[Present international status and basic approach of lung and heart-lung transplantation]

Lung transplantation has been established as an optional treatment for variable irreversible diffuse lung diseases. To date, more than 5,000 patients have underwent lung transplantation, and nearly 1,000 procedures a year are performed recently. Although heart-lung transplantation has also been technically established, this procedure is confined to quite limited conditions due to the severe shortage of donors and many difficulties in operative procedure and the patient management. Preservation, post-transplantation edema, diagnosis of rejection, chronic rejection, shortage of donor organs, are principal problems in clinical lung transplantation, 24-hour preservation proved to be possible in several recent experimental studies, and the reperfusion injury has been revealed to be one of causes of post-transplantation edema. Establishment of methods for long-term pulmonary preservation and for the treatment of post-transplantation edema may be promising in the near future. Shortage of donor lung is one of major limiting factors. Research works on xenotransplantation and cadaver lung transplantation are on going, and these may help in solving this problem.

Is Baker's cyst a risk factor for pulmonary embolism?

We encountered a 73-year-old man with acute pulmonary embolism (PE) and Baker's cyst. Venography revealed that the right popliteal vein was compressed by Baker's cyst and deep venous thrombosis (DVT) had developed. DVT associated with Baker's cyst is rather common and these two conditions are thought to be causally related. Baker's cyst is the most frequent mass lesion in the popliteal region. We suggest that Baker's cyst is a risk factor for PE as well as surgery and trauma.

[Dermatomyositis complicated by sarcoidosis]

We encountered a patient with dermatomyositis complicated by sarcoidosis. A 57-year-old woman was admitted to our hospital because of fever dry cough, and myalgias. There were reticular shadows on her chest X-ray film. Although the typical skin rash and myositis suggested the diagnosis of dermatomyositis biopsy specimens from a salivary gland, muscle, and lung revealed noncaseating granulomas as well. Uveitis was also noted. These findings suggested the coexistence of sarcoidosis with dermatomyositis. Examination of the lung-biopsy specimens showed interstitial pneumonia compatible with dermatomyositis, except for the granuloma. The typical rash of dermatomyositis and pathological findings of the lung specimen were inconsistent with sarcoidosis. Therefore we concluded that this patient had both dermatomyositis and sarcoidosis. This case sheds new light on the importance of pathological examinations.

[Inhibitory effect of ONO-1078, a novel leukotriene receptor antagonist, on human peripheral blood eosinophils]

To determine whether ONO-1078, leukotriene receptor antagonist, inhibits the activation of eosinophils, we investigated the effect of ONO-1078 on the release of leukotriene (LTC4) and eosinophil cationic protein (ECP) from human peripheral blood eosinophils of allergic patients and normal subjects. After preincubation with ONO-1078, eosinophils were incubated with calcium ionophore (A23187). ONO-1078 10(-5) and 10(-6) M inhibited LTC4 release of allergic patients eosinophils and 10(-5)-10(-9) M inhibited LTC4 release of normal subjects eosinophils. ONO-1078, 10(-5) M, also inhibited ECP release of eosinophils obtained from both asthma patients and normal subjects. We think that ONO-1078 may have another pharmacological effect to prevent the activation of human peripheral blood eosinophils by inhibiting LTC4 and ECP release. These results suggest that ONO-1078 might be useful in controlling bronchial asthma.

Analysis of anomalous CD44 gene expression in human breast, bladder, and colon cancer and correlation of observed mRNA and protein isoforms

Many studies have now demonstrated disorganized overexpression of the CD44 gene in various types of human malignant tumors, and this abnormality has emerged as an interesting candidate marker for early cancer diagnosis. The purpose of this work was to analyze and compare the patterns of transcription and translation of this gene in human breast (ZR75-1; MDAMB-435 clone 4A4) and colon (HT29) tumor cell lines and in tumors of the breast, bladder, and colon, with the aim of identifying the most suitable analyte for diagnostic purposes. Transcription was studied by reverse transcription-polymerase chain reaction using CD44-specific primers and probes complementary to exons in the standard (exons 3 to 5 and 16 to 18) and variably expressed regions of this gene (exons 7, 8, 10, 11, and 15). Translation was investigated by Western blot analysis and immunohistochemistry using monoclonal antibodies specific to the standard form of CD44 and to the products of the same variant exons. Southern blot hybridization analysis of the reverse transcription-polymerase chain reaction products showed a large number of CD44 transcripts in tumor cells. Direct comparison of these Southern blots with Western blots on matched tumor-cell-line extracts indicated that most of the diverse mRNA isoforms did not detectably translate into proteins. However, immunohistochemistry of normal and malignant breast (n = 17 and 23, respectively), bladder (n = 5 and 19), and colon (n = 19 and 19) tissue specimens showed increased staining of CD44 standard and CD44 variant proteins in the carcinoma cells. Combination of this information with the data from reverse transcription-polymerase chain reaction and Western blot analysis indicates that the overexpression at the protein level involves only a minority of the aberrant RNA transcripts. We conclude that the development of methods for the accurate quantitation of over-abundant CD44 RNA species in clinical samples offers the most promising approach to improved early diagnosis of malignancy using this new marker.

[Assessment of prognostic factors in surgical treatment for the pulmonary metastasis of osteosarcoma based on results of 17 patients]

Seventeen cases with surgical treatment for pulmonary metastases of osteosarcomas have been experienced for past 20 years in our institute. Disease free intervals, tumor doubling time, the number of metastatic lesions, the size of metastatic lesions, pathological features on nuclear findings were assessed in relation to their prognosis. These parameters were concluded to have no significant relations to the survival outcomes after the surgery for pulmonary lesions except for the number of metastatic lesions less than 20 in total which is likely to be associated with long survivals, supporting previous reports on the resectability of pulmonary metastatic lesions as an only reliable prognostic indicator. It was also stressed from our experience that the meticulous follow-up after each surgery for both primary and metastatic lesions is absolutely necessary for the early detection of recurrent pulmonary lesions in order not to overlook curable cases with aggressive treatment.

[Clinicopathologic assessment of primary thymic carcinoma based on eighteen cases]

In order to study clinicopathologic characteristics of thymic carcinomas, 18 patients with thymic carcinoma and 56 patients with invasive thymoma were reviewed. All of them were underwent thoracotomy. Both 5-year and 10-year survival rates were 44% in the thymic carcinoma patients, while 5-year survival and 10-year survival rates were respectively 62% and 52% in the invasive thymoma patients. The survival rate of the thymic carcinoma cases was significantly lower than that of invasive thymoma cases (p < 0.05). Both surgical technique and anticancer chemotherapy. However, have been improved in these years, such as artificial vessels for great veins, panpleuro-pneumonectomy, cisplatin and so on. Those new techniques have brought the significantly higher survival rate in recent 10 cases of thymic carcinoma patients. Three-year survival rate of 10 cases after 1990 was 80% and it was 13% in 8 cases before 1989 (p < 0.01). We conclude that surgical procedure are necessary for the treatment of thymic carcinoma patients, and both chemotherapy and radiotherapy should be combined with the surgical procedures to completely remove the tumors.

Inhomogeneous disappearance of myofilament-related cytoskeletal proteins in stunned myocardium of guinea pig

The decrease in Ca2+ responsiveness of myofilaments in stunned myocardium implies that there may be structural changes in proteins composing the contractile machinery. To elucidate the lesion in stunned myocardium, isolated guinea pig hearts were subjected to global ischemia at 37 degrees C and reperfused. SDS-PAGE revealed that the contents of desmin, alpha-actinin, and spectrin decreased in the myofibrillar fraction isolated from hearts reperfused after 60-minute ischemia compared with nonischemic control hearts. To examine the change of cytoskeletal proteins in stunned myocardium, immunohistochemical studies with antibodies against these proteins were performed after 15 minutes of ischemia. In stunned myocardium, the staining was largely intact, but there were some lesions where desmin was not stained and alpha-actinin and spectrin were only weakly identified. The percentage of normally stained areas in the myocardium (percent stained area), quantified by image processing, was significantly lower in stunned myocardium (79.6 +/- 3.6%, mean +/- SEM) than in nonischemic control myocardium (96.5 +/- 0.7%). Percent recovery of developed pressure significantly correlated with percent stained area (r = .82, P < .001). In hearts subjected to 15-minute ischemia but not reperfused, or in hearts reperfused with Ca(2+)-free solution after 15-minute ischemia, staining by the antibodies remained intact, suggesting that the change of the cytoskeletal proteins is mediated by Ca2+ overload during reperfusion. In hearts treated with the protease inhibitor leupeptin (50 mumol/L) or calpain inhibitor I (100 mumol/L), both developed pressure and staining were well preserved. These results indicate that contractile dysfunction in stunned myocardium has a strong correlation with the disappearance of cytoskeletal proteins that may be mediated by a Ca(2+)-dependent intracellular protease activated during reperfusion. The disruption of cytoskeletal proteins is a possible mechanism for stunning, although it may be a secondary effect of protease activation.

Role of endogenous angiotensin II in renal hemodynamic and excretory responses to L-arginine infusion

The purpose of this study was to investigate whether endogenous angiotensin II has a functional role in renal hemodynamic and excretory changes induced by L-arginine, a substrate for nitric oxide (NO), in anesthetized rats. During the intravenous infusion of L-arginine (50, 100, 200 mumol/kg.min), there was no significant change in systemic or renal hemodynamics, but urine flow and urinary sodium excretion markedly increased in a dose-dependent manner. Simultaneously, L-arginine infusion produced an increase in urinary excretion of NO metabolites, NO2- and NO3-. Treatment with L-158809 ¿5,7-dimethyl-2-ethyl-3-[[2'-(1H-tetrazol-5-yl) [1,1']-biphenyl-4-yl]methyl]-3H-imidazo[4,5-b]pyridine¿ (0.3 mg/kg), a selective angiotensin II type I receptor antagonist, caused a reduction in mean arterial pressure, and a rise in renal blood flow and glomerular filtration rate, with no changes in excretory responses. In the presence of L-158809, L-arginine-induced diuretic and natriuretic actions were observed to the same extent as seen in the absence of L-158809. These data suggest that the infusion of L-arginine causes diuresis and natriuresis, possibly via the formation of nitric oxide in the kidney, and that endogenous angiotensin II is not involved in the L-arginine-induced renal actions.

[Successful treatment of diffuse aspiration bronchiolitis by cricopharyngeal myotomy]

A 62-year-old man was admitted to our hospital with complaints of coughing and fever. He had poliomyelitis at the age of 4 years, and had experienced difficulty in swallowing and chronic aspiration for the past 3 years. A chest roentgenogram and a high-resolution CT scan obtained on admission showed many small nodular shadows in the lower lung fields. Cricopharyngeal myotomy was done to decrease aspiration. The patient was then able to eat without aspiration, and the chest-roentgenographic and CT findings improved. Diffuse aspiration bronchiolitis was diagnosed from the clinical course and the radiographic findings. Cricopharyngeal myotomy can reduce the risk of aspiration in patients with diffuse aspiration bronchiolitis.

Inhibitory effects of endothelin-3 on antidiuresis and norepinephrine overflow induced by stimulation of renal nerves in anesthetized dogs

The effects of endothelin-3 (ET-3) on changes in renal hemodynamics, urine formation, and norepinephrine (NE) overflow induced by renal nerve stimulation (RNS) were examined in anesthetized dogs. RNS at a low frequency (0.5-2.0 Hz) produced significant decreases in urine flow (UF), urinary excretion of sodium (UNaV), and fractional excretion of sodium (FENa), and increased the NE secretion rate (NESR) without affecting systemic or renal hemodynamics. RNS at a high frequency (2.5-5.0 Hz), which diminishes renal hemodynamics by causing renal vasoconstriction, affected urine formation and NESR more potently than did low-frequency RNS. When ET-3 (2.0 ng/kg/min) was infused into the renal artery, there was a slight and transient increase in renal blood flow (RBF); this response was followed by a gradual reduction. ET-3 infusion tended to increase the basal levels of UF without affecting UNaV, indicating the excretion of hypotonic urine with administration of this peptide. During ET-3 infusion, low-frequency RNS-induced antidiuretic action was significantly attenuated. Simultaneously, increase in NESR elicited by low-frequency RNS was markedly suppressed. Qualitatively similar results were observed in the case of high-frequency RNS. In addition, high-frequency RNS-induced decreases in the glomerular filtration rate (GFR) and the filtration fraction (FF) were suppressed by ET-3 infusion. These findings suggest that ET-3 suppresses renal responses to stimulated renal noradrenergic neurotransmission by inhibiting the release of NE. These findings, together with our previous findings, suggest that ET-3 (and/or ET-1) functions as an inhibitory modulator of the renal noradrenergic nervous system through the prejunctional ETB-receptor mechanism.

A brief review of epidemiological studies on ischemic heart disease in Japan

The age-adjusted death rate from ischemic heart disease in Japan is the lowest among developed countries and the rates have decreased since 1970. The incidences of myocardial infarction in selected populations ranged between 0.12 and 2.56 per 1,000 for middle-aged males, and between 0.00 and 1.52 per 1,000 for females. The incidences of sudden death within 24 hours were from 0.00 to 1.58 per 1,000 for males and from 0.00 to 0.76 per/1,000 for females. The incidences in Japanese populations appeared to be far below those in Western populations. In the Cox proportional hazard regression model, hypertension and smoking were selected as independent risk factors for myocardial infarction in an agricultural district. It was noteworthy that the level of serum cholesterol was not associated with development of myocardial infarction in rural areas. No positive relation between dietary fat and serum cholesterol was observed in school children, suggesting that growth, sexual maturation and others might be confounding variables between them. The levels of serum cholesterol for females were more affected by menopause than those of blood pressures and body mass index. Although some polymorphisms in selected candidate genes appeared to be associated with some serum lipids and apolipoproteins, the effect of individual RFLP on the inter-individual variations in serum traits was relatively subtle in comparison with that of lifestyle factors.

National Nutrition Survey in Japan

The National Nutrition Survey in Japan has played an important role for nutrition policy in this country, by monitoring nutrition and health status of the Japanese since 1946. During those 50 years, diet of the Japanese has remarkably changed, with the proportion of fat intake in total energy being more than 25% and salt intake gradually decreased. The aim of this survey also has shifted from the policy making for food supplies to monitoring the over intake for prevention of diet-related chronic diseases and health promotion.

Endothelin-1 secretion from cultured vascular endothelial cells of DOCA-salt hypertensive rats

The profile of endothelin-1 (ET-1) release from cultured vascular endothelial cells (ECs) obtained from deoxycorticosterone acetate (DOCA)-salt hypertensive rats, was examined and compared with that from normotensive sham rats. ET-1 release from ECs was increased in a time-dependent manner, and the level of DOCA-salt hypertensive rats was higher than that of sham rats. Incubation of ECs with transforming growth factor (TGF)-beta 1 or thrombin resulted in a significant increase in the ET-1 release, while FK409, a novel nitric oxide donor, produced a dose-dependent decrease in the release. In the case of ECs from DOCA-salt hypertensive rats, the potencies of TGF-beta 1- or thrombin-induced action was much less than that seen with sham rats, while the difference of reactivity to FK409 was not observed between ECs of DOCA-salt rats and sham rats. Thus, ET-1 production in ECs appears to be up-regulated in DOCA-salt hypertensive rats. In addition, there seems to be an abnormalities in the signaling pathway via TGF-beta 1- or thrombin-induced enhancement of ET-1 production in ECs of DOCA-salt hypertensive rats.

[A case of idiopathic thrombocytopenic purpura combined with lung cancer]

A 71-year-old male was admitted to our hospital because of a chest abnormal shadow. His chest X-ray film showed a mass in the right lower lobe (S6), which was diagnosed as adenocarcinoma by transbronchial lung biopsy. A lab data on the admission showed thrombocytopenia (44,000 per cu. mm), and the results of the bone marrow aspiration was compatible with idiopathic thrombocytopenic purpura. Immediately after the right lower lobectomy with lymphnode dissection, intrathoracic bleeding from the wound due to hemorrhagic tendency appeared necessitating a re-thoracotomy. High-dose intravenous gamma-globulin infusion for 4 days and the frequent concentrated platelet transfusion were employed to prevent the hemorrhagic tendency after the 2nd operation, and the postoperative hemorrhage was successfully controlled. Perioperative high-dose intravenous gamma-globulin infusion was concluded to be useful in the patient of idiopathic thrombocytopenic purpura for preventing hemorrhagic tendency after the operation.

Japanese siblings with missense mutation (717Val --> Ile) in amyloid precursor protein of early-onset Alzheimer's disease

We report Japanese siblings with the missense mutation 717Val --> Ile in the amyloid precursor protein. The maternal grandmother died of an unknown dementing disorder. The proband's mother had gradually increasing amnesia beginning at age 64, which was diagnosed as Alzheimer's disease (AD). She died in a psychiatric hospital (duration of illness: 16 years). Both the proband and her elder sister were affected at about age 55 years. Disturbances of memory, judgment, and emotion, as well as personality changes, occurred first, with dementia eventually predominating. The elder sister died of pneumonia (duration of illness: 9 years). The amyloid precursor protein (APP) gene was analyzed from each sibling. Genomic DNAs obtained from blood samples were amplified by the polymerase chain reaction (PCR) method. PCR products were digested with the restriction enzyme Bcl I. The resulting restriction fragment length polymorphisms (RFLPs) showed the missense mutation 717Val --> Ile in both patients, but not in a normal control. DNA sequencing showed the presence of the 2149G --> A missense mutation only in the patients. We conclude that this familial AD may originate from the missense mutation 717Val --> Ile in the amyloid precursor protein gene and that the clinical picture is typical of AD, except for normal-pressure hydrocephalus and psychiatric phenomena.

Cell death of oligodendrocytes or demyelination induced by overexpression of proteolipid protein depending on expressed gene dosage

The transgenic mice, which were produced by introducing the wild type proteolipid protein (PLP) gene, revealed different neurological symptoms depending on expressed gene dosage. Homozygotes, which bore four more copies of the extra PLP gene, died before 4 weeks old with severe tremors and convulsions, while histologically hypomyelination and death of the oligodendrocytes were particularly noticeable. Heterozygotes, which bore two more copies and survived nearly 1 year, suffered from severe hindlimb palsy and bladder-rectal disturbances before death. These symptoms probably resulted from striking demyelination which occurred abruptly at a later stage of life. The heterozygous PLP-transgenic mice are thus available for a model of demyelination diseases.

Nutritional regulation of insulin-like growth factor-I receptor mRNA levels in growing chickens

Insulin-like growth factor-I (IGF-I) exerts its effect through the IGF-I receptor. To investigate the effects of nutritional status on chicken IGF-I receptor gene expression, a solution hybridization/RNase protection assay for IGF-I receptor mRNA was developed. A cDNA clone corresponding to the carboxyl-terminal region of the IGF-I receptor was obtained by reverse transcription-PCR (RT-PCR). Sequence analysis of the clone showed that this region of the chicken IGF-I receptor is highly divergent from the human IGF-I receptor. IGF-I receptor mRNA was detected in all tissues examined from newly hatched chickens. The rank order of the IGF-I receptor mRNA levels was liver < thigh muscle < stomach < heart < lung < kidney < brain. In 1-week-old chickens, 5 days of starvation caused a 2.5- to 3-fold increase in the mRNA in muscle and kidney. Starvation of 4-week-old chickens for 5 days caused a 1.7 to 2.2-fold increase in IGF-I receptor mRNA levels in kidney, liver, and muscle. In contrast, IGF-I receptor mRNA levels in brain failed to change. The mRNA levels were reduced to the control level by refeeding of the starved chickens for 24h. These data suggest a tissue- and development-specific response of chicken IGF-I receptor gene expression to nutritional status.

Purification and properties of D-aspartate oxidase from Cryptococcus humicolus UJ1

D-Aspartate oxidase (EC 1.4.3.1), which is highly specific to D-aspartate, was inducibly produced by a yeast strain which was isolated from soil and identified as Cryptococcus humicolus UJ1. The enzyme was purified to homogeneity as indicated on SDS-polyacrylamide gel electrophoresis. The molecular mass of the monomer subunit was determined to be 40 kDa. The native enzyme was suggested to be a homotetramer by its behavior on gel filtration. The enzyme was shown to be a flavoprotein by its absorption spectral properties, and the flavin was found to be tightly, but not covalently, bound FAD. The purified preparation had a specific activity of 76.1 mumol/min per mg protein with D-aspartate as substrate. Optimum pH was 7.5 and optimum temperature was around 35 degrees C. D-Glutamate was a very poor substrate for the enzyme. N-Methyl-D-aspartate was better than D-glutamate as substrate but markedly poorer than D-aspartate. Malonate was the most effective competitive inhibitor of the compounds tested. The N-terminal amino-acid sequence of the enzyme showed a significant homology with those of D-aspartate oxidases from beef kidney and Octopus vulgaris and those of D-amino-acid oxidases from various sources.

[Two cases of the congenital posterolateral diaphragmatic hernia were reported]

Case 1, a 9-year-old woman, was admitted to our hospital because of nausea, vomiting, and epigastralgia. Diagnosis of Bochdalek hernia was made by the unusual course of naso-gastric tube. At surgery through the left posterorateral thoracotomy, the herniation of the stomach, small intestine, and colon to the thoracic cavity through the dorsolateral defect of the diaphragm were revealed. Case 2, a 35-year-old man, was admitted to our hospital because of dyspnea. Similar diagnosis was made by the examination of upper G1 series and barium enema, which demonstrated the presence of multiple loops of the small intestine and colon in the left thoracic cavity. Their postoperative courses were uneventful. Most of Bochdalek hernia is observed in infancy, and adolescent or adult case is is rarely reported (approximately 10% of all cases). Since this often misdiagnosed as pleuritis or pulmonary tuberculosis, a cautious examination is necessary for the establishment of the correct diagnosis.