Acute myeloblastic leukemia associated with an intermediate state between the healthy carrier state and adult T-cell leukemia

This report describes an intermediate state between the human T-cell lymphotropic virus type I (HTLV-I) healthy carrier and adult T-cell Leukemia (ATL) who developed acute myeloblastic leukemia (AML, FAB subtype M2). The polyclonal integration of HTLV-I proviral DNA was demonstrated in the peripheral blood lymphoid cells, whereas AML cells had no HTLV-I proviral DNA. The patient achieved remission after combination chemotherapy but cells with lobulated nuclei persist at a low level and the polyclonal integration of HTLV-I proviral DNA is still demonstrated. We suggest that the patients with the integration of HTLV-I proviral DNA might develop secondary neoplasms more frequently than healthy carriers and this case stresses the need to exercise caution with these patients. The relationship between HTLV-I and AML is briefly discussed.

[Cataract epidemiology survey in the three climatically different areas in Japan--prevalence of cataracts and types of lens opacification]

A cataract epidemiology study of 1,615 subjects from three climatically different places in Japan, village S in Hokkaido, town M in Noto and village Y in Okinawa, was conducted by one study group. Cataract diagnosis and grading of cataracts were objectively done with a photo-documentation system. The percentages of cataracts of over grade I classified by the Japanese Cooperative Cataract Epidemiology Study Group were 46.6%, 64.6% and 38.0% in village S, town M, and village Y, respectively. Those in their 50s, 60s, and 70s in the above places were 24.3%, 51.1% and 71.4% (village S), 38.4%, 65.3% and 84.6% (town M), and 25.2%, 42.9% and 65.4% (village Y), respectively. Cortical cataract was the most common, followed by nuclear and subcapsular types. Although the highest percentage of nuclear cataracts was seen in the subjects of village Y, subcapsular cataract was seen almost equally in the three areas. Lens transparency changes were evaluated by the light scattering intensities in the lens layers through photographed images. Intensity increased with ageing either linearly or exponentially.

Intravascular ultrasound imaging of peripheral arteries as an adjunct to atherectomy: preliminary experience

12 atherosclerotic lesions in nine patients, including four restenoses after balloon angioplasty, were treated by atherectomy under the guidance of intravascular ultrasound (US). Echogenicities of the plaques and morphological alterations in the arterial walls produced by atherectomy were evaluated. The two-layered appearance of post-angioplasty restenoses was found to be inner fibrous intimal thickening with proliferation of smooth muscle cells and outer residual collagen-rich plaque. The deep cut surfaces were shown as concave U-shaped defects. Medial tissues were present in all cases where intravascular US demonstrated the disruption of a thin hyperechoic layer of the internal elastic lamina. Intravascular US imaging may provide valuable information on the degree, eccentricity and histological type of stenosis, the presence of calcification before atherectomy, and on the extent of excision and the morphological changes in the arterial wall after atherectomy.

Impaired glucose uptake and intact gluconeogenesis in perfused rat liver after carbon tetrachloride injury

The dynamics of glucose movement across perfused livers were assessed in carbon tetrachloride (CCl4)-injured rats. Rats were given CCl4 for 8 weeks and became glucose intolerant and hyperinsulinemic. The fasted rat liver was cyclically perfused with 4 mM lactate and various concentrations (0-20 mM) of glucose for 20 min. In the CCl4-injured liver, net glucose output was less suppressed at high glucose levels than in the normal liver (147 +/- 70 vs 18 +/- 10 mumol at 20 mM glucose, P < 0.05). Deposition of the carbon from [14C] glucose into glycogen was stimulated at high glucose levels and was markedly reduced in the CCl4-injured liver compared to the normal liver (0.58 +/- 0.33 mumol vs 1.44 +/- 0.20 mumol at 20 mM, P < 0.01). Conversion of [14C] lactate to [14C] glucose was not different between the CCl4-injured and the normal liver at each glucose level. Deposition of the carbon from [14C] acetate into glycogen in the CCl4-injured liver was larger than that in the normal liver at 0 mM glucose (0.81 +/- 0.15 mumol vs 0.32 +/- 0.06 mumol, P < 0.01), but was similar to the normal at 20 mM glucose. In the CCl4-injured liver, utilization of exogenous glucose was impaired at high glucose levels, and gluconeogenetic activity was not impaired at low glucose levels. These changes in the hepatic glucose metabolism seem to account for postprandial hyperglycemia without fasting hypoglycemia associated with liver diseases.

[Successful treatment of aortic prosthetic valve endocarditis and aortic root abscess by Bentall procedure]

A 53-year-old woman had undergone aortic valve replacement in 1990. Three years later, aortic prosthetic valve endocarditis and aortic root abscess had been noted. Debridement of all apparently infected tissue created left ventricular-aortic discontinuity, but the orifice of the coronary arteries were intact. We decided to reconstruct the left ventricular outflow tract and aortic root by Bentall procedure. Composite graft was made with 26 mm gelseal tube graft and a 23 mm SJM prosthetic valve, and the coronary ostia were sutured into the side of the graft. The patient's recovery was uneventful, and the aortography revealed no aortic regurgitation. We suggest that Bentall procedure using gelseal tube graft is useful to reconstruct the left ventrivular-aortic discontinuity if the coronary ostia were intact.

Evaluation of lens transparency changes through photographed images during a 13-month observation period

Since the development of the anterior eye segment analysis system, several new types of anterior eye segment biometry have been performed. The main aim of this study was to evaluate whether changes in cataractous progression or an increase in lens transparency loss are detectable during a relatively short period of 13 months by measuring the intrapupillary opaque shadow area through retroillumination images or by calculating the light scattering intensity at the deepest cortical layer of the lens through Scheimpflug slit images. Secondly, the relationship between maximally dilated pupil sizes and patients' ages and that between cases with and without diabetes were studied. Thirty-one eyes (49.2%) of sixty-three cataractous lenses showed more than 5% increase in the opaque shadow area. Forty-five eyes (60.0%) showed more than a 5% increase in light scattering intensity. 92.5% of diabetic eyes and 92.3% of nondiabetic eyes showed pupil sizes over 6.5 mm after an instillation of mydriatica. In our study the applied method guaranteed a high reproducibility; thus is might be possible to detect an increase in cataractous changes and lens transparancy in around 50% of examined subjects in a period as short a 1 year. For the evaluation of cataract progression through a retroillumination image, the recommendable pupil size is > or = 6.5 mm.

Computed tomographic images and three-dimensional expression of crystalline lens findings from multiple slices of Scheimpflug slit images

Although the observation of lens changes in clinical examination has been made through a slit lamp microscope under dilated pupil, precise documentation and analysis of lens changes are presently possible through Scheimpflug photographic images. However, the methodology is still unsatisfactory because the image analysis is two dimensional. In order to overcome this disadvantage, the authors aimed at developing a new methodology for obtaining computed tomographic images of the lens. 60 Scheimpflug slit images of a cataractous human lens were taken by an anterior eye segment analysis system as digital data. After the locations of the whole slit images had been matched, reconstruction of the coronal section line images was performed utilizing extracted image information. The total number of reconstructed coronal section images in additional procedures of the image interpolation was 150. Computed tomography of the lens image was made from those 150 images. A whole lens figure was also demonstrated as a moving three dimensional image.

[Surgical treatment of infective endocarditis: application of DNA probe method]

DNA probe method is a new bacteriological method for diagnosis of bacteria. The authors tried to apply the method to diagnosis of bacteremia and treatment of infective endocarditis. We could diagnose the patient's illness as bacteremia with this method even when blood cultures are not positive. We suggest that cardiac surgery should be performed in case bacteria is detected repeatedly with DNA probe method. Therefore it is useful for decision whether cardiac surgery for patients with active infective endocarditis should be done or not.

Successful treatment of a 93-year-old patient with hypoplastic acute monocytic leukemia using macrophage colony-stimulating factor

A 93-year-old patient with hypoplastic acute monocytic leukemia (AMoL) achieved a complete remission after macrophage colony-stimulating factor (M-CSF) therapy. Initially, the patient was treated with a low dose of cytarabine, but this treatment proved ineffective. M-CSF was administered for 14 days by drip intravenous infusion, 800 x 10(4) units per day. After a gradual decrease in the number of leukemic cells, a rapid increase in neutrophils was observed in the peripheral blood, and a bone marrow examination 22 days after discontinuation of M-CSF medication revealed a complete remission. These findings suggest that M-CSF may be useful in treating some elderly patients who have hypoplastic AMoL.

Role of the sodium-calcium exchange mechanism and the effect of magnesium on sodium-free and high-potassium contractures in pregnant human myometrium

OBJECTIVE

Periodic uterine relaxation in labor relieves the fetus from hypoxia related to sustained contractions. A reduction in intracellular calcium is essential for relaxation. Therefore we aimed to clarify the extrusion mechanisms of intracellular calcium ions in pregnant human myometrium.

STUDY DESIGN

Isometric contraction of small muscle bundles obtained from human myometrium at term was recorded. High-potassium and sodium-free solutions could induce stable contractures that revealed initial phasic contractions followed by tonic contractions. The effects of external calcium, external magnesium, nifedipine, and calcium adenosine triphosphatase inhibitors on both contractures were then examined.

RESULTS

Because maximum tonic contraction was induced by 48 mmol/L potassium, this concentration was used. Both contractures depended on external calcium concentrations. Nifedipine, 10(-7) mol/L inhibited both initial phasic contractions and the tonic phase of the high-potassium contracture; however, it could not suppress the tonic phase of the sodium-free contracture. Calcium adenosine triphosphatase inhibitors, cyclopiazonic acid and lauryl sulfate, potentiated the tensions of tonic phases in both contractures; the effect of lauryl sulfate was stronger than that of cyclopiazonic acid. When external magnesium was gradually increased (from 0 to 9.6 mmol/L), both phasic contractions and the tonic phase of the high-potassium contracture transiently increased, followed by a reduction of tension, whereas the tonic phase of the sodium-free contracture was markedly inhibited by magnesium in a dose-dependent manner.

CONCLUSION

The presence of the sodium-calcium exchange mechanism and the specific inhibitory effect of magnesium were indicated in human myometrium during pregnancy. These mechanisms might prevent the long tonic contractions, to protect the fetus from hypoxia during pregnancy and parturition.

[Percutaneous transluminal angioplasty of the ilio-femoro-popliteal arteries: initial and long-term results]

The initial and long-term results of percutaneous transluminal angioplasty (PTA) were assessed in 254 atherosclerotic lesions of the ilio-femoro-popliteal arteries in 130 patients. There were 122 men and 8 women, aged 36-85 years (average, 68 years). Follow-up periods ranged from 1 to 131 months, with a mean of 42 months. PTA was performed in 6 patients in Fontaine's stage I, 112 patients in stage II, and 12 patients in stage III-IV. We reported initial success rates of 92%, 58%, 83% and 74% for iliac stenosis, occlusion, femoro-popliteal stenosis and occlusion, respectively. Overall, the initial success rate was 82% (203/247). The 5-year patency rates according to Kaplan-Meier analysis were 70%, 69% and 63% for iliac stenosis, occlusion and femoro-popliteal stenosis, respectively. In femoro-popliteal occlusion, the 1-year patency rate was 42%, which was significantly worse than that for stenosis (P < 0.01). The longest patency periods obtained were 131 months in the iliac artery, and 106 months in the femoro-popliteal artery. The recurrence rate within 6 months was significantly higher in patients with diabetes. The recurrence rate between 6 and 12 months was significantly higher in patients with poor run-off, and those of advanced age.

Urinary excretion of acid-soluble peptides in children with Duchenne muscular dystrophy

In order to investigate the validity of the hypothesis that acid-soluble peptides (ASP) in urinary excreta can be applied as an index of the protein catabolism of the whole body, we measured the urinary excretion of ASP in 46 normal children and in 18 children with Duchenne muscular dystrophy (DMD), in which continuous breakdown of skeletal muscle protein is presumed. The mean value of ASP in the children with DMD was significantly higher than that in normal controls. The concentration of ASP was correlated with that of 3-methylhistidine (3MH), which has been proposed as an index of muscle breakdown. This finding indicates that urinary ASP reflects the catabolism of body proteins. No correlation was observed between the concentration of ASP and that of 1-methylhistidine (1MH), which is used as an objective index of meat and fish ingestion. After the administration of bestatin, an inhibitor of leucine aminopeptidase, for 9 months, the urinary ASP concentration of children with DMD increased markedly. This increase is thought to have been directly caused by the bestatin itself. Urinary ASP is therefore apparently a more conveniently applied index of protein catabolism than is urinary 3MH, which requires the application of several restrictions. However, it should not be applied when the effect of bestatin administration is evident.

[Acquired resistance and cross-resistance of gemcitabine to cisplatin or vindesine in human lung cancer xenografted in nude mice]

One of the problems in the treatment of cancer is the development of resistance to anti-tumor agents when used repeatedly. We described the induction of resistance, cross-resistance to cisplatin (CDDP) or vindesine (VDS) and the side effects of gemcitabine, a new Ara-C derivative, in human lung cancers, Mqnu-1 or H-74 xenografted in nude mice. We investigated the effects of 4-week observation period. Gemcitabine was effective and did not show the acquired resistance when given repeatedly. In contrast, CDDP but not VDS, when given repeatedly, showed a decrease of the anti-tumor effect in the second course. Gemcitabine was still effective to the large tumor grown after CDDP or VDS therapy. Thus, gemcitabine may not develop resistance nor show cross-resistance to CDDP or VDS. In addition, repeated treatment with gemcitabine was much safer than CDDP or VDS. These results suggest that gemcitabine is a candidate for the first choice drug in cancer treatment.

Species difference in cholesteryl ester cycle and HDL-induced cholesterol efflux from macrophage foam cells

The species difference in the turnover rates of the cholesteryl ester (CE) cycle in macrophage foam cells (MFC) was examined in mice and rats. MFC were induced by acetyl-LDL and pulsed with [3H]oleate, followed by a chase with [14C]oleate. The replacement of the initial amount of cholesteryl [3H]oleate by cholesteryl [14C]oleate within 24 hours was 63% in mouse MFC, whereas it was 33% in rat MFC. The corresponding replacement in rabbit MFC was < 10%. In addition, HDL removed 41% of the CE mass from mouse MFC but only 22% from rat MFC. HDL-induced CE reduction from mouse MFC was enhanced by 40% by the inhibitor for acyl-coenzyme A:cholesterol acyltransferase (58-035), whereas the enhancing effect was not observed with rat MFC. These results indicate that the rate of CE turnover may serve as a critical factor to determine the capacity of MFC to respond to HDL-induced CE reduction, suggesting the possibility that the species difference in the turnover rates of the CE cycle in MFC might explain, in part, the species difference in susceptibility to experimental atherosclerosis.

[Antitumor activity of combination treatment combining gemcitabine with cisplatin or vindesine against human lung cancer xenografted in nude mice]

Gemcitabine is a new ara-C derivative and shows much more potent cytotoxic action than ara-C, which may be explained by the fact that its intracellular concentration can be maintained over a longer period. We investigated anti-tumor activity combining gemcitabine with cisplatin (CDDP) or vindesine (VDS) with a lung cancer line H-74 that was relatively insensitive to gemcitabine. Mice were observed for 8 weeks, including the 4 week treatment period and the subsequent 4 week drug-free period. The tumor growth inhibition rate, histological changes, and side effects were evaluated at 4 and 8 weeks after the initiation of therapy. The anti-tumor effects of treatment combining gemcitabine with CDDP or VDS were more potent and lasted longer than each drug separately. Statistical analysis shows that the treatment combining gemcitabine with CDDP was additive or synergistic at 4 and 8 weeks after initiation, whereas the treatment combining gemcitabine with VDS was only additive at 4 weeks after initiation and additive or synergistic at 8 weeks after initiation. The side effects of both combination groups were less than those observed in only CDDP or VDS-treated animals. These results suggest the usefulness of a combination therapy combining gemcitabine with CDDP or VDS in future clinical applications.

Visibility of epidermoid tumors on steady-state free precession images

PURPOSE

To determine whether steady-state free precession sequences improve the MR visibility of epidermoid tumors in comparison with spin-echo images.

METHODS

Patients were four women and three men with epidermoid tumors in the subarachnoid spaces. MR was performed with a 1.5-T superconductive unit. For steady-state free precession imaging, three-dimensional Fourier transform fast imaging with steady-state free precession (FISP) images were used (20-40/7 [repetition time/echo time], flip angle of 25 degrees). The visualization and contrast-to-noise ratio were compared in FISP images and spin-echo images. In one case, the images of FISP and fast low-angle shot were obtained with variable repetition times and flip angles to evaluate the best pulse sequences for the visualization of epidermoid tumors.

RESULTS

The contrast-to-noise ratios between tumors and cerebrospinal fluid ranged from 7.9 to 17.5 (average was 12.9) on FISP images. The average of contrast-to-noise ratios on T1, T2, and proton density-weighted spin-echo images were 1.6, 2.0, and 4.2, respectively. Three-dimensional Fourier transform FISP images best showed central nervous system and demonstrated epidermoid tumors excellently.

CONCLUSIONS

Epidermoid tumors in the subarachnoid spaces were better demonstrated on steady-state free precession (three-dimensional Fourier transform FISP) than on conventional spin-echo images.

Lipopolysaccharide primes human basophils for enhanced mediator release: requirement for plasma co-factor and CD14

Lipopolysaccharide (LPS) is known to enhance IgE-mediated basophil degranulation. Recently, the complex of LPS and plasma LPS-binding protein(LBP) has been shown to induce secretory response via CD14 in monocytes and neutrophils. In the current study, we observed that the sensitivity to LPS of basophils was increased to 100-fold by co-incubation with plasma. LPS promptly completed its effect and amplified degranulation by stimuli bypassing IgE-receptors. Treatment with anti-CD14 completely abolished the priming effect of LPS. These results indicate that the priming effect of LPS on basophil mediator release is mediated via CD14, and that plasma co-factor, possibly identical to LBP, potentiates this reaction.

Enhanced chemiluminescence response of polymorphonuclear leukocytes by new quinolone antimicrobials

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

Specific immunotherapy reduces the antigen-dependent production of eosinophil chemotactic activity from mononuclear cells in patients with atopic asthma

BACKGROUND

The efficacy of specific immunotherapy has been verified. There is accumulating evidence focusing on the T lymphocyte-eosinophil interaction in the pathogenesis of asthma. The aim of this study was to clarify whether immunotherapy affects the production of eosinophil chemotactic activity (ECA) from peripheral blood mononuclear cells (PBMC).

METHODS

PBMC obtained from persons with bronchial asthma who were sensitive to Dermatophagoides farinae (Df) or from healthy volunteers were cultured for 96 hours in the presence or absence of Df. ECA in culture supernatants was assayed by means of the modified Boyden's chamber method.

RESULTS

There was no significant difference in the baseline levels of ECA between asthmatic persons treated with immunotherapy and those without immunotherapy. The addition of Df (10 to 10(4) ng/ml) enhanced the ECA production in a dose-dependent fashion in asthmatic persons without immunotherapy, and there was a statistically significant correlation between the concentrations of Df and the levels of ECA (rk = 0.34; p < 0.05). In contrast, Df-dependent ECA production was suppressed in asthmatic persons with immunotherapy, and the suppressive effect was observed from 4 weeks after rush immunotherapy.

CONCLUSIONS

These results indicate that immunotherapy induces the suppression of antigen-dependent production of ECA from PBMC. This may contribute to the attenuation of eosinophil infiltration into the airways in asthma patients.

[A case of quadricuspid aortic valve associated with mitral insufficiency]

We report a case of a 70-year-old woman who had congenital quadricuspid aortic valve. She had undergone Manouguian's operation because of the narrow annulus associated with aortic steno-insufficiency and mitral insufficiency. The aortic valve was found to have 4 equal-sized cusps. The noncoronary cusp was divided into two equal parts. This congenital quadricuspid valve was extremely rare anomaly and we have nerve seen the case which had been corrected surgically by Manouguian's procedure. The aortic valve was replaced by a 23 mm St. Jude Medical prosthesis and the mitral valve was replaced by a 29 mm CarboMedics prosthesis. The postoperative course was uneventful and she is doing well six months after operation.

[Combination chemotherapy of BOF-A2, a new 5-FU derivative, with various anticancer agents against human cancer xenografts in nude mice]

In order to select a suitable combination chemotherapy with BOF-A2 from the view of both anti-tumor effect (IR) and decrease of side effect, we studied a combination significance of BOF-A2 with CPT-11 that promised for a new anticancer drug, CDDP or mitomycin C (MMC) that used widely to many cancer patients and interferon-alpha (IFN-alpha) against colon, stomach and renal cancer, respectively, by using xenografted nude mice. The combination therapy of BOF-A2 with CDDP was effective against stomach cancer (H-111) from the cellular change and decreased side effect. The combination therapy of BOF-A2 with MMC showed additive effect against stomach cancer (H-111) from IR and cellular changes. The combination effect of BOF-A2 with IFN-alpha was additive and synergistic against renal cancer (H-12). The combination therapy with CPT-11 was effective (IR > or = to 58%) from antitumor effect, additive from IR and synergistic from cellular change against lung cancer (H-74) and colon cancer (H-110), to which conventional drugs were generally insensitive and spontaneously tolerant. BOF-A2 was expected to be a promising new anti-cancer agent in the future clinical trial.