Morphological evaluation of amyloid-laden arteries in leptomeninges, cortices and subcortices in cerebral amyloid angiopathy with subcortical hemorrhage

To investigate the relationship between cerebral amyloid angiopathy and subcortical (lobar) hemorrhage, we examined the severity of amyloid deposition in the leptomeningeal, cortical and subcortical arteries in 28 autopsied elderly patients with cerebral amyloid angiopathy with subcortical hemorrhage, deep cerebral hemorrhage or without hemorrhage. The severity was evaluated in terms of the frequency of amyloid-laden arteries and the degree of amyloid deposition within the arteries. The frequency of amyloid-laden arteries, especially among arteries over 200 microns in diameter, was higher in subcortical hemorrhage group than in the deep hemorrhage group and the non-hemorrhage group, and when the degree of amyloid deposition in the arteries was divided into four grades (none, mild, moderate or severe), the severity was higher in the subcortical hemorrhage group than in the deep cerebral hemorrhage group and the non-hemorrhage group. These results suggest that severe cerebral amyloid angiopathy is related to non-traumatic subcortical hemorrhage in elderly persons.

Effects of spiraprilat, an angiotensin-converting enzyme inhibitor, on anesthetized dogs in a new model of acute left ventricular failure

Spiraprilat, a new angiotensin-converting enzyme (ACE) inhibitor, was compared with enalaprilat for its ability to improve left ventricular (LV) function and metabolism in anesthetized open-chest dogs with a new model of acute LV failure (ALVF) induced by embolization of the left coronary artery with 50 microns plastic microspheres followed by intravenous (i.v.) infusion of methoxamine. With this procedure, LV end-diastolic pressure (LVEDP) increased from 4.2 +/- 0.7 to 12.8 +/- 1.3 mm Hg and remained at approximately 12 mm Hg throughout the experiment. Cardiac output (CO) decreased from 1.25 +/- 0.12 to 0.79 +/- 0.06 and 0.55 +/- 0.02 L/min at 30 and 90 min after methoxamine infusion, respectively. LVdP/dtmax and dP/dt/P decreased, while total peripheral resistance (TPR) increased. These hemodynamic changes indicated establishment of stable ALVF of a moderate degree. Moreover, decreases in myocardial lactate consumption and contents of creatine phosphate in the myocardium indicated the existence of moderate ischemia. The new ACE inhibitor, spiraprilat, as well as enalaprilat (30 micrograms/kg i.v.) effectively decreased mean aortic pressure (30%), LVEDP (20%), and TPR (30%) and increased stroke volume (SV) CO, and dP/dt/P. Both agents decreased myocardial oxygen consumption (20%) and caused a significant increase in myocardial creatine phosphate contents. These data indicate that the beneficial effects of both inhibitors extended not only to LV function but also to myocardial energy metabolism in ALVF.

Molecular cloning and tissue distribution of a receptor for pituitary adenylate cyclase-activating polypeptide

Pituitary adenylate cyclase-activating polypeptide (PA-CAP) is a polypeptide hormone related to vasoactive intestinal polypeptide (VIP). Rat PACAP receptor cDNA was isolated from a brain cDNA library by cross-hybridization with rat VIP receptor cDNA. The recombinant PACAP receptor expressed in COS cells bound PACAP with about 1000 times higher affinity than VIP, and PACAP stimulated adenylate cyclase through the cloned PACAP receptor. The rat PACAP receptor consists of 495 amino acids, contains seven transmembrane segments, and has a significant similarity with other Gs-coupled receptors, such as VIP, glucagon, and secretin receptors. PACAP receptor mRNA was abundantly expressed in the brain, but not in the peripheral tissues except for the adrenal gland. In situ hybridization revealed a high level of expression of PACAP receptor mRNA in the hippocampal dentate gyrus, olfactory bulb, and cerebellar cortex.

Detection of tracheal stenosis by frequency analysis of tracheal sounds

To develop a simple noninvasive method for detecting tracheal stenosis, tracheal sounds were analyzed using fast-Fourier transform. The subjects were all female and included 5 normal volunteers and 13 patients with tracheal stenosis mostly secondary to thyroid cancer (11 extrathoracic and 2 intrathoracic lesions). Tracheal sounds were recorded during spontaneous breathing and were digitized with an analog-to-digital converter. Pulmonary functions, including forced expiratory volume in 1 s (FEV1) expressed as percentage of vital capacity, peak expiratory flow rate (PEFR), the ratio of FEV1 to PEFR (Empey's index), and the ratio of expiratory to inspiratory flow rates at 50% vital capacity, were measured. A computed tomography scan was used to obtain the tracheal minimum cross-sectional area. Whereas PEFR demonstrated a weak correlation with the stenotic area, FEV1%, Empey's index, and the ratio of expiratory to inspiratory flow rates at 50% vital capacity did not. The power of the fast-Fourier transform spectrum of normal tracheal sounds decreased as the frequency increased up to 500 Hz. A small spectral peak was observed at approximately 1 kHz. Patients with significant tracheal stenosis demonstrated an increase in the peak spectral power at approximately 1 kHz and in the mean spectral power from 600 to 1,300 Hz in their tracheal sounds. In patients with extrathoracic lesions, the peak and mean spectral powers correlated well with the area of the stenosis as defined by computed tomography scan. In patients with intrathoracic lesions, abnormalities in the pulmonary functions as well as tracheal sound spectra appeared more evident despite milder stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous hematocrit monitoring method in an extracorporeal circulation system and its application for automatic control of blood volume during artificial kidney treatment

A two-frequency electrical conductivity method for measuring hematocrit has been developed for use in the continuous monitoring of circulating blood volume during artificial kidney treatment. Using this method, an algorithm for programmed control of blood volume also has been developed. This hematocrit measurement method is based on the beta-dispersion of blood conductivity, and the values measured during hemodialysis are in good agreement with the laboratory hematocrit values obtained by a Coulter counter. Programmed control of blood volume was used 29 times on 11 patients undergoing long-term dialysis. In each case, the blood volume was maintained within 2.5% of the desired level, and stable control was achieved even with disturbances caused by eating, change in body position, and so on. These methods can be used to study the relationship between blood volume and dialysis-induced hypotension during artificial kidney treatment and to achieve adequate ultrafiltration without clinical adverse effects.

[A combination chemotherapy of carboplatin and etoposide for malignant fibrous histiocytoma with marked effect on the metastatic lung region]

For metastatic lung region, a 82-year-old woman with malignant fibrous histiocytoma was successfully treated with combination chemotherapy of Carboplatin and Etoposide. First, the tumor appeared on her right thigh, and we operated on August 1991. However, at the same time, a metastatic lung region was also noticed. Over a year, it worsened. We gave her 350 mg Carboplatin once a week and 100 mg Etoposide 3 times a week. After 3 weeks' treatment, we stopped treatment because of sudden granulocytopenia and thrombocytopenia. But to our surprise, the metastatic lung region almost disappeared 2 months after therapy. Considering the difficulty of medical treatment for malignant fibrous histiocytoma, this case suggests that combination chemotherapy of Carboplatin and Etoposide is valuable. However, due care must be taken for side effects such as granulocytopenia and thrombocytopenia.

[Bacteriological, pharmacokinetic and clinical studies of cefditoren pivoxil in the pediatric field]

Bacteriological, pharmacokinetic and clinical studies on cefditoren pivoxil (CDTR-PI, ME 1207) in granules, a new oral cephalosporin, were performed in the field of pediatrics. The results are summarized below. 1. Antibacterial activities: Antibacterial activities of CDTR were studied against Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, Haemophilus parainfluenzae and Branhamella catarrhalis in comparison with those of cefteram (CFTM), cefixime (CFIX), cefaclor (CCL), cefpodoxime (CPDX) and cefotiam (CTM). MIC80's of CDTR against S. aureus, S. pneumoniae, S. pyogenes, H. influenzae, H. parainfluenzae and B. catarrhalis were 1.56, 0.39, < or = 0.025, < or = 0.025, 0.05 and 0.20 micrograms/ml, respectively. These results showed that CDTR has high antibacterial activities against these organisms. 2. Absorption and excretion: Serum concentrations and urinary recovery rates of CDTR-PI (administered in granules) were determined. Upon single oral doses of 3 mg/kg and 6 mg/kg, the peak serum concentrations were 0.5-2.45 micrograms/ml at 2 to 4 hours and 1.79-4.05 micrograms/ml at 1 to 4 hours, respectively, and T 1/2 was 1.07-9.67 hours and 0.99-3.00 hours, respectively. At 8 hours after dosing, serum concentrations were 0-0.87 micrograms/ml with a dose of 3 mg/kg and 0.27-0.73 micrograms/ml with 6 mg/kg. These values indicated that the drug has a dose-dependent pharmacokinetic behavior. Urinary recovery rates in the first 8 hours were 12.9-34.2% with a dose of 3 mg/kg and 11.8-26.9% with 6 mg/kg. 3. Clinical study: Clinical efficacies were examined in a total of 81 cases consisting of 20 cases of acute bronchitis, 13 of acute pneumonia, 21 of tonsillitis, 5 of pharyngitis, 7 of scarlet fever, 2 each of impetigo, otitis media and purulent cervical lymphadenitis, 1 of pertussis and 8 of UTI. The clinical efficacy rate was 97.5% (79/81), and bacteriological eradication rate was 100% (76/76). As for side effects, 2 cases of watery stools and 1 case of minor elevation of GPT were observed.

[Treatment of common bile duct stones by peroral cholangioscopy]

Endoscopic papillotomy (EPT) has become a popular form of treatment in managing common bile duct stones. But it may fail in difficult cases such as large stones of over 20 mm, confluence stones, and impacted stones. Over the past 5 years, our success rate in clearing the bile duct by conventional endoscopic techniques (mechanical lithotripsy) was about 90 per cent. Recently, we have performed electrohydraulic lithotripsy or laser lithotripsy with peroral cholangioscopy in these difficult cases. Complete clearance of the duct was obtained in all 23 patients who underwent peroral cholangioscopic lithotripsy. No complication occurred. In conclusion, peroral endoscopic treatment of common bile duct stones should be safe and effective.

Muscle damage progression in Duchenne muscular dystrophy evaluated by a new quantitative computed tomography method

The progression of muscle damage was studied in the lower extremity and trunk muscles of patients with Duchenne muscular dystrophy (DMD) with a new quantitative computed tomography (CT) method. The degree of muscle fiber loss and fat tissue replacement was quantified using the indices of percent cross-sectional area (%CSA) of muscle and fat, or the percentages of the area having the CT numbers of normal muscle and fat. A cross-sectional study in 71 patients showed that as the disability stage progressed, both CT number and %CSA of muscle decreased while %CSA of fat increased. The rate of progression was different for each muscle, and the order of involvement was clarified. The CT findings were also significantly correlated with muscle strength, indicating validity of our method. Our findings of the natural course of muscle involvement would be useful in providing appropriate rehabilitative care as well as assessing the efficacy of therapeutic interventions.

[Effect of carperitide (alpha-human atrial natriuretic polypeptide) on the cardiovascular system in experimental animals]

The cardiovascular and diuretic actions of carperitide were studied in experimental animals. Carperitide relaxed various canine arteries and veins that were contracted by high K+ or norepinephrine. Carperitide stimulated particulate guanylate cyclase from rat thoracic aortas. Carperitide had almost no effect on coronary perfusion pressure or heart rate, but caused a slight decrease in contractile force in isolated guinea pig hearts. Carperitide tended to decrease isoproterenol-induced renin release from isolated rat kidney slices and elicited decreases in angiotensin II-induced aldosterone release from bovine zona glomerulosa cells. Intravenous injection of carperitide elicited decreases in arterial blood pressure and total peripheral resistance in the anesthetized and conscious dogs. Carperitide also elicited transient increases in cardiac output and coronary blood flow followed by slight decreases in them. Intravenous infusion of carperitide elicited decreases in pulmonary capillary wedge pressure, pulmonary pressure and right atrial pressure in association with elevating plasma carperitide (ANP like immuno-reactivity) level in dogs with heart failure induced by coronary artery occlusion and saline loading. These results suggest that carperitide decreases both preload and afterload and can improve the untoward hemodynamic alterations in animals with acute experimental heart failure.

Localized amyloidosis in squamous cell carcinoma of uterine cervix: electron microscopic features of nodular and star-like amyloid deposits

An ultrastructural study of amyloid deposits in four cases of squamous cell carcinoma of uterine cervix was performed. The amyloid deposits reacted with anti-keratin antiserum on frozen sections. Amyloid deposits showed nodular (4 cases) and star-like forms (3 cases). Nodular amyloid deposits were composed of slightly whorled fibrils, measuring 7-10 nm in width. Some of them contained cellular debris and thicker, more electron-dense filaments than amyloid fibrils. In three cases, filamentous tumour cells and filamentous masses were observed together with amyloid. Star-like amyloid deposits were composed of bundles of straight amyloid fibrils. Some of the tumour cells in contact with star-like amyloid deposits had deep cytoplasmic invaginations, where closely packed amyloid fibrils were arrayed in parallel fashion. In addition, a few tumour cells had membrane-bound amyloid fibrils in the cytoplasm. It is suggested that nodular amyloid deposits are derived from the tumour cells through filamentous degeneration. Amyloid fibrils in star-like amyloid deposits are thought to be formed within the cytoplasm or in the vicinity of invaginated cytoplasmic membranes of the tumour cells.

Growth hormone (GH) secretion from human lymphocytes is up-regulated by GH, but not affected by insulin-like growth factor-I

Regulation of GH secretion from phytohemagglutinin (PHA)-stimulated lymphocytes was investigated in six normal subjects. Peripheral blood mononuclear cells were incubated with PHA (10 micrograms/mL) in the presence of various amounts of recombinant human GH (0-100 ng/L) and/or recombinant human insulin-like growth factor-I (0-1000 micrograms/L), and the secreted GH was measured by a highly sensitive enzyme immunoassay. PHA-stimulated lymphocytes secreted immunoreactive GH in all subjects (13.6 +/- 2.4 ng/L). Exogenous GH up-regulated the GH secretion in a dose-dependent manner, while IGF-I did not affect either basal GH secretion or the up-regulation by exogenous GH. These findings suggest a difference in the regulation of GH secretion between endocrine and immune systems.

[Effects of carperitide (alpha-human atrial natriuretic peptide) on acute congestive heart failure in dogs]

Effects of carperitide (alpha-human atrial natriuretic peptide) on hemodynamics and renal function in dogs with congestive heart failure (CHF) produced by volume expansion and ligation of the left anterior descending coronary artery were compared with those of various anti-heart failure agents (cardiotonic, vasodilator and diuretic). Carperitide (0.1-1 microgram/kg/min) dose-dependently decreased the elevated left ventricular end-diastolic pressure (LVEDP). No significant changes in cardiac contractility (LV dP/dtmax) and heart rate (HR) were noted, although cardiac output (CO) tended to reduce during the infusion of carperitide. Nitroglycerin (NG; 3 micrograms/kg/min) and furosemide (1 mg/kg) also decreased LVEDP, but the potency was less than that of carperitide. Sodium nitroprusside (SNP; 10 micrograms/kg/min) and dobutamine (10 micrograms/kg/min) caused a reduction in LVEDP and increased CO with an increase in HR. Hydralazine (H; 100 micrograms/kg/min) increased CO without reduction in LVEDP and induced a pronounced increase in HR. Double product (systolic blood pressure x HR), an index of myocardial oxygen consumption, was significantly reduced by carperitide, but significantly increased by DB and H. Carperitide, unlike NG, SNP, H and DB, increased urine volume and urinary electrolyte excretion. These results suggest that carperitide will be an useful therapeutic agent for the treatment of CHF.

Necrotizing pancreatitis and gizzard erosion associated with adenovirus infection in chickens

Cases of focal necrotic pancreatitis and gizzard erosion in chickens are reported. Intranuclear inclusion bodies were seen in necrotic pancreatic acinar cells and necrotic epithelial cells of the gizzard, and electron microscopy demonstrated virus particles in affected gizzard epithelium. Adenovirus antigens were detected immunohistochemically in these intranuclear inclusion bodies. These findings suggest that the necrotizing pancreatitis and gizzard erosion were associated with adenovirus infection.

Effects of exercise and pacing loads on myocardial amino acid balance in patients with normal and stenotic coronary arteries, with special reference to branched chain amino acids

Arterial and coronary sinus differences (A-S) of alanine, glutamate, isoleucine, leucine, valine and phenylalanine were measured in 7 control subjects and 12 patients with coronary artery disease (CAD) at rest and during exercise, and in 8 controls and 21 CAD patients at rest and during pacing. Lactate, great cardiac vein flow and oxygen were also measured. However, none of these parameters distinguished CAD from controls. Changes in alanine and glutamate during each load were, for the most part, consistent with previous studies, i.e., a greater release of alanine and uptake of glutamate was observed in the ischemic group. A-S of isoleucine, leucine and valine showed significant positive correlation to that of alanine (r = 0.59, r = 0.89, r = 0.77, respectively, during exercise, and r = 0.57, r = 0.65, r = 0.72, respectively, during pacing). A-S of isoleucine, leucine and valine showed significant positive correlations to each arterial concentration during exercise (r = 0.54, r = 0.62, r = 0.63, respectively), but not during pacing. Although none of the uptakes of the branched chain amino acids (BCAA) were significant, the mean A-S of each BCAA was positive at rest in both controls and CAD, and declined during each load. A-S of leucine was significantly smaller in CAD than in controls during exercise (0.7 +/- 7.0 vs 6.8 +/- 4.1 mumol/l, p < 0.05) and those of leucine and valine were significantly smaller in CAD patients with ischemic electrocardiographic change than in those without electrocardiographic change during pacing (0.1 +/- 5.9 vs 6.1 +/- 5.5, p < 0.05; -3.1 +/- 10.1 vs 9.9 +/- 6.8 mumol/l, p < 0.01, respectively). These results suggest that BCAA, especially leucine and valine, tend to be taken up by human myocardium physiologically and show characteristic changes under myocardial stress similar to those seen with alanine and glutamate.

Quantitative Southern blot analysis in the dystrophin gene of Japanese patients with Duchenne or Becker muscular dystrophy: a high frequency of duplications

Eighty-four unrelated patients with Duchenne or Becker muscular dystrophy in Japan were studied by quantitative Southern blot analysis with dystrophin cDNA probes. We found partial deletions and duplications in 47 (56%) and 12 (14%) cases respectively by HindIII digestion. The duplications were confirmed by BglII digestion and densitometric scanning. The frequency of duplications in this study is significantly higher than those previously reported. This may be because of the small sample number, the racial difference, or our quantitative methods. Our results suggest that attempts to detect duplications are important for a precise diagnosis. Both deletions and duplications clustered at the two hot spots as reported previously. Six cases were exceptions to the 'reading frame hypothesis'. We detected three types of HindIII RFLP. Based on the results of one duplication case, we propose a revised sequential order of exons in the cDNA10 region of the dystrophin gene.

Epithelial myoepithelial tumour of the tracheal gland

A case of epithelial myoepithelial tumour originating from the tracheal gland in a 57 year old woman is described. The tumour was removed by segmental tracheal resection and end-to-end anastomosis. Histologically, the tumour comprised clear cells and presented a monophasic pattern. Immunohistochemical analysis showed that the tumour cells were positive for both S-100 protein and smooth muscle actin. suggesting that this tumour resembles a subtype of epithelial-myoepithelial carcinoma described in the 1990 WHO international classification of salivary glands. Although some reports describe a clear cell dominant epithelial myoepithelial carcinoma, in this case local invasiveness or regional lymphnode metastasis was not proved through investigation. It is therefore concluded that this was an epithelial myoepithelial tumour rather than a carcinoma.

A case of late-onset congenital adrenal hyperplasia due to partial 3 beta-hydroxysteroid dehydrogenase deficiency

Late-onset congenital adrenal hyperplasia due to 3 beta-hydroxysteroid dehydrogenase deficiency has been reported with increasing frequency, but only a few adult women have been found to have this disorder in Japan. We report a 26-year-old Japanese hirsute woman with partial 3 beta-hydroxysteroid dehydrogenase deficiency. The diagnosis was based on significantly increased ratios of 17-hydroxypregnenolone to 17-hydroxyprogesterone and of dehydroepiandrosterone to androstenedione after administration of ACTH. Hirsutism improved with the administration of dexamethasone (0.5 mg) every evening. Since routine assay of delta 5-steroid metabolites has become available, the incidence of this disorder will increase. Diagnostic effort should be attempted since the disorder is treatable with low-dose dexamethasone.

Castleman disease. Unusual retroperitoneal location indistinguishable from malignant tumor in preoperative angiographic appearance

Castleman disease (angiofollicular lymph node hyperplasia) has been reported rarely as a solitary retroperitoneal mass radiographically indistinguishable from retroperitoneal malignancies. We report a case of a hyaline-vascular variant of Castleman disease presenting as a pararenal mass. The computerized tomographic and angiographic appearances of this lesion are presented, and the clinical importance of the differential diagnosis of retroperitoneal tumors is discussed.

Is growth hormone associated with diabetic retinopathy?

The role of growth hormone (GH) in the pathogenesis of diabetic retinopathy was evaluated in 150 patients with non-insulin-dependent diabetes mellitus by measuring urinary GH excretion using a highly sensitive enzyme immunoassay. Urinary GH excretion was not significantly different among diabetic patients without retinopathy (mean, 2.4 ng/day; range, < 0.3-20.0 ng/day), with background retinopathy (2.7 ng/day; < 0.3-22.0 ng/day), and with proliferative retinopathy (3.1 ng/day, 0.9-15.6 ng/day). These data suggest that GH does not play a role for the pathogenesis of diabetic retinopathy through the increased physiological secretion.

Sclerosing lipogranuloma of the male genitalia: analysis of the lipid constituents and histological study

An analysis of lipids and histological examination were performed on tissues resected from 2 patients with sclerosing lipogranuloma of the scrotum. The clinical course and histological characteristics were consistent with those reported previously for typical primary sclerosing lipogranuloma of the male genitalia. There was no history of the injection or topical application of oils or fats. Both of our patients had eosinophilia and the lesions showed eosinophilic infiltration. Complete natural regression occurred several months after partial resection of the lesion in both cases, and no recurrence has been noted during follow-up. This lipid analysis and histological study revealed that no exogenous fatty elements were present and suggested that degeneration of endogenous fat due to some allergic mechanism might be involved in the development of sclerosing lipogranuloma. The eosinophilia associated with this disease and its spontaneous regression after partial resection also support this assumption.