[Remission and recurrence of chronic obstructive lung disease in air pollution caused lung disease patients in the Yokkaichi area]

A study was conducted of patients covered by National Health Insurance (NHI) with chronic obstructive lung diseases legally-recognized as being caused by air pollution (Group A) and those not legally-recognized as air pollution caused (Group B) in the Yokkaichi area. Records of medical examinations (medical fee NHI statement), were examined, focusing on recurrence and remission. Over all incidence of recurrence after remission in asthmatic bronchitis and bronchial asthma conditions was 25% in Group A and 18% in Group B patients although with differences observed in different age groups. Approximately 50%-70% of the recurrence occurred within 3 years, and this incidence decreased approximately in proportion to time elapsed. Total remission rates for patients who had remission without recurrence and those who had remission after recurrence of bronchial asthma was approximately 39% in Group A and about 77% in Group B.

Postsurgical intrahepatic portal thromboembolism: a possible cause of perfusion defects on CT during arterial portography

OBJECTIVE

Our goal was to investigate unexplained nontumorous perfusion defects on CT arterial portography (CTAP).

MATERIALS AND METHODS

The CTAP images of 35 patients who underwent partial hepatectomy or open biopsy were analyzed. Hepatic tumors consisted of hepatocellular carcinoma (n = 18) and colorectal carcinoma metastases (n = 17). Nontumorous perfusion defects were categorized into those previously explained and those unexplained. We investigated unexplained ones and their relationship with the underlying conditions.

RESULTS

Eight unexplained nontumorous perfusion defects were found in four patients with colorectal metastases. Statistical analysis showed that the defects occurred with significantly higher incidence in patients with colorectal metastases than in those with hepatocellular carcinoma (p = 0.046, Fisher test). All four patients with defects underwent CTAP within 1 month after colorectal surgery. A significant difference was seen in the distribution of surgery-CTAP time intervals between those patients with and those without defects (p < 0.05, Wilcoxon-Mann-Whitney test). Intrahepatic portal thrombi were pathologically proven in one of the four patients.

CONCLUSION

Unexplained nontumorous hepatic perfusion defects may represent postsurgical portal thromboemboli.

Crohn's disease associated with growth hormone secretory dysfunction

A 10-year-old boy presented in 1989 with repeated episodes of vomiting, abdominal distension and severe growth retardation. Endocrinologic examination indicated growth hormone (GH) secretory dysfunction. Administration of recombinant human GH (rhGH) led to growth, but the patient discontinued treatment. He was readmitted to our hospital in 1993, at the age of 16. His stature was very short. Laboratory findings suggested malnutrition. Radiologic examination revealed regional stenosis and a cobblestone appearance of the intestine. The histologic diagnosis was compatible with Crohn's disease. Administration of prednisolone alleviated gastrointestinal symptoms with the improvement of GH secretory function.

[Renal cell carcinoma in a patient with malignant lymphoma: a case report]

This is a case report of a 51-year-old male in the late stage of malignant lymphoma who presented with pathological fracture renal cell carcinoma secondary to metastatic. He underwent right nephrectomy followed by immunotherapy consisting of interferon alpha and some cytokines. According to his condition and extension of the disease, OK-432, interleukin-2 and interferon gamma were combined. He was also given irradiation to the bone metastases. He died of progressive disease 8 years and 6 months after the initiation of interferon alpha therapy. The autopsy revealed evidence of pancreatic involvement with renal cell carcinoma and malignant lymphoma as well. Malignant lymphoma also infiltrated into the mesentery and left femur. We reviewed other reports regarding multiple malignant tumors associated with renal cell carcinoma and discussed the occurrence of malignant lymphoma in renal cell carcinoma patients.

Low incidence of acute GVHD in patients transplanted with marrow from HLA-A,B,DR-compatible unrelated donors among Japanese

To prevent GVHD in BMT from unrelated donors, the matching of HLA between patient and donor is crucial. The appearance of acute GVHD was studied in 51 patients with hematological malignancies who were transplanted with non-T cell purged marrow from HLA-A,B and DR compatible unrelated donors with the assistance of the Tokai Marrow Donor Bank of Nagoya, Japan. Probability of grade II-IV acute GVHD was 32.0% and of grade III-IV acute GVHD was 17.0%. HLA-class II antigen compatibility showed a good correlation with the occurrence of acute GVHD. When the percentage relative response (RR) of MLC between patient and donor (GVHD vector) was < or = 5, grade II-IV acute GVHD was found in only 7.7% of patients (n = 16) and no severe grade III-IV GVHD occurred. Among patients with 6-10% RR (n = 10), 25.9% showed grade II-IV GVHD and 14.3% grade III-IV GVHD. Among patients with > or = 11% RR (n = 20), however, the incidence of grade II-IV acute GVHD reached 51.8% and that of grade III-IV acute GVHD 36.2%. These reactivities of MLC reflected the compatibility of HLA-DRB1 and DPB1. The fact that the incidence of acute GVHD in BMTs from HLA-A,B,DR compatible Japanese pairs was found to be lower than in the USA may be due to less diversity of the genetic background in Japan.

Enhanced pressor response in spontaneously hypertensive rats induced by stimulation of vasopressin-V1 receptors

To elucidate the effect of the arginine vasopressin (AVP) system in vivo, especially V1 and V2 activity, on blood pressure, we measured the acute changes in blood pressure and heart rate after AVP, OPC-21,268 (a V1 receptor antagonist), and OPC-31,260 (a V2 receptor antagonist) were injected intravenously in anesthetized spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) rats at the age of 15 weeks. Compared with the control period, single injection of AVP 5 ng/kg significantly increased systolic blood pressure in WKY rats without a concomitant increase in heart rate, but there was no significant increase in blood pressure in SHR. In contrast, single injection of either OPC-21,268 3 mg/kg or OPC-31,260 3 mg/kg did not affect blood pressure or heart rate in either SHR or WKY rats. Injection of AVP after the administration of OPC-31,260 induced a greater increase in blood pressure in SHR than in WKY rats, whereas injection of AVP after the administration of OPC-21,268 did not induce any clear increase in blood pressure in SHR or WKY rats. These results suggest that SHR have enhanced pressor activity mediated by V1 receptors and that this increase may be due to an increase in their number. In conclusion, enhancement of V1 activity may contribute to the development of high blood pressure in SHR.

Continuing immunoglobulin heavy chain gene rearrangements in chronic myeloid leukemia with recurrent B-lymphoid blast crises after bone marrow transplantation

We sequentially analyzed the immunoglobulin heavy chain variable (IgH V) region gene of leukemia cells obtained from a chronic myeloid leukemia (CML) patient who had three episodes of B-lymphoid crisis after bone marrow transplantation. Southern blot analysis using the JH probe showed different rearranged bands at each crisis, although the same rearranged bands of the BCR gene were observed. We amplified and sequenced the IgH V region gene of the leukemia cells by reverse transcriptase polymerase chain reaction (RT-PCR) using the primers corresponding to the consensus 5'VH and mu constant regions. The dominant leukemia clone at each crisis had a unique VH-D-JH rearrangement; VH4A (V79)-DLR2-J5 (clone-1), VH4B (DP70)-DK4-J6 (clone-2) and VH4A (V79)-DN4-J6 (clone-3) at the first, second and third crises, respectively. Further analysis by PCR amplification using the consensus 5'VH and clone-specific primers revealed that clone-1 underwent VH4-->VH3 replacement at the second crisis, and that clone-3 was already in existence at the first crisis. Moreover, the DN4-J6 joining clone, in which the sequence was the same as that of clone-3, was identified at the first and third crises by PCR amplification using primers corresponding to the region upstream of the DN4 segment and DN4-J6 boundary of clone-3. These observations suggest that multiple clones were generated from the progenitor cells of blast crisis, which were transformed at a very early stage of B-lymphocyte ontogeny, by continuing rearrangement mechanisms of the IgH genes, and that the dominant clone at each crisis was undergoing change.

Synthesis and Structure Determination of Gibberellin-Derived Antheridiogens From Fern Gametophytes of the Lygodium Genus

Two successful and two unsuccessful synthetic routes are described for the conversion of commercially available fungal gibberellins to the antheridiogen GA73 methyl ester (5), originally isolated from gametophytes of the fern Lygodium japonicum. The more efficient route began with the Birch reduction of either the GA7 derivative (31) or methyl gibberellate 3,13-dimesylate (32) to give the ∆1(10),16-diene acid (33), which was converted into the ∆1,9-diene acid (40) by means of a four step procedure. This intermediate could be selectively hydrogenated to the ∆9-ene derivative which underwent iodolactonization and then elimination of HI to afford enone (29), Wittig methylenation of which furnished the target antheridiogen (5). In addition, (29) was functionalized at C12 by free radical bromination to give access to the 12β-hydroxy derivative of (5), i.e. (6), a new antheridiogen isolated from Lygodium circinnatum.

Human fibroblast cells produce a factor that stimulates prostacyclin synthesis by vascular endothelial cells

The prostacyclin (PGI2) produced by vascular endothelium plays a key role in maintaining vascular homeostasis. The present study demonstrated that the conditioned medium (CM) of human diploid fibroblast cells contained PGI2-stimulatory activity (PSA) for bovine aortic endothelial cells (BAEC) and human umbilical vein endothelial cells (HUVEC). CM significantly stimulated the production of 6-keto-PGF1 alpha, a stable PGI2 metabolite, by both cultured BAEC and HUVEC in a concentration-dependent manner. Since the factor responsible for the PSA seemed to be negatively charged, PSA was partially purified using a DEAE-5PW high performance liquid chromatography column. The partially purified PSA was completely inhibited by preincubation with 15 microM indomethacin, a cyclooxygenase inhibitor. However, partially purified PSA was partially inhibited by preincubation with 50 microM mepacrine, a phospholipase A2 inhibitor. These findings suggest that PSA stimulates preferentially cyclooxygenase relative to phospholipase A2 in vascular endothelial cells. The partially purified PSA showed no effect on thromboxane A2 production by human washed platelets, and had no growth-promoting activity on BAEC. We conclude that cultured human fibroblast cells produce factor that stimulate the synthesis of prostaglandin by vascular endothelial cells but not by platelets.

[Voiding dysfunction after abdominal radical hysterectomy. Comparison between patients with and without adjuvant irradiation therapy]

We evaluated 59 patients with voiding dysfunction after abdominal radical hysterectomy for uterine cancer. Of 59 patients, 45 underwent the surgery alone, and the other 14 underwent surgery and postoperative radiotherapy. Irradiation (mean dose, 60 Gy) was performed in bilateral commoni iliac regions excluding the bladder. In principle, the indwelling urethral catheter was removed 4 days after operation. All patients were followed up at the gynecological department until the onset of the voiding dysfunction. The mean interval between operation and the onset of voiding dysfunction was significantly longer (P < 0.01) in the group treated by surgery alone (7.9 years) than in the group treated by surgery in combination with radiotherapy (3.8 years). Voiding dysfunction developed earlier as the age at the time of operation was higher. No differences were observed in the volume of residual urine, the detrusor function, or the incidence of urinary tract infection between the two groups. These results suggest that aged patients develop voiding dysfunction earlier after radical hysterectomy than young patients, and postoperative radiotherapy shortens the interval between operation and the onset of postoperative voiding dysfunction.

Mediastinal lymph node metastasis 38 months after surveillance for stage I seminoma: a case report

We present a case report of a relapse to the mediastinal lymph node alone, 38 months after orchiectomy on surveillance for stage I typical seminoma. The patient, a 63-year-old man, was treated with high inguinal orchiectomy for left testicular tumor and close follow-up. After 38 months from the initial treatment, the chest X-ray film and CT scan revealed mediastinal tumor. Fine needle aspiration cytology performed under the bronchoscopy showed seminoma cells. Complete remission was achieved after three courses chemotherapy of cisplatin, vincristine, methotrexate, peplomycin and etoposide (COMPE). He has continued to be clinically disease-free 8 months after completion of the treatment. According to the available data in the literature, 94% of the recurrences was detected within 3 years after orchiectomy, and 92% involved retroperitoneal lymph node metastases. This is a rare case who had a late relapse in the mediastinum alone.

Dietary salt intake and blood pressure among schoolchildren

We studied the relationship between dietary salt intake, urinary salt excretion, blood pressure and anthropometric measurements in 322 Japanese schoolchildren, aged between 6 and 11 years. Two surveys were carried out: one among a small group of 22 children from the 322, and one involving all 322. In the former group, both a detailed and a simplified dietary questionnaire were used, and nocturnal and 24 hr urinary salt excretion samples were collected. The latter group's survey used only the simplified questionnaire and nocturnal salt excretion measurements. The surveys from the two different groups were then compared to each other. It was found that the simplified questionnaire and nocturnal urinary samples were statistically accurate enough to be used for the purpose of this study. From the latter survey, dietary salt intake among the children was 7.5 +/- 2.7 g per day, (mean +/- SD), and 65 pupils (20%) consumed more than 10 g of salt per day. It was also found that nocturnal urinary salt excretion levels were 1.47 +/- 0.82 g per day, with 30 pupils (9.3%) registering levels of more than 2.5 g per day. There was a significant correlation between these dietary and urinary salt levels. Systolic blood pressure (SPB) among the schoolchildren showed significant correlation with age, height, weight and BMI. For diastolic blood pressure (DBP), a significant correlation was seen in age only. SBP and DBP showed little relation with either dietary salt intake or urinary salt excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Glycosides of 19-formylthevetiogenin and 5 alpha-thevetiogenin from Thevetia neriifolia

C-nor-D-homo-homologues of cannogenin and uzarigenin glycosides were isolated along with known cardenolide glycosides from the frozen fresh leaves of Thevetia neriifolia. A bisdesmosidic tetraoside of 3 beta,14,21-trihydroxy-5 beta,14 beta-pregnan-20-one was also obtained from the polar fraction and the structure established.

Purification and molecular cloning of prostacyclin-stimulating factor from serum-free conditioned medium of human diploid fibroblast cells

We attempted to identify the factor that stimulated prostacyclin (PGI2) production using conditioned medium from cultured human diploid fibroblast cells subjected to a series of purification steps using h.p.l.c. on DEAE-5PW, Heparin-5PW, Protein-Pak 300, and an insulin-like growth factor-1 ligand affinity column. The purified prostacyclin-stimulating factor (PSF) ran as a single band with a molecular mass of 31 kDa by SDS/PAGE. Analysis of the purified PSF by C4 reversed-phase h.p.l.c. showed a single sharp peak in 31% (v/v) acetonitrile. The material was purified 8000-fold with an overall yield of about 18%. The purified PSF stimulated PGI2 production by cultured bovine aortic endothelial cells at a concentration of about 10 ng/ml; maximal stimulation was achieved at a concentration of 25 ng/ml. A cDNA coding for PSF was cloned and sequenced, revealing an apparently novel protein with no obvious sequence similarity to known proteins.

Developmental changes of protein substrates of Ca2+/calmodulin-dependent protein kinase II in the rat forebrain

We previously reported that the level of Ca2+/calmodulin-dependent protein kinase II (CaM kinase II) alpha and beta proteins increases with postnatal age. In the present study, we investigated the developmental changes in whole protein substrates of CaM kinase II as compared with those of cAMP-dependent protein kinase (A-kinase) in the rat forebrain. Protein substrates were phosphorylated with [gamma-33P]ATP, and analysed by two-dimensional gel electrophoresis. More than 50 substrates for CaM kinase II were found in the soluble and particulate fractions. The phosphorylation level of more than 15 substrates increased in the particulate fraction during development. Similarly, that of more than 3 substrates increased in the soluble fraction. Some substrates for A-kinase also increased during development, although some decreased. These findings suggest that the expression of some substrates is regulated during development and that the phosphorylation reaction involves the regulation of neuronal development.

Specific distribution of Ca2+/calmodulin-dependent protein kinase II alpha and beta isoforms in some structures of the rat forebrain

The immunohistochemical distribution of Ca2+/calmodulin-dependent protein kinase II (CaM kinase II) alpha and beta isoforms in the rat forebrain was examined by using monoclonal antibodies specific to each isoform. The present study confirmed that alpha and beta immunoreactivities are localized only in neuronal elements. At the light microscopic level, specific distribution patterns of these isoforms and staining characteristics were recognized in some regions of the forebrain as follows. Firstly, alpha-immunoreactive neurons were more homogeneously distributed throughout the cellular layers of the cerebral cortex (i.e., layers II-VI) than beta-immunoreactive ones. Secondly, neurons in the globus pallidus were immunostained by the anti-beta antibody, but not by the anti-alpha antibody. Thirdly, neurons in the medial habenular nucleus, the subthalamic nucleus and the reticular thalamic nucleus were more densely stained with the anti-beta antibody than with the anti-alpha antibody. However, marked differences were not observed in the hippocampal formation at the light microscopic level. The electron microscopic analysis of the cerebral cortex demonstrated that subcellular localizations of alpha- and beta-immunoreactive products within the cortical neurons were quite dissimilar: (i) the nucleus was stained only with the anti-alpha antibody, but not with the anti-beta antibody, and (ii) beta-immunoreactive products were more sporadically localized in the cytoplasms of the perikarya and dendrites than the alpha-immunoreactive ones. These regional and subcellular differences between the distribution patterns of alpha and beta immunoreactivities suggest the functional diversity of CaM kinase II alpha and beta isoforms in the central nervous system.

Synergistic activation by Ras and 14-3-3 protein of a mitogen-activated protein kinase kinase kinase named Ras-dependent extracellular signal-regulated kinase kinase stimulator

We have identified, in Xenopus oocyte cytosol, a protein kinase named REKS (Ras-dependent extracellular signal-regulated kinase (ERK)/mitogen-activated protein kinase kinase (MEK) stimulator), which phosphorylates and activates recombinant ERK2 through recombinant MEK in a recombinant GTP gamma S (guanosine 5'-(3-O-thio)triphosphate)-Ras-dependent manner. We show here that this REKS activity is synergistically enhanced by a combination of mammalian recombinant GTP gamma S-KiRas and 14-3-3 protein purified from rat brain. 14-3-3 protein is known to activate tyrosine and tryptophan hydroxylases, to modulate the protein kinase C activity, to stimulate secretion, and to show phospholipase A2 activity per se. 14-3-3 protein did not affect the MEK activity. 14-3-3 protein neither interacted with Ki-Ras nor affected the neurofibromin activity to stimulate the GTPase activity of Ki-Ras under the conditions where the recombinant N-terminal fragment of c-Raf-1 inhibited it. These results suggest that 14-3-3 protein has an additional function in the regulation of the Ras-MEK-ERK cascade pathway through the activation of REKS.

Steroidal constituents from the roots and stems of Aclepias fruticosa

Steroidal constituents from the roots and stems of Asclepias fruticosa L. were investigated separately. From the roots, twelve pregnane pentaosides and uzarigenin beta-sophoroside were isolated together with three known coroglaucigenin and corotoxigenin glycosides. Pregnane glycosides were composed of ikemagenin or kidjolanin as an aglycone, and D-digitoxose, D-cymarose, D-oleandrose and terminal D-glucose as component sugars. Among the constituents from the stems, cardenolides show a similar pattern to those from leaves. 17 alpha-Hydroxycalactin and 17 alpha-hydroxyafroside were newly obtained along with known doubly linked and normally linked glycosides. Two pregnane glycosides and uzarigenin beta-sophoroside obtained from the roots were also isolated.

[A case of completely responding stage D2 prostatic cancer with no evidence of disease 14 years after diagnosis]

A 58-year-old male complaining of pollakisuria, miction pain and back pain visited us Dec. 26, 1979. Rectal examination revealed the prostate enlarged by 5 digital width, stony hard and irregular. Transrectal needle biopsy revealed moderately differentiated adenocarcinoma of the prostate. Bladder neck invasion, pelvic and mediastinal lymph node metastases and multiple bone metastases were found. The case was diagnosed with prostatic adenocarcinoma T3N2M1 (OSS, LYM) stage D2. Three courses of chemotherapy using ifosfamide applied from Feb. 2, 1980 showed no marked effect except for partial pain relief. Hormonal treatment with diethylstilbestrol diphosphate was started from May 28 and arterial infusion chemotherapy using CDDP and 5-FU was performed 2 months later, resulting in size reduction of the prostate and pelvic lymph node metastases and disappearance of mediastinal lymph node metastases. Needle biopsy of the prostate was negative for cancer cells. After 8 months, Tegafur was started, and 12 months later radiotherapy was added to the prostate and pelvic lymph nodes. The abnormal accumulation in bone scan began to decrease after 14 months and achieved complete remission 28 months after the initial therapy. We discontinued the hormonal therapy 31 months later because of his complaint of chest discomfort and palpitation. At the present time, 14 years after the initial therapy, the prostate was 35 x 29 x 19 mm in size on transrectal ultrasonography with undetectable serum PSA level and no tumor cells but only mass fibrosis has been seen by pathological examinations. We considered this patient to be with no evidence of disease.