Anaphylactoid purpura with intestinal perforation: report of a case and review of the Japanese literature

A 78 year old man suffering from anaphylactoid purpura complained of abdominal pain and bloody stools. Combined therapy with Prednisolone and cyclophosphamide had been given against nephrotic syndrome caused by purpura nephritis. Severe abdominal pain with symptoms and signs of pan-peritonitis necessitated laparotomy. Rectosigmoid perforation due to necrotizing angiitis (phlebitis) was also demonstrated histologically. The patient died of septicemia 18 days after surgery. Perforation of the alimentary tract rarely occurs in anaphylactoid purpura. Twenty similar cases were briefly reviewed from the Japanese literature.

A cooperative randomized controlled study of adjuvant chemoendocrine therapy for breast cancer in Japan

A randomized trial was carried out in 55 Japanese institutions to examine the significance of postoperative adjuvant chemoendocrine therapy in Stages II and IIIA breast cancer patients after radical mastectomy. A total of 619 patients were entered from November 1982 to November 1984, of whom 554 were eligible. Patients were administered MMC (13 mg/m2) after surgery, and were randomized by the envelope method into either group A (ftorafur, 400 mg/m2/day; 275 patients), or group B (ftorafur, 400 mg/m2/day, and tamoxifen, 20 mg/day; 279 patients). Treatment was continued for 1 year from postoperative day 7. There were no significant differences between the two groups with regard to age, menopausal status, ER status, method of operation, stage, or number of positive lymph nodes. There was also no significant difference between the two groups in the 5-year survival and disease-free survival (DFS) rates (Kaplan-Meier method). Stratification by ER status, nodal status, or menopausal status produced no significant differences between the groups. However, postmenopausal patients and lymph node-positive patients who were also ER-positive showed a significantly higher DFS in group B. Furthermore, group B in ER-positive patients with four or more positive lymph nodes also had a higher survival rate.

Correlation of heat shock protein 70 expression with estrogen receptor levels in invasive human breast cancer

The authors studied the role of 70-Kd heat shock protein (HSP70) in the progression of breast cancer by examining the correlation between the expression of HSP70 and epidermal growth factor receptor, c-erbB-2, p53, and estrogen receptor in 124 cases of invasive primary human breast cancers. Positivity of an anti-HSP70 monoclonal antibody, C92, was closely associated with the elevation of estrogen receptor (P < .008), whereas it inversely correlated with the expression of p53 (P < .01). In addition, the expression of HSP70 correlated inversely with the expression of epidermal growth factor receptor, although the correlation was not statistically significant (P = .06). These results suggest that the expression of HSP70 plays a role in the progression of human breast cancer.

A resected case of giant leiomyosarcoma of the pancreas

Leiomyosarcoma of the pancreas is very rare. We report a case of giant leiomyosarcoma of the pancreas treated by distal pancreatectomy. A 53-year-old female was admitted with an large abdominal mass. Computed tomography, magnetic resonance imaging, and ultrasonography revealed a huge tumor adjacent to the pancreas. However, we could not identify the primary organ with these imagings. Angiographic findings strongly suggested that the tumor originated from the pancreas, as main feeding arteries arose from the great pancreatic artery. Fourteen days after trans-catheteric arterial embolization, we performed a distal pancreatectomy with splenectomy; the patient's postoperative course was uneventful. Histologically, we confirmed the diagnosis as a leiomyosarcoma originating from the pancreas.

[Computed tomography findings of malignant pleural mesothelioma]

Computed tomography (CT) findings were assessed in 7 patients with malignant mesothelioma. CT findings were also reviewed in 9 patients with lung cancer and pleuritis carcinomatosa and in 11 patients with tuberculous pleuritis. Five patients with malignant mesothelioma underwent CT scans twice, on admission and from 1 to 7 months after admission. Tuberculous pleuritis could be distinguished from pleuritis carcinomatosa and malignant mesothelioma by the presence or absence of pleural nodularity and chest wall invasion. Although it was difficult to identify specific CT features clearly distinguishing malignant mesothelioma from pleuritis carcinomatosa, characteristic findings of malignant mesothelioma appeared to include the rapid development and progression of pleural rind and a tendency to spread directly into the chest wall. We divided the pleura into the four regions; upper anterior, upper posterior, lower anterior and lower posterior regions. Pleural changes were more frequently seen in the lower pleural regions than in the upper pleural regions, in malignant mesothelioma.

A case of Sipple's syndrome with malignant pheochromocytoma treated with 131I-metaiodobenzyl guanidine and a combined chemotherapy with cyclophosphamide, vincristine and dacarbazine

A 39-year-old woman with Sipple's syndrome and a malignant pheochromocytoma (PHE) is presented. She is a member of a big family with this syndrome and had undergone bilateral, subtotal adrenalectomy because of bilateral PHE six years prior to the present admission. In 1989, a small nodule was identified in her right thyroid lobe by ultrasonography and was suspected to be a medullary thyroid carcinoma (MTC). Further examinations revealed the coexistence of multiple lung and liver masses. These tumors were considered to be metastases of PHE because of the increased urinary excretion of catecholamines as well as extremely high catecholamines both in the hepatic venous blood and in the cystic fluid of the liver tumor even though there was no apparent recurrences of PHE in the adrenal region. After surgical removal of the MTC in August, 1989, she was given 3.7 GBq of 131I-metaiodobenzyl guanidine (131I-MIBG) infusions twice--in October, 1989 and in August, 1990. 131I-MIBG showed a strong accumulation in the lung and liver masses on both occasions. Periodic increases in blood pressure and tachycardia with an excessive catecholamine secretion were observed over two weeks after the first treatment. However, this treatment was not effective in reducing urinary catecholamines nor the size of the metastatic tumors. She, therefore, underwent chemotherapy with cyclophosphamide, vincristine and decarbazine in 1991, which slightly but significantly reduced urinary excretion of catecholamines and the size of the lung tumors. She had clinically stable period for one year after the treatment but rapid growth of these metastatic tumors occurred afterwards and she died in August, 1992.(ABSTRACT TRUNCATED AT 250 WORDS)

A case in which a branch from the superior gluteal nerve innervated the rectus femoris and the vastus lateralis

During dissection of the gluteal region, a branch from the most cranial root of the superior gluteal nerve was found to innervate the rectus femoris and the vastus lateralis on the right side of a 41-year-old Japanese male cadaver. This case is an example of Eisler's so-called "competition for innervation areas" (Eisler 1895).

Gastric carcinoma, an endoscopically curable disease

Following refinement of endoscopic diagnosis of gastric cancer, the concept of 'early gastric carcinoma' and its endoscopic features have become established. After the wide acceptance of the techniques of endoscopic mucosal resection (EMR), laser therapy and accurate endoscopic-endosonographic assessment of the depth of invasion, curative endoscopic treatment of intramucosal gastric carcinoma has become established. On the basis of the analysis of lymphatic metastasis, the indications for endoscopic treatment of gastric carcinoma have been defined as (1) well-differentiated, intramucosal adenocarcinoma of a superficial elevated lesion (diameter < 2 cm), and (2) well-differentiated, intramucosal adenocarcinoma of a superficial depressed lesion (diameter < 1 cm) having no ulcer or scar inside. The preferred procedure of endoscopic treatment is EMR with careful histological examination of the resected specimen. It is supplemented by repeat EMR, laser therapy, or surgical gastrectomy in case of incomplete resection. For detection of residual cancer and recurrence, periodic endoscopic follow-up is necessary. Early gastric carcinoma is endoscopically curable.

Unusual complications caused by endo-clip migration following a laparoscopic cholecystectomy: report of a case

We present herein the case of a woman who developed unexpected complications following a laparoscopic cholecystectomy. The clinical manifestations were unique in that symptoms of obstructive jaundice were in fact caused by endo-clips which had migrated into the common bile duct, and the resulting choledochoduodenal fistula presented as persistent cholangitis. While the overall safety of this new procedure appears to be superior to that of open cholecystectomy, the risk of bile duct injury seems more likely. This case stresses the need for caution by surgeons, and emphasizes the necessity for careful surveillance and strict follow-up to ensure the safety of this procedure.

Enzymic synthesis of the trisaccharide core region of the carbohydrate chain of N-glycoprotein

Transmannosylation from mannotriose (Man beta 1-4Man beta 1-4Man) to the 4-position at the nonreducing end N-acetylglucosaminyl residue of N,N'-diacetylchitobiose was regioselectively induced through the use of beta-D-mannanase from Aspergillus niger. The enzyme formed the trisaccharide Man beta 1-4GlcNAc beta 1-4GlcNAc (3.7% of the enzyme-catalysed net decrease of N,N'-diacetylchitobiose) from mannotriose as a donor and N,N'-diacetylchitobiose as an acceptor. Mannobiose (Man beta 1-4Man) was also shown to be useful as a donor substrate for the desired trisaccharide synthesis.

The protective effect of preconditioning on reperfusion-induced arrhythmia is lost by treatment with superoxide dismutase

The purpose of this study was to investigate the relation between free radicals and the effect of preconditioning on reperfusion arrhythmias using the isolated working rat heart model. Rats were divided into 3 groups: control, preconditioned without superoxide dismutase (SOD) and preconditioned with SOD (n = 8 each group). The incidence of reperfusion-induced ventricular fibrillation (Vf) in the preconditioned without SOD group was reduced from 100% to 13% (p < 0.005 vs control). This protective effect of preconditioning was not observed in the SOD-treated group (incidence of Vf increased from 13% to 75%, p < 0.025). The protective effect of preconditioning on reperfusion arrhythmias is related to the presence of oxygen free radicals which occur during the reperfusion period of the preconditioning phase.

Antiphospholipid antibodies. A prognostic factor in sarcoidosis?

Serum antibodies against five types of phospholipids, antiphospholipid antibodies (aPL), were determined by an enzyme-linked immunosorbent assay in 55 patients with sarcoidosis. Either IgG or IgM aPL were detected in 21 patients (38 percent). This positive rate was significantly higher than that (7 percent) of healthy control subjects (p < 0.001). In terms of immunoglobulin classes, 5 cases had IgG aPL only, 11 cases had IgM aPL only, and 5 cases had both classes of aPL. No correlation was observed between the occurrence of aPL and disease activity of sarcoidosis. A significant correlation was noted between the occurrence of aPL and many extrathoracic organ lesions or the persistence of abnormal chest x-ray film findings for periods of 2 and 5 years. Taken together, the presence of aPL in sarcoidosis is a useful index to judge the prolongation of the disease.

Molecular characterization of a novel serine protease involved in activation of the complement system by mannose-binding protein

Mannose-binding protein (MBP) plays an important role in host defense by recognizing sugar residues on certain pathogens and activating the complement cascade. Recently, we described a new protease, designated MBP-associated serine protease (MASP) which is required for complement activation by MBP. We have cloned the cDNA that encodes this protease and found that the deduced amino acid sequence contains an epidermal growth factor-like domain, two short consensus repeats and a serine protease domain. The overall structure of MASP is similar to serine proteases of the first complement component complex, C1r-C1s. Unlike C1r-C1s, however, MASP has a histidine loop structure common to many serine proteases such as trypsin and chymotrypsin. The MASP gene was mapped on the long arm of chromosome 3 which is different from C1r-C1s as well as from trypsin and chymotrypsin. These findings suggest that MASP may have emerged prior to C1r-C1s from a common ancestor. This implies that MBP-MASP, a complex of lectin and serine protease, presumably evolved prior to adaptive immune recognition involving antibody and the classical complement pathway.

Resolution of 4-(4-chlorobenzyl)-2-(hexahydro-1-methyl-1H-azepin-4yl)-1(2H)-phthalazi none enantiomers in plasma with frit-FAB LC-MS using a conalbumin column

A new column-switching method for analysis of drug enantiomers in plasma has been developed with liquid chromatography-frit fast atom bombardment mass spectrometry in combination with a chiral resolution column, which consists of conalbumin (egg-white glycoprotein) immobilized on silica gel and can be used in the reversed-phase separation mode. This method makes it possible to inject a large volume of deproteinized plasma and obtain resolution of drug enantiomers with high sensitivity. The optimum mobile phase, including a non-volatile buffer such as phosphate buffer, for separation of drugs from a large amount of endogenous compounds can be used, because of inclusion of a trapping column with a desalting function. This method is very simple and rapid, and should be very powerful in studies requiring high-sensitivity analysis with chiral separation of drugs from biological samples such as plasma.

[Effect of nifedipine and enalapril on cardiac autonomic activity in elderly hypertensive patients]

To clarify the effect of the calcium antagonist Nifedipine and the ACE inhibitor Enalapril on cardiac autonomic activity, power spectral analysis of heart rate variability (PSA) was conducted in 39 elderly patients with essential hypertension (mean age: 63: +/- 11 years) before and after treatment. Twenty patients were treated with 10-20 mg of Nifedipine (N group) and 19 with 5 mg of Enalapril (E group) for 3 months. beta-blocker (Atenolol 12.5 mg) was added to Nifedipine in 12 patients of the N group for 1 month, and the modified effect of Atenolol on cardiac autonomic activity was also evaluated. Blood pressures were significantly reduced in both N and E groups after the treatment. The low frequency component (LF) in PSA, which was considered to be a quantitative marker of cardiac sympathetic activity, increased significantly and the high frequency component (HF), which was a marker of cardiac parasympathetic activity, significantly decreased with increase of PNA levels in N group after the treatment. However, the LF decreased significantly after addition of Atenolol. On the other hand, there was little significant change in LF and PNA in E group. These results suggest that Nifedipine increased cardiac sympathetic activity and that Enalapril had little influence on the cardiac sympathetic tone, while both antihypertensive agents significantly reduced blood pressure itself.

[A case of aspirin-induced asthma which developed due to rubbing a lotion containing a non-steroidal anti-inflammatory drug, ketoprofen, on the skin]

A forty-year-old woman was admitted to our hospital because of a severe attack of bronchial asthma. The asthmatic attack developed 3 hours after her rubbing a large amount of a lotion containing a non-steroidal anti-inflammatory drug (NSAID), ketoprofen, over her skin. The patient had a past history of asthmatic attack induced by another NSAID (Sedes-G) given per os. The previous asthmatic attack developed about 3 hours after her rubbing the lotion containing the NSAID over her skin. The relatively long interval between the per cutaneous NSAID administration and the onset of the asthmatic attack indicates that the time delay is dependent on the absorption route of the administered NSAID. The severity of the attack is considered to be related to the amount of NSAID absorbed.

Arachidonic acid liberation induced by phosphatidic acid endogenously generated from membrane phospholipids in rabbit platelets

The action of phosphatidic acid generated from membrane phospholipids on phospholipase A2 activation in rabbit platelets was investigated. When [3H]arachidonic acid-labelled platelets were treated with phorbol 12-myristate 13-acetate (PMA) and the membranes isolated from the cells incubated at 37 degrees C with 50 microM CaCl2 and 50 microM guanosine 5'-O-(3-thiotriphosphate) (GTP gamma S), both phosphatidic acid production and arachidonic acid liberation increased in PMA- and GTP gamma S-concentration-dependent manners. Ethanol dose-dependently inhibited these responses, accompanied by the formation of phosphatidylethanol. Since propranolol, an inhibitor of phosphatidic acid phosphohydrolase, had no influence on the production of phosphatidic acid, the arachidonic acid liberated does not appear to be derived from diacylglycerol which may be produced from phosphatidic acid through the action of this enzyme. In another approach, treatment of [3H]arachidonic acid-labelled membranes with phospholipase D from Streptomyces chromofuscus induced arachidonic acid liberation as well as phosphatidic acid formation in time- and dose-dependent manners. The former response was suppressed by p-bromophenacyl bromide, a phospholipase A2 inhibitor. These results suggest that phosphatidic acid derived from membrane phospholipids potentiates phospholipase A2 activation and contributes to the amplification of platelet activation.

Cloning and sequencing of a cDNA encoding the rat Bcl-2 protein

A rat cDNA encoding the Bcl-2 protein was cloned and sequenced. The primary amino-acid sequence deduced from the nucleotide sequence reveals a 236-aa protein having extensive homology with the mouse (95%), human (87%) and chicken (71%) Bcl-2 proteins.

Structure of [2Fe—2S] ferredoxin I from Equisetum arvense at 1.8 Å resolution

Ferredoxin I (Fd I) from Equisetum arvense is an iron-sulfur protein composed of 95 amino-acid residues and one [2Fe-2S] cluster. It crystallized in the space group P2(1), a = 30.4, b = 57.4, c = 47.5 A and beta = 78.7 degrees with two molecules per asymmetric unit. X-ray diffraction data up to 1.8 A resolution were collected by using a Rigaku four-circle diffractometer. The initial model of Fd I, which was derived by the molecular replacement method using a structure of the Fd I from the blue-green alga Aphanothece sacrum, was refined by molecular dynamics simulation and a least-squares minimization with stereochemical restraints. Positional parameters and isotropic temperature factors for 1420 non-H protein atoms and 183 water molecules were refined on 13 838 observed structure factors (F(o) > sigma(Fo)) between 10.0 and 1.8 A resolution. The final Rfactor was 17.0%, and the standard deviation of atomic position estimated by Luzzati plot [Luzzati (1952). Acta Cryst. 5, 802-810] was 0.2 A. The electron-density map was well defined for the two independent molecules except for the N-terminal residue and the three C-terminal residues. Equivalent Calpha atoms of two independent molecules in the asymmetric unit were superposed by the least-squares method with root-mean-square deviations of 0.26 A. Reasonable structural differences were observed at a polypeptide segment having few intramolecular interactions. Highly flexible regions of the molecule were assigned from the structural differences between the two independent molecules in the crystal and the distribution of temperature factors along the polypeptide chain.

Induction of estrogen receptor and cell division in genital tracts of male mice by neonatal exposure to diethylstilbestrol

Estrogen receptor (ER) and ER mRNA expression and cell division induced by neonatal diethylstilbestrol (DES) exposure in male C57BL/Tw mouse genital organs were studied using immunohistochemistry, in situ hybridization, and cell counting at metaphase. A single injection of 3 micrograms DES on the day of birth induced ER in both epithelial (E) and stromal (S) cells of the epididymis and the seminal vesicles, in E cells of the ductus deferens, and in S cells of the ductus efferens and the anterior prostate 24 h after the injection. After 5 daily injections of DES, ER was induced in S cells of the ventral prostrate at 5 days of age. The staining intensity of ER increased in E cells of the epididymis and the ductus efferens at 5 days. A single injection of DES induced ER mRNA in both E and S cells of the ductus efferens, the caput epididymis, and the ductus deferens 4 to 12 h after injection of the newborn mice. A single injection of DES stimulated cell division of both E and S cells in the ductus deferens and the epididymis; cell division of S cells of the ductus efferens, the anterior prostate, and the urethra was stimulated 24 h after the injection. After 5 daily injections of DES, cell division was stimulated significantly in E and S cells of the epididymis, the ductus deferens, and the ventral prostate, and in S cells of the seminal vesicle at 5 days. At 30 days of age, mitotic rates were significantly higher in E cells of the seminal vesicles and the epididymides of mice given 5 daily injections of DES.(ABSTRACT TRUNCATED AT 250 WORDS)

Differentiation of histochemical properties of masticatory muscles in Bovidae and Cervidae (Artiodactyla)

We analyzed the masticatory muscles (masseter, temporal, medial pterygoid and lateral pterygoid muscles) of Bovidae and Cervidae (Artiodactyla) for the histochemical characteristics of their fiber types. Analysis of muscle fiber types in the present study was based on the staining reaction for SDH, Sudan black B, alpha-GPDH, and myosin-ATPase after alkaline preincubations. Histochemical properties were found to contribute to masticatory function, including a slow-twitch fatigue resistant activity derived from the high percentage of red fibers, in spite of the differences in the distributions of fiber types in three portions (superficial, medial and profound portions) of each masticatory muscle. These results indicate a correlation between the histochemical profiles of individual masticatory muscles in these species and their functions during jaw movements.

Immunodeficiency and IL-6 production by peripheral blood monocytes in multicentric Castleman's disease

To study the pathogenesis of multicentric Castleman's disease (MCD), IL-6 producing cells and immune function were investigated in four MCD patients. The expression of IL-6 mRNA in one MCD lymph node was analysed by in situ hybridization. IL-6 mRNA expressing cells were scattered in the interfollicular areas and did not resemble plasma cells. Spontaneous IL-6 production was detected in the culture supernatants of peripheral blood mononuclear cells (PBMNC) from four patients. The IL-6 producing cells among the PBMNC were found to be monocytes by both in situ hybridization and immunohistochemistry. We evaluated immune function in four MCD patients. These studies show: (1) a negative PPD skin test in 3/4 patients, (2) decreased IL-2 production in 3/4 patients, (3) decreased T cell colony formation in 3/4 patients, (4) decreased NK activity and NK cell number in 2/4 patients, (5) increased soluble IL-2 receptor in 4/4 patients, and (6) decreased CD4/CD8 ratio in 3/4 patients. These results show that MCD resembles, in several ways, acquired immunodeficiency syndrome (AIDS).

Meristem-specific gene expression directed by the promoter of the S-phase-specific gene, cyc07, in transgenic Arabidopsis

A genomic clone for the cyc07 gene, which is expressed specifically at the S phase during the cell cycle in synchronous cultures of periwinkle (Catharanthus roseus) cells, was isolated. Determination of the nucleotide sequence of the clone revealed that the cyc07 gene consists of seven exons separated by six introns. Genomic Southern analysis indicated that the cyc07 gene is present as a single copy per haploid genome in periwinkle. Expression of related genes was detected in a wide range of other plants. Transgenic Arabidopsis plants were generated that expressed the gene for beta-glucuronidase (GUS) under the control of the promoter of the cyc07 gene. The tissue-specific pattern of expression directed by the promoter was investigated by analysis of GUS activity. Histochemical tests demonstrated that 589 bp of the 5'-upstream sequence of the cyc07 gene could direct specifical expression of the GUS reporter gene in meristematic tissues in transgenic plants. The spatial pattern of expression directed by the promoter was closely correlated with meristematic activity and cell proliferation, suggesting an association between the function of the cyc07 gene and cell proliferation.

Limited effectiveness of FK506 administration for ongoing rejection in heterotopic rat heart transplantation

A comparison was made of the histological findings for myocardial tissue of heterotopic transplanted rat hearts administered with FK506. ACI rats were used as donors and Lewis rats as recipients. FK506 was used for 6 days except for group I (control group). Group II received 0.32 mg/kg/day of FK506 from the day of operation while group III was given the same dosage from the 4th day after transplantation. Group IV was given 1.28 mg/kg/day of the agent from the day of grafting and group V received the same dose from the 4th postoperative day. The graft survival time was longer for all groups given FK506, but was significantly longer only for groups administered with FK506 from the day of operation. Histological studies performed 10 and 20 days after transplantation showed that a moderate rejection was seen in about half of the grafts receiving FK506 from the 4th day after grafting. An ultrastructural study of these cases showed that infiltrating large lymphocytes still remained in the interstitial tissues and that the cytoplasmic organelles of the myocytes had been focally destroyed. These results suggest that, although FK506 suppressed any further rejection, the effect might be limited and the myocardial changes of the cardiac graft might persist even after administration for ongoing rejection.