Homogenized stress analysis in a dental implant system

In this study, the stress state occurring at each trabecular due to three different types of dental implant is investigated by a homogenization technique, in which the trabecular structure is assumed to be composed of repeating hexagonal units. This technique helps make a proper material model of bone and to analyse such a non-homogeneous structure at the level of an individual microstructural unit. Stress analyses with the homogenization technique show a much higher stress level in the sponge bone, compared to those with conventional FEM. It also shows that even a minor lateral force results in crucial stresses in the dental implant system. The stress states of the mandible with a hemisphere-rooted implant and a wedge type implant show similar levels, while those with a rectangular-rooted implant result in higher stresses. It is suggested that the distance between the implant tip and cortical bone be kept far enough apart to prevent stress concentrations in the mandible.

A study on a new antineural antibody in a case of paraneoplastic sensory neuropathy associated with breast carcinoma

Paraneoplastic sensory neuropathy is a remote effect of cancer, usually associated with small cell lung carcinoma and anti-Hu antibody. This report details the case of a 59 year old woman with a breast carcinoma and a paraneoplastic sensory neuropathy characterised by chronic asymmetric sensory neuropathy. Anti-Hu antibody was not detected in her serum; nor were other known antineuronal antibodies such as anti-Ri and Yo. However, we have found an antineural antibody that reacted to a 106 kDa mouse neural antigen which has not yet been reported. Immunohistochemically, this antineural antibody bound to the posterior grey horn. This finding suggests that this antineural antibody may play an important part in the pathogenesis of the sensory neuropathy of this patient.

Tumor necrosis factor-alpha and transforming growth factor-beta production by isolated mononuclear cells from the spinal cords of Lewis rats with experimental autoimmune encephalomyelitis

We demonstrated time course of the number of mononuclear cells (MNCs) isolated from spinal cords (SCs) correlates with the degree of experimental autoimmune encephalomyelitis (EAE) of Lewis rats, and analyzed their tumor necrosis factor (TNF)-alpha and transforming growth factor (TGF)-beta production by MNCs, using enzyme-linked immuno sorbent assay and enzyme-linked immuno spot (ELISPOT) assay. The number of MNCs varied from 5 to 620 x 10(4) per SC of normal Lewis rat and Lewis rat with EAE. MNCs increased and reached a peak on day 2 post clinical onset (Day 2), and subsequently declined through the clinical course. The increase of infiltrating MNCs in SCs paralleled the severity of the disease development. TGF-beta 1 in plasma of rats with EAE significantly increased on Day 1 and reached the peak on Day 3. TNF-alpha levels in culture supernatants of MNCs from SCs increased on Day 1, and it decreased from Day 2, and declined on Day 4 when animals began to recover. TGF-beta 1 was not detected in culture supernatant during the whole clinical course. The number of TNF-alpha and TGF-beta 1 producing cells that were detected by ELISPOT assay increased on Day 0, and decreased rapidly after the onset of neurological symptoms. Thus, increase of TNF-alpha appeared in the early phase of the disease and then promptly decreased. In contrast, TGF-beta 1 was activated during the later recovering phase of the disease. We consider that TNF-alpha may play an important role in the pathogenesis of EAE and TGF-beta may inhibit the development of EAE.

Fibrin deposition in the central nervous system correlates with the degree of Theiler's murine encephalomyelitis virus-induced demyelinating disease

We examined the role of coagulation-fibrinolysis system in Theiler's murine encephalomyelitis virus-induced demyelinating disease (TMEV-IDD). The degree of fibrin deposition around the vessels in the spinal cord was significantly higher in susceptible SJL/J mice on 30 days post intracerebral injection (i.c.) than resistant C57BL/6 mice on 30 days post i.c. or mock infected SJL/J mice. Treatment with batroxobin (30 BU/kg/day), which is a thrombin-like defibrinogenating enzyme, causing a profound degree of afibrinogenemia, suppressed clinical signs of TMEV-IDD. Plasma fibrinogen concentration was significantly decreased in batroxobin-treated mice. Histologically, though the degree of perivascular mononuclear cell infiltration in the spinal cord was not suppressed in batroxobin-treated mice compared to saline-treated control mice, fibrin deposition was markedly suppressed in batroxobin-treated mice. These findings suggest that batroxobin suppresses TMEV-IDD through its defibrination effect, and provide evidence that CNS-associated deposition of fibrin and ensuing fibrinolysis, together with increased permeability of the blood-brain barrier (BBB), are prerequisite events for clinical manifestations of TMEV-IDD.

Clinical significance of hepatic visualization on iodine-131 whole-body scan in patients with thyroid carcinoma

The purpose of this study was to evaluate the frequency and clinical significance of diffuse hepatic uptake on 131I whole-body scan in 399 patients (53 males, 348 females) with well-differentiated adenocarcinomas of the thyroid.

METHODS

Two hundred and ninety-one diagnostic scans were performed 2 days after the administration of 74-370 MBq (2-10 mCI) 131I, and 824 post-therapy scans were done 3-5 days after the administration of 1.11-7.4 GBq (30-200 mCI) 131I. There was no evidence of liver metastasis in these patients. Liver and thyroid visualization on each 131I scan were graded from 0-4. To evaluate the incorporation of radioiodine to thyroglobulin and thyroid hormones, a patient's serum was extracted by 80% ethanol/20% trichloroacetic acid solution and analyzed by silica gel thin-layer chromatography.

RESULTS

Diffuse hepatic uptake (> Grade 2) was definitely seen in 239 of 399 (59.9%) of the patients and 397 of 1115 (35.6%) of the studies. In the diagnostic scans, 36 (12.0%) showed uptake in the liver. In post-therapy scans, however, the incidence of liver uptake increased according to increased doses of 131I (39.1% with 1.11 GBq, 61.5% with 2.775-3.7 GBq and 71.3% with 5.55-7.4 GBq). The more that uptake appeared in the residual thyroid, the more it appeared in the liver. There were 13 patients whose scans showed metastatic and liver uptake without any thyroid uptake. Fifteen patients showed diffuse liver uptake without uptake by the thyroid or metastasis. Follow-up studies of seven of these patients revealed metastatic lesions. Liver uptake on scan related to the fraction of 131I-labeled thyroglobulin in the serum.

CONCLUSION

Diffuse liver uptake indicated functioning thyroid remnant or metastasis. In a few cases, liver uptake without uptake by the thyroid or metastasis on whole-body scans suggests hidden metastases.

In vitro and in vivo properties of murine monoclonal antibody for a novel immature thymocyte-differentiated antigen, JL1

JL1 is a novel thymocyte-differentiated antigen strictly confined to stage II immature cortical thymocytes. It is expressed in several types of leukemias and lymphomas. Murine anti-JL1 monoclonal antibody labeled with 131I and 99mTc showed 60-70% of immunoreactivity and 1.4-1.9 x 10(9) L/mol of affinity constant. The incubation of the radiolabeled antibody with Molt-4 cells showed no evidence of modulation or shedding. Localization indices increased from day 3 to day 5 in SCID mice bearing Molt-4 cells.

Phosphatidylserine suppresses Theiler's murine encephalomyelitis virus-induced demyelinating disease

Intracerebral inoculation of susceptible strains of mice with Theiler's murine encephalomyelitis virus (TMEV) results in immune-mediated demyelinating disease. Various cytokines may play an important role in the pathogenesis of this disease. Tumor necrosis factor (TNF)-alpha contributes to the further development of perivascular cellular infiltration and demyelination in the central nervous system (CNS). Phosphatidylserine (PS), a major anionic phospholipid of mammalian cells, has been proposed to function as a regulator of immune and inflammatory responses, especially reducing TNF-alpha production and release in mice. We studied the effect of PS on TMEV-induced demyelinating disease (TMEV-IDD). We injected TMEV intracerebrally into susceptible SJL/J mice and induced TMEV-IDD. PS were injected intraperitonealy, and clinical course and various immunological indicators were closely studied. The results show that when PS were administered in the effector phase. TMEV-IDD was significantly (P < 0.01) suppressed both clinically and histologically. In an ELISPOT assay, the number of TNF-alpha producing spleen cells was low in PS treated mice compared with saline treated control mice. mRNA of TNF-alpha was not detected in spleen cells of mice PS treated in the effector phase. These data suggest that administration of PS suppresses TMEV-IDD by suppressing TNF-alpha production in the effector phase.

Detection of the soluble form of the Fas molecule in patients with multiple sclerosis and human T-lymphotropic virus type I-associated myelopathy

We evaluated the presence of soluble Fas molecule (sFas) in the cerebrospinal fluids (CSF) and the sera of patients with multiple sclerosis (MS) or human T-lymphotropic virus type I (HTLV-I) associated myelopathy (HAM) using an enzyme-linked immunosorbent assay (ELISA). Patients with multiple sclerosis in the active phase had higher sFas serum levels than control (p < 0.005). In addition, significantly increased serum levels of sFas were found in patients with HAM (p < 0.005). We found a significantly increased CSF levels of sFas in patients with HAM and patients with MS in the active stage (p < 0.005). These results suggest that serum sFas may be related to clinical activity in patients with MS and that Fas may play an important role in the pathogenesis of HAM.

International differences in approaches to 131I therapy for Graves' disease: case selection and restrictions recommended to patients in Japan, Korea, and China

Members of the American Thyroid Association (ATA), European Thyroid Association (ETA), Japan Thyroid Association (JTA), Korean Thyroid Association (KTA), and Chinese Thyroid Association (CTA) were surveyed independently through an identical questionnaire on their management of Graves' disease. One of the major purposes of the survey was to determine how expert thyroidologists in different regions of the world use three different therapies available for a typical Graves' patient as well as for clinical variations provided. In this report, we summarized, contrasted, and interpreted the results of the surveys in three Asian countries by focusing on therapeutic preference of radioiodine. For the index patient with hyperthyroidism due to Graves' disease, radioiodine was the therapy of choice for 69% of ATA respondents but only 22%, 22%, 11%, and 11% of ETA, CTA, JTA, and KTA respondents, respectively. The goal of radioiodine therapy in Asian countries was to restore the euthyroid state. For the case of recurrence after surgery, there was consensus on choosing radioiodine among all countries surveyed. To interpret the reluctance to advocate radioiodine therapy for a typical Graves' patient in Japan, a new survey concerning the current trends in radioiodine therapy in Japan was conducted among clinical members of the JTA. The phobia of radiation and stringent safety rules for radioactive pharmaceuticals were the two major reasons found. Nevertheless, the percentage of JTA respondents who aim for the euthyroid of hypothyroid state by radioiodine therapy for typical Graves' significantly increased compared with respondents to the former survey in 1988. Moreover, a considerable number of JTA members believe that more radioiodine therapy should be applied for achievement of the rapid improvement of hyperthyroidism, for convenience, and for medical cost benefits.

Major linear antibody epitopes and capsid proteins differentially induce protective immunity against Theiler's virus-induced demyelinating disease

Theiler's murine encephalomyelitis virus-induced immunologically mediated demyelinating disease (TMEV-IDD) in susceptible mice provides a relevant infectious model for multiple sclerosis. Previously, we have identified six major linear antibody epitopes on the viral capsid proteins. In this study, we utilized fusion proteins containing individual capsid proteins and synthetic peptides containing the linear antibody epitopes to determine the potential role of antibody response in the course of virus-induced demyelination. Preimmunization of susceptible mice with VPI and VP2 fusion proteins, but not VP3, resulted in the protection from subsequent development of TMEV-IDD. Mice free of clinical symptoms following preimmunizations with fusion proteins displayed high levels of antibodies to the capsid proteins corresponding to the immunogens. In contrast, the level of antibodies to a particular linear epitope, A1C (VP1(262-276)), capable of efficiently neutralizing virus in vitro increased with the progression of disease. Further immunization with synthetic peptides containing individual antibody epitopes indicated that antibodies to the epitopes are differentially effective in protecting from virus-induced demyelination. Taken together, these results suggest that antibodies to only certain linear epitopes are protective and such protection may be restricted during the early stages of viral infection.

Crossed-cerebellar diaschisis in cerebral infarction: technetium-99m-HMPAO SPECT and MRI

We studied 26 patients with a single supratentorial infarction using 99mTc-HMPAO SPECT and MRI to investigate the phenomenon of crossed-cerebellar diaschisis (CCD).

METHODS

From the total single-photon emission counts obtained from each cerebellar hemisphere, the percent difference between the contralateral (CCH) and ipsilateral (ICH) cerebellar hemispheres [delta %cbll = (CCH-ICH)/ ICH x 100] was calculated. Both SPECT (SVD) and MRI volume deficit (MVD) were measured to examine their relationship with CCD.

RESULTS

A CCD was observed in 12 of the 26 patients (46%) with cerebral infarction. There was no significant correlation between SVD and delta %cbll or MVD and delta %cbll in the patients with cerebral infarction. There were no significant differences in SVD and MVD between the patients with and without CCD. The frequency of CCD was significantly higher in the patients whose infarctions were in the frontoparietal lobes or the deep middle cerebral artery territory, including the basal ganglia and internal capsule (11/19) than in the patients whose infarctions were in other regions (1/7) (p = 0.048). The severely hemiparetic patients had a higher frequency of CCD and lower delta %cbll than the patients with milder or no hemiparesis (frequency, 5/5 compared with 6/18, p = 0.008; delta %cbll, -21.4% +/- 3.8% compared with -8.3% +/- 11.1%, p = 0.018). However, CCD also occurred in 5 of the 14 patients without hemiparesis and was not seen in 5 of the 12 hemiparetic patients. None of the patients with CCD demonstrated the apparent clinical signs of cerebellar dysfunction.

CONCLUSION

The location rather than the extent and severity of the lesion may be the major determinant for the occurrence and magnitude of CCD in patients with cerebral infarction. Our results also support the notion that CCD is a consequence of the interruption of the corticopontocerebellar pathway at the supratentorial level.

Serial magnetic resonance imaging (MRI) study of a patient with Balo's concentric sclerosis treated with immunoadsorption plasmapheresis

A 28-year-old Japanese woman with Balo's concentric sclerosis developed a rapidly progressive form of encephalopathy. Magnetic resonance imaging (MRI) showed multiple concentric lesions in the central white matter and the cerebellum. The administration of corticosteroid regimen resulted in little benefit. Immunoadsorption plasmapheresis led to a remission within 1 month of onset. Serial MRI study was described here for the first time, which allowed us to observe the development of concentric structures. The observation indicated that, initially, a central core, a round demyelinated area, and surrounding edema appeared around a vessel. Subsequently, concentric demyelinated bands formed simultaneously, not centrifugally, with diminution of the edema. Analysis of cerebrospinal fluid showed elevated levels of interleukin-6 and tumor necrosis factor-alpha. The success of immunoadsorption plasmapheresis therapy in this patient suggests that both humoral demyelinating factors and cell-mediated immunity may be involved in the pathogenesis of this disorder.

Suppression of cell-transferred experimental autoimmune encephalomyelitis in defibrinated Lewis rats

The role of coagulation-fibrinolysis system in experimental autoimmune encephalomyelitis (EAE) was studied by using batroxobin, derived from the venom of the South American pit viper Bothrops atrox moojeni. Batroxobin converts circulating fibrinogen into an insoluble form and causes a profound degree of afibrinogenemia. Batroxobin treatment (30 BU/kg/day) suppressed clinical signs of cell transferred EAE; the mean cumulative clinical score for batroxobin treated rats was 3.97, while saline treated controls scored 6.9 (P < 0.01). Plasma fibrinogen concentration decreased significantly in batroxobin-treated rats. Histologically, the degree of perivascular mononuclear cell infiltration in the spinal cord was not suppressed in batroxobin-treated rats compared to saline-treated control rats, however, deposition of fibrin around the vessels in the spinal cord was markedly suppressed in batroxobin-treated rats. These findings suggest that batroxobin suppresses EAE by preventing fibrin deposition, and provide evidence that CNS-associated deposition of fibrin and ensuing fibrinolysis, together with increased permeability of blood brain barrier (BBB), are related prerequisites for the clinical manifestation of EAE.

Low prevalence of immunogenetic markers of IDDM in adult Koreans with diabetes detected on OGTT

In the Asian populations, it is not uncommon for adult patients with NIDDM to eventually lose beta-cell function and develop IDDM. Accepting that IDDM is an autoimmune disease, which occurs on a genetic background, it could by hypothesized that by measuring autoantibody prevalence and HLA DQ gene polymorphism, known important prediagnostic markers of IDDM, the prevalence of adult-onset IDDM in patients with previously undiagnosed NIDDM patients could be estimated. To do this, anti-GAD prevalence and HLA DQ A1 and DQ B1 polymorphisms after PCR amplification of genomic DNA were analyzed in 121 newly diagnosed diabetic patients of Yonchon cohort and compared to the results with those of 100 matched health control subjects. We also compared the results with those of other populations to assess the difference of genotype distribution. The overall prevalence of anti-GAD antibodies was 1.7% (2 of 121) in patients with previously undiagnosed NIDDM, whereas 1 of 100 controls had positive antibodies. Among those who were positive, their titer of antibodies to GAD were not high. No statistically significant differences in the distribution of either mean levels of anti-GAD or DQA1 and DQB1 alleles were found comparing NIDDM patients to controls. Interestingly, the frequency of DQB1*non-Asp-57 and DQA1*Arg-52 alleles in the Korean adult control population was similar to that of US Caucasians (DQB1*non-Asp-57: 0.431 vs. 0.475; DQA1*Arg-52: 0.492 vs. 0.463). The low prevalence of anti-GAD antibodies and HLA-DQA1 and DQB1 susceptibility alleles among recent-onset NIDDM patients, not different compared to controls suggests that diabetes in Korean adults is unlikely to have an autoimmune component to its pathogenesis.

Community-based epidemiologic study on atherosclerotic cardiovascular risk factors

The present study was undertaken to determine the prevalence of hyperlipidemia and to find out the possible impact of serum lipid profiles on other cardiovascular risk factors in Yonchon County, Korea. Population-based cross-sectional study by random cluster sampling of registered residents over 30 years of age was performed. Out of the 3804 subjects scheduled for the survey, 2520 underwent the actual examination. The prevalence of hypercholesterolemia (serum cholesterol > or = 240 mg/dl) was only 1.2%, whereas that of hypertriglyceridemia (serum triglyceride > or = 250 mg/dl) was as high as 11.3%. The serum levels of cholesterol, triglyceride and HDL cholesterol correlated with anthropometric indices, body mass indices and waist hip ratios. The prevalences of diabetes and/or hypertension increased as either serum cholesterol or triglyceride level increased. In addition, the prevalence rates of obesity, impaired glucose tolerance, hypertriglyceridemia and hypercholesterolemia in its isolated form (free of the others) were much lower than overall prevalence indicating an existence of major overlap among these cardiovascular atherosclerotic risk factors in the form of multiple combinations. Central obesity was found to be an independent associated factor for the aggregation of the conditions related to the increase in cardiovascular risks. The prevalence of hypercholesterolemia in Yonchon County was substantially lower than that previously suggested, albeit that of hypertriglyceridemia was very high. We could also observe a varying degree of transition in cardiovascular risks related to insulin resistance from the rural to the urban area with rapid emergence of non-communicable diseases as a result of modernization.

[A study of soluble form of L-selectin in blood of patients with neuroimmunological disorders]

Members of the selection family mediate the first step of leukocyte-endothelial cell interaction in inflammatory lesion. We have examined the soluble form of L-selectin (sL-selectin) in patients with neuroimmunological disorders (48 multiple sclerosis, 2 Balo's sclerosis, 18 Guillain-Barré syndrome, 7 Miller-Fisher syndrome, 8 chronic inflammatory demyelinating polyneuropathy, and 25 human T-lymphotropic virus type-1 associated myelopathy). The levels of sL-selectin were measured by monoclonal antibody-based enzyme immunoassay on serum samples taken from patients with neuro immunological disorders. The level of sL-selectin were significantly decreased in the blood of patient with inactive stage of multiple sclerosis (MS), Guillain-Barré syndrome (GBS), and human T-lymphotropic virus type-1 associated myelopathy (HAM). The levels of sL-selectin in the sera of patients with active phase of MS tended to be high, but not significantly increased. The levels of sL-selectin, however, in the sort of patients with Balo's concentric sclerosis tended to be decreased. Thus, the findings that the serum concentrations of sL-selectin were decreased in stable phase of MS and acute phase of GBS and HAM suggest that sL-selectin may be differently involved in between patients with MS and patients with GBS or HAM.

The level of tumor necrosis factor-alpha producing cells in the spinal cord correlates with the degree of Theiler's murine encephalomyelitis virus-induced demyelinating disease

The levels of tumor necrosis factor (TNF)-alpha producing cells were analyzed in mice with Theiler's murine encephalomyelitis virus-induced demyelinating disease (TMEV-IDD). Using an ELISPOT assay, we demonstrate an increase in TNF-alpha producing cells in the spinal cords of TMEV-infected SJL/J mice, especially at an active disease stage. The numbers of TNF-alpha producing cells were extremely high in susceptible SJL/J mice compared with the numbers in resistant BALB/c and C57BL/6 mice. TNF-alpha producing cells were also immunohistochemically identified in active lesions of TMEV-IDD at acute as well as chronic stages. The percentage of TNF-alpha producing cells compared with the total number of cells isolated from spinal cords was higher in TMEV-infected SJL/J mice than resistant BALB/c and C57BL/6 mice. Correspondingly, the level of TNF-alpha was much higher in the culture supernatants of both infiltrating cells in the spinal cords and spleen cells from clinically affected animals than that from similarly treated resistant mice. Treatment of virus-infected mice with a mAb specific for TNF-alpha at the beginning of the onset of disease suppressed the development of the demyelinating disease. These findings suggest that TNF-alpha may play an important role in the pathogenicity of TMEV-IDD.

Relationships between angiotensin I converting enzyme gene polymorphism and renal complications in Korean IDDM patients

OBJECTIVES

The prognosis of IDDM is mainly dependent on complicated diabetic nephropathy which is probably determined by both metabolic abnormalities and genetic predisposition. Angiotensin I converting enzyme (ACE) regulates systemic and renal circulations through angiotensin II formation and kinins metabolism. The insertion(i)/deletion(D) polymorphism in intron 16 of ACE gene is strongly associated with ACE levels, and subjects homozygote for deletion (genotype DD) have the highest plasma values. Recently, it was reported that I/D polymorphism of ACE gene is associated with diabetic nephropathy in Caucasian IDDM patients. We studied the relationship between the ACE gene polymorphism and diabetic nephropathy in Korean IDDM patients.

METHODS

The study population consisted of 59 IDDM patients (duration > 5 yrs) and 107 control subjects. IDDM subjects were divided into 2 groups according to the presence or absence of diabetic nephropathy (with nephropathy: n = 31, without nephropathy: n = 28). After extraction of genomic DNA from peripheral blood leukocytes, PCR was performed using the sense primer (5' -GCC CTG CAG GTG TCT GCA GC-3') and anti-sense primer (3'-TGC CCA TAA CAG TGC TTC ATA -5'), respectively. The PCR products were electrophoresed in 2% agarose gels, and DNA was visualized directly with ethidium bromide staining.

RESULTS

Frequencies for II, ID and DD genotypes were similar in IDDM subjects and controls (23: 19:17 vs 49:41:17, p = 0.142) and derived allele frequencies for I and D alleles were similar in both groups (0.551:0.449 vs 0.649:0.351, p = 0.098). The ACE genotype distributions were not different in diabetic subjects with or without nephropathy (12:9:10 vs 11:10:7, p = 0.78) and derived allele frequencies were also similar (0.532:0.468 vs 0.571:0.429, p = 0.81).

CONCLUSION

The I and D allele frequency in our controls was different compared to ACE allele frequencies of Caucasian populations, but very similar compared to those of Chinese or Japanese subjects. We found that I/D polymorphism of ACE gene is not implicated in the diabetic nephropathy of Korean IDDM patients and may be explained by ethnic differences.

Quantitative lung perfusion scintigraphy in postoperative evaluation of congenital right ventricular outflow tract obstructive lesions

Improved methods to relieve pulmonary artery stenosis have emphasized the need for an accurate noninvasive method to quantify the pulmonary blood flow. The aim of this study was to compare the roles of Tc-99m MAA perfusion lung imaging, chest x-ray, MRI, and cine-angiography for postoperative evaluation of pulmonary blood flow in patients with congenital right ventricular outflow tract (RVOT) obstructive lesions. Eleven patients underwent chest x-ray, MRI, perfusion lung imaging, and cine-angiography after corrective surgery of RVOT obstruction. The perfusion ratio on lung scans was calculated on the posterior views. The correlation coefficient of the left to right perfusion ratio measured by lung scans obtained with that by visual assessment of chest x-rays, with the most stenotic diameter ratio on MRI and on angiography being 0.57, 0.88 (P < 0.001), and 0.87 (P < 0.001), respectively. Follow-up perfusion lung scans in seven patients, before and after pulmonary artery intervention showed significantly improved perfusion ratios (0.30 +/- 0.11 to 0.70 +/- 0.22; P < 0.001), which were concordant with the clinical findings. The authors conclude that the quantitative perfusion lung scan is the noninvasive method of choice for postoperative evaluation of the pulmonary artery in congenital RVOT obstruction.

Bone marrow scintigraphy using technetium-99m-antigranulocyte antibody in hematologic disorders

Bone marrow is the primary site for many hematologic disorders. To date, however, no suitable bone marrow imaging method has been found. The present study investigates the usefulness of bone marrow immunoscintigraphy using 99mTc-labeled antigranulocyte antibody (anti-NCA-95) in 31 patients with hematologic disorders.

METHODS

One milligram of antibody labeled with 259-370 MBq 99mTc was injected intravenously, and bone marrow images were taken 4 hr later. We also calculated the uptake ratios of lumbar bone marrow-to-background (L/B) and ilium-to-background (I/B).

RESULTS

Of 15 patients with aplastic anemia, 7 showed diffusely decreased antibody uptake (L/B = 2.3 +/- 0.8, I/B = 3.0 +/- 0.8) compared to control patients (n = 21, L/B = 8.2 +/- 2.5, I/B = 10.3 +/- 3.1) Six patients had both decreased and increased uptake areas and two had normal to slightly increased uptake. Of those patients receiving various types of therapy for aplastic anemia, all but one showed increased or irregular uptake. The degree of antibody uptake in the bone marrow correlated with peripheral blood analyses (hemoglobin, white blood cells, platelets). Of six patients with myelodysplastic syndrome, four had irregular uptake and two diffusely decreased uptake. Four patients with myelogenous leukemia showed normal uptake, whereas two with lymphocytic leukemia had decreased uptake. Patients with iron deficiency anemia, pure red cell aplasia or thalassemia minor exhibited normal uptake with bone marrow expansion.

CONCLUSION

Immunoscintigraphy with antigranulocyte antibody is a useful method for evaluating the bone marrow status of patients with various hematologic disorders.

Epitopes for thyroid-stimulating antibodies in Graves' sera: a possible link of heterogeneity to differences in response to antithyroid drug treatment

To evaluate the extent and clinical relevance of epitope heterogeneity for stimulating TSH receptor antibodies (TSHRAbs), we measured the activity of IgG preparations from 66 untreated patients with Graves' disease using Chinese hamster ovary (CHO) cells transfected with wild-type human TSHR and two TSHR chimeras with residues 9-165 (Mc1 + 2) or 90-165 (Mc2) substituted by equivalent residues of the LH/CG receptor. IgG from 68% of patients lose all of the stimulating TSHRAb activity with the chimeras; IgG from 27% lose most of the activity. Thus, we show that 95% of patients have stimulating TSHRAbs that require epitopes on the N-terminal portion of the extracellular domain of the TSHR and demonstrate the importance of epitopes within residues 90-165 for the first time. Heterogeneous epitope distribution, residual activity with one or both chimeras, i.e. with epitopes other than on the N-terminus of the TSHR, occurred in 21 patients (group A). Forty-five patients with homogeneous epitope distribution (group B) had stimulating TSHRAbs that depended only on epitopes on the N-terminus of the TSHR. Patients in group A were more likely to become euthyroid during antithyroid drug therapy and to do so more quickly than group B patients. The CHO-human TSHR cell system described herein appears to be as effective as the FRTL-5 rat thyroid system in stimulating TSHRAb detection; however, the two systems appear to measure different antibody populations in about 30% of cases. Further, stimulating TSHRAb activities measured in the FRTL-5 system tend to correlate better with goiter size and 99mTc pertechnetate uptake, whereas stimulating activities measured in the CHO-human TSHR/chimera system correlate better with free T4 and T3 levels.

[A study on the pathogenesis of hepatomegaly in patients with Crow-Fukase syndrome]

We studied pathogenesis of hepatomegaly in Crow-Fukase syndrome. Hepatocytes were isolated from BALB/c mice and cultured with serum or ascites of three patients with Crow-Fukase syndrome. After 24 hours culture, total number of hepatocytes was counted. The levels of human hepatocyte growth factor (h-HGF) in the serum were also measured. In the hepatocyte culture study, the numbers of hepatocytes after 24 hours cultured in the serum of two patients were significantly larger than those of the control group. When the hepatocytes were cultured with patients' serum after corticosteroid therapy, the survival numbers were markedly reduced. The serum levels of h-HGF in our three patients were 0.62, 0.52, 0.53 ng/ml respectively. They were all slightly higher than normal values (< or = 0.39 ng/ml). Our study indicates that in the serum or ascites of patients with Crow-Fukase syndrome, there may be some humoral factors other than h-HGF, which promote proliferation of hepatocyte or protect hepatocyte.

Intestinal leakage of technetium-99m-MDP in primary intestinal lymphangiectasia

We present a case in which a patient with primary intestinal lymphangiectasia demonstrated abnormal intestinal accumulation of tracer during 99mTc-methylene diphosphonate (MDP) skeletal scintigraphy. Early intestinal leakage with gradual colonic migration and concentration was confirmed by repeat bone scan with serial acquisitions. The mechanism for the intestinal localization of 99mTc-MDP seen in this patient is not clear. Thus, intestinal lymphangiectasia can be a cause for extra-osseous localization of bone scan agents in the intestine.

The low prevalence of immunogenetic markers in Korean adult-onset IDDM patients

OBJECTIVE

IDDM is an autoimmune disease that occurs among genetically susceptible individuals. In Asian populations, it is not uncommon for adult patients with NIDDM to eventually lose beta-cell function and develop IDDM. These individuals may be characterized by autoantibodies to GAD and high-risk HLA-DQ alleles, which are unlikely to be prevalent among patients with true NIDDM or in the general population. The objective of the present study was to evaluate and compare the prevalence of these immunogenetic markers in NIDDM patients and healthy nondiabetic individuals from Korea.

RESEARCH DESIGN AND METHODS

The prevalences of anti-GAD antibodies and HLA-DQA1 and DQB1 alleles among 121 patients with newly diagnosed NIDDM identified from a population-based study in Yonchon, Korea, and 100 matched healthy control subjects were evaluated and compared.

RESULTS

The overall prevalence of anti-GAD antibodies was 1.7% (2 of 121) in patients with previously undiagnosed NIDDM, whereas 1 of 100 control subjects had a positive test for antibodies. Among those who tested positive, titers of antibodies to GAD were not high. No statistically significant differences in the distributions of either mean levels of anti-GAD antibodies or DQA1 and DQB1 alleles were found comparing NIDDM patients with control subjects. Interestingly, the frequency of DQB1*non-Asp-57 and DQA1*Arg-52 alleles in the Korean adult control population was similar to that in the U.S. white population (DQB1*non-Asp-57: 0.431 vs. 0.475; DQA1*Arg-52: 0.492 vs. 0.463).

CONCLUSIONS

The low prevalence of anti-GAD antibodies and HLA-DQA1 and DQB1 susceptibility alleles among recent-onset NIDDM patients, which was similar to observations in control subjects, suggests that diabetes in Korean adults is unlikely to have an autoimmune component to its pathogenesis.

Suppression of Theiler's murine encephalomyelitis virus induced demyelinating disease by administration of gangliosides

Intracerebral (i.c.) inoculation of susceptible strains of mice with Theiler's murine encephalomyelitis virus (TMEV) results in immune-mediated demyelinating disease. Gangliosides are membrane components of essentially all eukaryotic cells and are abundant in plasma membranes. Endogenous gangliosides have been implicated in cell recognition, cell adhesion, cell differentiation and neurite outgrowth. We studied the effect of gangliosides on TMEV-induced demyelinating disease (TMEV- IDD). We injected TMEV intracerebrally into susceptible SJL/J mice and induced TMEV-IDD. Gangliosides were injected subcutaneously and examined for various immunological indicators. The results show that when gangliosides were administered in the effector phase, TMEV-IDD was suppressed both clinically and histologically. Cellular immunity such as delayed-type hypersensitivity, and the proliferative response of T cells against TMEV and mitogens were decreased, and only in this group anti-TMEV IgG2a antibody was not detected. Taken together, these data suggest that administration of gangliosides suppressed the function of pathogenic Th1 cells and suppressed TMEV-IDD. Additionally, this study proposes the possibility of a new therapy in multiple sclerosis.