[A case of hepatocellular carcinoma with survival of more than 7 years after extended right lobectomy]

A 48-year-old male was referred to our hospital because of a space occupying lesion that had been revealed by hepatic scintigraphy, which had been seen because of an evaluation of his serum alpha-fetoprotein level while under therapy for chronic hepatitis. Laboratory data revealed an impaired liver function and a hepatic angiography showed a hypervascular tumor of the right hepatic branch. An extended right lobectomy was performed. Postoperatively, this case was histologically diagnosed as hepatocellular carcinoma. Despite having had an intraportal tumor thrombus, the patient survived for 7 years and 3 months and died of a cancer recurrence with hepatic failure. In this case surgical resection proved very useful for survival over a long period.

Treatment of Graves' ophthalmopathy with high-dose intravenous methylprednisolone pulse therapy

This preliminary study was undertaken to investigate the efficacy of high-dose iv methylprednisolone pulse therapy in 5 patients with Graves' ophthalmopathy. One gram of methylprednisolone sodium succinate was given iv daily for 3 successive days. The 3-day infusion was repeated 3 to 7 times at intervals of 1 week; total duration of pulse therapy was 3 to 7 weeks. The clinical improvement of eye involvements by pulse therapy was assessed immediately after the last pulse therapy. The clinical assessment of the effect of pulse therapy for Graves' ophthalmopathy showed a good response in 3 patients, a fair response in one, and no response in one. However, in one patient, who was judged to show no response, complete improvement of the enlarged extraocular muscle was observed on orbital computed tomography. Moreover, two patients, who have been followed without any other therapies, showed no relapse of eye involvements for 32 and 10 months, respectively. Although it is impossible to determine whether pulse therapy is more effective than other immunosuppressive therapies, the results of this preliminary study suggest that pulse therapy may be a good immunosuppressive therapy for Graves' ophthalmopathy too. Controlled studies are desired.

[Adenocarcinoma of an extraperitoneal rectum in a 17-year-old female]

A 17-year-old female with an adenocarcinoma of the extraperitoneal rectum, which was diagnosed correctly by preoperative intrarectal ultrasonography as being in Dukes' A stage, was operated on, this surgery performed adhering to function preserving procedures. Histologically, the tumor uncovered was found to be a well differentiated adenocarcinoma and, as had been expected, in Dukes' A stage. An absolute curative operation was achieved. The operative procedure for juvenile rectal cancer must be planned to achieve both tumor removal and bodily function preservation to assure the best possible quality of postoperative life. We recommend intrarectal ultrasonography at the preoperative stage, the results to be used in deciding on the operative procedure.

Ultrastructural studies of concentric lamellar bodies in the bronchus of patients with sarcoidosis

Biopsy specimens of the major bronchus of sixty-nine patients with sarcoidosis were investigated electronmicroscopically. 22 patients (12 males, 10 females), 32% of the cases, showed concentric lamellar or similar kinds of dense bodies in the bronchial wall. Typically, the concentric lamellar bodies were observed in various numbers, scattered in the collagen-increased tunica propria or superficial submucosal layer, where adjacent or deeply located blood capillary vessels were mostly obliterated. They were generally of 0.2 to 1.8 micron in size, but occasionally smaller ones were observed. We also found large swollen and irregular lamellated bodies greater than 2 microns in the cell cytoplasm. Six cases with particularly large numbers of these bodies in the bronchial wall showed "capped" figures, in which the concentric lamellar bodies were partly attached to other demilunar dense bodies. These figures were assumed to be the very early stage of formation of conchoidal bodies at the LM level, so-called Schaumann bodies. Two cases (5%) (chronic bronchitis, lung cancer) among 40 control patients with other diseases disclosed the same small lamellated bodies in the bronchial wall. We were unable to resolve the problem of the origin of these deposited in them, but assume that they will initially occur in the cell cytoplasm in some patients with sarcoidosis and eventually develop into typical concentric lamellar bodies.

Binding characteristics of [3H]quinupramine to rat brain membrane fractions

The binding characteristics of [3H]quinupramine to rat brain membrane fractions were studied. The specific binding of [3H]quinupramine to rat brain membrane fractions was stable, reversible and saturable. Scatchard analysis of the data from saturation experiments indicated that the specific binding was a single population with an affinity (KD) of 3.04 nM, a maximal binding site number (Bmax) of 714 fmol/mg protein, and a Hill coefficient (nH) of 1.08. Compounds known to inhibit muscarinic cholinergic receptors such as atropine and quinuclidinyl benzilate were the most potent competitors of [3H]quinupramine binding. When the drug potencies in inhibiting [3H]quinupramine binding were tested in the presence of 10 nM atropine, mianserin was the most potent competitor. Studies of the subcellular fractions showed that there was an enrichment of [3H]quinupramine binding sites in the synaptosome fraction. The regional distribution study revealed the highest densities of binding sites in the cerebral cortex and the lowest in the cerebellum. Thus, the specific binding of [3H]quinupramine observed here can be accounted for by both muscarinic cholinergic and serotonin S2 receptors.

Inhibitory effect of interferon-gamma on the response of human thyrocytes to thyrotropin (TSH) stimulation: relationship between the response to TSH and the expression of DR antigen

Thyroid epithelial cells (thyrocytes) in autoimmune thyroid disease have been found to express DR antigens on their surfaces, and interferon-gamma (IFN gamma) induces DR antigen expression. This study was undertaken to determine the effect of IFN gamma on the response of human thyrocytes to TSH stimulation and the relationship between the response to TSH and the expression of DR antigen induced by IFN gamma, using monolayer cultures of Graves' thyrocytes. When confluent thyrocyte monolayers were incubated with TSH or Bu2cAMP (DBcAMP) for 7-9 days, T3 and thyroglobulin concentrations in the culture medium increased gradually in a dose-dependent manner. However, when TSH or DBcAMP was added after the cells had been cultured for 4 days with IFN gamma, T3 and thyroglobulin secretion in response to both 10 mU/mL TSH and 1 mM DBcAMP was significantly inhibited. The inhibition by IFN gamma was dose dependent and correlated with the number of DR antigen-positive thyrocytes present on the last day of culture. IFN alpha and -beta did not affect the response of thyrocytes to TSH or DBcAMP stimulation. These results suggest that DR antigen-positive thyrocytes fail to respond to TSH stimulation at a site located distal to cAMP formation.

Down-regulation of central serotonin S2 receptors after repeated treatment with quinupramine in rats

The present studies were undertaken to determine whether the repeated administration of quinupramine caused down- or up-regulation of beta-, alpha 2-adrenergic, serotonin S2, imipramine and muscarinic cholinergic receptors, as had been demonstrated for tricyclic and atypical antidepressant drugs. Quinupramine administered at 10 mg/kg (p.o.) twice daily for 10 days caused a down-regulation of serotonin S2 receptors in the frontal cortex of the rat as determined by [3H]ketanserin binding. However, quinupramine did not alter the binding populations of beta-adrenergic, muscarinic cholinergic and alpha 2-adrenergic receptors in the rat brain as determined by the Scatchard analysis of the [3H]ligand binding data. Differing from quinupramine, imipramine caused down-regulation of beta-adrenergic and serotonin S2 receptor bindings, and it caused slight but significant up-regulation of muscarinic cholinergic receptor bindings. These results show that the antidepressant activity of quinupramine is associated with the central serotonin system, but not with the beta-adrenergic system. Accordingly, quinupramine, chemically one of the typical tricyclic antidepressant drugs, seems to be pharmacologically one of the atypical antidepressant drugs, and it was suggested that the central serotonin system plays an important role in the antidepressant activity of quinupramine.

Heterogeneity of Graves' immunoglobulin G: comparison of thyrotropin receptor antibodies in serum and in culture supernatants of lymphocytes transformed by Epstein-Barr virus infection

It is well known that in patients with Graves' disease there is dissociation among values for TSH receptor antibodies such as TSH binding-inhibiting antibody (TBIAb) and thyroid-stimulating antibody (TSAb). This study was designed to compare TSH receptor antibodies in serum and in culture supernatants of lymphocytes transformed by Epstein-Barr virus (EBV) infection. TBIAb was assayed using solubilized porcine thyroid membranes and TSAb using cultured porcine thyroid cells. Transformation of peripheral lymphocytes by EBV was performed in eight untreated hyperthyroid patients with Graves' disease who had a clear dissociation between values for TBIAb and TSAb, even after multiple dilutions of serum. EBV-infected lymphocytes from a patient were distributed into the wells of 4 24-well culture plates. After the first 4-week culture, the cells in each well positive for TBIAb and/or TSAb were further distributed to 12 wells and cultured for 2 weeks. In the supernatants of 372 wells of the second culture in the 8 patients, 31 were positive for TBIAb, and 41 were positive for TSAb. Among the 76 wells positive for TSH receptor antibodies, 72 wells (94.7%) were positive in only 1 assay. These results suggest that there are two types of TSH receptor antibodies, one having a single function (TBIAb or TSAb) and the other multifunctional (both), in Graves' patients. The incidence of the single functional type is much greater than that of the multifunctional type. We conclude, therefore, that the heterogeneity of Graves' immunoglobulin G is due mainly to multiple antibodies with a single function.

Stimulation of thyroid adenylate cyclase activity by sera from patients with non-thyroidal illness

We have previously shown that sera from many hypothyroid patients stimulated adenylate cyclase activity as measured by serum bioactive TSH concentrations produced by FRTL-5 cell line. This TSH-stimulating activity did not correlate with serum immunoreactive TSH. IgG fractions of these sera did not stimulate FRTL-5 cells. The present study was, therefore, undertaken to investigate the thyroid stimulating activity of sera from patients with non-thyroidal illness. Studies were performed in 36 patients with various non-thyroidal illness. In these patients, serum concentrations of T4, free thyroxine, T3, and TSH were determined. In addition, sera were incubated with FRTL-5 cells or porcine thyroid cells in primary culture in the presence of 0.4 mM MIBX, and medium cAMP concentrations were determined by radioimmunoassay. Sera obtained from some patients with various non-thyroidal illness increased cAMP concentrations in culture media of FRTL-5 cells as well as that of porcine thyroid cells. The thyroid stimulating effects of sera were not disease specific and significantly correlated inversely with serum T3 and T4 concentrations. Serum TSH concentrations in these patients were within the normal range even by the newly developed ultrasensitive assay. Although the nature of substance(s) present in sera of patients with low T3 syndrome which stimulates thyroid adenylate cyclase is not entirely known, it is conceivable that there exist mechanisms independent of TSH to compensate the decreased serum T3 levels in low T3 syndrome.

Determination of the volume of the thyroid gland by a high resolutional ultrasonic scanner

We developed a new ultrasonic scanner for the thyroid and, in this study, the estimated volumes of the thyroids by this scanner were compared with the weights of those obtained at operation. In this ultrasonic scanner, an annular array transducer was employed instead of the conventional single element concave transducer. The distance of the focused area by this transducer was as long as 5 cm compared to 1 cm by the conventional transducer; therefore, the image obtained by the new scanner was so clear that it was not difficult to draw accurately the outlines of the thyroids. The volumes of the thyroids were calculated by a computerized digitizer. The estimated volumes of the thyroids by the ultrasonic scanner were closely correlated with their weights calculated by adding the actual weights of the thyroids removed to the estimates of the thyroids left at operation. Their correlation coefficients were as high as 0.99. This suggests that this new ultrasonic scanner is very useful in the determination of the volumes of the thyroids, since the measurement is very accurate, simple, and reproducible.

CGS 9896: agonist-antagonist benzodiazepine receptor activity revealed by anxiolytic, anticonvulsant and muscle relaxation assessment in rodents

CGS 9896, a pyrazoloquinoline that potently binds to benzodiazepine receptors, has been reported to have anticonflict activity in conventional footshock paradigms and to antagonize pentylenetetrazol-induced seizures. In the present experiments, the pentylenetetrazol discriminative cue was blocked by CGS 9896 with a potency comparable to that of diazepam. CGS 9896 also selectively lengthened the latency to terminate self-initiated brain stimulation reward. These procedures extend the anxiolytic activity of CGS 9896 to models that do not rely upon footshock-induced conflict. CGS 9896 did not impair the traction reflex in mice, did not impair rotorod performance in rats, did not reduce unpunished operant responding and decreased motor activity only slightly, indicating no distinguishable sedation or muscle relaxation in rodent models. In fact, diazepam-induced rotorod impairment was blocked by CGS 9896. The anticonvulsant effects of CGS 9896, as indicated by audiogenic seizure and pentylenetetrazol-induced seizure studies, were substantial but were weaker than those of diazepam, possibly because of the muscle relaxant component of diazepam. Ethanol-induced motor impairment was potentiated more markedly by diazepam than by CGS 9896. Mixed agonist-antagonist properties of CGS 9896 therefore emerge when a comprehensive battery of behavioral assessments is utilized. CGS 9896 may have clinical anxiolytic activity without sedation or muscle relaxation.

Receptor binding profile of quinupramine, a new tricyclic antidepressant

The receptor binding profile, composed of the Ki-values measured in eight different receptor binding models using rat brain membranes, is reported for the new tricyclic antidepressant quinupramine, 10,11-dihydro-5-(3-quinuclidinyl)-5H-dibenz[b, f]azepine, and three reference compounds with a tertiaryamine side chain. Quinupramine was found to possess high affinity for muscarinic cholinergic and histamine H1 receptor binding sites in rat brain, whereas its affinity for imipramine binding sites was only one seventieth that of imipramine. Receptor binding profiles of the reference compounds were almost similar to that of quinupramine, except in the case of imipramine binding sites.

In vitro characterization of benzodiazepine receptor agonists, antagonists, inverse agonists and agonist/antagonists

Using an extensively washed membrane preparation and standardized incubation conditions, the actions of benzodiazepine (BZ) receptor ligands were evaluated on [3H]flunitrazepam [+/- 10 microM gamma-aminobutyric acid (GABA)], [3H]muscimol (+/- 2.5 microM etazolate) and [35S]butyl bicyclophosphorothionate (TBPS) binding. Classical BZ receptor agonists stimulated [35S]TBPS binding and [3H]muscimol binding in the presence of etazolate. These agents also possessed ratios for [3H]flunitrazepam binding in the absence and presence of GABA (GABA ratio) of 2 to 5. BZ antagonists and inverse agonists had GABA ratios less than 1 and did not alter, or reduced, both [35S]TBPS and [3H]muscimol (+etazolate) binding. The nonsedating BZ agonist/antagonist agents CGS 9896, CL 218872, PK 8165 and PK 9084 all possessed GABA ratios between 1.1 and 1.4 and only stimulated [35S]TBPS and [3H]muscimol (+etazolate) binding to approximately 50% of the level of classical BZ agonists. The BZ partial agonists CGS 9895 and RU 39419 both were unique in that they possessed GABA ratios of 1 or less, stimulated [35S]TBPS binding and had no effect on [3H]muscimol binding (+etazolate). Therefore, by monitoring the major components of the BZ receptor complex (BZ receptor, GABA receptor and chloride channel), we were able to distinguish between different BZ drugs and to support suggestions that these drugs act via unique BZ receptor populations which possess differential couplings to the GABA receptor and chloride channel.

Gc types in western Japan: report of a new variant Gc 1C35

Gc types were examined in a total of 1,000 unrelated Japanese individuals from Western Japan. By isoelectric focusing the six common subtypes and several rare types were observed. In addition, a new variant with a mobility between the Gc 1S and 1C2 was identified in 2 individuals. A family investigation confirmed the inheritance of the corresponding allele Gc* 1C35.

PI(alpha 1-antitrypsin) polymorphism in the Japanese: confirmation of PI*M4 and description of new PI variants

PI phenotyping by separator isoelectric focusing (SIEF) was performed on a total of 1000 unrelated Japanese individuals from two different areas of Western Japan. The PI M1M4 subtype was observed together with the six common PI M subtypes. PI*M4 was confirmed to be present but rare in the Japanese. Several new PI variants were identified by comparison runs of each variant with previously reported genetic variants. The significance of treatment of serum with dithiothreitol (DTT) followed by iodacetic acid (IAC) in determination of PI variants is also described.

Radioimmunoassay of guanabenz, an antihypertensive agent

Antibodies with a high specificity and sensitivity for [(2,6-dichlorobenzylidene)amino]guanidine acetate (guanabenz, GB), a potent antihypertensive agent, were produced in rabbits immunized with GB conjugated to bovine serum albumin. GB-specific antibodies were detected 6-8 days after the first booster injection and the titer steadily increased over the initial 17-25 weeks of immunization. A high degree of specificity was demonstrated. No metabolite of GB detected in humans or several animal species cross-reacted, even when present in over 100-fold excess. A rapid and convenient radioimmunoassay procedure for GB was designed using these antibodies. Competition between tritiated GB tracer and unlabeled GB for specific antibody binding sites made feasible measurement of as little as 30 pg GB. GB was absorbed rapidly from the gastrointestinal tract and reached a maximum level in the plasma (2.50 +/- 0.45 ng/ml) at 2 h after oral administration (1 mg/kg) to dogs.

A new model of osteoarthritis in rabbits. III. Evaluation of anti-osteoarthritic effects of selected drugs administered intraarticularly

A battery of steroidal and nonsteroidal antirheumatic drugs and protease inhibitors were tested by intraarticular injection for effects on osteoarthritis of the knees of rabbits subjected to partial lateral meniscectomy and section of the sesamoid and collateral fibular ligaments. Among the standard drugs, only the glucocorticoid, triamcinolone hexacetonide, and the protease inhibitor, tranexamic acid, exhibited significant anti-osteoarthritic activity. An experimental drug, GPA 2163, also offered some protection against joint degeneration. The nonsteroidal antiinflammatory drugs had no effect on the development of osteoarthritis in the model.

Comparison of middle cerebral artery trunk occlusion by silicone cylinder embolization and by trapping

The authors produced occlusion of the middle cerebral artery (MCA) trunk in dogs by two methods: silicone cylinder embolization and trapping. Comparative analyses of the clinicopathological features in these models, extending from the acute to chronic stage, were performed. Within 24 hours after embolization, the brain exhibited swelling without macroscopic infarction. Microangiograms revealed impaired filling in the deep areas of the brain with midline shift. At 4 to 7 days after embolization, the animals showed major neurological deficits, evident deep cerebral infarction, and poorly perfused areas in the deep cerebrum with prominent midline shift. At 3 to 4 weeks after embolization, the neurological deficits improved and the affected regions showed cavities or localized lesions. Microangiograms demonstrated hypervascular areas with abnormal vessels in the affected cerebrum. On the other hand, trapping of the MCA trunk produced mild neurological deficits, although there was no evidence of macroscopic lesions or impairment of filling. This study shows that silicone cylinder embolization in the MCA trunk produces a reliable and reproducible deep cerebral infarction in dogs.