[A case of dural arteriovenous malformation associated with progressive dementia showing marked improvement with endovascular treatment]

An 81-year-old man was admitted with a 3-month history of progressive dementia. Neurological examination revealed marked dementia, parkinsonism and myoclonus in his extremities. His cerebrospinal fluid examination was normal. An electroencephalogram showed a mildly slowed background. Computed tomography (CT) disclosed diffuse low-density areas in bilateral cerebral white matter. Contrast-enhanced CT demonstrated vermiform enhancement of engorged cortical veins, suggesting increased pressure of the venous system. Magnetic resonance imaging (MRI) disclosed diffuse high-intensity areas in bilateral cerebral white manner on T2-weighted images, and abnormal flow-voids presenting venous congestion on proton-density images. Cerebral angiography revealed arteriovenous malformation (AVM) fed by four branches of the right external carotid artery with retrograde drainage into the right transverse sinus, superior sagittal sinus, and dilated cortical veins. The ipsilateral sigmoid sinus was not visualized. After transarterial embolization, transvenous embolization of the right transverse sinus was performed. These treatments resulted in a marked clinical improvement. We emphasize the role of AVM as a cause of progressive dementia.

Hematopoietic cytokine-dependent differentiation to eosinophils and neutrophils in a newly established acute promyelocytic leukemia cell line with t(15;17)

We recently established an acute promyelocytic leukemia (APL) cell line (HT93) that has the capacity to differentiate into neutrophils and eosinophils in response to all-trans retinoic acid (ATRA) and human hematopoietic cytokines. The cells had a myeloblastic morphology, were positive for surface CD33, CD34, and CD56, and showed the following karyotypes: 46, XY, t(1;12)(q25;p13), 2q+, t(4;6)(q12;q13), and t(15;17)(q22;q11). When the cells were cultured with ATRA, they showed nuclear segmentation and developed secondary granules consisting in part of neutrophils and eosinophils. In the presence of ATRA and granulocyte colony-stimulating factor (G-CSF), the cells showed polymorphonuclear neutrophil differentiation accompanied by expression of surface CD11b, CD15, CD10, positive activity for neutrophil alkaline phosphatase (NAP), and NAP mRNA expression. In cultures with ATRA and granulocyte-macrophage colony-stimulating factor (GM-CSF), IL (interleukin)-3, or IL-5, HT93 showed remarkable eosinophil maturation at day 8 as determined by luxol fast blue staining, in addition to expression of eosinophil peroxidase and major basic protein. These results indicate that HT93 is an APL cell line with the ability to differentiate into neutrophils and eosinophils, and that these lineages are dependent on the CSF added. HT 93 should prove to be a useful model in analyzing the effects of hematopoietic cytokines on proliferation, differentiation, and maturation of hematopoietic progenitors.

Application of chlorophyll fluorescence to evaluate Mn tolerance of deciduous broad-leaved tree seedlings native to northern Japan

We used chlorophyll fluorescence to examine photosynthetic responses to excess Mn accumulation in leaves of four tree species differing in successional traits. Betula ermanii Cham. (Be) and Alnus hirsuta Turcz. (Ah) were studied as representatives of early-successional species. Ulmus davidiana Planch. var. japonica (Rehder) Nakai (Ud) was selected as a mid-successional species, and Acer mono Maxim. var. glabrum (Lév. et Van't.) Hara (Am) was chosen as a late-successional species. In Be, Ah and Am, high foliar concentrations of Mn had little effect on maximum photochemical efficiency of photosystem II (PSII), as indicated by the values of dark-adapted F(v)/F(m), whereas a significant decrease was observed in Ud. Photochemical quenching (qP) and the excitation capture efficiency of open PSII (F'(v)/F'(m)) decreased with increasing leaf Mn concentration at photosynthetic steady state after a 15-min exposure to 430 &mgr;mol m(-2) s(-1) PPFD. Compared with early-successional species, these decreases were greater in mid- and late-successional species leading to lower effective quantum efficiencies of PSII (DeltaF/F'(m) = qP x F'(v)/F'(m) = (F'(m) - F)/F'(m)). To determine the extent of photoinhibition, F(v)/F(m) of the illuminated leaves was remeasured after a 15-min dark period. Compared with the dark-adapted F(v)/F(m), we observed a significant decrease in F(v)/F(m) in Am leaves containing high concentrations of Mn. These chlorophyll fluorescence studies indicate that the early-successional species Be and Ah have a higher tolerance to excessive accumulations of Mn in leaves than the mid- and late-successional species Ud and Am.

Establishment of a GM-CSF-dependent megakaryoblastic cell line with the potential to differentiate into an eosinophilic lineage in response to retinoic acids

We recently established a human granulocyte-macrophage colony-stimulating factor (GM-CSF)-dependent cell line (HML) from colony-constituent cells grown by peripheral blood cells of a patient with acute megakaryoblastic leukaemia. The HML cells possessed megakaryocytic features, as determined by cytochemical, electron microscopic and flow cytometric analysis. In the present study we examined the effects of retinoic acid (RA) on the development of HML cells. All-trans-RA, 13-cis-RA and 9-cis-RA at 10(-8) mol/l to 10(-5) mol/l inhibited the GM-CSF-dependent cell growth. Some of the RA-treated cells contained prominent azurophilic granules and were positive for peroxidase. They also reacted with Biebrich scarlet, Luxol fast blue and a monoclonal antibody against eosinophil peroxidase. In addition, exposure to RA increased the frequency and the intensity of major basic protein-positive cells. However, eosinophil-derived neurotoxin and eosinophil cationic protein were not detected or were only detected at a low level in the lysates of the HML cells treated with RA. Although IL-5 alone could not stimulate cell growth, the addition of IL-5 to the cultures containing stem cell factor + all-trans-RA was required for the expression of the eosinophilic phenotype. These results suggest that the HML cell line is a megakaryoblastic cell line with the potential to differentiate into the eosinophilic lineage. HML cells may be a useful model for elucidating the eosinophilic differentiation programme.

Ciprofloxacin immunomodulation of experimental antiphospholipid syndrome associated with elevation of interleukin-3 and granulocyte-macrophage colony-stimulating factor expression

OBJECTIVE

To evaluate the immunomodulatory potential of ciprofloxacin in mice with experimental antiphospholipid syndrome (APS).

METHODS

Ciprofloxacin or ceftazidime (control antibiotic) was given to mice with experimentally induced APS. The titers of autoantibodies, levels of cytokines, and number of cytokine-producing cells were determined by enzyme-linked immunosorbent assay. Myeloid progenitor cells were determined by granulocyte-macrophage colony-forming unit, and interleukin-3 (IL-3) messenger RNA (mRNA) was tested by Northern analysis.

RESULTS

A decrease in the incidence of pregnancy loss and an improvement in the clinical manifestations of APS were noted in the mice treated with ciprofloxacin, compared with the mice given ceftazidime. The effect of ciprofloxacin was found to be associated with increased serum levels of IL-3 and with increased IL-3 mRNA transcription in the splenocytes. Expression of granulocyte-macrophage colony-stimulating factor (GM-CSF) was documented by elevated titers in the sera and elevated numbers of colony-forming cells in the bone marrow.

CONCLUSION

Ciprofloxacin prevents the manifestations of experimental APS. This effect may be associated with increased IL-3 levels and GM-CSF expression.

A resected case of hilar type double primary lung cancer following endobronchial brachytherapy

A 61-year-old man with squamous cell carcinoma of the right B1 and the left second carina which extended to the left main bronchus, was treated with low dose rate brachytherapy bilaterally prior to resection. A complete response was gained at the right B1 and the left main bronchus, a resection of the left apical segment and the second carina was carried out with bronchoplastic procedures. The patient remains disease-free 2 years after the operation and maintains a good quality of life. In this case, the preoperative treatment with brachytherapy was effective.

[Correlation between 13C-urea breath test and gastric histological findings in Helicobacter pylori positive patients]

13C-urea breath test (UBT), available for diagnosis of Helicobacter pylori (HP) in the stomach, measures the 13CO in the breath in which 13C urea is resolved in the stomach by urease derived from HP. Accordingly UBT is useful for a test of HP infection. This study is aimed at clarifying the relationship between the UBT and gastric histological findings. For this study we selected 63 patients with HP infection who showed both positive UBT and positive histological diagnosis. Briefly in the UBT procedure, the patients were given 13C-urea (100 mg dissolved 100 ml water) in a fasting state and kept in the left decubitus position for 5 minutes, and then the patients were asked to expire into testing bags before and 20 minutes after administration of the urea. Biopsy specimens were taken endscopically from the gastric antrum and the body. The specimens of all patients showed positive CLO test. HP organisms, inflammation, activity, and atrophy of the gastric specimens, were expressed in score from 0 to 3 according to the Update Sydney system. The UBT values were high correlated with the increase of HP organisms. The UBT was 11.8, 26.3, and 37/1000 in the groups with the scores of 0.1, and 2 in the number of HP organisms from the gastric body, respectively. The UBT was 19.2, 22.2, 36.1, 26.7/1000 in the groups with scores of 0, 1, 2, and 3 for the specimens from the antrum, respectively. The results show that there is a positive correlation between the UBT values and HP organisms. As a result, the UBT correlated with the activity score. Grade of gastric mucosal atrophy was expressed histologically in scores of 0,1,2, and 3. The UBT was 29.4, 19.1, 17.5, and 9.3/1000 in the groups with scores 0,1,2, and 3 in the grades of gastric atrophy from the gastric body, respectively. There was a negative correlation between the UBT values and the grade of gastric atrophy. We conclude that the UBT values which indicate the number of HP organisms can be used not only for diagnosis of HP infection but also the quantitative index of HP load.

[Antiphospholipid syndrome]

Antiphospholipid antibodies (aPL) are a family of autoantibodies with specificity for negatively charged phospholipids, or more accurately for their complex to phospholipid binding proteins. Their presence is associated with arterial/venous thrombosis and recurrent pregnancy loss. These clinical manifestations with the persistence of aPL are recognized as antiphospholipid syndrome(APS), one of the most common acquired thrombophilia. beta 2-glycoprotein I(beta 2GPI) bears the epitope(s) for anticardiolipin antibodies (aCL) on its molecule, and lupus anticoagulant activity depends on the presence of beta 2GPI or prothrombin. Thus phospholipid binding proteins may have some crucial roles in the pathophysiology of thrombotic events in APS. It has been hypothesized that aPL bind to cells and induce procoagulant activity via phospholipid binding proteins.

Subclinical alterations in coagulation and fibrinolysis in patients undergoing autologous peripheral blood stem cell transplantation

We monitored 30 laboratory hemostatic parameters in an attempt to better comprehend alterations in coagulation and fibrinolysis in 10 patients with hematological malignancies subjected to autologous peripheral blood stem cell transplantation (APBSCT). These parameters were assessed before and just after high-dose conditioning chemotherapy, on days 1, 7, 14 and 28. Although, clinical manifestations associated with fibrino-coagulation disorders never occurred, including veno-occlusive disease, a statistically significant increase was seen in 7 of 30 parameters, compared to values seen before conditioning chemotherapy. These were subdivided into early and late phase parameters. The early phase parameters, which increased during the first day after the conditioning chemotherapy was given, then returned to baseline values, included protein C, plasma tissue factor and tissue-plasminogen activator. The late phase parameters, which increased over baseline values during days 7 to 28, included free-protein S, fibrinogen, plasmin-alpha2-plasmin inhibitor complex and soluble-thrombomodulin. The increase of early phase parameters, as produced by the liver and by endothelial cells, may reflect tissue damage by conditioning chemotherapy. Late phase parameters increased in parallel with C-reactive protein, which suggests a correlation with the degree of inflammation, such as the presence of infective disease during neutropenia. These subclinical alterations in coagulation and fibrinolysis which take on a biphasic pattern during the course of APBSCT should be kept in mind by the attending physicians during therapy.

IgA class anti-beta2-glycoprotein I in patients with systemic lupus erythematosus

OBJECTIVE

To search for a possible relationship between the presence of IgA class anti-beta2-glycoprotein I antibody (abeta2-GPI) and clinical manifestations, including thrombotic episodes, in patients with systemic lupus erythematosus (SLE).

METHODS

Serum IgA abeta2-GPI levels in 124 Japanese patients with SLE were measured using a phospholipid independent enzyme immunoassay. Relationships to clinical histories and to various laboratory data including IgG and IgM class abeta2-GPI were examined.

RESULTS

Twenty-five percent of patients with SLE were positive for IgA abeta2-GPI. Patients with a history of thrombosis had significantly higher probabilities for positivity of IgA abeta2-GPI, compared to those without. The presence of IgA abeta2-GPI was correlated with presence of lupus anticoagulant and/or biological false positive result for serological syphilis test. Titer of IgA abeta2-GPI significantly correlated with values of IgG abeta2-GPI, IgM abeta2-GPI, and anti-DNA antibodies.

CONCLUSION

The presence of IgA abeta2-GPI may be related to the occurrence of thrombosis in patients with SLE. Measurements of IgA abeta2-GPI may be of value for evaluating risk of thrombosis in patients with SLE.

Acquired immune thrombocytopenia caused by IgG antiglycoprotein Ib antibody in a patient with Hodgkin's disease

We studied a patient with thrombocytopenia associated with Hodgkin's disease (HD). The megakaryocyte number in the bone marrow and the level of platelet-associated IgG were both increased in the patient. Intravenous gamma-globulin therapy and chemotherapy for HD dramatically normalized the platelet count, suggesting that antibody produced by lymphoma cells is likely to account for the thrombocytopenia. Antigen-captured ELISA and Western blotting showed that the patient's serum had an IgG autoantibody against platelet membrane glycoprotein Ib. The patient's plasma had no inhibitory effect on normal platelet aggregation induced by ristocetin. These findings suggest that the autoantibody found in the patient had a pathogenetic role in the thrombocytopenia, but not in platelet dysfunction.

Identification of an autocrine chondrocyte colony-stimulating factor: chondromodulin-I stimulates the colony formation of growth plate chondrocytes in agarose culture

Chondrocytes are unique among non-transformed cells in that they are capable of anchorage-independent growth in soft agar. Fibroblast growth factor (FGF) is known as a potent colony-stimulating factor for chondrocytes. However, cartilage extracts contain a potent colony-stimulating activity which is not explicable only by contaminating FGF. We previously isolated the 25 kDa cartilage-specific glycoprotein chondromodulin-I (ChM-I) which stimulates the growth of chondrocytes. In the present study, we observed that ChM-I stimulates the colony formation of rabbit growth plate chondrocytes in agarose culture. ChM-I alone weakly stimulated the formation of chondrocyte colonies, but it markedly stimulated colony formation synergistically in the presence of an optimal dose of FGF-2. This effect was dependent on the dose of ChM-I. These results suggest that ChM-I participates in an autocrine signaling mechanism for the anchorage-independent growth of chondrocytes in vitro.

Anastomosis of the superficial temporal artery to the middle cerebral artery with the interposed occipital artery graft in moyamoya disease: case report

BACKGROUND

Although there have been various interposed bypass grafts used for cerebral revascularization, the occipital artery has never been used as a graft. Interposed occipital artery bypass graft in an adult case with moyamoya disease after failed indirect revascularization is presented.

CASE DESCRIPTION

This 34-year-old woman with moyamoya disease, who had suffered from cerebral ischemic symptoms since the age of 6 years, was admitted to our hospital because of an intracerebral hemorrhage on the left side. She had undergone superficial temporal-to-middle cerebral artery anastomosis, encephalo-galeo-synangiosis on the right side, and encephalo-duro-arterio-synangiosis on the left side at age 29 years. Four months after the intracerebral hemorrhage, she still had cerebral ischemic symptoms in the left hemisphere where cerebral revascularization was poor. Since neither the superficial temporal nor occipital artery could be used for direct anastomosis because of spontaneous transdural anastomoses of the superficial temporal artery and the short length of the occipital artery, anastomosis between the left superficial temporal artery and left posterior parietal artery was performed using a left occipital artery graft 6 months after the hemorrhage. Postoperative external carotid angiograms showed good patency of the graft.

CONCLUSION

In cases in which direct anastomosis is infeasible for cerebral revascularization, the occipital artery could successfully be used as a bypass graft.

Analysis of synergism between stem cell factor and granulocyte-macrophage colony-stimulating factor on human megakaryoblastic cells: an increase in tyrosine phosphorylation of 145 kDa subunit of c-kit in two-factor combination

In normal hematopoiesis, stem cell factor (SCF) stimulates survival, proliferation and differentiation of hematopoietic progenitors. Although SCF acts synergistically with a variety of cytokines, the mechanism of growth factor-cooperation remains to be determined. To analyze the synergism between SCF and granulocyte-macrophage colony-stimulating factor (GM-CSF), we established a new megakaryoblastic cell line, HML-2, by culture in the presence of both SCF and GM-CSF. While SCF alone or GM-CSF alone supported modest cell growth, SCF and GM-CSF together induced substantial growth of this cell line. SCF alone tyrosine-phosphorylated several bands including the 145 kDa subunit of c-kit. GM-CSF alone did not cause the tyrosine phosphorylation of the 145 kDa subunit, but markedly up-regulated the expression of the 145 kDa subunit of c-kit. The combination of SCF and GM-CSF resulted in a synergistic increase in tyrosine phosphorylation of the 145 kDa subunit of c-kit. Several proliferation inhibitors which removed the two-factor interaction on the growth of the HML-2 cells down-regulated the 145 kDa subunit of c-kit. Thus, a synergistic increase in tyrosine phosphorylation of the 145 kDa subunit of c-kit may be one possible mechanism underlying the cooperation of SCF and GM-CSF on the HML-2 cell growth.

Effects of transfection of p210bcr-abl and bcr-v-abl into the factor-dependent human leukemia cell line HSM-911

In order to clarify the action of the bcr-abl, a growth factor dependent human leukemic cell line (HSM-911) was transfected with p210bcr-abl or bcr-v-abl by electroporation. The cells transfected with bcr-v-abl, but not the cells transfected with p210bcr-abl, became growth factor independent. Some clones of the cells transfected with p210bcr-abl demonstrated cellular maturation (nuclear segmentation, becoming positive for naphthol ASD chloroacetate esterase, the disappearance of CD34 expression and the appearance of glycophorin A and CD10 expression). Moreover, these clones transfected with p210bcr-abl demonstrated apoptosis (increased expression of Fas and DNA ladder formation suggesting apoptotic DNA fragmentation). These findings demonstrated the different actions of p210 bcr-abl and bcr-v-abl, the former of which gave the cells the characteristics of maturation like the cells from chronic myelogenous leukemia, and the latter of which rendered the cells grow autonomously.

An aggressive case of Burkitt's lymphoma with t(8;14) and c-myc rearrangement transformed from CD5+ B-cell lymphoma

We experienced a case of Burkitt's lymphoma showing an unusual surface phenotype, CD5 expression, at an early stage of the disease. Initially, this patient showed massive abdominal para-aortic lymph node swelling which rapidly developed into leukemic change. Based on the clinical course and cytogenetic features of lymphoblasts in the bone marrow, which showed t(8;14) and c-myc gene rearrangement, the patient was diagnosed with Burkitt's lymphoma. Combination chemotherapy induced short-term remission, but central nervous system (CNS) involvement developed, followed by a regrowth of lymphoma cells in the bone marrow. The bone marrow at the end stage showed monotonous expansion of large cells with conspicuous vacuolation in the basophilic cytoplasm. The initial lymphoma cells showed pan-B markers and were CD5 positive but weakly CD10 positive; however, the lymphoma cells obtained from the bone marrow at the terminal stage did not express CD5. The chromosomal t(8;14) was seen, and identical rearrangement of immunoglobulin heavy chain joining gene and c-myc gene were detected by Southern blot analysis in the bone marrow lymphoblasts throughout the clinical course. This case is evidence that remarkable transformation of CD5-positive lymphoblasts to CD5-negative lymphoblasts occurred in an identical clone of Burkitt's lymphoma.

Intra-aneurysmal pressure changes during angiography in coil embolization

BACKGROUND

Although elevation of blood pressure in aneurysms induced by injection of contrast medium has been postulated as a major cause of rerupture of ruptured cerebral aneurysms during angiography, no study has proved the elevation of intra-aneurysmal pressure because of difficulty in measuring the intra-aneurysmal pressure during angiography. The present study demonstrated intra-aneurysmal pressure to be raised by injection of contrast medium, using a microcatheter introduced into aneurysms.

METHODS

To confirm the accuracy of pressure measurement through a microcatheter, we measured intra-aneurysmal pressure in a plastic model of an artery and an aneurysm during and after injection of contrast medium through a microcatheter and a needle inserted into the aneurysm. In a clinical study, intra-aneurysmal pressures were measured through the microcatheter in nine cerebral aneurysms of seven patients.

RESULTS

In the model experiment, changes in the pressure measured through the microcatheter correlated well with those observed through the needle. In the clinical study, intra-aneurysmal systolic pressures increased by 5-23 mm Hg immediately after injection of contrast medium for 1-3 s in four basilar tip, three internal carotid-ophthalmic, and one middle cerebral artery aneurysm, whereas no pressure change was observed in a posterior cerebral artery aneurysm. Systemic blood pressure during angiography remained unchanged in all cases.

CONCLUSIONS

This abruptly elevated intra-aneurysmal pressure by injection of contrast medium might cause rerupture of an aneurysm soon after rupture of the aneurysm, especially when the rupture site is fragile.

Expression of somatostatin receptor subtype 2 mRNA in human lymphoid cells

We analyzed the mRNA expression of somatostatin receptor subtypes 1 to 5 (SSTR1-5) in human lymphoid cell lines, human peripheral blood lymphocytes (PBL), and human lymphatic leukemia cells, using the reverse transcription-polymerase chain reaction method. In human lymphoid cell lines, SSTR2 mRNA expression was clearly detectable, and there was no evidence of SSTR1 mRNA expression. SSTR2 mRNA was barely detectable in PBL from healthy individuals but was clearly detectable in EB virus-transformed lymphocytes. Lymphocytes from some of the leukemic patients showed elevated SSTR2 mRNA expression. SSTR2 mRNA expression in PBL was upregulated upon stimulation by PHA. SSTR3 mRNA was also observed in all the cell lines examined, although in one cell line, the expression was weak. Some cell lines showed little or no SSTR4 or 5 mRNA expression. The expression pattern of SSTR2 mRNA suggests that this receptor may have some important roles in lymphocyte activation, development, and/or tumorgenesis.

Diversity in the renal hemodynamic effects of dihydropyridine calcium blockers in spontaneously hypertensive rats

Effects of dihydropyridine (DHP) Ca2+ channel blocker (CaB) on glomerular hemodynamics are controversial. We examined the effects of two DHP derivatives, benidipine hydrochloride (BDP) and nifedipine (NDP), on glomerular hemodynamics by an in vivo micropuncture method by using spontaneously hypertensive rats (SHRs). Systemic bolus infusion of BDP (4 microg/kg) or NDP (250 microg/kg) elicited comparable decreases in mean arterial blood pressure (MAP). The proximal stop-flow pressure (Psf), an indicator of glomerular capillary pressure, revealed significant decreases in BDP but nonsignificant increases in NDP. To minimize the influence of MAP or other systemic events, we monitored Psf during perinephron infusion of CaB and observed significant increases in Psf during 10(-3) M NDP perfusion and nonsignificant changes with 10(-3) M BDP. Moreover, the stability of Psf during alteration of renal perfusion pressure was significantly impaired in the nephron treated with topical NDP. These findings support the notion that CaB has diverse effects on glomerular hemodynamics, and such effects may in part be the result of different pharmacologic actions on the renal microvasculature.

Identification of surface molecules on eosinophils and lymphocytes in blood from patients with eosinophilia

Surface molecules on eosinophils and lymphocytes in blood from patients with hypereosinophilic syndrome (HES), Kimura's disease and normal volunteers were examined. In all 3 patients with HES, CD54-positive eosinophils were increased and in some patients with HES and Kimura's disease HLA-DR-positive eosinophils were increased. Additionally, CD11b-positive, CD16-positive, CD25-positive, CD54-positive, CD69-positive and HLA-DR-positive lymphocytes were increased in some of these patients.