Disaccharide analysis of skin glycosaminoglycan in localized scleroderma

BACKGROUND

Altered metabolism of skin glycosaminoglycan has rarely been investigated in localized scleroderma in contrast to systemic sclerosis.

OBJECTIVE

The aim of this investigation is to elucidate the change in skin glycosaminoglycan of localized scleroderma.

METHODS

We analyzed 5 skin samples of localized scleroderma and 10 site-matched control skin samples using high performance liquid chromatography after 1-phenyl-3-methyl-5-pyrasolone labeling.

RESULTS

The involved skin constantly showed an increased amount of delta Di-4S(DS), the main disaccharide unit of dermatan sulfate, a decreased amount of delta Di-HA, the main disaccharide unit of hyaluronic acid, and an elevated ratio of delta Di-4S(DS)/delta Di-HA as compared with the uninvolved skin or the site matched control skin.

CONCLUSION

These results correlate well with those findings in systemic sclerosis, indicating that the alteration in skin GAG may be closely related to the fibrotic process.

Modulation of c-fms proto-oncogene in an ovarian carcinoma cell line by a hammerhead ribozyme

Co-expression of macrophage colony-stimulating factor (M-CSF) and its receptor (c-fms) is often found in ovarian epithelial carcinoma, suggesting the existence of autocrine regulation of cell growth by M-CSF. To block this autocrine loop, we have developed hammerhead ribozymes against c-fms mRNA. As target sites of the ribozyme, we chose the GUC sequence in codon 18 and codon 27 of c-fms mRNA. Two kinds of ribozymes were able to cleave an artificial c-fms RNA substrate in a cell-free system, although the ribozyme against codon 18 was much more efficient than that against codon 27. We next constructed an expression vector carrying a ribozyme sequence that targeted the GUC sequence in codon 18 of c-fms mRNA. It was introduced into TYK-nu cells that expressed M-CSF and its receptor. Its transfectant showed a reduced growth potential. The expression levels of c-fms protein and mRNA in the transfectant were clearly decreased with the expression of ribozyme RNA compared with that of an untransfected control or a transfectant with the vector without the ribozyme sequence. These results suggest that the ribozyme against GUC in codon 18 of c-fms mRNA is a promising tool for blocking the autocrine loop of M-CSF in ovarian epithelial carcinoma.

Immunohistochemical study of estradiol, epidermal growth factor, transforming growth factor alpha and epidermal growth factor receptor in endometrial neoplasia

In a total of 113 cases of endometrial neoplasm, we studied the immunohistochemical expression of estradiol (E2), epidermal growth factor (EGF), transforming growth factor alpha (TGFalpha), and epidermal growth factor receptor (EGFR). Positive immunoreactivity of E2 was found in 61% of the neoplasms. E2 immunoreactivity correlated well with high histologic grade and early clinical stage. Positive immunoreactivity for EGF or EGFR was found in 25.6% or 53.1% of the neoplasms, respectively. However, this was unrelated to histologic grade or clinical stage. On the other hand, TGFalpha immunoreactivity was found in 67% of endometrial neoplasias and was correlated with poor histologic grade and advanced stage. Contingency tables indicated a significant negative association between the status of E2 and that of TGFalpha. Simultaneous expression of E2, EGF and EGFR, or E2, TGFalpha and EGFR was found in 6.8% and 15.9% of endometrial carcinomas, respectively. These results suggest that a predominant number of endometrial carcinomas escape autocrine/paracrine growth regulation by EGF and E2 or TGFalpha and E2, and that TGFalpha may be involved in the progression of endometrial carcinoma.

Establishment of gastric Helicobacter pylori infection in Mongolian gerbils

An animal model of Helicobacter pylori infection was obtained with Mongolian gerbils. Culture broth of H. pylori ATCC 43504 was orally administered to the gerbils. Animals were killed 1, 7, 14, 21, and 42 days after the oral inoculation and the stomachs were excised. Colonization of H. pylori was maintained in the stomachs of all animals throughout the study period of up to 42 days. On microscopic examination after immunological and hematoxylin and eosin staining, the organisms were detected in the mucus layer of the gastric epithelium. All gerbils exhibited a slowly progressive but typical gastritis, showing superficial erosion with increasing numbers of infiltrating neutrophils and mononuclear cells. Forty-two days after the inoculation, lymph follicles were detected in the gastric submucosa. These features are similar to the manifestations of H. pylori infection in humans and, accordingly, this model could be of value for studying H. pylori pathogenicity and for research into agents for the treatment of H. pylori infection in humans.

Effects of cilazapril on exercise tolerance in the chronic phase of acute myocardial infarction

The present study was conducted to investigate the effects of cilazapril on exercise tolerance and the hormone kinetics of catecholamines, the reninangiotensin-aldosterone system and alpha-atrial natriuretic peptide (ANP) in patients in the chronic phase of acute myocardial infarction (AMI). The subjects consisted of 19 cases of AMI. Cardiopulmonary exercise testing was performed 1 month after the onset of AMI, and patients were randomly assigned to either a group treated with 1 mg/day of cilazapril (9 cases) and or an untreated group (10 cases). After the completion of 2 months of exercise training at the anaerobic threshold (AT), blood samples were taken during a cardiopulmonary exercise test and various hormones were measured. In comparing the parameters of exercise tolerance before and after the completion of exercise training there were no significant differences between the 2 groups with respect to oxygen uptake, oxygen pulse, or exercise time at AT or at peak exercise. With regard to temporal changes in exercise tolerance, oxygen uptake, oxygen pulse and exercise time all tended to increase in both groups. With regard to hormone kinetics, the alpha-ANP concentration at peak exercise was significantly lower, and the noradrenaline secretions also tended to be lower, in the cilazapril-treated group, even though the peak exercise time was similar in both groups. These results may be support the hypothesis that cilazapril mitigates the left ventricular load during exercise therapy in patients in the chronic phase of AMI.

[A case of internal supravesical hernia]

We report a case of internal supravesical hernia. A 74-year-old male with complaint of abdominal pain underwent an operation for small intestinal obstruction due to its incarceration into the internal supravesical hernia. Retrospectively, the preoperative abdominal CT film showed the relation of the incarcerated intestine, the urinary bladder, and the middle umbilical ligament. This is the first case of the internal supravesical hernia in which the preoperative CT had taken and it will contribute to the preoperative correct diagnosis in the future.

[A case of cerebral aspergillosis associated with induction chemotherapy for acute lymphoblastic leukemia]

A case of cerebral aspergillosis during induction chemotherapy for acute lymphoblastic leukemia was described. A 5-year-old boy complained of headache and left homonymous hemianopsia during induction chemotherapy for acute lymphoblastic leukemia. CT scan and MR imaging survey demonstrated cerebral fungal lesion as well as multifocal lung lesions. A cerebral lesion appeared as a low density mass in right occipital lobe with marginal enhancement on CT scan, and iso- and high-signal intensity appeared with marginal gadolinium enhancement on T1- and T2-weighted MR imaging. Although fungus balls in the lung responded well to daily intravenous administration of amphotericin-B for 2 months, the cerebral lesion showed a rather expansive character as invading into neighbouring falx, opposite occipital lobe, meninges, and occipital bone. Extensive removal of the brain lesion from the parenchyma, falx, invaded dura, and skull was surgically performed. The lesion was confirmed as aspergillosis by Grocott's methenamine histological stain. Surgical intervention and concomitant use of amphotericin-B for a month resulted in complete remission of the aspergillosis. After 6 years, a cranioplasty was successfully completed for the occipital bone defect.

Malignant lymphoma of the gastric stump developing 25 years after a distal gastrectomy for benign gastric disease: report of a case

We report herein the case of a 57-year-old man in whom malignant lymphoma originating in the gastric remnant was confirmed 25 years after a subtotal gastrectomy with Billroth II reconstruction had been performed for gastric ptosis. Gastroscopy revealed an ulcerated tumor on the fornix, and histologic examination of the endoscopic biopsy specimens demonstrated malignant lymphoma. Thus, total gastrectomy with splenectomy, pancreatectomy, and resection of the previously anastomosed jejunal stoma were performed. Histologic examination of the stomach remnant confirmed a diagnosis of B-cell lymphoma of the large-cell type. Although we were unable to study the surgical specimen from the initial operation, the possible relationship between pseudolymphoma and malignant lymphoma has been presented in the literature, which is reviewed following this case report.

Complement plays an essential role in shock following intestinal ischaemia in rats

Intestinal ischaemia lasting more than 30 min in rats causes fatal systemic shock. Systemic shock was suppressed by preadministration of cobra venom factor (CVF), which reduced the serum complement to less than 5% of the normal level, indicating that complement is involved in the syndrome. After complement activation, anaphylatoxins such as C3a and C5a are generated, and their activity is restricted by carboxypeptidases which remove C-terminal arginine from such bioactive peptides. As expected, preadministration of a carboxypeptidase inhibitor enhanced the systemic shock induced by the intestinal ischaemia. However, when the complement level was suppressed by CVF treatment, no fatal systemic shock was induced by the intestinal ischaemia even with preadministration of the carboxypeptidase inhibitor. These results indicate that complement plays a crucial role in systemic shock induced by intestinal ischaemia, and that anaphylatoxins generated by the complement activation should be involved in induction of the shock syndrome.

"Oblique path"--the optimal needle path for computed tomography-guided biopsy of small subpleural lesions

PURPOSE

To determine the optimal needle path for computed tomography (CT)-guided biopsy of small lesions just beneath the pleura.

METHODS

A biopsy of 61 subpleural lesions measuring less than 2.5 cm was done prospectively with regard to the approach and the results. One of two needle paths was randomly chosen: a nearly right angle path (n = 30) or an "oblique path" in which the needle was sharply inclined within the slice, using a course nearly parallel to the pleura (n = 32). One lesion was sampled twice. The procedures were considered successful when diagnostic samples were obtained.

RESULTS

The success rate of the oblique path was 81.2% and that of the near 90 degrees path was 43.3% (p < 0.05).

CONCLUSION

For percutaneous biopsy of small subpleural lesions under CT guidance, the oblique path is better than the perpendicular path.

Focal dermal hypoplasia (Goltz syndrome): a decreased accumulation of hyaluronic acid in three-dimensional culture

We report a 28-year-old female with focal dermal hypoplasia, (Goltz syndrome). We compared the growth kinetics and the production of type I collagen and glycosaminoglycans by fibroblasts from affected and unaffected skin. Fibroblasts were grown in conventional medium supplemented with ascorbic acid 2-phosphate, which makes fibroblasts from a tissue-like structure in vitro. The population doubling time of fibroblasts in affected skin was slightly shorter than that of unaffected skin. There was no difference in the levels of the carboxyterminal propeptide of type I procollagen liberated into the media between affected skin and unaffected skin. However, the cell layer of affected skin fibroblasts revealed a decreased amount of hyaluronic acid-derived disaccharide unit (delta Di-HA). The abnormal metabolism of glycosaminoglycan in the affected dermis might be involved in the development of skin changes in focal dermal hypoplasia.

[Neoadjuvant chemotherapy in high-grade advanced gastric cancer with protracted infusional 5-fluorouracil and consecutive low-dose cisplatin]

Twenty-one evaluable patients with primary gastric cancer/local invasion, liver metastasis and peritoneal metastasis were entered in a pilot study of neoadjuvant chemotherapy that used continuous 24-hour infusion 5-FU, 330 mg/m2/day plus low dose CDDP, 6 mg/m2 daily by bolus infusion d1-5. This regimen was repeated for 4 weeks. The overall response rate was 52%, including one complete and ten partial responses. The response rate of differentiated adenocarcinomas was significantly higher than that of poorly differentiated adenocarcinomas. In 15 patients (71%), gastrectomy and lymphadenectomy could be done after this regimen. chemotherapy-induced downstaging from the initial clinical stage was pathologically found in 5 patients who underwent gastrectomy. Toxicity was primarily hematologic. Leukopenia and thrombocytopenia of grade 3 or 4 occurred in 19% and 14% of patients, respectively. The patients were able to take meals during therapy and preserved good quality of life. Median survival time was 11 months for the cancers with liver metastasis and five of the 8 locally advanced cancers are alive 11 months after the therapy. This therapy was effective for patients with high-grade advanced gastric cancer.

Separation and determination of amino acids, creatinine, bioactive amines and nucleic acid bases by dual-mode gradient ion-pair chromatography

A simple and fast high-performance liquid chromatography method for the analysis of amino acids and biological bases such as creatinine was developed using a technique termed "dual-mode gradient ion-pair chromatography". A butyl-silica reversed-phase column and water-acetonitrile eluent containing sodium dodecyl sulfate (SDS) and perchloric acid were used for the separation. A concentration gradient of acetonitrile from 15 to 35% provided a good separation of such organic cations. Since change in concentration of acetonitrile causes change in distribution equilibrium of SDS between mobile and stationary phases, a complete regeneration of the column to the initial state is required for the reproducible separations. Completion of the reequilibrium was indicated by a system peak appearing in the UV chromatogram and by conductivity measurements. The formation mechanism of the system peak was revealed. A flow-rate gradient from 1 to 2 ml/min was introduced in addition to the concentration gradient to shorten the cycle time of the chromatography. More than twenty kinds of amino acids, creatine and creatinine were simultaneously separated within 50 min and the cycle time was 80 min including the reequilibration time. A post-column derivatization fluorescence detection system was usable as well as UV detection. This elution system was also useful for the separation of bioactive amines and nucleic acid bases. The developed method was applied to the simultaneous determination of urinary creatinine and diagnostic amino acids due to inherited metabolic disorders.

Clinical usefulness of electrically elicited pain-related evoked potentials

In 14 patients with sensory disturbance, the clinical usefulness of electrical pain-related evoked potentials (EPREPs) were studied. In four patients with deep sensation disturbance, conventional somatosensory evoked potentials (SEPs) were abnormal. However, EPREPs were abnormal only in one of the patients. In nine patients with pain-temperature sensation disturbance, SEPs were normal except for only one patient and EPREPs were abnormal in seven of the nine patients. In a patient with herpes zoster myelitis, EPREPs elicited by electrical stimulation below the disturbed spinal level were delayed. After symptomatic improvement, EPREPs recovered. EPREPs are useful in the clinical field.

Muscle fiber changes of the vastus medialis in rheumatoid patients

To study the pathology of muscle atrophy in rheumatoid arthritis (RA), we examined the vastus medialis in rheumatoid patients histologically. The relationship of the findings to their ambulatory ability and long-term steroid therapy was investigated. The muscles of the RA patients were also compared with those of patients with osteoarthritis (OA). Specimens of the vastus medialis were collected from 29 knees of 23 patients with RA and 16 knees of 13 patients with OA during total knee arthroplasty. Muscle fibers were classified according to their type, and the ratio between the area of single type I and type II fibers as well as the ratio between the total area of these fibers was calculated. The total area of type II fibers in the RA group was significantly greater than in the OA group (P < 0.05). In the RA group, the mean proportion of the type II fibers relative to the total muscle fiber area tended to increase with the decline of ambulatory ability, while there was no such increase in the OA group. The proportion of type II fibers was increased significantly in RA patients on long-term steroid therapy when compared to those without therapy. In the ratio of the area of a single fiber, there was no clear relationship to ambulatory ability and long-term steroid therapy. It is considered that muscle atrophy in RA is not solely disuse atrophy, but also has a close relationship to steroid therapy and the pathology of the disease itself.

[Relationship between ischemic ST depression and oxygen uptake kinetics during ramp exercise test in patients with effort angina]

The relationship between ischemic ST depression and oxygen uptake kinetics was examined during cardiopulmonary exercise test using the ramp protocol in 22 patients (17 males and 5 females, mean age 61.4 +/- 8.1 years) with ischemic ST change (horizontal or down sloping ST depression over 1 mm) during a previous multi-stage exercise test (Bruce method). Patients were classified into three groups according to coronary angiographic findings: absence of significant stenosis group (control, n = 7), single-vessel disease group (n = 7) and multivessel disease (MVD) group (n = 8). Peak exercise time, peak heart rate, peak systolic blood pressure, anaerobic threshold, peak oxygen uptake (peak Vo2), exercise time, heart rate, systolic blood pressure, and oxygen uptake at appearance of ischemic ST change were measured. The ratio of oxygen uptake increase at appearance of ischemic ST change was calculated. Peak Vo2 was lower in the MVD group than in the control group (20.9 +/- 6.2 vs 27.3 +/- 3.3 ml/min/kg, p < 0.05), and exercise time from the beginning of ramp exercise to the appearance of ischemic ST depression was shorter in the MVD group than in the control group (5.2 +/- 2.1 vs 8.2 +/- 1.9 ml/min/kg, p < 0.05). The ratio of oxygen uptake increase was smaller in the MVD group than in the control group (0.7 +/- 0.3 vs 1.2 +/- 0.2, p < 0.01). These results could be caused by impaired increase of cardiac output due to myocardial ischemia occurring during exercise. In the clinical setting, these phenomena could be used as a parameter for differentiating ischemic from non-ischemic ST depression or evaluating the sensitivity of ischemic heart disease.

Effect of hyperthermia on proliferation and deviation of carcinoembryonic antigen and squamous cell carcinoma-related antigen of human esophageal carcinoma cells in culture

As a basic study of hyperthermia on malignant tumors, we investigated the kinetics of proliferative activity and the values of tumor markers carcinoembryonic antigen (CEA) and squamous cell carcinoma-related antigen (SCC) in a human esophageal carcinoma cell line, SGF-4, following a change of culture temperature. The temperature range allowing cultured SGF-4 cells to proliferate was from 37 degrees C to 40 degrees C. In an experiment examining the recovery of proliferative activity, no proliferative activity was observed after the cultured cells were exposed to 42 degrees C for 72 hours. The values of CEA and SCC as tumor markers were found to be increased in association with the cell damage due to the change of temperature. These markers could thus be useful as indicators for evaluations of hyperthermia therapy effectiveness.

[Changes in plasma level of brain natriuretic peptide during exercise in recovery phase of myocardial infarction and the clinical significance]

Brain natriuretic peptide (BNP) plasma levels increase in patients with myocardial infarction and may reflect the degree of left ventricular dysfunction. The changes in plasma level of BNP during exercise in the recovery phase and the clinical significance were investigated in 60 patients (55 men and 5 women; mean age 62.3 +/- 9.8 years) with initial acute infarction. Cardiopulmonary exercise testing was performed with a treadmill using the ramp protocol in 60 patients in the first month and 46 in the third month after the onset of the disease. Blood samples for measuring BNP and atrial natriuretic peptide (ANP) were obtained in the resting control state and immediately after peak exercise. Plasma BNP in the first month had a significant negative correlation with anaerobic threshold (AT) and peak oxygen uptake (peak VO2), and the serial change in plasma BNP from the first to third month had a significant negative correlation with the serial change of AT (peak: r = -0.35, p < 0.05) and peak VO2 (rest: r = -0.35, p < 0.05; peak: r = -0.45, p < 0.01). The serial change of plasma ANP had no relationships with the serial change of AT or peak VO2. Because the serial change ratio of plasma BNP reflects the serial change of exercise tolerance in the recovery phase of myocardial infarction, we conclude that the serial measurement of plasma BNP level is a useful non-invasive parameter for predicting latent heart failure in patients with myocardial infarction.

Mechanism of inhibition of H+, K(+)-ATPase by sodium 2-[[4-(3- methoxypropoxy)-3-methylpyridin-2-yl]methylsulfinyl]-1H-benzimidazole (E3810)

Sodium 2-[[4-(3-methoxypropoxy)-3-methylpyridin-2-yl]methylsulfinyl ]- 1H-benzimidazole (E3810) and omeprazole inhibit gastric acid secretion through inhibition of the activity of H+, K(+)-ATPase present in parietal cell membrane vesicles, by chemical modification of SH groups in the enzyme molecule. In order to clarify the mechanism of the chemical modification, reaction products of E3810 and omeprazole with 2-mercaptoethanol under acidic conditions (pH 3, 4, 5, 6) were isolated by HPLC, and subjected to structural analysis by UV, 1H-NMR and mass spectrometry. E3810 and omeprazole appeared to undergo two kinds of reactions, affording disulfide-type products (type I reaction) and sulfide-type products (type II reaction). The rates of these reactions were determined by HPLC, and the stability of the products in the presence and absence of glutathione was investigated. In the case of E3810, type I reaction was found to proceed faster than type II reaction at every pH value studied. The type I reaction of E3810 was faster than that of omeprazole. The rate of type I reaction decreased at pH 5 and 6, especially for omeprazole, and the contribution of type II reaction increased as the pH of the reaction mixture was increased. The sulfide-type modification products were stable, whereas the formation of the disulfide-type modification products was reversed by the action of endogenous SH compounds such as glutathione. These results suggest that higher inhibitory activity of E3810 against gastric acid secretion and faster recovery of the enzyme activity after inhibition by E3810 can be expected, as compared with those of omeprazole.

Generalized morphea with vascular involvement. A case report and disaccharide analysis of the skin glycosaminoglycans

We report a 69-year-old man with severe generalized morphea, who showed over 80% of skin involvement, while the internal organs were not affected. We performed histological examinations and analysis of skin disaccharides constituting chondroitinase-digestible glycosaminoglycans in the center and periphery of the sclerotic lesions and the clinically uninvolved skin. In both the central and peripheral parts of the sclerotic lesions, sclerotic fibrosis and a dense perivascular cell infiltration, consistent with morphea, were seen in the entire dermis and subcutis. Furthermore, various vascular changes were observed, such as endothelial cell swell, thickened basement membrane and obstruction of vascular lumen in the fat lobules. In the clinically uninvolved skin, interstitial edema was prominent along with a slight perivascular cell infiltration. On disaccharide analysis, the increase in the amount of delta Di-4S(DS), the main disaccharide unit of dermatan sulphate, delta Di-6S and delta Di-6S, the main disaccharide units of chondroitin sulphate, and the decrease in delta Di-HA, which is derived from hyaluronate, were found not only in the sclerotic lesions but also in the clinically uninvolved skin, though less prominent. These alterations were consistent with systemic sclerosis, suggesting a close relationship between severe forms of generalized morphea and systemic sclerosis.