[An autopsy case of Sjögren syndrome with organized and fresh subdural hemorrhage (hematoma)]

An autopsy case of Sjögren syndrome with organized and fresh subdural hemorrhages (hematoma) is reported. A 49-year-old woman who had been suffering from Sjögren syndrome had gradually lost her consciousness and was taken to the hospital where she died several hours later. Subsequently a doctor found the subdural hematoma of unknown origin on her Brain CT. At autopsy, her skin was dry and all of her teeth were missing. There were sporadic cutaneous purpura and subcutaneous hemorrhages in her trunk and limbs. The histopathological examination revealed that the submandibular gland had no normal acini, and was replaced by fibrous and adipose tissues with numerous lymphocytes. There were signs of fibrosis with inflammation in her liver, kidneys and lungs. The thyroid gland showed thyroiditis. Serological findings showed a significant high level of antinuclear antibody, positive RA factor and high gamma-globulinemia. The autopsy revealed that her cause of death was acute subdural hematoma and uncal herniation. There were no external injuries on her head or face. It is suggested that her acute subdural hematoma according to the hemorrhagic tendency, affected by her Sjögren syndrome.

Increased safety by two-stage hepatectomy with preoperative portal vein embolization in rats

We evaluated the usefulness of preoperative portal vein embolization (PVE) in rats for increasing the safety of liver resection. During PVE, portal vein branches that perfused the central and left lobes of the liver were embolized. Liver weight, the elimination of indocyanine green, and the number of Kupffer cells were examined 7 days after PVE and in intact rats. Then we examined rats that had undergone PVE (PVE group), rats in which the embolized part of the liver was resected 7 days after PVE (PVE-Hx group), rats without PVE in which the same lobes of the liver were resected (Hx group), and rats that had undergone a sham operation (sham-operation group) for liver weight, the mitotic index of the hepatocytes, serum alanine aminotransferase activity, total bilirubin, and antithrombin III activity. Some rats in the four groups received an intravenous injection of 0.5 or 2.5 mg/kg endotoxin 48 hr after the operation (the second operation, if done), and the 24-hr survival rate was calculated. Some rats given 0.5 mg/kg endotoxin were killed 6 hr after the injection, and the extent of liver injury was examined biochemically and histologically. Seven days after PVE, the nonembolized part of the liver was about twice the weight of the corresponding lobes in the intact rats, the density of Kupffer cells was doubled, and the hepatic function per unit weight was about the same as that in these controls. Hepatic dysfunction and the endotoxin-induced liver injury were significantly slighter in the PVE and PVE-Hx groups than in the Hx group. Preoperative PVE could make hepatectomy safer.

Influence of hyperosmotic environment comparable to the renal medulla upon membrane NADPH oxidase of human polymorphonuclear leukocytes

Hyperosmotic environment in the renal medulla seems important for bacterial pyelonephritis because it exerts inhibitory influences upon the function of polymorphonuclear leukocytes (PMN). Urea and NaCl primarily contribute to high osmolarity in the renal medulla. We previously reported that PMN function was actually suppressed in phagocytosis, intracellular bacterial killing and superoxide generation in the hyperosmotic solution of urea and NaCl. In the present report, to verify the mechanism of this inhibitory effect, a kinetic study for NADPH oxidase in the cell membrane, the key enzyme complex of superoxide generation, was carried out in the cell membrane-solubilizing system under the hyperosmotic condition caused by urea or NaCl. Urea directly denaturated NADPH oxidase, and its inhibitory mechanism was reversible and uncompetitive with a decrease in Vmax and Km, while NaCl had no effect upon it, maintaining Lineweaver-Burk plots in the same position as those of the control. This result suggests that urea at least produces an inhibitory effect upon PMN through the direct inactivation of NADPH oxidase, although NaCl was unable to do so.

A neonatal case of hydranencephaly caused by atheromatous plaque obstruction of aortic arch: possible association with a congenital cytomegalovirus infection?

A neonate was seen with hydranencephaly and aortic arch obstruction possibly caused by congenital cytomegalovirus infection. At autopsy the aortic arch was occluded by atheromatous plaque between the right brachiocephalic artery and left common carotid artery. Congenital cytomegalovirus infection may have caused cardiovascular disease and hydranencephaly in this case.

Immunohistological investigations of autopsied carotid bodies and their application to diagnosing strangulation

Using immunohistochemical staining, the histological changes and the presence of neuropeptides (enkephalin and VIP) in the carotid body have been investigated in medico-legal autopsy cases, especially asphyxia cases. Only in cases of manual and/or ligature strangulation cases that sustained a force near the carotid body, were the chief cells mainly lightly stained, indicating that they had been "active" cells. Furthermore, these cells and their nuclei were enlarged in comparison to the chief carotid body cells in other autopsy groups. It was thus felt that these changes had resulted from the force that had directly affected the carotid body. Based on these findings, it was concluded that immunohistochemical investigation of the carotid body offers a useful possibility for diagnosing manual asphyxia, especially in autopsy cases involving strangulation.

The distribution of secretory immunoglobulin A in the intrahepatic biliary epithelium of patients with hepatolithiasis

In the treatment of hepatolithiasis, liver resection helps to prevent recurrence and may reduce the incidence of infection by removal of the atrophic tissue. This study was conducted to determine if the affected liver tissue in hepatolithiasis is inflamed or has lowered local immunity by examining the distribution of secretory immunoglobulin A (sIgA) and proliferating cell nuclear antigen (PCNA) in the intrahepatic biliary tracts of 27 patients with hepatolithiasis. Operative specimens were sectioned and stained with avidinbiotin complex, and the labeling index for both sIgA and PCNA was calculated as a percentage of the biliary epithelial cells stained. Cells stained for sIgA increased to a certain point as the cholangitis became more severe; however, in advanced cholangitis, with severe parenchymal atrophy or actively proliferating biliary epithelium, there were fewer cells stained for sIgA than in mild cholangitis. In hepatolithiasis, the decreased local immunity related to sIgA accompanied severe chronic proliferative cholangitis and parenchymal atrophy.

Enhanced chemiluminescence response of polymorphonuclear leukocytes by new quinolone antimicrobials

Some of the many antimicrobial agents (beta-lactams, macrolides, aminoglycosides, tetracyclines, new quinolones; NQs) were reported to have a bactericidal or bacteriostatic effect cooperating with host defense mechanisms including polymorphonuclear neutrophils (PMNs). We investigated the effect of new quinolone antimicrobials on chemiluminescence (CL) response of human PMNs. Among many NQs, we chose ofloxacin, lomefloxacin, fleroxacin, sparfloxacin, AM-1155, NM-394, Q-35, Y-26611 and T-3761. Twenty-five or 100 micrograms/ml of fleroxacin and ofloxacin enhanced luminol-dependent CL response of PMNs up to 1.5-2.0 times compared to the drug free condition. Other antimicrobial agents, however, inhibited CL response. This suggested that fleroxacin and ofloxacin were more efficient in the treatment of bacterial infections with respect to the interaction between antimicrobials and PMNs.

Florid cemento-osseous dysplasia. Radiographic study with special emphasis on computed tomography

This article describes the computed tomographic and conventional radiographic findings for florid cemento-osseous dysplasia. A low-density thin layer or cystlike area was observed around the high-density masses in the tooth-bearing area in the seven cases studied. Expansion of the buccal and lingual cortical plates was observed in association with cystlike areas, but was infrequently observed in florid cemento-osseous dysplasia not having such areas. The computed tomographic number of the high-density masses ranged from 772 to 1587 Hounsfield Units and was equivalent to that of cementum or cortical bone.

Surgical treatment of brain metastases of lung cancer: retrospective analysis of 89 cases

The records of 89 patients who underwent surgery for solitary or multiple parenchymal brain metastases of lung cancer at the Osaka Center for Adult Diseases between 1978 and 1990 were reviewed with follow up until March 1992. The aim of this retrospective analysis was to identify prognostic features that were associated with a favourable outcome. The benefits of brain tumour surgery were evaluated in terms of the cause of death (brain metastasis, tumour in another organ, or treatment related) as well as the postoperative changes in functional state indicated by the Karnofsky scale. The overall mean survival time was 11.6 months, and the one and two year survival rates were 24% and 8%. The brain lesion itself was the cause of death in only 19% of the patients; the other 81% died of systemic disease. Functional state improved after surgical excision of the brain tumour in 36%, remained unchanged in 53%, and worsened in 11%. These data suggest that surgical intervention is beneficial for patients with parenchymal brain metastases. Variables significantly associated with a favourable prognosis included surgical excision of the primary lesion, adenocarcinoma as the histological diagnosis, the use of adjuvant treatment, especially chemotherapy, a preoperative score of over 80% on the Karnofsky scale, and metastasis confined to the brain with no extracranial metastatic foci or residual primary tumour. Additional but non-significant contributors to a good prognosis included age under 65 or 70 years, early tumour stage (stage 1), curative lung cancer surgery, a single metastatic brain tumour (v multiple lesions), a solid tumour (v cystic), and a supratentorial location of the brain metastasis. The disease free interval and the cerebrospinal fluid cytology were not significant prognostic factors. On the basis of these findings, it is concluded that the surgical removal of brain metastases of lung cancer should be undertaken if the primary tumour has already been removed whether or not there are extracranial metastases, and that postoperative chemotherapy should generally be given.

Radiographic patterns of osteomyelitis in the mandible. Plain film/CT correlation

Mandibular osteomyelitis often is associated with involvement of the masticator space. Assessment of mandibular osteomyelitis should therefore involve assessment of soft tissue involvement of the lesion. The purpose of this study was to clarify the relationship between computed tomography patterns and the presence of inflammation in soft tissues. Thirty-three cases diagnosed with osteomyelitis of the mandible were analyzed radiologically with conventional radiographs and with computed tomography scans. Computed tomography patterns of osteomyelitis were classified into four types, lytic, mixed, sclerotic, and sequestrum patterns. Location, extent of the lesion, and change of the cortical plate were evaluated and compared with conventional radiographic findings. Mixed pattern cases displayed diffuse bone abnormalities, which sometimes were accompanied by cortical plate disruption and periosteal reaction. In addition, most mixed pattern cases showed soft tissue involvement, especially of the masseter muscle. Inflammation of the masseter muscle was found to be related to periosteal reaction and disruption of the buccal cortical plate. The data demonstrate a close interaction between cortical plate disruption and muscle inflammation. The extent of inflammation including soft tissue involvement was better appreciated with computed tomography in osteomyelitis, especially in mixed pattern cases.

Induction of Ly-49 on an interspecies hybridoma between differentiation stage specific murine T cells and a rat T lymphoma

Ly-49 can be expressed in interspecies hybridoma cells resulting from the fusion of Ly-49 negative lymphoid cells from normal mice and Ly-49 negative T cells from the rat thymoma W/Fu(C58NT)D (C58). Several hundred hybridoma clones of this type were studied. Hybridoma clones derived from the fusion between activated C57BL/6 mouse spleen cells and C58 expressed Ly-49 on their surface although Ly-49 was undetectable on both parental cells. No Ly-49 antigen was expressed on hybrids when BW5147, a T lymphoma derived from AKR mouse, replaced C58 as parental cell. Thymocytes from C57BL/6 mice also produced Ly-49 positive interspecies hybridomas with C58. Subsequent manipulation of these thymocytes with a mixture of anti-CD4 and anti-CD8 antibodies plus complement to obtain double negative cells (CD4-/CD8-) prior to the fusion abolished the expression of Ly-49 on hybridomas. On the other hand, if the thymocytes were treated with either anti-CD4 or anti-CD8 antibody plus complement, the resultant thymocytes which were a mixture of cells with a single positive (CD4+/CD8- or CD4-/CD8+) and a double negative phenotype (CD4-/CD8-) retained the ability to produce Ly-49 positive hybridomas. Interspecies hybridomas between either CD4+/CD8- or CD4-/CD8+ functional T cell clones and C58 expressed Ly-49 on their surface, though these parental T cells lacked Ly-49 on their surfaces. Northern hybridization analysis using Ly-49 cDNA revealed that C58 cells do not express Ly-49 mRNA, indicating that a trans-acting factor(s) from C58 plays an important role in the induction of cell surface Ly-49 expression on interspecies hybridomas. Our data indicate the complex nature of the regulatory mechanisms for expression of the Ly-49 molecule.

Investigation of melena and hematochezia as the chief complaint of gastrointestinal bleeding in pediatric surgical patients

The causes of melena or hematochezia in 48 pediatric patients were examined. Malrotation with volvulus was an important cause of hemorrhage during the newborn period, and intussusception was very typical in patients aged from 1 month to 1 year. Polyps of the rectum and colon were the most common causes of melena or hematochezia in patients older than 1 year. No cause of melena or hematochezia could be identified in 11 children. Ten patients have remained in good health with no further episodes of melena or hematochezia. Localized multiple polyps of the rectum with focal carcinoma were detected in only one patient. In general, although no further investigation is required after detection of the cause of bleeding and its successful treatment, it should be kept in mind that gastrointestinal malignancy can occur in children.

Long-acting nicardipine for elderly hypertensive patients: effect on diurnal variation of blood pressure

The effect of long-acting nicardipine tablets on diurnal variation of blood pressure was compared with that of standard nicardipine tablets and long-acting nifedipine tablets by 24-hour ambulatory blood pressure monitoring in 35 patients with hypertension. Long-acting nicardipine decreased systolic blood pressure in each age group, and there was no difference in its anti-hypertensive effect when compared with the other two drugs. All three drugs had no effect on the amplitude of daily blood pressure variation, and all three drugs decreased the baseline blood pressure in each age group when compared with untreated patients. In addition, no change was observed in the decrement of baseline blood pressure after switching from the other two drugs to long-acting nicardipine. Long-acting nicardipine had less effect on diurnal blood pressure variation than standard nicardipine tablets, which are administered three times daily. In each age group, long-acting nicardipine also more effectively inhibited the increase in cardiac work resulting from the morning rise phenomenon when compared with standard nicardipine tablets. These findings suggest that long-acting nicardipine may be a more useful preparation for the treatment of essential hypertension, particularly in elderly patients.

Suppression of renal scarring by prednisolone combined with ciprofloxacin in ascending pyelonephritis in rats

To prevent renal scarring, which occurs at the end stage of chronic pyelonephritis due to vesicoureteral reflux of infected urine, immediate antimicrobial treatment is reported to be essential. When treatment is delayed, the antimicrobial agent is believed to be effective only in eliminating bacteria, not in preventing scar formation. Using the ascending pyelonephritis model in rats, we investigated the effect of immediate or delayed treatment with ciprofloxacin and that of delayed treatment with a combination of ciprofloxacin and prednisolone in preventing renal scarring following infection. An inoculum of 1 x 10(9) colony forming units (cfu)/0.1 ml. of the HM32 strain of Escherichia coli, which was isolated from a patient with a urinary tract infection, was injected directly into the rat bladder, and the urethra was clamped for 4 hours in each rat. Treatment by ciprofloxacin (15 mg./kg., twice a day for 5 days) alone or in combination with prednisolone (2 mg./kg., once a day for 4 days) was initiated 6 or 72 hours after bacterial inoculation. The kidneys of each rat were examined 6 weeks later. Immediate treatment by ciprofloxacin significantly inhibited renal scarring (no scarring was seen in any of the 8 rats), but delayed treatment had no effect on scarring (4 of 8 rats showed scarring) when compared with the untreated controls (7 of 8 rats showed scarring). However, the addition of prednisolone to the delayed treatment with ciprofloxacin significantly inhibited renal scarring (only 1 of 10 rats showed scarring) when compared with the untreated controls (7 of 8 rats showed scarring). These data suggest that prednisolone is effective in preventing renal scarring which occurs due to vesicoureteral reflux when the initiation of antimicrobial treatment is delayed.

A novel form of self tolerance dictated in the thymus of transgenic mice with autoreactive TCR alpha and beta chain genes

Transgenic (TG) mice with TCR alpha and beta chain genes from a CD4-dependent auto-I-Ak reactive T cell clone were generated. H-2k TG mice had a large number of thymic and splenic CD4 T cells expressing the autoreactive TCR without manifestation of autoimmunity. The cells were not anergic, as they could respond to autologous antigen presenting cells and anti-TCR antibodies in vitro to proliferate and to produce interleukins. Various degrees of down-regulation of CD2 and CD44 was observed in TG mice, indicating the presence of a defective co-stimulatory process in TG T cells. These features indicate that the self tolerance in autoreactive TCR TG mice is due not to clonal deletion and anergy but to a novel mechanism where T cells cannot sufficiently respond to normally existing self ligand in vivo. That such an in vivo unresponsiveness of autoreactive T cells is dictated in the thymus during CD4 T cell differentiation atypical form of positive selection of autoreactive T cells was suggested by the abnormal surface expression of CD69 and HSA.

Stimulation of phagocytic activity of murine Kupffer cells by tuftsin

Tuftsin (Thr-Lys-Pro-Arg) is a natural immunomodulating peptide. We have investigated for the presence of a specific tuftsin receptor on murine Kupffer cells using fluorescein-labeled tuftsin, which retains full biological activity. After incubation with fluorescein-labeled tuftsin, Kupffer cells displayed clear binding of this compound on the plasma membrane. Excess tuftsin inhibited this binding, indicating the presence of specific tuftsin receptors on the Kupffer cells. We then investigated the effect of tuftsin on the phagocytic activity of these cells. Phagocytosis assays were performed on 24-well plates between murine Kupffer cells and fluorescent microspheres. The greatest stimulatory effect of tuftsin on percent phagocytic cells over the control value was observed when the cells were incubated with particles at 1 microgram/ml tuftsin for 15 min at 37 degrees C with a particle-to-Kupffer cell ratio of 50:1. Tuftsin also markedly increased the number of particles engulfed by Kupffer cells under the same conditions. These results indicate that Kupffer cells have specific tuftsin receptors; thus tuftsin can stimulate phagocytic activity of Kupffer cells, which constitute the majority of macrophages in the host and are situated strategically in the liver for host defense.

[Two-stage hepatectomy with preoperative portal vein embolization in rats]

We studied the functional reserve and ability to regenerate of non-embolized liver made hypertrophic by portal vein embolization (PVE) to evaluate the usefulness of two-stage hepatectomy with preoperative PVE. Rats underwent one of four treatments: 1, 70% hepatectomy; 2, 70% hepatectomy 7 days after PVE; 3, 30% hepatectomy; and 4, sham operation. Liver weight, the bromodeoxyuridine labeling index (LI), and the mitotic index (MI) were calculated after surgery. The lipid peroxide level of the liver, serum hepatic enzyme activities, total bilirubin concentration, prothrombin time, and antithrombin-3 activity were also assayed after surgery in each group. Non-embolized lobes made hypertrophic by PVE regenerated further after resection of the embolized portion of the liver. The increases in liver weight, LI, and MI in group 2 were significantly lower than in group 1, but tended to be higher than in group 3. In group 2, lipid peroxidation in the liver and postoperative disorders of liver function and the coagulation system were significantly less than in group 1, and were similar to those in group 3. Preoperative PVE increases not only the weight but also the function of the residual liver, which makes extended hepatectomy safer.

[Myelin basic protein in the cerebrospinal fluid of patients with neurological disease: especially with malignant brain tumors]

Myelin basic protein (MBP) in the cerebrospinal fluid (CSF) of patients with brain tumors and other neurological diseases was measured before, during and after various treatments such as surgery, chemotherapy and irradiation. We assessed the significance of changes in the MBP levels during the course of treatment, and speculate on what the elevated level of MBP in brain tumor patients indicates. In meningeal dissemination of malignant tumors, meningeal carcinomatosis from cancer of the systemic organ showed the highest level of MBP followed by meningeal gliomatosis and meningeal lymphoma. Meningeal carcinomatosis and meningeal lymphoma, which have responded to chemotherapy, showed normal levels of MBP after chemotherapy. Six of eight patients with newly diagnosed malignant glioma showed moderate to high levels of MBP (range 4.6-35.5ng/ml) just before intraarterial chemotherapy with VP-16 and CDDP. The level increased in five patients during the course of chemotherapy and then decreased in relation to the degree of tumor reduction by chemotherapy. In the solid type of metastatic brain tumor, five of seven patients with multiple tumors showed high levels of MBP and these levels also returned to normal after treatment in four patients. As for the influence of irradiation, levels of MBP did not increase after irradiation except in three patients who developed radiation necrosis, local extensive edema or atrophic change. In other brain tumors, levels of MBP were high in a patient with a large meningioma with very extensive edema and during an unstable postoperative condition after total removal of a large craniopharyngioma.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathogenetic mechanisms involved in mesangial interposition in IgA nephropathy

To investigate the pathogenetic mechanisms of mesangial interposition (MI) in IgA nephropathy, we examined renal biopsy samples from 20 patients with IgA nephropathy. Electron microscopic morphometric analysis showed that cytoplasmic protrusion of mesangial cells (MCs) into endothelial cells (ECs) or capillary lumina, and widening of the lamina rara interna (LRI) were significantly more prominent in glomeruli with MI than in those without. Immunoelectron microscopy revealed that the ratio of positive endothelial staining with a polyclonal antibody against human platelet-derived growth factor (PDGF) BB was significantly higher in capillary loops with MI than in those without. Enhanced capillary staining of fibronectin related to MI was not recognized. These results suggest that MI in IgA nephropathy is caused by factors such as enhancement of cytoplasmic extensibility of the MCs, widening of the LRI and chemotactic influence of PDGF-BB located in the glomerular ECs.