function was recognized in 3 cases with neurogenic bladder before reconstruction. The other 2 cases had normal renal function. Gastric segment was isolated with right gastroepiploic artery as a pedicle. Bladder was opened vertically and augmented with gastric segment. In 4 cases urethrogastrostomy with submucosal tunnel was performed in both sides. In neurogenic bladder cases, urethra was left without any surgical intervention, while other 2 cases underwent continent diversion using Mitrofanoff principle with urethra being closed. Postoperative follow up period was 18 to 22 months. All cases had increased bladder volume and the dilatation of upper urinary tract disappeared or decreased in size in those who had upper urinary tract dilatation before operation. Urinary incontinence completely disappeared in continent diversion cases. In neurogenic bladder cases urinary leakage through urethra was negligible with 4 hour interval clean intermittent catheterization. Laboratory examination showed no metabolic derangement in blood gas analysis and electrolytes even in those who had decreased renal function. Blood urea nitrogen (BUN) and serum creatinine showed a little improvement or the same level as before. We didn't encounter any troubles in CIC such as the obstruction caused by mucus produced by gastric segment. From our experience with those 5 pediatric cases underwent gastrocystoplasty, we thought gastric segment had some advantage as a tissue for augmentation cystoplasy compared with intestinal segment.

Kinetic studies on the removal of extracellular hydrogen peroxide by cultured fibroblasts

To investigate the function of antioxidant enzymes in intact cells, we examined the removal of extracellular H2O2 by cultured fibroblasts (IMR-90). H2O2 concentration dependence of the reaction rate was interpreted as that the process involves two kinetically different reactions (referred to as reactions 1 and 2). Reaction 1 was characterized by a relatively low Km value (about 40 microM), and reaction 2 by linear dependence of the rate up to 500 microM H2O2. The magnitude of reaction 1 was reduced by treatment of the cells with diethyl maleate or 6-amino-nicotinamide, while reaction 2 was inhibited by 3-amino-1,2,4-triazole treatment. It was concluded that reactions 1 and 2 are principally due to GSH peroxidase and catalase, respectively. The values of kinetic parameters were estimated by curve-fitting, and it was inferred that 80 to 90% of H2O2 is decomposed by GSH peroxidase at H2O2 concentrations lower than 10 microM. The contribution of catalase increases with the increase in H2O2 concentration. The intact cells showed a low catalase activity (about 15%), as compared with the activity found in the solubilized cells. The low catalase activity was ascribed to the latency of the enzyme caused by localization in peroxisomes. Fibroblasts also removed intracellular H2O2 generated by menadione. Treatment with diethyl maleate greatly impaired the H2O2-removing capability and caused H2O2 efflux into the medium.

Neuroblastomas of the central nervous system--clinicopathological features of a cerebellar neuroblastoma in comparison with a metastatic cerebral neuroblastoma

Two patients with neuroblastoma of the central nervous system are described. The first, a 10-month-old male infant with symptoms of vomiting and weakness of the right upper extremity, was found on magnetic resonance imaging (MRI) to have enhanced mass lesion in the left hemisphere, vermis of the cerebellum and part of brain stem. The second, a 3-year-old boy who had swelling of the right side of the head, was found on computed tomography (CT) to have enhanced mass lesion of the frontal hemisphere and frontal bone. Histological examination of the surgical specimen of both cases demonstrated neuronal differentiation. The clinicopathological features of cerebellar neuroblastoma in comparison with metastatic neuroblastoma of the frontal lobe were discussed.

Benign intracerebellar cyst without epithelial lining

A case of benign intracerebellar cyst is reported in a 61-year-old woman who presented progressive neurological deficits. MRI and operative findings could not reveal any evidence of neoplastic growth. The biopsied cyst wall revealed normal cerebellar tissue. The simple cyst of the cerebellum is rare, thus we discuss the clinical features and etiology of this rare entity.

Expression of laminin, type IV procollagen and 230 kDa bullous pemphigoid antigen genes by keratinocytes and fibroblasts in culture: application of the polymerase chain reaction for detection of small amounts of messenger RNA

In order to clarify whether keratinocytes and/or fibroblasts express genes encoding basement membrane zone macromolecules, we examined laminin, type IV collagen and 230 kDa bullous pemphigoid antigen (BPAG1) gene expression in keratinocytes and fibroblasts in culture. Northern transfer analysis revealed the presence of specific mRNA transcripts for alpha 1(IV) and alpha 2(IV) chains of type IV collagen as well as B1 and B2 chains of laminin in both fibroblast and keratinocyte RNA. Laminin A mRNA, however, was detected in fibroblasts but not in keratinocytes. In contrast, BPAG1 mRNA was detected in keratinocytes but not in fibroblasts using the same RNA preparations. A polymerase chain reaction (PCR) using laminin A and BPAG1-specific primers produced amplified DNAs with the predicted sizes in reverse-transcripted cDNA derived from keratinocyte and fibroblast RNA, respectively. These results provide evidence that normal human skin keratinocytes and fibroblasts express genes encoding laminin A, B1, B2, alpha 1(IV), and BPAG1 at a steady-state level. Moreover, the PCR for detecting small amounts of mRNA suggested that both keratinocytes and fibroblasts can be utilized for the analysis of DNA mutations in inherited skin diseases affecting the basement membrane zone, such as epidermolysis bullosa.

Pineocytoma with intratumoral hemorrhage following ventriculoperitoneal shunt--case report

A 58-year-old female with pineocytoma developed intratumoral hemorrhage after ventriculoperitoneal shunting for hydrocephalus. Neurological examination revealed Parinaud's sign and papilledema. Computed tomography and magnetic resonance (MR) imaging revealed a pineal neoplasm and obstructive hydrocephalus. Serum and cerebrospinal fluid levels of human chorionic gonadotropin, alpha-fetoprotein, carcinoembryonic antigen, and placental alkaline phosphatase were negative or within normal limits. MR images after the ventriculoperitoneal shunting disclosed intratumoral hemorrhage and markedly smaller ventricles. The tumor was totally removed via the occipital transtentorial approach and was diagnosed histologically as a pineocytoma with astrocytic differentiation. The tumor probably shifted away from the surrounding structures following the marked reduction in ventricular size after ventriculoperitoneal shunting, resulting in changed venous circulation in the tumor and the formation of intratumoral hematoma.

A polymerase chain reaction system for rapid diagnosis of scrub typhus within six hours

A rapid diagnostic system for scrub typhus (tsutsugamushi disease) was established using the polymerase chain reaction (PCR) combined with microplate hybridization. With this system, diagnosis can be made within six hours without the need for radioisotopes, electrophoresis, or membrane hybridization. The use of a PCR processor and DNA-precoated enzyme-linked immunosorbent assay plates allows a rapid and precise diagnosis to be easily made even in primary medical care clinics.

Implication of membrane factors other than DAF and CD59 in complement-mediated lysis of paroxysmal nocturnal hemoglobinuria erythrocytes

Erythrocytes from two patients (F.K. and A.M.) with paroxysmal nocturnal hemoglobinuria, which were almost completely deficient in decay-accelerating factor and CD59, were found to differ in their susceptibility to homologous complement. Whereas 50-70% of F.K. erythrocytes were lysed, almost 100% of the erythrocytes from A.M. were lysed. These observations were seen under both acidified and nonacidified conditions, and regardless of whether or not the normal human serum was adsorbed with normal erythrocytes to remove natural antibodies. Erythrocytes from two other patients, J.S. and Y.K., about 85% of which did not express CD59, showed lytic profiles similar to those of patient F.K. The differences between patients were not related to levels of natural antibody or other membrane regulatory proteins such as complement receptor type I or membrane cofactor protein. Erythrocytes from F.K. and A.M. differed in their reconstitution with decay accelerating factor and CD59. While erythrocytes from F.K. were reconstituted with CD59 in a unimodal pattern, erythrocytes from A.M. showed a bimodal pattern of reconstitution assessed by flow cytometry. After reconstitution with CD59, erythrocytes from F.K. and A.M. differed in their protection against homologous complement. It is concluded that erythrocyte membrane constituents other than the known inhibitors differ in these patients.

Determination of carboxyl-terminal residue and disulfide bonds of MACIF (CD59), a glycosyl-phosphatidylinositol-anchored membrane protein

MACIF (CD59) is a glycosyl-phosphatidylinositol (GPI)-anchored membrane glycoprotein which inhibits the formation of membrane attack complex of human complement. MACIF prepared from human erythrocyte membranes was digested with pronase. When the digest was subjected to two-phase partition with butanol and 0.1 N HCl, the carboxyl-terminal peptide was recovered in the butanol phase because of the attachment of the highly hydrophobic GPI. The amino acid sequence of the peptide was determined to be Asn72 at its amino-terminus and up to Glu76, while the presence of Asn77 was ambiguous. To allow unequivocal determination of the carboxyl-terminus, a soluble form of MACIF was prepared from human urine on a large scale. The carboxyl-terminal peptide from the soluble form was prepared by tryptic digestion followed by reversed-phase HPLC. The sequence and composition of the peptide unequivocally revealed Asn77 as the carboxyl-terminus. The pattern of disulfide bonds of MACIF was also determined with the membrane form as well as the soluble form. Cystine-containing peptides were prepared by chymotryptic and tryptic digestion, purified by HPLC, and their amino acid sequences were determined. The results indicated that disulfide bonds were formed at Cys3-Cys26, Cys6-Cys13, Cys19-Cys39, Cys45-Cys63 (or 64), and Cys63 (or 64)-Cys69.

Acute promyelocytic leukemia with CD59 deficiency

CD59 is a phosphatidyl inositol-anchored protein (which is lost in paroxysmal nocturnal hemoglobinuria (PNH) cells) with the capacity to block the formation of membrane attack complex, and protects host cells from autologous complement-mediated cytolysis. We found a patient with acute promyelocytic leukemia (APL) accompanied by disseminated intravascular coagulation (DIC), the cells of which were CD59-negative. Although the CD59 deficiency in the malignant cells was not related to PNH, we offered the possibility that DIC was induced by APL lysis secondary to the deficiency of CD59.

Cloning and characterization of a 23-kDa stress-induced mouse peritoneal macrophage protein

Exposure of mouse peritoneal macrophages to oxidative and sulfhydryl-reactive agents in vitro enhances synthesis of a few cellular proteins that may be important in a self-defense system. A cDNA encoding a novel stress-inducible protein, designated MSP23 (macrophage 23-kDa stress protein), was cloned from a cDNA library of the macrophages by differential screening. A 1.0-kilobase mRNA transcript hybridized with the MSP23 cDNA gradually increased in macrophages upon culture in vitro. Treatment with diethylmaleate or glucose/glucose oxidase, which generates H2O2, markedly enhanced the induction of the transcript after several hours. Cadmium chloride and sodium arsenite also induced the transcript. An antiserum raised against recombinant MSP23 reacted with the 23-kDa stress-inducible protein of the macrophages. The amounts of 23-kDa protein in the cells rapidly increased during culture with diethylmaleate. The mRNA was detected in various tissues, and it was especially high in content in the liver. A search of databases revealed that six proteins of various species from bacteria to the mouse have a sequence homology to MSP23. One of the proteins is the C22 component of alkyl hydroperoxide reductase, which is induced by hydrogen peroxide in Salmonella typhimurium.

[Type II citrullinemia triggered by acetaminophen]

We report a 19-year-old man with type II citrullinemia triggered by the administration of acetaminophen when he caught a cold. He was admitted to our hospital of impairment of consciousness and abnormal behaviors. On admission he was comatose and laboratory data revealed respiratory alkalosis which was probably induced by hyperammonemia. Liver dysfunction was mild. Plain CT scans showed brain edema, and EEG revealed triphasic waves. Analysis of plasma and urine amino acids showed a significant increase in citrulline and the activity of argininosuccinate synthetase was markedly reduced in a liver biopsy specimen. Histopathology of the liver revealed inflammatory changes which was probably induced by acetaminophen. Branched chain amino acids transfusion was effective for consciousness disturbance, and sodium benzoate was effective for hyperammonemia. We reviewed 28 patients reported in the literature from 1981 to 1992 to evaluate the probable triggering episodes in type II citrullinemia. Four categories of probable trigger were found, which included 1) stress, 2) liver dysfunction, 3) alcohol, and 4) drugs. Avoidance of these triggers, early diagnosis, and treatment seem most important for the good prognosis and the quality of life.

Analysis of responsive cells in tolerance by the oral administration of ovalbumin

The induction of immune tolerance is the most common consequence of protein feeding, i.e., "oral tolerance". In this study we investigated the genetic basis of oral tolerance using various kinds of recombinant and congenic mice, and the cells involved in the development of this phenomenon in mice. The footpad swelling response to ovalbumin (OVA) was inhibited in mice that were orally fed OVA 7 days before sensitization. No effect of strain of mouse was seen in this inhibition. This inhibition could be transferred by Peyer's patch cells. The CD4-8+ T cells were responsible for the inhibition of footpad swelling. The number of CD4+ cells from OVA-fed tolerant mice decreased significantly, but CD8+ cells did not. The number of CD4-8+ T cells was increased in Peyer's patches of OVA-fed tolerant mice, and were involved in the development of oral tolerance.

[Immunohistochemical analysis of cell surface markers in leprosy patients]

Nine biopsy specimens from 3 tuberculoid (TT), 1 borderline tuberculoid (BT), 2 borderline (BB), 2 borderline lepromatous (BL), and 1 lepromatous (LL) patients were studied using immunoperoxidase procedures with monoclonal antibodies. In TT patients 4B4+, TCR alpha beta+, CD4+ T cells were dominant in dermal granulomas. In LL patient, dermal granulomas with 4B4+, TCR alpha beta+, CD4+ T cells and 2H4+, TCR alpha beta+, CD4+ T cells also had CD8+ T cells. The proportion of 4B4+ T cells increased in granulomas from LL to TT and 2H4+ T cells proportionately increased from TT to LL. TCR gamma delta+ T cells were detected only in BB and BL patients. However, there is no difference of staining pattern of ICAM-1 or LFA-1 antigen in any type of leprosy. These results indicate that the immunohistochemical pattern of T cells (CD4, CD8, 4B4, 2H4, TCR) may be useful in the diagnosis of the spectrum of leprosy.

Induction of a 23 kDa stress protein by oxidative and sulfhydryl-reactive agents in mouse peritoneal macrophages

The synthesis of 23 kDa protein was enhanced when mouse peritoneal macrophages were exposed to oxidative agents such as hydrogen peroxide and menadione, or to sulfhydryl-reactive agents such as diethylmaleate, cadmium chloride and sodium arsenite. After 11 h exposure to these agents the 23 kDa protein was one of the actively synthesized proteins in the macrophages. Under similar conditions the 34 kDa protein previously identified as heme oxygenase, was induced and its synthesis preceded that of the 23 kDa protein. Neither the 23 kDa or the 34 kDa protein was induced by hyperthermia. Conversely, the various oxidative and sulfhydryl-reactive agents employed here did not induce the major heat shock proteins in the macrophages. When the macrophages were activated by bacterial lipopolysaccharide or other stimulants, many proteins are known to be induced, however, the 23 kDa and 34 kDa proteins were not induced. The 34 kDa protein, i.e., heme oxygenase, has been found to be stress-induced in various types of cell, but not the 23 kDa protein. This suggests that the 23 kDa protein is a stress protein predominantly expressed in macrophages.

Two sisters with leprosy

Leprosy is a rare entity in Japan, but remains quite common in developing countries. We report two sisters with leprosy from Brazil but currently working in Japan who presented to our clinic. The younger sister was infected with the BB type with HLA-A2, A24, B51, Bw52, DR2, DRw8, DRw52, DQw1, and DQw3. The elder sister had the TT type with HLA-A2, A31, B51, Cw3, DRw6, DRw8, DRw52, DQw1, and DQw3. Immunohistochemical findings revealed that CD4+, 4B4+ helper/inducer T-cells were dominant in the granulomas of both cases. Bacilli were not detectable in the biopsy specimens. However, Mycobacterium leprae-specific DNA fragments were found in their peripheral blood and biopsy specimens by polymerase chain reaction.