Tl-201 uptake and retention in a Warthin's tumor

We report scan findings of Tl-201 in a case of histologically proved Warthin's tumor. Dual isotopes acquisition was performed in a case of left parotid Warthin's tumor. Both early and delayed Tc-99m-pertechnetate (Tc-99m) images showed increased uptake at the tumor. Tl-201 scan also showed an increase of uptake on the early image and retention on the delayed image. The uptake ratios of Tl-201 were 3.0 (early) and 2.3 (delayed). Scan findings of Tl-201 in a case of Warthin's tumor were similar to those of Tc-99m, and the interpretation of Tl-201 images should be accompanied with Tc-99m images.

[A case of AIDS with miliary tuberculosis]

A 22 year-old Thai male was admitted to our hospital because of chest pain and dyspnea. In 1989, he met with a traffic accident and was injured his head and the arm, and was given a blood transfusion in Thai. Laboratory examinations on admission revealed that serolopositivity for HIV, and CD4+T lymphocyte count was 17/microliter. Chest X-ray on admission showed bilateral diffuse nodular shadow, and he was diagnosed as miliary tuberculosis with AIDS. On the chest X-ray, in the right upper middle lung fields, the shadow was rough and partly influent. In the left lung, the nodular shadow were smaller and distributed evenly. As there was a difference in the distribution of nodular shadows between the left and right lung, the chest X-ray findings of this case was atypical of miliary tuberculosis.

Absorption, distribution and excretion of beta-cyclodextrin and glucosyl-beta-cyclodextrin in rats

The absorption, distribution and excretion of intravenously and orally administered beta-cyclodextrin (beta-CD) and glucosyl (G)-beta-CD in rats were studied using HPLC with pulsed amperometric detection. Within 10 h after intravenous administration, unchanged beta-CD and G-beta-CD recovered in urine were about 90% of each dose. The nephritic accumulation of G-beta-CD after the intravenous administration of G-beta-CD was slightly lower than that of beta-CD using the same treatment. The maximum plasma concentrations of beta-CD and G-beta-CD after the oral administration of CDs (500 mg/kg) were observed within 40 min. After oral administration, 0.6% of beta-CD and 0.3% of G-beta-CD were excreted in urine. The pharmacokinetic behaviour of both CDs after the intravenous administration of CDs (50 mg/kg) was almost the same. Furthermore, the inclusion complexes of estriol and betamethasone with CDs were prepared, and their absorption was evaluated after oral administration in rats. The plasma concentrations of CDs after oral administration of drug-CD complexes were significantly decreased in comparison with those after the oral administration of CDs alone. On the other hand, the plasma concentrations of drugs after the oral administration of drug-CD complexes were higher than those after the administration of drugs alone.

[A study on the background factors of cases died of pulmonary tuberculosis detected by symptomatic visit]

Forty three patients detected by symptomatic visit and died of active pulmonary tuberculosis were investigated on their social background factors. As to age of 43 cases, 17 cases (40%) were fortieth of fiftieth; namely in young productive age. Sixteen were male and 13 cases lived alone and thirteen cases had no regular occupation when they were admitted. Three were too serious to talk about their case histories. Among other 13 cases, none visited a hospital within three months from the appearance of their symptoms and 8 cases visited a hospital after six months or long from the appearance of their symptoms. Thus, the patient's delay was obvious, and this was actually the cause of death in this cases.

Role of cytokines in leukemic type growth of myelodysplastic CD34+ cells

The clonal growth of progenitor cells from myelodysplastic syndromes (MDS) can be subdivided into four growth patterns: (1) normal, (2) no growth or low plating efficiency, (3) low colony and high cluster number, and (4) normal or high colony number with a large number of clusters. The former two (1 and 2) can be referred to as nonleukemic patterns and latter two (3 and 4) as leukemic. In a search for a role for cytokines in leukemic-type growth of MDS progenitor cells, marrow CD34+ cells were purified up to 94% for 8 normal individuals and 88% for 12 MDS patients, using monoclonal antibodies and immunomagnetic microspheres (MDS CD34+ cells). The purified CD34+ cells were cultured for 14 days with various combinations of cytokines, including recombinant human macrophage colony-stimulating factor (rM-CSF), granulocyte-CSF (rG-CSF), granulocyte-macrophage-CSF (rGM-CSF), interleukin-3 (rIL-3), and stem cell factor (SCF; a ligand for c-kit) in serum-free medium. The clonal growth of MDS CD34+ cells supported by a combination of all of the above cytokines was subdivided into the two patterns of leukemic or nonleukemic, and then the role of individual or combined cytokines in proliferation and differentiation of MDS CD34+ cells was analyzed in each group. Evidence we obtained showed that SCF plays a central role in the leukemic-type growth of MDS CD34+ cells and that G-CSF, GM-CSF; and/or IL-3 synergize with SCF to increase undifferentiated blast cell colonies and clusters over that seen in normal CD34+ cells. SCF is present in either normal or MDS plasma at a level of nanograms per milliliter, and this physiologic concentration of SCF can stimulate progenitor cells. This means that progenitor cells are continuously exposed to stimulation by SCF in vivo and that MDS leukemic cells have a growth advantage over normal blast cells. This depends, at least in part, on cytokines such as G-CSF, GM-CSF, IL-3, and SCF.

[A role of radionuclide studies for gastrointestinal and hepatobiliary diseases]

Radionuclide studies for gastrointestinal and hepatobiliary diseases were presented. Some are routinely done, but others are rarely done due to complicated technique. For the evaluation of functional abnormalities in gastrointestinal and hepatobiliary diseases, an important role of the radionuclide studies was discussed.

Isolation by HPLC of the positional isomers of heterogeneous doubly branched cyclomaltohexaose having one alpha-D-galactosyl and one alpha-D-glucosyl side chain and determination of their structures by enzymatic degradation

Each of the six and five positional isomers of 2n- and 6n-O-alpha-D-galactopyranosyl-6(1)-O-alpha-D-glucopyranosyl-cyclomalt ohexaose (alpha-cyclodextrin, alpha CD; 2n: n = 1-6, 6n: n = 2-6), which were produced from 6-O-alpha-D-glucopyranosyl-alpha CD and melibiose by transgalactosylation with coffee bean alpha-galactosidase, were isolated by high-performance liquid chromatography (HPLC) on a reversed-phase column and a graphitized carbon column. The structures of those isomers were elucidated by analyses of enzymatic degradation products with cyclomaltodextrin glucanotransferase and glucoamylase.

[A case of posterior tuberculous spondylitis of the lumbar vertebra with the skull inoculated by acupuncture]

A 77-year-old male consulted an orthopedist with complaints of lumbago and a lumbar swelling, and was treated with acupuncture. As the symptoms deteriorated, and smear of a specimen aspirated from the lumbar swelling was positive for acid fast bacilli which were later identified as Mycobacterium tuberculosis, he was hospitalized in the National Chiba Higashi Hospital. On admission to our hospital, CT-scan of lumbar vertebrae showed the destructive change of spinous process of the third lumbar vertebra accompanied by the abscess formation, and an occipital swelling with the destructive change of skull was also detected. Whole body examinations with CT-scan and bronchoscopy did not reveal any other abnormal findings suspective of tuberculous lesions. The above lesions were both gradually improved by antituberculous chemotherapy with INH, RFP, and EB. He was finally diagnosed as posterior tuberculous spondylitis of the lumbar vertebra with cold abscess, and also clinically diagnosed as skull tuberculosis caused presumably by the inoculation of tubercle bacilli from the lumbar lesion by acupuncture.

Uptake and washout of I-123-MIBG in neuronal and non-neuronal sites in rat hearts: relationship to renal clearance

We investigated the uptake and washout of I-123-metaiodobenzylguanidine (MIBG) in neuronal (both intra- and extravesicular) and non-neuronal sites in the heart and its relationship to renal clearance. Acute renal failure was induced in rats by ligating the renal vessels, and the findings were compared with those of sham-operated rats. Each group consisted of control, reserpine-treated and 6-hydroxydopamine (6-OHDA)-treated subgroups. Rats were sacrificed at 10 minutes and 4 hours after injection of MIBG. MIBG activity was calculated in specimens of heart, spleen, lung and blood. At 10 minutes, no significant difference in MIBG uptake in the heart was observed among the subgroups or between sham-operated and renal failure rats despite a significantly higher blood MIBG activity in the latter. At 4 hours, however, the hearts of both reserpine-treated and 6-OHDA-treated rats showed significantly lower MIBG uptake than control rats. Furthermore, the hearts of renal failure rats showed higher MIBG uptake in the control and reserpine-treated rats than in the corresponding subgroups in sham-operated rats. Intra and extravesicular neuronal uptake of MIBG in the heart were estimated using control, reserpine-treated and 6-OHDA-treated rats. Vesicular uptake values were similar in both the sham-operated group (0.51% ID/g) and the renal failure group (0.44% ID/g). But extravesicular neuronal uptake values were quite different in the renal failure group (0.86% ID/g) and the sham-operated group (0.19% ID/g). In conclusion, uptake to and washout from extravesicular neuronal sites may depend on the concentration of MIBG in the blood or the state of renal clearance, but vesicular uptake may be independent of these factors.

Mobilization of peripheral blood progenitor cells following CHOP treatment combined with delayed granulocyte colony-stimulating factor administration in patients with non-Hodgkin's lymphoma

The kinetic change in peripheral blood progenitor cells (PBPC) during 3 to 6 cycles of standard CHOP regimen supported with human recombinant granulocyte colony-stimulating factor (rG-CSF) was investigated in three patients with newly diagnosed intermediate grade, diffuse large cell type, non-Hodgkin's lymphoma (NHL) without bone marrow invasion. Patients were given rG-CSF subcutaneously (2 mu g/kg/day) initiated when total leukocytes was < 3.0 x 10(9)/1. When the leukocyte count remained at >3.0 x 10(9)/1, rG-CSF was started 10 days following the prior CHOP. Treatment with rG-CSF was discontinued after the leukocyte count reached >10.0 x 10(9)/1, and CHOP was started the next day (CHOP-G regimen). The number of PBPC was monitored by clonal assay in patients 1-3. No severe leukopenia with <0.5 x 10(9)/1 of neutrophils was seen in any patient. Colony-forming unit granulocyte-macrophage (CFU-GM) significantly increased after 2-3 days of consecutive administration of rG-CSF. The magnitudes of maximum amplification of CFU-GM in patients 1, 2, and 3, were 56-fold (during 3 cycles of CHOP-G), 216-fold (during 2 cycles), and 67-fold (during 4 cycles), respectively, and the absolute numbers of the maximum CFU-GM/ml blood were 983, 7,568, 9,865, respectively. In one patient who was given 6 cycles of CHOP-G, the peak values of mobilized CFU-GM in each cycle did not substantially decrease until 6 cycles of CHOP-G had been completed. Thus, the CHOP-G regimen described here seems to be very efficient increasing the circulating CFU-GM prior to harvesting PBPC.

Application of Tc-99m-tetrofosmin as a tumor imaging agent: comparison with Tl-201

Tc-99m-tetrofosmin SPECT was performed on 6 occasions in 4 patients with hypopharyngeal carcinoma, lung carcinoma, esophageal carcinoma and maxillary plasmocytoma and compared with Tl-201 SPECT. All lesions accumulated both Tc-99m-tetrofosmin and Tl-201. Early uptake ratios of Tc-99m-tetrofosmin were about 2 but those of Tl-201 were much higher (more than 3). Washout rates of Tc-99m-tetrofosmin were higher than those of Tl-201. There was a good positive correlation between the early uptake ratio of Tc-99m-tetrofosmin and that of Tl-201. The delayed uptake ratio and washout rate showed poor correlation. In conclusion, early uptakes of both the agents were similar but their retention patterns were different. Tc-99m-tetrofosmin may be used for tumor imaging though more studies are required to evaluate diagnostic accuracy and the significance of delayed images.

Reduced activity of anabolizing enzymes in 5-fluorouracil-resistant human stomach cancer cells

The mechanism of resistance to 5-fluorourcil (5-FU) was studied with NUGC-3/5FU/L, a human stomach cancer cell line which had acquired resistance as a consequence of repeated 5-day exposures to stepwise-increasing concentrations of 5-FU in vitro. NUGC-3/5FU/L was 200-fold and over 16-fold resistant to 96-h and 1-h exposures to 5-FU, respectively. NUGC-3/5FU/L incorporated less 5-FU into RNA, indicating resistance to the RNA-directed action of 5-FU. On the other hand, NUGC-3/5/5FU/L also showed resistance to in situ thymidylate synthase (TS) inhibition by 5-FU. Polymerase chain reaction-single-strand conformation polymorphism analysis of TS cDNA and a FdUMP ligand binding assay showed that quantitative and qualitative alterations of TS are not responsible for this resistance. In contrast, the ability to metabolize 5-FU to its active metabolites, FUTP and FdUMP, was reduced in NUGC-3/5FU/L. We found that not only the activities of uridine phosphorylase/kinase and orotate phosphoribosyl-transferase (OPRT), but also the level of phosphoribosyl pyrophosphate, a cosubstrate for OPRT, were significantly lower in NUGC-3/5FU/L than in the parent NUGC-3. These results indicated that resistance to 5-FU in NUGC-3/5FU/L is due to reduced activities of 5-FU-anabolizing enzymes, but not to an alteration of TS. 2'-Deoxyinosine effectively enhanced TS inhibition by 5-FU in the resistant cells, thus markedly sensitizing them to 5-FU.

Myocardial sympathetic dysinnervation in doxorubicin cardiomyopathy

Single photon emission computed tomography (SPECT) using I-123 metaiodobenzylguanidine (MIBG) was evaluated for the detection of doxorubicin (DXR) cardiomyopathy in seven patients with malignant lymphoma receiving DXR doses ranging from 70 to 530 mg (DXR group), and 20 normal subjects without hypertension, diabetes mellitus or electrocardiographic abnormalities (control group). The ratio of the heart to mediastinal counts (H/M) and the washout rate (WR) in MIBG SPECT images were compared between the two groups. Correlation of total doses of DXR with H/M and the relationship of H/M to WR were investigated. The H/M of the DXR group was lower than that of the control group (3.00 +/- 0.97 vs 4.90 +/- 1.08, p < 0.001). The WR of the DXR group was higher than that of the control group (30.9 +/- 10.5% vs 16.5 +/- 9.1%, p < 0.001). Total DXR doses were inversely correlated with H/M (r = -0.86), H/M correlated inversely with the WR (r = -0.83) only in the DXR group. Pathological findings of one patient, who died of DXR cardiomyopathy, showed atrophic and fibrotic nerve fibers in the apical inferior segment of the left ventricle where MIBG uptake was reduced markedly. DXR cardiomyopathy can be detected with MIBG SPECT as cardiac sympathetic nervous dysinnervation. The pathological findings correspond to the MIBG SPECT findings.

Chemical modification of PA-48153C, a novel immunosuppressant isolated from Streptomyces prunicolor PA-48153

5beta-Methoxy (20), 14-methyl (24), 14,14-dibromo-15-nor (25), 8-O-acyl (26-45), 8-O-alkyl (46), 8-O-alkoxycarbonyl (47, 48), and 8-O-carbamoyl (49) derivatives of PA-48153C, a novel immunosuppressant isolated from fermentation products of Streptomyces prunicolor PA-48153, were prepared. These compounds were found to retain the inhibitory activity on the responses of both T and B cells to mitogens. Among them, the C-8 hexanoate 28 showed potent suppressive effects on mitogen responses with less cytotoxicity to EL4 cells and was selected for in vivo evaluation.

[Evaluation of the prognosis of patients with stage I non-small cell lung cancer with respect to predicted postoperative lung function]

One hundred and forty patients underwent absolute curative resction for stage I non-small lung cancer from 1982 to 1993 at our department. For these, prognosis and changes in quality of life (QOL) were evaluated retrospectively with respect to the predicted postoperative lung function. The average age of the patients was 62 years (range 31 to 84 years), and 103 males and 37 females were included. Seventy-five of the patients had adenocarcinoma, 61 squamous cell carcinoma, and 4 large cell carcinoma. These 140 patients were classified into two groups, H and N, according to the predicted postoperative %FEV1.0 and %VC. Group H patients (n = 39) had a predicted %FEV1.0 and/or %VC of 55% or less for postoperative respiratory disease. Group N patients (n = 101) had a predicted %FEV1.0 and %VC of 56% or more for expected normal respiratory conditions postoperatively. Group N patients showed a 98% one-year survival rate, and 72% five-year survival rate and good QOL postoperatively. On the other hand, group H patients showed 86% and 45% one- and five-year survival rates respectively, the same as those predicted for patients with stage II non-small cell lung cancer. Furthermore, group H patients more than 70 years old showed 80% and 17% one- and five-year survival rates, the same as those predicted for patients with stage IIIA non-small cell lung cancer, and poor prognosis in comparison with that of the group N patients more than 70 years old. Then, QOL was investigated one year postoperatively. The group H patients showed deterioration of performance status in comparison with the group N patients. Since there was a high incidence of postoperative respiratory disease in the patients with a predicted %FEV1.0 and/or %VC of 55% or less, physicians should avoid extended lung resection, which might cause deterioration of the cardiopulmonary reserve volume, in patients in whom respiratory disease is predicted to occur, particularly for patients more than 70 years old. In conclusion, physicians should consider limiting surgical intervention to preserve lung volume and QOL of patients more than 70 years old with restricted cardiopulmonary function.

High-performance liquid chromatographic separation of carbohydrates on graphitized carbon columns

Graphitized carbon columns (GCC) for high-performance liquid chromatography are relatively new and have a unique ability to resolve isomeric and closely related compounds. The retention mechanism of carbohydrates on GCC is mainly based on adsorption and the flat surface of GCC packings brings about unique selectivity, but also includes hydrophobic interactions. The chromatographic behaviour of monosaccharides, disaccharides, cyclodextrins (CDs), branched CDs, oligosaccharide alditols, chito-oligosaccharides, N-linked oligosaccharides and glycopeptides has been studied, and it has become apparent that the elution patterns are based on the size and planarity of the molecule (position and configuration of linkage).

Decreased signal intensity of cerebral cortex on T2-weighted MR images

To define the frequency of decreased signal intensity (DSI) in cerebral cortex on T2-weighted images relative to aging and to the incidence of identifying white matter pathology, T2-weighted MR brain images of 906 patients consecutively examined between July 1989 and June 1991 were reviewed. MR images of cerebral cortex were divided into five areas: frontal lobe (F), pre- and postcentral gyri (C), parietal lobe (P), occipital lobe (O) and temporal lobe (T). Each area was separately and independently evaluated for the presence or absence of DSI. The frequency of DSI in each area was plotted against patients' ages. The severity of leukoaraiosis was evaluated in relation with DSI in each cortical area. Patients with DSI in area F numbered 61 (5.7%), in area C 236 (26.0%), in area P 174 (15.9%), in area O 428 (47.2%), and in area T 10 (1.1%). The number of patients with DSI in each area increased with age. The greater the severity of leukoaraiosis, the greater the chance of finding DSI of the cerebral cortex. The incidence of DSI in the cerebral cortex increased with the patient's age as well as with the severity of co-existent white matter pathology.

[A case of virus-associated hemophagocytic syndrome (VAHS) complicated by rhabdomyolysis which were associated with herpes-simplex virus infection]

A 60-year-old male was admitted to our hospital complaining abdominal pain and fatigue. Complete blood count showed as follows; WBC 3,900/microliters (48% of monocytes), Hb 11.5 g/dl, Plt 0.9 x 10(4)/microliters. Marrow smears showed the presence of phagocytic histiocytes that consist 22.4% of total nuclear cells. Laboratory findings showed as follows; BUN 109.5 mg/dl, Creatinine 7.4 mg/dl, CPK 1,259 IU/l, Aldolase 195 IU/l, Myoglobin 4,200 mg/dl. Serological studies showed a 16-fold increase in herpes-simplex virus (HSV) antibody titers 4 weeks after admission. So we diagnosed his illness as virus-associated hemophagocytic syndrome (VAHS) and rhabdomyolysis that were associated with HSV. We performed three times of hemodialysis for acute renal failure and used prednisolone for VAHS. These treatments were successful, and he made a complete recovery from illness. VAHS complicated by rhabdomyolysis is very rare, and we think this case is full of suggestions.

[Aneurysmal bone cyst of the left 5th rib]

A case of aneurysmal bone cyst of the left 5th rib is reported. A 57-year-old male complained of palpable lump and pain on his back. Chest X ray and CT showed expansive tumor arid pathological fracture of the left 5th rib. The tumor and the adjacent segments of the 4th and 5th ribs were resected en bloc. The pathological examination showed multiple blood filled spaces and fibrous trabeculae, confirming the diagnosis of aneurysmal bone cyst. He has been followed up for 3 years and 6 months with no signs of recurrence.

Cerebellar afferents to neuroendocrine cells: implications for adaptive responses to simulated weightlessness

The hypothalamo-neurohypophyseal system as well as the autonomic nervous system is involved in homeostatic responses associated with changes in head position and orthostatic reflex. The responses induced by body tilt on earth are thought to be attributed to changes in inputs from baroreceptors, vestibular organs and proprioreceptors that are normally required for postural control. The information from these organs is sent to the hypothalamus which thereby influences both neuroendocrine and autonomic systems as well as various kinds of emotional behavior. Our findings showing the fastigial input to the hypothalamus suggested that the FN plays a significant role in these homeostatic responses through its connections with the brain stem and the hypothalamus. Figure 4 shows the input-output organization among the hypothalamus, cerebellum and brain stem, described in detail in sections III to V. This hypothesis may help to account for the autonomic and endocrine disorders often observed in weightlessness.

Isolation and characterization of novel heterogeneous branched cyclomalto-oligosaccharides (cyclodextrins) produced by transgalactosylation with alpha-galactosidase from coffee bean

Transgalactosylated derivatives of cyclomalto-hexaose (alpha CD), -heptaose (beta CD), and -octaose (gamma CD) were synthesized by alpha-galactosidase from coffee bean using melibiose as a donor and alpha CD, beta CD or gamma CD as an acceptor. Mono- and di-O-alpha-D- galactosylated CDs were isolated and purified by HPLC. Their structures were elucidated by fast-atom bombardment mass spectrometry (FABMS) and 13C NMR spectroscopy. For structural determination of positional isomers of 6(1),6n-di-O-alpha-D-galactosyl-CDs, digestion products with cyclodextrin glucanotransferase were analyzed by HPLC and FABMS.

Atrophic nerve fibers in regions of reduced MIBG uptake in doxorubicin cardiomyopathy

A myocardial MIBG-SPECT examination was conducted 2 wk after doxorubicin chemotherapy on a 52-yr-old woman without cardiac symptoms. Despite normal 201TI scintigraphy, reduced MIBG uptake was detected in the apical anterior, inferior and lateral segments of the left ventricle. The patient died of congestive heart failure due to doxorubicin-induced cardiomyopathy 10 mo later. At necropsy, the left ventricle was markedly dilated and the apical anterior, inferior and lateral walls were thin, stiff and whitish. Nerve fibers in the apical inferior wall were atrophic and markedly fibrotic where MIBG uptake was most reduced. Nerve fibers in the septum were normal where MIBG uptake had remained normal. The histologic findings correspond with the findings on the MIBG image. MIBG imaging may detect cardiac sympathetic denervation in doxorubicin-induced cardiomyopathy before cardiac symptoms are manifest and cardiac function deteriorates.