[Spontaneous rupture of the hydronephrotic renal parenchyma associated with urinoma in a child]

Presented is a case report of spontaneous rupture of the renal parenchyma associated with urinoma. A 3-year-old boy had a history of transient gross hematuria followed by sudden onset of left flank pain. Echograms and computed tomographic (CT) scan revealed a left hydronephrotic kidney with perirenal urinoma which had a cyclic change in size corresponding to the pain. Left retrograde pyelogram showed stenosis of the ureteropelvic junction without extravasation of contrast medium. A pin-hole tear was detected in the middle of the left renal parenchyma on exploratory surgery. Left pyeloplasty and retroperitoneal drainage were performed. The postoperative course was satisfactory. Spontaneous rupture of the renal parenchyma, which is frequently caused by renal tumor, vascular disease and/or infection, seems to be seldom caused by increased renal intrapelvic pressure as in rupture of the renal pelvis.

Molecular cloning of the murine homologue of CD63/ME491 and detection of its strong expression in the kidney and activated macrophages

The mouse homologue of CD63/ME491 (Mu-CD63) was molecularly cloned and analyzed. Mu-CD63 exhibited a strikingly high similarity to CD63/ME491 and the rat homologue. Northern blot analysis revealed that Mu-CD63 mRNA was expressed strongly in the kidney of adult mice, especially in the glomerulus fraction, implying the possibility that Mu-CD63 plays an important role in maintaining normal renal function. Activated macrophages and splenocytes exhibited strong expression of Mu-CD63 mRNA, whereas cultured thymocytes barely expressed the mRNA irrespective of cell activation. Taken together, the present results suggest that Mu-CD63 expression is associated with differentiation and/or development of certain cell types, but not necessarily with cell proliferation.

The effect of sodium concentration on myocardial viability in donor heart preservation using a nondepolarizing solution

This study examined the effect of different sodium concentrations in a nondepolarizing solution on myocardial viability and functional recovery of the canine donor heart. Isolated canine hearts were preserved for 6 h at 5 degrees C, followed by normothermic reperfusion for 2 h. Dogs were divided into two groups of nine dogs each: group 1 received a nondepolarizing solution with 70 mM Na+ and group 2 with 30 mM Na+. The myocardial Ca2+ concentration at the end of preservation was significantly higher in group 1 than in group 2 and increased after reperfusion in both groups without any intergroup difference. Myocardial concentrations of ATP, ADP, and total adenine nucleotide at the end of reperfusion were significantly higher in group 1 than in group 2. Myocardial cyclic adenosine monophosphate concentration was significantly higher in group 1 than in group 2 at the end of both preservation and reperfusion. The myocardial cyclic guanosine monophosphate concentration in group 1 increased and was higher than in group 2 at the end of preservation, but had returned to normal levels by the end of reperfusion. However, it remained unchanged through preservation and reperfusion in group 2. The left ventricular systolic and diastolic function, assessed by pressure-volume relationship, was better in group 1 than in group 2. Mitochondrial ultrastructural changes were similar. These results suggest that a nondepolarizing solution containing 70 mM Na+ provides better myocardial protection than a solution containing 30 mM Na+.

Steroid injection therapy for pseudocyst of the auricle

In our clinic, we encountered 8 patients with pseudocyst of the auricle during a 6-year period from 1987 to 1992 and injected steroid solution locally into the pseudocysts. Three of these patients had no recurrences and 4 were treated successfully after 1-3 recurrences. In only one case was this therapy ineffective. After 11 injections, which resulted in permanent deformity of the auricle, the patient underwent surgery. We believe that local steroid injection therapy should be the first choice method for treating auricular pseudocysts. However, frequent injections can cause auricular deformity and if there are more than 3 recurrences, the pseudocyst should be managed surgically. The lactate dehydrogenase levels of the cystic fluid were determined in 3 of the 8 patients and proved high; in only one patient was the etiology of the pseudocyst thought to be associated with minor trauma.

A case of the 'dapsone syndrome'

The 'dapsone syndrome' developed in a 44-year-old woman who was treated for pyoderma gangrenosum with 100 mg/day dapsone for about 5 weeks. Symptoms included fever, malaise, jaundice with hepatic dysfunction, lymphadenopathy, mononucleosis and dermatitis. These symptoms disappeared with 30 mg/day of oral prednisolone. A lymphocyte stimulation test with dapsone was positive, as was the delayed-type intradermal skin test with 0.5 and 0.05% dapsone in saline. Immunohistochemical studies of the rash and skin test reaction revealed that the dominant infiltrating T cells in the upper dermis were of the Leu 2a+ cytotoxic/suppressor-type rather than the Leu 3a+ helper/delayed hypersensitivity-type.

Characterization of two polysaccharides having activity on the reticuloendothelial system from the root of Rehmannia glutinosa

Two acidic polysaccharides, called rehmannan SA and rehmannan SB, were isolated from the dried root of Rehmannia glutinosa Liboschitz. They were homogeneous on electrophoresis and gel chromatography, and their molecular masses were estimated to be 6.4 x 10(4) and 7.9 x 10(4), respectively. They were commonly composed of L-arabinose:D-galactose:L-rhamnose:D-galacturonic acid in the molar ratios of 10:10:1:1 (rehmannan SA) and 14:7:3:8 (rehmannan SB), in addition to small amounts of peptide moieties. About eighty percent (rehmannan SA) and about thirty percent (rehmannan SB) of the hexuronic acid residues exist as methyl esters. Reduction of carboxyl groups, methylation analysis, nuclear magnetic resonance and the controlled Smith degradation studies indicated the structural features of rehmannan SB, the major one in terms of the yield. It has a core structural unit of a characteristic rhamnose-rich arabino-3,6-galactan type. Both polysaccharides showed remarkable reticulo-endothelial system-potentiating activity in a carbon clearance test.

[Extended extrapleural pneumonectomy by median approach for advanced malignant mesothelioma with right supraclavicular lymph node metastasis--a case report]

A 52-year-old woman of diffuse malignant mesothelioma of the right pleura with metastasis to right supraclavicular lymph nodes underwent extended extrapleural right pneumonectomy and neck dissection. For this resection we selected the new approach: median sternotomy with hemi-collar incision. Through this approach systematical dissection of the cervical-mediastinal lymph nodes was performed together with resection of the right lung, parietal pleura, the pericardium and the diaphragm. As a result of this en bloc resection, she is alive without recurrence for one year after the operation.

Immunohistochemical microquantitation method for type I collagen in kidney histological section of the rats

An immunohistochemical micromethod for quantitation of type I collagen in frozen histological section of rat kidney was developed. A principle of this method is enzyme-linked immunosorbent assay (ELISA). The intensity of immunoreactivity of the section to an anti-type I collagen antibody was quantitated, and then the total protein content in the same section was measured colorimetrically. Type I collagen content was expressed as mg of type I collagen per g of total protein. In this micromethod, the minimum area and optimum thickness of the section were 5 mm2 and 10 microns, respectively. Type I collagen content in the rat kidney section was 3.02 +/- 0.12 mg/g. This method should be useful for diagnosis of renal failure.

Unilateral anophthalmia in a Holstein calf

Unilateral anophthalmia in a Holstein calf was examined morphologically. On the left side, a small cystic remnant of the eye ball (CRE) was present in the orbit. The CRE was adhered to the dura mater through an abnormal foramen formed in the orbital region of the cranial base. At this region of the left cerebral hemisphere, a porencephalic change was detected. Histologically, the pigment epithelium was continued from the lining of the inner surface of CRE to the residual cerebrocortical tissue attached to the dura mater. These characteristic changes seem to suggest the partial fusion of the outer layer of the optic cup to the telencephalon during optic organogenesis.

A new immunohistochemical method for quantification of fast-myosin in frozen histologic sections of the rat skeletal muscles

An immunohistochemical micromethod for quantification of fast-myosin in frozen histologic sections of rat skeletal muscles was developed. The principle of this method was enzyme-linked immunosorbent assay (ELISA). We used frozen tissue sections as models of the antigen-coated wells of ELISA plate. The intensity of immunoreactivity of the frozen section to an anti-fast-myosin monoclonal antibody was quantified directly from the color developed with the second antibody coupled with peroxidase using phenol-4-aminoantipyrine as a substrate. Then, the same section was incubated in 0.01 M acetic acid solution to cleave antigen-antibody complexes, followed by colorimetric measurement to obtain the absolute value of total protein per section. Fast-myosin content in the frozen tissue section was expressed as mg of fast-myosin per g of total protein. In this micromethod, the minimum area and the optimum thickness of the section were 5 mm2 and 10 microns, respectively. Fast-myosin contents in the extensor digitorum longus and soleus muscles were 185.0 +/- 6.1 and 17.5 +/- 2.4 mg/g, respectively. The results obtained by this micromethod were in good agreement with those obtained by two conventional methods, immunohistochemical morphometry and biochemical determination. This micromethod is useful for a quantitative evaluation of the contractile function of the mammalian skeletal muscles.

Change in density of K+ current of HeLa cells during the cell cycle

We investigated the cell cycle-dependency of the channel, using cells synchronized by harvesting them at the mitotic stage. The inward K+ currents by whole-cell patch-clamp were highest in early G1, and then decreased with time to a minimum in the S phase, increasing again in the M phase. In contrast, membrane surface area increases with progression of the cell cycle, whereas the currents decreases from early G1 to an apparent minimum in the S phase. Therefore, the densities of K+ current at fixed membrane potentials were highest in early G1 phase and lowest in the S phase.

[A female case of isolated angiitis of the central nervous system]

Isolated angiitis of the central nervous system (IACNS) is an extremely rare disorder in childhood. This report presents an 8-year-old female case of IACNS. She showed paresis at the right face and upper limb at the onset, followed by various focal neurological symptoms. Cranial T2-weighted magnetic resonance imaging revealed multiple subcortical high signal lesions, which appeared and disappeared in accordance with her clinical manifestations. The level of her plasma thrombin-antithrombin III complex (TAT) was high during the active phase of the illness and seemed to be a useful marker for the detection of vasculitis in the CNS. Complete remission was achieved by the combination therapy of prednisone and cyclophosphamide.

[The necessity of extended systemic dissection of the regional lymph node in radical operation for lung cancer]

Since 1979, 109 patients underwent bilateral mediastinal lymph node dissection through a median sternotomy as a routine procedure in the treatment of left lung cancer, because of the high possibility of contralateral mediastinal node involvement in cases of left lung cancer. The five-year survival rates of the initial 50 patients who underwent this operation from Oct. 1979 till Mar. 1988 were 76.5% in N0 (n = 17), 69.2% in N1 (n = 13), 50.0% in N2 (n = 10) and 20.0% in N3 (n = 10). The five-year survival rate of 7 patients with pT1-2 N2M0 disease was 71.4%. This survival rate was only slightly different from that of the pT1-2N0-1M0 group. From May 1985 till April 1993, 20 patients who had the cervical or the highest mediastinal lymph node involvement underwent cervical and bilateral mediastinal lymph node dissection through a cervical collar incision and median sternotomy. Two patients with the scalene node involvement (one each of right and left lung cancer) are surviving for five years or more after surgery. Extended ipsilateral mediastinal lymph node dissection (R2b) has been adopted as a routine procedure in the treatment of right lung cancer in our institute since 1990. The survival rate at forty months in 15 patients with N2 disease who underwent R2b operation was 51%. In 3 of these fifteen patients the anterior mediastinal lymph node metastases were revealed by post-operative pathological investigation.(ABSTRACT TRUNCATED AT 250 WORDS)

Retroperitoneal tumor eleven years after initial treatment of testicular cancer

Presented is a case report of retroperitoneal tumor eleven years after orchiectomy for testicular cancer. Complete remission was achieved with combined chemotherapy and retroperitoneal lymph node dissection. Histologic examination revealed that primary testicular tumor was pure choriocarcinoma and that the retroperitoneal tumor was likely embryonal cell carcinoma without foci of choriocarcinoma. It is difficult to determine whether the retroperitoneal tumor is a late recurrence of testicular cancer of a primary extragonadal germ cell tumor.

Phosphorus-31 nuclear magnetic resonance study of energy metabolism in intact slow- and fast-twitch muscles of rats

The time course of the catabolism of phosphorylated metabolites was studied by phosphorus-31 NMR(31P NMR) spectroscopy over a 6-h period after the isolation of rat slow- and fast-twitch muscles, the soleus and the extensor digitorum longus (EDL), respectively, obtained without any muscle damage. In both muscles, rapid depletion of creatine phosphate was followed by a decrease in ATP. These high-energy phosphates disappeared earlier in the soleus than in the EDL. In both muscles, inorganic phosphate (Pi) largely increased in a biphasic pattern, and sugar phosphates (SP) also showed considerable increase. The NMR-visible total phosphates (NTP) increased significantly in the soleus during the latter stage of observation. This increase in NTP was attributed to an increase in Pi. Although the two muscles showed the same initial (7.21) and final (approximately 5.9) intracellular pH (pHi), the pattern of pHi decline differed between these muscles. The rapid fall of pHi in the soleus in the early stage suggests that nonlactic acid acidosis plays a significant role in postmortem changes.

Changes in carotid blood flow and electrocardiogram in humans during and after walking on a treadmill

Blood flow velocity in the common carotid artery and the electrocardiogram were measured simultaneously by telemetry in seven male subjects during 20-min walking on a treadmill at an exercise intensity corresponding to a mean oxygen uptake of 26.0 (SD 2.9) ml.kg-1.min-1. The mean cardiac cycle was shortened from 0.814 (SD 0.103) s to 0.452 (SD 0.054) s during this exercise. Of this shortening, 73% was due to shortening of the diastolic period and 27% to shortening of the systolic period. In the relatively small shortening of the mean systolic period [from 0.377 (SD 0.043) s to 0.268 (SD 0.029) s], the isovolumetric contraction time was shortened by 56%. During exercise, the heart rate (fc) increased by 79.4% [from 74.3 (SD 9.3) beats.min-1 to 133.3 (SD 14.8) beats.min-1], and the peak blood velocity (S1) in the common carotid artery increased by 56.1% [from 0.82 (SD 0.10) m.s-1 to 1.28 (SD 0.11) m.s-1]. After exercise, the S1 decreased rapidly to the resting level. The fc decreased more slowly, still being higher than the initial resting level 5 min after exercise. The diastolic velocity wave and the end-diastolic foot decreased during exercise. The blood flow rate in the carotid artery increased transiently by 13.5% at the beginning of exercise [from 5.62 (SD 0.63) ml.s-1 to 6.38 (SD 0.85) ml.s-1] and by 26.5% at the end of the exercise period [from 5.62 (SD 0.63) ml.s-1 to 7.11 (SD 1.34) ml.s-1].(ABSTRACT TRUNCATED AT 250 WORDS)

Protein profiles of Legionella pneumophila Philadelphia-1 grown in macrophages and characterization of a gene encoding a novel 24 kDa Legionella protein

Legionella pneumophila Philadelphia-1 strain was grown in cultured macrophages of guinea pigs, hamsters, and A/J mice and the bacteria were purified by Percoll density gradient centrifugation without any detergent. Patterns of the bacterial proteins were compared by SDS-PAGE with those of organisms cultured in vitro. A 24 kDa protein was a major protein of intracellularly grown bacteria: its expression was about four times as much as a 24 kDa protein of agar-grown bacteria. At least three novel proteins (100, 65, and 16 kDa) that were not found on agar-grown bacteria were also observed. In this paper, we focused on the 24 kDa major Legionella protein expressed within macrophages. Western blot and N-terminal amino acid analysis revealed that this protein is a novel protein different from Legionella proteins previously reported, including a 24 kDa macrophage infectivity potentiator protein (Mip). On the basis of amino acid sequence (MQRIKKI and IANAQGK), two kinds of oligonucleotides were synthesized and radiolabeled. Using these oligonucleotides as DNA probes, a 7.2 kb EcoRI-digested DNA fragment encoding the 24 kDa protein was cloned into lambda ZAP II phage vector in Escherichia coli XL1-Blue. A 0.9 kb DNA fragment from the 7.2 kb fragment was further subcloned into pUC118 in E. coli CSR603 for maxicell analysis or XL1-Blue for DNA sequencing. Maxicells which carry recombinant plasmids consisting of the 0.9 kb DNA fragment and vector plasmid pUC118 expressed the 24 kDa protein. When the DNA fragment encoding the protein was sequenced, an open reading frame of 555 base pairs was identified. The inferred polypeptide had a molecular weight of 20 kDa and an estimated isoelectric point of 8.14. Both the nucleotide sequence and the deduced amino acid sequence were distinct from those of bacterial proteins reported previously, suggesting that the protein is a novel Legionella protein.

[History of the term "tan" (phlegm) (II) -- studies of the term "tan" found in medical books before the Liang dynasty]

The first description of the term "tan" is found in the Shan Han Za Bing Lun published at the end of the later Han dynasty. This book refers to this term as a disorder of the cold fluid in the body. The meaning of this term was revised to a viscous fluid as the years went on. The term "tan" from the Zhou Hou Bai Yi Fang published in the Liang dynasty was the same sense of phlegm as that found in present works. Our studies showed that changes of the words used for the concept "phlegm" in Chinese medical books coincided with those in Chinese Buddhist literature. We suggested that the concept "phlegm" in Buddhist medicine influenced Chinese tradition medicine.

Cutaneous B-cell lymphoma--a clinical, pathological and immunohistochemical study

Eleven cases of cutaneous B-cell lymphoma (CBCL) were studied. The ages at presentation ranged from 34 to 79 years (mean = 59.9 years). Six patients were female and five male. Five of the 11 patients had a solitary tumour and the other six had multiple tumours at initial presentation. According to Burg's classification, six cases were at stage I, two stage II, two stage III and one was at stage IV at initial presentation. Abnormalities in laboratory data were rare, except for serum lactic dehydrogenase values. Epidermotropism was not detected, and the area mainly affected by neoplastic cells was the reticular dermis (seven cases) and subcutis (four cases). Biopsy specimens from the patients analysed by immunohistochemical techniques on paraffin or cryostat sections showed CD20 and/or CD22 positivity. Biopsy specimens from two patients which showed CD10 positivity were diffuse large cell types by the working formulation and presented as pre-B-cell lymphoma. At least two groups of CBCL were demonstrable on the basis of prognosis. One was a benign low-grade lymphoma presenting with solitary tumours, mature B-cell markers and intermediate-grade pathology, and the other was a high-grade lymphoma with multiple tumours, pre-B-cell or mature B-cell markers and a poor prognosis.

Powered Orthosis for Lower Limbs -Its Structure and Control-

This paper describes a powered orthosis for lower limbs which restores the gait of locomotion of disabled persons, such as paraplegics, with its structure and control as well as its clinical experiments. The powered orthosis supports the patient's weight, and it has four electrohydraulic digital actuators to motorize hip and knee joints, as well as sensors to detect joint angles and plantar contacts. Each joint angle is controlled by a microcomputer such that an appropriate gait pattern is restored for a stable, powered level walk. This second prototype of the powered orthosis has been designed and developed for testing on patients in order to determine its effectiveness. For the control of this orthosis, the gait pattern is generated by a 16-bit master microcomputer using the preprogrammed pattern which is synthesized with 20 parameters; six 8-bit slave microcomputers measure and control joint angles. A new type of digital actuator was developed specifically for this purpose. In addition, a desktop microcomputer is used for the change of parameters as well as for the dialogue with the master computer. The orthosis weighs only 19.5kg, and the hydraulic power unit 68kg. Clinical experiments of this prototype are conducted on two paraplegics. A powered walk of 6.0 sec/step is realized for the first time, and then 4.5 sec/step for approximately 10 meters.

Successful treatment of adult T-cell leukemia/lymphoma with MACOP-B, M-FEPA and VEPP-B combination chemotherapy

A 45-year-old man was referred to our department in March of 1989. Physical examination showed erythroderma, palmo-plantar hyperkeratosis, generalized lymphadenopathy, hepatosplenomegaly, and leukemic manifestation. The lymphocyte count in the peripheral blood before treatment was 1.7 x 10(4) cells/mm3. Atypical lymphocytes such as flower cells and lobulated cells were seen in the peripheral blood. A sample excised from a lymph node showed immunoblastic, pleomorphic T cells by a modified classification scheme of the Working Formulation. A high level of serum LDH was detected (2.1 times the upper normal limit). Anti HTLV-1 antibody was also detected in the serum. The atypical lymphocytes were positive for CD3, CD4, CD5, CD7 and HLA-DR, and negative for CD8. Thus, the clinical, pathologic and immunologic features were those of typical acute-type ATL. The patient was treated with VEPA-M for three months starting in March of 1989. Because of poor response, the patient was then treated with MACOP-B, M-FEPA, and VEPP-B for about one year from June of 1989 and has been free of disease up to the time of writing, March of 1993.