[Malignant lymphoma of the chest wall in a patient with chronic empyema]

A 76-year-old man presented with the chief complaints of appetite loss and general fatigue. He was admitted with the initial diagnosis of empyema necessitatis, and right thoracic drainage was performed. Nevertheless, the subcutaneous mass in the right side of the chest wall did not shrink, and examination of a specimen obtained by percutaneous needle biopsy resulted in the diagnosis of non-Hodgkin's lymphoma, intermediate lymphocytic type. The patient was treated with Adriamycin, vincristine, prednisolone, and cyclophosphamide, but died of pneumonia and cachexia five months after symptoms first appeared. The diagnosis of intermediate lymphocytic lymphoma, B cell type was made at autopsy. Only 53 cases of malignant lymphoma associated with chronic empyema have been reported in Japan. Surgery was often not done because of the patient's advanced age or poor pulmonary function; diagnosis was often difficult. However, review of the 53 reported cases suggested that resection of the tumor, if possible, would improve the prognosis. Malignant lymphoma should be considered when there is chronic empyema, because such cases are now being reported more frequently.

Roles of light chains in the activity and conformation of smooth muscle myosin

The 20-kDa regulatory (LC20) and 17-kDa essential (LC17) light chain subunits could be removed from porcine aorta smooth muscle myosin by the use of trifluoperazine and ammonium chloride. The isolated heavy chain rebound both light chains, resulting in the restoration of native properties. Experiments on reconstitution of the isolated heavy chain with LC17 and/or LC20 showed that both light chains were required for folding into the 10 S conformation and thus for the phosphorylation-dependent filament formation of smooth muscle myosin. However, LC17 was not essential for the phosphorylation-dependent regulation of actin-activated ATPase activity and superprecipitation but was required for full regulation. LC17 and phosphorylated LC20 were found to act as activators, and dephosphorylated LC20 was found to act as a repressor of the motor activities of smooth muscle myosin.

Does an allergy skin test on school-children predict respiratory symptoms in adulthood?

BACKGROUND

It is interesting from the correct point of preventive health care whether allergy skin tests at entry have the positive relationship with common respiratory symptoms such as persistent cough, persistent phlegm and wheeze with colds at end point in longitudinal studies.

OBJECTIVE

The purpose of this study is to investigate this relationship in subjects followed from when they were school-children until they were young adults.

METHODS

Young adults aged 18-31 years who had participated in an allergy skin test and a health survey for common respiratory symptoms during primary and junior high school were asked about their respiratory symptoms at the end-point in the follow-up study. Three cohort groups were employed in the follow-up study.

RESULTS

According to a multiple logistic analysis with adjustments made for sex, symptoms at entry in childhood, and age and smoking habits at the end-point, young adults with a positive skin test to an extract of house dust as school-children showed a higher prevalence of wheeze with colds compared with those with a negative skin test. However, this relationship was not found for persistent cough or persistent phlegm, indeed, the latter symptom was significantly associated with negative skin tests in one cohort group.

CONCLUSION

The respective symptoms at entry in childhood were also predictors of their occurrence in young adults. The results show that the common respiratory symptoms such as persistent phlegm and wheeze with colds in childhood are related to those in young adults rather than is an allergy skin test to an extract of house dust in childhood.

[Surgical treatment for ruptured aneurysm of distal arch or aortic arch: report of three cases]

We experienced three cases of surgery for ruptured aneurysm of the distal aortic arch (2 cases) or aortic arch (1 case). A 59-year-old man who was diagnosed as distal arch aneurysm ruptured to the pericardial cavity underwent graft replacement of the aneurysm and reconstruction of a left subclavian artery under selective cerebral perfusion (SCP). This patient had left hemiplegia postoperatively. A 73-year-old man who was diagnosed as an aneurysm of distal arch and descending aorta ruptured to left pleural cavity underwent graft replacement of the aneurysm and reconstruction of a left subclavian artery under SCP, and died of severe left ventricular failure possibly due to preoperative myocardial ischemia. A 70-year-old man who was diagnosed as a saccular aneurysm of aortic arch ruptured to mediastinum underwent resection of the aneurysm and patch plasty of the aorta under SCP. The postoperative course was uneventful. We discussed the approach to aneurysm, adjunctive method and surgical precedures from standpoint of our ruptured three cases.

The usefulness of MR in establishing the diagnosis of parotid pleomorphic adenoma

PURPOSE

To assess the usefulness of MR findings in establishing a specific diagnosis of parotid pleomorphic adenoma.

METHODS

T1-weighted and T2-weighted MR images with and without contrast enhancement were obtained in 82 patients with parotid tumors. Imaging findings in the 38 patients in whom surgery subsequently revealed pleomorphic adenomas were compared with findings in the 44 patients who had other types of tumor. Specifically, the homogeneity, signal intensity, contrast enhancement, capsule thickness, lobulation, adenopathy, and infiltration of adjacent fat were compared among the different types of tumor. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

RESULTS

A low-signal capsule on T2-weighted images and a lobulated contour characterized most pleomorphic adenomas. The sensitivity of the first finding for pleomorphic adenoma was 82%; specificity, 85%; positive predictive value, 82%; and negative predictive value, 84%. For the second finding, the sensitivity was 53%; specificity, 84%; positive predictive value, 74%; and negative predictive value, 67%.

CONCLUSION

None of the signs evaluated had perfect sensitivity and specificity. The MR findings of a complete capsule, lobulated contour, or high T2 signal intensity have a high predictive value for the diagnosis of pleomorphic adenoma.

[Analysis of initial potential of signal-averaged QRS complex in patients with acute myocardial infarction]

Non-invasive recording of the late potential (LP) by signal-averaging technique is useful in predicting ventricular tachycardia (VT), especially in patients with myocardial infarction (MI). However, the rate of positive LP is LOW in anterior or anteroseptal MI, since the LP is masked by QRS complex. The purpose of the present study is first, to detect local conduction delay in initial portion of QRS complex and secondly, to evaluate the clinical significance of the initial delay in patients with MI. Eighty patients with MI were analyzed; AS: anteroseptal, n = 18, including 6 VT, A: anterior, n = 22, 7 VT, I: inferior, n = 28, 9 VT, and P: posterior, n = 12, no VT. Twenty non-MI patients were used as normal controls (N). A signal processor (NEC 7 T 18) was used to record signal-averaged electrocardiograms and each 10 msec integral value of filtered QRS complex from the initial upstroke to the 60 msec point was automatically measured. The integral values of groups AS and A were lower than those of groups I, P, and N. AS with VT showed a lower integral value than AS without VT, but no differences were observed between A with VT and A without VT. We conclude that there is a much lower upstroke of signal-averaged initial QRS complex in patients with anteroseptal MI with VT, suggesting that the local conduction delay at the ventricular septum plays an important role in the mechanism of VT in these patients.

Changes in autonomic activity preceding onset of nonsustained ventricular tachycardia

BACKGROUND

The triggering role of the autonomic nervous system in the initiation of ventricular tachycardia has not been established. To investigate the relationship between changes in autonomic activity and the occurrence of nonsustained ventricular tachycardia (NSVT) we examined heart rate variability (HRV) during the 2-hour period preceding spontaneous episodes of NSVT. Twenty-four subjects were identified retrospectively as having had one episode of NSVT during 24-hour Holter ECC recording.

METHODS

We measured the mean interval between normal heats (meanRR), the standard deviation of the intervals between beats (SD), the percentage of counts of sequential intervals between normal beats with a change of >50 ms (%RR50), the logarithms of low- and high-frequency spectral components (lnLF, lnHF) of HRV for sequential 10-minute segments preceding NSVT. The correlation dimension (CDim) of HRV was calculated similarly for sequential 20-minute segments. We assessed the significance of the time-course change of each marker over the 120-minute period prior to NSVT onset.

RESULTS

MeanRR (P < 0.05), lnLF (P < 0.0001), lnHF (P < 0.0001), the natural logarithm of the ratio of LF to HF (ln[LF/HF]; P < 0.05), and CDim (P < 0.05) showed significant time-course changes during that period, while SD and %RR50 did not. MeanRR, lnLF, lnHF, and CDim all decreased prior to the onset of NSVT, whereas ln(LF/HF) increased. We divided the subjects into two groups: one consisting of 12 patients with coronary artery disease; and the second group of 12 patients without known coronary artery disease. Both groups showed significant changes (P < 0.05) of CDim, lnLF, and lnHF preceding the episodes of NSVT.

CONCLUSIONS

Changes in the pattern of HRV prior to the onset of episodes of NSVT suggest that changes in autonomic activity may commonly play a role in the triggering of spontaneous episodes of NSVT in susceptible patients. The measured changes suggest a reduction in parasympathetic activity, perhaps in conjunction with an increase in sympathetic activity, may trigger NSVT.

Incidence of human parvovirus B19 DNA detection in blood donors

1000 serum samples from blood donors were tested for human parvovirus B19 (B19) DNA by a nested PCR assay: six samples were positive for B19 DNA. The frequency was 1/167 (0.6%), considerably higher than previous surveys (0.004-0.03%). Five of the six samples were also positive for anti-B19 IgM, indicating an acute phase of infection. It is recommended to screen for B19 DNA in blood products to prevent transfusion mediated viral infection for those susceptible such as immunocompromised patients and pregnant women.

[Application of molecular biology to occupational health field--the frequency of gene polymorphism of cytochrome P450 1A1 and glutathione S-transferase M1 in patients with lung, oral and urothelial cancer]

A polymorphism in exon 7 of the cytochrome P450 1A1 (CYP1A1) and A homozygous gene deletion at the glutathione S-transferase M1 (GSTM1) locus of genomic DNA isolated from peripheral blood were investigated for its relationship with lung, oral and urothelial cancer using the polymerase chain reaction (PCR) technique. As for the CYP 1A1 Val/Val genotype, 5 of 88 healthy controls (5.6%), 1 of 33 lung cancer patients (3.0%, P > 0.05, odds ratio 0.52, 95% confidence interval 0.21-17.3 with Ile/Ile Ile/Val type as base line), 4 of 32 oral cancer patients (12.4% P > 0.05, odds ratio, 2.37, 95% confidence interval 0.60-9.30) and 4 of 85 urothelial cancer patients (4.8% P > 0.05], odds ratio, 0.82, 95% confidence interval 0.21-3.16) were CYP 1A1 Val/Val types. The frequency of GSTM1 deletion genotype was 39.8% in the healthy controls and 45.5%, 50.0% and 61.2% in lung cancer, oral cancer and urothelial cancer patients, respectively. The frequency of GSTM deletion genotype was statistically increased in urothelial cancer patients (P < 0.05, odds ratio 2.38, 95% confidence interval 1.28-4.34). The odds ratio of combined genotypes of CYP1A1 Val/Val and GSTM1 deletion was 1.42 (95% confidence interval 0.12-16.8), 3.64 (95% confidence interval 0.47-27.9), 1.02 (95% confidence interval 0.14-7.53) in lung cancer, oral cancer and urothelial cancer patients, respectively. Thus, the GSTM1 deletion genotype as a host factor predisposing to urothelial cancer was proved in this study.

Crosslinking of a 28-residue N-terminal peptide of actin to myosin subfragment 1

The N-terminal 28-residue peptide of actin whose Cys10 was labeled with 5-iodoacetamido-fluorescein (F3K peptide) was isolated from the fluorescently labeled thrombin digest of actin. The effect of myosin subfragment 1 (S1) on the fluorescence of F3K peptide was examined in the absence of ATP. With increasing concentration of S1 added, the fluorescence intensity of F3K peptide increased by maximally 7.3% with an apparent dissociation constant of 5.7 microM, suggesting a role of this peptide region of actin in acto-S1 binding in rigor. F3K peptide was crosslinked with S1 at 10 mM NaCl using a zero-length crosslinker by the method of Grabarek and Gergely [Anal. Biochem. 185, 131-135 (1990)]. The crosslinking was greatly inhibited by the presence of either 0.2 M NaCl or 5 mM MgATP. The analyses of amino acid compositions and sequences of the fluorescent peptides isolated from a lysylendopeptidase digest of the crosslinked S1 indicated that F3K peptide was mainly crosslinked to residues 637-642 of the S1 heavy chain. The crosslinked S1 was isolated by selectively pelleting the uncrosslinked S1 with F-actin. ATPase activity of the isolated crosslinked S1 alone was twice as high as that of control S1. The actin-activated ATPase activity of the crosslinked S1 was much lower than that of uncrosslinked S1. The estimated Vm and Km values were 1.72 s-1 and 125 microM, respectively. The Vm decreased to less than 1/8, while Km increased only twofold. The results suggest that the N-terminal 28-residue segment of actin may be implicated in the rigor binding of actomyosin and in the actin-activation of myosin ATPase, but may not be the main determinant of actomyosin binding in the presence of ATP.

[Influence of cardiopulmonary bypass on biological response]

To investigate the influence of cardiopulmonary bypass (CPB) on biological response, we measured the serum level of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), and granulocyte elastase (GEL) in 24 patients who underwent elective cardiac surgery and 32 patients who underwent elective gastroenterological surgery. All patients were alive. The serum level of GEL in cardiac patients was significantly higher than that in gastroenterological patients on the 1st and the 3rd postoperative day (P = 0.00008, P = 0.00097 respectively). In addition. there was a significant relationship between CPB time and the serum level of GEL immediately after CPB (r = 0.53, P = 0. 007). That is a reason why higher level of serum GEL in cardiac surgery is due to the bacterial translocation. TNF-alpha and IL-1beta were detected in only :3 patients who underwent over 250 minutes CPB. It is most important to shorten the CPB time in order to decrease the serum GEL and lessen the biological response surgery.

Cross-sectional assessment of renal function in the inhabitants of a cadmium-polluted area

To understand the development of cadmium (Cd)-induced renal tubular dysfunction, cross-sectional assessment of renal function in the inhabitants of the Cd-polluted Jinzu River basin in Toyama, Japan, was carried out. Sixty-seven men and 78 women, aged 56 to 71 years whose urinary beta 2-microglobulin (beta 2-m) exceeded 1,000 micrograms/g creatinine, were examined and divided into five groups according to their values of fractional excretion of beta 2-m (FE beta 2-m). Comparisons were made between six groups including the inhabitants of a non-polluted area as a reference group. Significantly increased values of fractional excretion of urate (FEUA), calcium (FECa), sodium (FENa), and chloride (FECl), serum creatinine and beta 2-m, and urinary protein were detected even in the subjects with FE beta 2-m level below 1 percent compared with the reference group. Fractional phosphate reabsorption (percent TRP) was significantly decreased in the subjects with FE beta 2-m level above 10 percent. Creatinine clearance (CCr) decreased with increase in FE beta 2-m, and the subjects with FE beta 2-m above 30 percent showed significantly decreased CCr values compared to those with FE beta 2-m below 30 percent. In summary, FEUA, FECa, FENa, and FECl, as well as low-molecular-weight proteins such as beta 2-m, are increased in the early stage of Cd-induced renal tubular dysfunction. Although percent TRP was maintained by the decreased CCr, there was a marked decrease in percent TRP in subjects with progressive stage showing FE beta 2-m level above 10 percent. No sex difference in renal tubular dysfunction was found in this cross-sectional study.

The effect of cross-linking of the two heads of porcine aorta smooth muscle myosin on its conformation and enzymic activity

The two heads of porcine aorta smooth muscle myosin can be cross-linked by a disulfide bridge between the two 17-kDa essential light chains with 5,5'-dithiobis(2-nitrobenzoic acid) [Katoh, T., Tanahashi, K., Hasegawa, Y. & Morita, F. (1995) Eur. J. Biochem. 227, 459-465]. When the cross-linked myosin sample was visualized by rotary shadowing, the two heads of myosin molecules appeared predominantly to adhere to each other. The cross-linking of dephosphorylated myosin in the presence of ATP was greatly inhibited by a decrease in the concentration of NaCl from 0.4 M to 0.15 M, suggesting that the cross-linking of the two heads was suppressed in 10S myosin. However, the fraction of dephosphorylated myosin in a filamentous state at 0.1 M NaCl in the presence of 1 mM ATP was increased from 33% to 83% by the cross-linking. The cross-linking of the two heads might inhibit the formation of the 10S conformation, leading to the increase in the fraction of filamentous myosin. The filaments of the cross-linked myosin sample were visualized by electron microscopy and appeared morphologically similar to those of uncross-linked myosin. The ATPase activity of the cross-linked dephosphorylated myosin sample was more than three times as high as that of an uncross-linked control. The increase in the activity may be related to the increase in the fraction of filamentous myosin caused by the cross-linking. The ATPase activity of dephosphorylated myosin in the presence of actin was increased more than twofold by the cross-linking, but the activity of phosphorylated myosin was affected only slightly. The degree of phosphorylation-dependent regulation of actin-activated ATPase activity decreased with an increase in the degree of cross-linking and was extrapolated to zero at 100% cross-linking. Superprecipitation of acto-cross-linked dephosphorylated myosin was activated, while that of acto-cross-linked phosphorylated myosin was inhibited only slightly. These results suggest that the freedom of each head in myosin molecules may be required to keep the ATPase activity and superprecipitation of acto-dephosphorylated myosin low but not for keeping these activity levels high in acto-phosphorylated myosin.

[Clinical evaluation of patients with cardiopulmonary bypass by plasma granulocyte elastase]

To evaluate the role of granulocyte elastase (GEL) at cardiopulmonary bypass (CPB), the plasma GEL level was measured in 24 patients who underwent elective cardiac surgery and 47 patients who underwent elective gastroenterological surgery. The cardiac surgical patients were divided into two groups: 5 patients with CPB less than 120 minutes (HL group), and 19 patients with CPB more than 120 minutes (HH group). The patients with gastro-enterological surgery were also divided into two groups: 15 patients with postoperative complications (GC group), and 32 patients without postoperative complications (GU group). All the patients of GU, HL and HH groups were alive. Two patients of GC group died because of multiple organ failure (MOF). The serum levels of GEL in both the HH group and the GC group remained higher than in the GU group at 6 postoperative day (POD). The high serum level of IL-8 gave rise to high serum level of GEL in the HH group, even after cardiac surgery. We assumed that anti-cytokine therapy and aggressive administration of Ulinastatin are useful against postoperative complications and that careful management is need after long CPB.

Isolation of dermatophytes from house dust on a medium containing gentamicin and flucytosine

Dermatophytes are usually isolated from house dust by using actidione-chloramphenicol Sabouraud glucose medium (ACS medium). We have prepared a new medium, 5FC medium, by adding gentamicin sulphate (GS) and 5-fluorocytosine (5FC) to ACS medium to achieve more efficient isolation of dermatophytes from house dust. 5FC medium was more effective in isolating dermatophytes than ACS medium or ACS medium supplemented with GS alone. Trichophyton rubrum could be grown from 13 out of 19 house dust samples from the homes of patients with tinea pedis (68.4%), and T. mentagrophytes could be grown from 17 out of 21 (81.0%). Two of 20 house dust samples from the home of a control family without dermatophytosis grew only one colony of dermatophytes in 5FC medium; the rest of the samples showed no growth. The number of colonies isolated on 5FC medium was much higher than on ACS medium (5.3 vs. 2.0 for T. rubrum and 17.2 vs. 2.1 for T. mentagrophytes). In addition, the size of the isolated colonies was much larger than that on ACS medium. Thus, 5FC medium can be regarded as a useful tool for isolating dermatophytes from various contaminated samples.

GAP-43 mRNA suppression by the ribozyme in PC12 cells and inhibition of evoked dopamine release

We constructed a ribozyme designed to cleave the GAP-43 mRNA and which contained a bacteriophage T7 transcription terminator at its 3' site to maintain stability. The ribozyme was overexpressed in PC12 cells by pEF-BOS, a powerful mammalian expression vector. Consequently, PC12 cells overexpressing the GAP-43 ribozyme revealed a drastic decrease in the levels of GAP-43 mRNA expression, and the evoked dopamine release was significantly suppressed in these cell lines. These results support the previous observations that GAP-43 is associated with Ca-dependent dopamine release in PC12 cells, and the ribozyme expression system used in the present study was demonstrated to be useful for suppression of the functions of specific mRNAs and exploration of specific gene products.

[Relationships between atmospheric Sugi (Japanese cedar)-pollen counts and indices of climatic conditions]

Atmospheric pollen surveys have been conducted using Durham's standard sampler for 12 years in Toyama Prefecture. The relationships between Sugi (Japanese cedar, Cryptomeria japonica D. Don) pollen and some indices of climatic conditions were analyzed. The results were as follows: 1. Total pollen counts showed a tendency to increase for 12 years, although the variation of the count was relatively large. 2. Significant correlations were found between pollen counts and some indices of the climatic conditions in July of the previous year, such as duration of sunshine, mean daily temperature and daily maximum, as well as minimum temperature. 3. Significant correlation was found between pollen count and duration of sunshine in January and March, and the amount of snowfall in March of the observed year using multiple regression analysis. Pollen counts were shown to be relatively high in years with short sunshine in January and long sunshine and heavy snow in March.

Evidence for involvement of a 12-residue peptide segment of the heavy chain in the neck region of smooth muscle myosin in formation of the 10S conformation

Two synthetic peptides having amino acid sequences of the heavy chain segments in the neck region of porcine aorta smooth muscle myosin were used to study the formation of the 10S folded conformation. These peptides, MHC821-835 and MHC835-846, correspond to residues 821-835 and 835-846, respectively, of the chicken gizzard myosin heavy chain. The effects of these peptides on the filament formation of porcine aorta smooth muscle myosin were examined. The filamentous myosin fraction increased on the addition of MHC835-846 at NaCl concentrations lower than 0.25 M for both dephosphorylated and phosphorylated myosin, while the filament formation of dephosphorylated myosin was unaffected by the addition of MHC821-835 up to 30 microM. The filaments formed in the presence of MHC835-846 were observed by electron microscopy to be morphologically indistinguishable from those formed in the absence of the peptide. Rotary shadowed images of dephosphorylated myosin monomers revealed mostly the 10S form in the absence of MHC835-846, while the 6S form was predominant in the presence of the peptide. The results indicate that MHC835-846 inhibits the formation of the 10S conformation. On cosedimentation assaying with myosin, rod and light meromyosin, MHC835-846 bound to each of them with a stoichiometry of nearly 1 mol/mol heavy chain. Altogether, these results suggest that the region in the myosin heavy chain corresponding to MHC835-846 may be involved in the binding site for the light meromyosin portion of myosin for formation of the 10S conformation.