Hypertrophic olivary degeneration: MR imaging and pathologic findings

PURPOSE

To assess magnetic resonance (MR) imaging findings of hypertrophic olivary degeneration (HOD) due to hemorrhage and correlate them with pathologic findings.

MATERIALS AND METHODS

MR imaging was performed in 11 patients--eight with pontine tegmental hemorrhages (THs) and three with cerebellar hemorrhages in the dentate nuclei. The interval from hemorrhagic ictus to the MR studies was 3 weeks to 49 months. Pathologic specimens came from a woman who died of brain stem hemorrhage.

RESULTS

Involvement of the central tegmental tract produced ipsilateral HOD; that of the dentate nucleus or superior cerebellar peduncle produced contralateral HOD. Bilateral olivary changes occurred only when the TH also involved the superior cerebellar peduncle. In bilateral THs, HOD was limited to the dominant bleeding side because of the lateral position of the central tegmental tract. Hyperintense areas of the oliva appeared 3 weeks after ictus. Hypertrophy appeared after 5-15 months. Microscopically, vacuolar degeneration of neurons and hypertrophy of astrocytes with gliosis were seen.

CONCLUSION

MR images may depict very early neuronal changes in the oliva and are well correlated with pathologic staging.

[Transluminal atherectomy for occlusive peripheral vascular disease: preliminary results]

We studied the preliminary results of atherectomy of atherosclerotic lesions involving the lower extremities in 10 patients. Fifteen arterial stenotic lesions, five iliac, eight superficial femoral, one popliteal, and one anterior tibial, were treated. Five lesions were re-stenoses after balloon angioplasty, while the remaining lesions were previously untreated primary stenoses. For atherectomy, over-the-wire atherectomy catheters ranging in size from 7 to 10-F were used. Balloon angioplasty was also performed in cases 3, 6 and 9. Atherectomy was considered a success in all patients based on angiographic and clinical criteria. Complications occurred in three patients: intimal dissection, distal embolism and arterial spasm. In the patients with distal embolism, a surgical approach was required to remove the embolus. The internal elastic lamina or media was resected in 10 lesions on the histopathologic specimens. Although further assessment of complications and long-term results is required, these results suggest that atherectomy is useful for treating occlusive peripheral vascular disease.

The production of CINC/gro, a member of the interleukin-8 family, in rat anterior pituitary gland

We investigated the possibility of detection of CINC/gro, which is a IL-8-like neutrophil chemoattractant, immunoreactivity in rat normal anterior pituitary gland by immunohistochemistry, western blot analysis and an ELISA. We first ascertained the possibility of detection of CINC/gro immunoreactivity in the anterior pituitary gland by immunocytochemistry. In the anterior lobe of the pituitary gland, a few CINC/gro-like immunoreactive cells were observed (1-3% of all cells in the anterior pituitary). The positive cells were middle or large in size and looked angular in shape. Intense immunoreactivity was observed in the cytoplasm but not in the nucleus. Analysis by immunoblotting with anti-CINC/gro antiserum gave a characteristic single CINC/gro band with a molecular weight of 6.3 kDa. CINC/gro immunoreactivity was also detected in 3-h conditioned medium of normal anterior pituitary cells by an ELISA, and that immunoreactivity increased significantly in a time-dependent manner during 24-h incubation. This immunoreactivity could be induced by TNF-alpha in a dose-dependent manner. These findings indicate that CINC/gro is produced in pituitary gland and also suggests the possibility that CINC/gro may play some role asa modulator of anterior pituitary function, especially in the cross-talk mechanism between the immune and neuroendocrine systems.

In vitro effects of CINC/gro, a member of the interleukin-8 family, on hormone secretion by rat anterior pituitary cells

We investigated the effects of CINC/gro on hormone secretion using normal rat anterior pituitary cells. In normal anterior pituitary cells, 10-100 ng/ml of CINC/gro significantly increased the secretion of PRL within 3 h of incubation, and two-fold enhancement of PRL secretion was induced by 100 ng/ml of CINC/gro within 24-h incubation, while the response of GH and ACTH secretions to CINC/gro was weak. On the other hand, CINC/gro suppressed basal LH and FSH secretions in a concentration-dependent manner. The percent inhibition of basal secretion by CINC/gro (50 ng/ml) within 24-h incubation was 70% for LH and 43% for FSH. Twenty-four-hour incubation with 100 ng/ml of IAP completely blocked the CINC/gro-stimulated PRL and GH secretions and CINC/gro's suppression of both basal LH and FSH secretions. These data demonstrate a new biological activity for CINC/gro and provide evidence for immune system regulation of anterior pituitary hormone secretion.

Detection of bacteria in phagocyte-smears from septicemia-suspected blood by in situ hybridization using biotinylated probes

We report herein the detection of intracellular bacteria in phagocyte-smears obtained from septicemia-suspected blood samples by in situ hybridization. This was obtained by using nick-translated biotin-11-dUTP-labeled DNA probes and streptavidin-alkaline phosphatase conjugates for visualization of the hybridized signals. The probes were made from random genomic DNA clones of bacteria which are frequently the causative agents of bacteremia, such as Staphylococcus spp., Pseudomonas aeruginosa, Enterococcus faecalis, Escherichia coli, Klebsiella spp. and Enterobacter spp. When our in situ hybridization method was compared with conventional culture protocols for the ability to detect bacteria from the blood of patients suspected of having septicemia, 30 positive results were obtained in 50 specimens by in situ hybridization methods. In contrast, only 7 positive results were obtained by blood cultures. Thus, even if bacteria cannot be detected by conventional blood cultures and histology, our in situ hybridization method allows for direct observation of bacterial foci in circulating phagocytes and identification of the bacteria. Our investigations suggest that in septicemia, circulating polymorphonuclear neutrophils carry some surviving bacteria as well as metabolized bacterial DNA and RNA for a considerable period of time. Thus, our in situ hybridization method using the phagocyte-smears have diagnostic value for detecting most bacteria which cause septicemia.

Burkitt type leukaemia associated with multiple myeloma

We describe a 77-year-old man with multiple myeloma (MM) who developed Burkitt type leukaemia (BTL) 16 months after the initial diagnosis of MM. MM was positive for CD10 with immunoglobulin (Ig) kappa, kappa Bence Jones protein (BJP) and a normal karyotype. BTL was positive for CD10, CD19, CD20 and HLA-DR with Ig mu and lambda, lambda BJP and a clonal abnormal karyotype of 46,XY,-13, t(8;14)(q24;q32),11q+,14q+, +mar. The patient died 9 d after diagnosis of BTL despite treatment with multiple agents. This is, to our knowledge, the first such case to be reported.

Inhibition of analgesic-induced asthma by leukotriene receptor antagonist ONO-1078

We evaluated the effect of ONO-1078, a selective leukotriene-C4, -D4, and -E4-receptor antagonist, on bronchoconstriction intensity during inhalation challenge with dipyrone (a pyrazolone derivative) in six aspirin-sensitive asthmatics. A double-blind, randomized, crossover design was used. After ingestion of 225 mg ONO-1078 or matching placebo, subjects underwent bronchial provocation with dipyrone on two occasions, separated by 4 wk. Aerosol inhalation of dipyrone was performed increasing the concentration stepwise from 0.08 to 10% (wt/vol). FEV1 was measured every 10 min up to 30 min after inhalation of each concentration. Threshold concentrations causing a fall in FEV1 > or = 20% of baseline value were 0.4% in four subjects and 2% in the other two on the placebo day. After pretreatment with ONO-1078, threshold concentration was 10% in two subjects, and no fall in FEV1 was observed in the other four, even after inhalation of 10% dipyrone. Values of PD20 were 21.9 +/- 8.2 units (mean +/- SEM) after placebo and 311.6 +/- 40.3 units after ONO-1078, respectively, and a statistically significant difference occurred (p < 0.001). Provocation of bronchoconstriction was completely inhibited in subjects whose plasma ONO-1078 levels were more than 0.5 microgram/ml. These results support the hypothesis that sulfidopeptide leukotriene-induced bronchoconstriction is one important component in the pathophysiology of aspirin-induced asthma.

Rectangular field of view for dynamic MR imaging of sellar and parasellar regions

The effectiveness and quality of a rectangular field of view (R-FOV) were compared with those of a square FOV (S-FOV) in dynamic MR study of sellar regions. Cranial nerves in the cavernous sinus were identified more clearly with R-FOV. The image quality grading of R-FOV was significantly superior to that of S-FOV.

Suppressive effect of cyclosporin A on delayed-type hypersensitivity to syngeneic testicular cells

We have investigated the immunosuppressive effect of cyclosporin A (CsA) on delayed-type hypersensitivity (DTH) to syngeneic testicular cells (TC). DTH to syngeneic TC was induced by subcutaneous (sc) immunization with viable syngeneic TC and was augmented by a high dose of cyclophosphamide (CY)-pretreatment. DTH was suppressed by administration of CsA in a dose-dependent manner. When the mice were immunized alone or with 100 mg/kg of CY-pretreatment, 30 mg/kg or more of CsA suppressed DTH to TC. In mice immunized with 200 mg/kg of CY-pretreatment, 50 mg/kg of CsA was needed to suppress DTH. DTH is thought to play a key role in the induction and/or maintenance of experimental autoimmune orchitis (EAO). Our data show that DTH to syngeneic TC induced by immunization is suppressed by administration of CsA. Pretreatment of mice with immunization and administration of CsA suppressed DTH significantly when the mice were challenged with immunization with CY-pretreatment. However, DTH was rather enhanced significantly in mice pretreated with administration of CsA alone without preimmunization. Therefore, even though administration of CsA with immunization suppresses DTH, administration of CsA alone might rather eliminate suppressive mechanism resulting in augmentation of DTH.

Comparisons between invasive and noninvasive determinations of embryonic heart rate in chickens

The embryonic heart rate (HR) of chicken eggs was determined by ballistocardiography, electrocardiography, impedance-cardiography and acoustocardiography. The effects of these different methods on the HR were examined for young (12-day-old) and late (16- and 18-day-old) embryos. Ballistocardiography is a non-invasive method. Nevertheless, the mean HRs determined using this method at 5-hr intervals were significantly different in many embryos. This difference was caused by the natural variability of embryonic HR. The statistical analyses indicated that any of these four methods did not influence the HR measurement and can be used as a simple means for determination of the embryonic HR.

[Autologous fibrin glue from concentrated platelet rich plasma: intraoperative plasma sequestration using autotransfusion device]

Making autologous fibrin glue from intraoperatively collected concentrated platelet rich plasma (C-PRP) was attempted in 5 patients who underwent elective coronary artery bypass. The autologous blood was withdrawn from the patient before cardiopulmonary bypass and sequestrated for C-PRP, concentrated red cells (CRC) and platelet poor plasma (PPP) using an Electromedics Elmd-500 autotransfusion device. CRC and PPP were returned intravenously to the patient as needed intraoperatively or postoperatively. Aprotinin was dissolved in C-PRP to yield a concentration of 1000U/ml to the aim of suppressing the plasmin activity. In another syringe, thrombin was dissolved in 2% calcium chloride solution to 1000U/ml. The C-PRP/aprotinin was mixed in ratios of 20:1, 10:1, 5:1, 3:1 to the thrombin/C a++ solution and observed the time for clotting. The 10:1 and 5:1 mixture usually clotted within 3-5 seconds, whereas it was necessary 5 or more seconds in other ratios. Therefore we used in the ratio of 5:1 for all patients. The fibrin glue from this technique is little different from the fibrin glue on the market in its viscosity, and has some major advantages 1. large amount of glue is available 2. simple and inexpensive 3. eliminate the risk of side effect such as virus transmission.

Value of phase-shift gradient-echo MR imaging in the differentiation of pelvic lesions with high signal intensity at T1-weighted imaging

PURPOSE

To assess the value of phase-shift gradient-echo magnetic resonance (MR) imaging with the fast low-angle shot (FLASH) technique in the differentiation of hemorrhagic tumors and teratomas.

MATERIALS AND METHODS

T1- and T2-weighted spin-echo imaging and phase-shift MR imaging were performed in 60 patients. On T1-weighted images, the signal intensity of lesions was compared with that of intraperitoneal fat. Findings at MR imaging were compared with the surgical findings. The diagnostic performance of each pulse sequence was analyzed with receiver operating characteristic curves.

RESULTS

Sixty high-signal-intensity lesions were identified in 45 patients at T1-weighted imaging. Hemorrhagic lesions and teratomas had similar signal intensities on both T1- and T2-weighted images. Lesions were detected more decisively with FLASH imaging than with T1- and T2-weighted imaging.

CONCLUSIONS

Phase-shift gradient-echo imaging is a readily available method for the differential diagnosis of lesions with high signal intensity at T1-weighted MR imaging.

[Long term observation on beta-hemolytic streptococci in institutions for handicapped preschool children. Streptococcal Diseases Study Group]

Studies on beta-hemolytic streptococci have been carried out in 2 institutions for handicapped preschool children during the last nine-year period from 1985 to 1993. These studies were based on continuous throat cultures, 4 to 12 times a year, from 244 children including Down's syndrome and mentally retarded children in K-institution (K), and from 134 including cerebral palsy and other cerebrospinal disorders in H-institution (H). A significant difference (p < 0.05) was demonstrated in the isolation rates between K (11.1%) and H (6.4%). In K, isolation rates of beta-hemolytic streptococci ranged from 0 to 43.5%, showing a higher rate in winter (16.5%) than in summer (6.6%), and elevated-isolation rates of homologous types were demonstrate four times during the study period; i.e., type T12 in '87, type T28 in '88, type T1 in '90 and '92. In H, on the other hand, no higher rates (as to group A) were observed in winter or summer. In relation to disorders of children, the rates were 12.6% in Down's syndrome (mean age 2.7y), 10.0% in mentally retarded children (3.9y) and 6.4% in cerebral palsy or others with cerebrospinal disorders (3.3y). Down's syndrome, the youngest group, revealed the highest isolation rate of beta-hemolytic streptococci. In only two cases isolated hemologous types detected were over two times continuously.

Expression of insulin-like growth factor II by a gastric carcinoma associated with hypoglycaemia

A gastric cancer with liver metastases was associated with low morning levels of plasma glucose (24 mg/dl), insulin (< 2.5 microU/ml) and growth hormone (0.23 ng/ml). Primary and metastatic tumour tissue stained positively with anti-insulin-like growth factor II (IGF-II) monoclonal antibody. Western immunoblot analysis revealed a high molecular weight IGF-II in the serum: 15 kDa (normal: 7.5 kDa). Postmortem reverse transcription polymerase chain reaction on mRNA from both sites revealed 471 base pairs size cDNA encoding prepro-IGF-II. These results suggest that the gastric carcinoma encoded, expressed, and secreted IGF-II, probably causing the extrapancreatic tumour hypoglycaemia.

Richter's syndrome showing pronounced lymphadenopathy in response to administration of granulocyte colony-stimulating factor

A patient with Richter's syndrome developed rapid generalized lymph node enlargement with a decrease of peripheral blood lymphocytes after recombinant human granulocyte colony-stimulating factor (rhG-CSF) therapy for neutropenia induced by chemotherapy. The lymphadenopathy subsided spontaneously following discontinuation of rhG-CSF medication. Reinstitution of rhG-CSF therapy was followed by the same response as during initial therapy. Histopathologically, the lesions were characteristic of diffuse large cell lymphoma (DLL) with no evidence of myeloid cell involvement. No spontaneous contraction of enlarged lymph nodes followed withdrawal of the second course, but the enlargement subsided with chemotherapy. The patient died of myocardial infarction. All residual tumors examined post mortem presented microscopic features of small lymphocytic lymphoma (SLL), and G-CSF receptor was demonstrated on these neoplastic cells by Northern blot hybridization analysis. This observation indicates that some B cell malignancies may retain G-CSF receptor and respond to G-CSF.

In vitro effects of CINC/gro, a member of the interleukin-8 family, on interleukin-6 secretion by rat posterior pituitary cells

We investigated the effects of CINC/gro on IL-6 secretion by rat posterior pituitary cells. CINC/gro immunoreactivity was already detected in 1-h conditioned medium of normal posterior pituitary cells, and it increased significantly in a time-dependent manner during the first 24 h of culture. This immunoreactivity could be induced by TNF-alpha in a dose-dependent manner. On the other hand, CINC/gro stimulated IL-6 secretion by posterior pituitary monolayer cultures in a concentration dependent manner. Thus, CINC/gro significantly (P < 0.01) increased the secretion of IL-6 within 13 h of incubation, and this effect continued throughout 24 h of incubation. The stimulatory effect of 100 ng/ml CINC/gro on IL-6 secretion was completely blocked by 24-h incubation with 100 ng/ml IAP. These data demonstrate a new biological activity for CINC/gro in the posterior pituitary system.

Elevated serum levels of IgE-binding factor/soluble CD23 in bullous pemphigoid

IgE-related abnormalities and impaired B cell function have been reported in patients with bullous pemphigoid (BP). CD23 is a low affinity Fc epsilon RII on haematopoietic cells and its soluble form (sCD23) is involved in B cell growth and differentiation. In order to determine the role of CD23 in the pathomechanisms of BP, the present study assayed the level of sCD23 in sera of BP patients using an ELISA method. Levels of sCD23 were elevated in BP patients compared with mean levels in the sera of normal control. Furthermore, the increase in sCD23 levels correlated with the degree of disease activity. A significant correlation was found between sCD23 and serum IgE levels in BP sera, but not in normal control sera. These results suggest that sCD23 is an important index for monitoring BP with respect to IgE-related abnormalities and impaired B cell function.

Platelet aggregation inhibiting activity of human placental chorioepithelial brush border membrane vesicles--the role of alkaline phosphatase

Human placental chorioepithelial brush border membrane, which is in direct contact with maternal blood flow, has platelet aggregation inhibiting activity. In the present study, the mechanism of this action has been examined in relation to ADP (adenosine diphosphate) degrading activity and alkaline phosphatase activity of brush border membrane vesicles (BBMV). BBMV prepared from human early and term placental villi, inhibited platelet aggregation induced by ADP. BBMV had potent ADP degrading (ADPase) activity. ADP was quickly degraded by BBMV. ADP degrading activity of BBMV was not so different between early and term placenta. Alkaline phosphatase activity of late placental BBMV was about three times greater than that of early placental BBMV. On the other hand, ADP degrading activity of late placental BBMV was almost the same as that of early placental BBMV. Inhibiting activity of platelet aggregation induced by ADP and ADP degrading activity of BBMV, were not inhibited by levamisole (alkaline phosphatase inhibitor).

Meisenheimer rearrangement of azetopyridoindoles, VI. Synthesis of 12-carbaeudistomin and related compounds

For structure-activity relationship investigation of eudistomins 1, 12-carbaeudistomin 3, its 1,10-trans isomer 4, and 11,12-didehydro-12-carbaeudistomin 5 have been synthesized. The [2,3]-Meisenheimer rearrangement of the corresponding N-oxide of the 2-vinylazetopyridoindole 12a bearing a benzenesulfonyl group as a protective group of the indole nitrogen atom afforded the oxazepino ester 14, which was easily isomerized to 20a. Compounds 3 and 4 were synthesized from 14 and 20a, respectively, according to the following reaction sequences [hydrogenation of the double bond (Pd-C/H2), desulfonylation (Mg in MeOH), hydrolysis (AlBr3-EtSH), and Curtius rearrangement (a mixed anhydride method using NaN3), followed by debenzylation (Pd-C/H2)]. The Curtius reaction of the carboxylic acid 27 using DPPA gave the carbamate 29, which was subjected to debenzylation (AlBr3-EtSH) followed by desulfonylation (LiAlH4) to afford 5. Evaluation of anti-influenza virus activities of the amino compounds 3, 4, and 5 revealed that 12-carbaeudistomin 3 possesses a specific activity against influenza virus B.

Acetylated low density lipoprotein reduces its ligand activity for the scavenger receptor after interaction with reconstituted high density lipoprotein

Complexes of apolipoprotein A-I (apoA-I) with phospholipids are known to induce cholesterol efflux from cells. In a cholesteryl ester accumulation system in which rat peritoneal macrophages were incubated with acetylated low density lipoprotein (acetyl-LDL) and either dimyristoylphosphatidylcholine complexes (DMPC/apoA-I) or native high density lipoprotein (HDL), DMPC/apoA-I exhibited a much stronger effect than native HDL in preventing cholesteryl ester accumulation. The mechanism for this phenomenon was investigated in the present study. After 18 h incubation with DMPC/apoA-I in a cell-free system, acetyl-LDL was re-isolated from DMPC/apoA-I by Sephacryl S-300 gel filtration chromatography. Re-isolated acetyl-LDL exhibited an increase in its phospholipid content by 86% as well as a reduction in the electrophoretic mobility. Its endocytic degradation by macrophages was reduced by 60% when compared with control acetyl-LDL, suggesting a significant reduction in the ligand activity for the macrophage scavenger receptor. Transfer of apolipoproteins between acetyl-LDL and DMPC/apoA-I did not occur. These results indicate that transfer of DMPC from DMPC/apoA-I to acetyl-LDL weakens the ligand activity for the scavenger receptor due probably to a decrease in net negative charge. This study demonstrated for the first time that lipid modification (change in the lipid moiety) of acetyl-LDL can induce alteration in its apolipoprotein moiety, leading to a significant loss of its biological activity. Because discoidal HDLs are known to occur in vivo, this phenomenon may explain one of the anti-atherogenic functions of HDL in vivo.

[Extramedullary pleural myelo-megakaryoblastic crisis during hematological chronic phase in chronic myeloid leukemia]

A 77-year-old man, in whom chronic myeloid leukemia (CML) had been diagnosed in October 1990, was admitted to hospital with right chest pain in November 1992. Bone marrow examination revealed the chronic phase of CML. Chest X-ray showed right pleural effusion. The cells from pleural effusion were positive for CD7, CD13, CD33, CD41a, including CD33, CD41a-double positive cells in 57.5%. Southern blot analysis revealed 3'bcr rearrangement. Electron microscopic examination showed the presence of platelet peroxidase. An abnormal karyotype with various additional chromosomes was observed. This is a rare case of extramedullary pleural myelo-megakaryoblastic biphenotypic crisis during the chronic phase of CML.

Leukotriene A4 hydrolase in human skin

The biochemical properties and immunohistochemical localization of leukotriene (LT) A4 hydrolase were investigated in human skin. The activity of LTA4 hydrolase, which catalyzes the hydrolysis of LTA4 to LTB4, the most chemotactic compound known, was detected in the 100,000 x g supernatant of homogenates of human epidermis and a transformed epidermal cell line (HSC-1). No significant LTA4 hydrolase activity was detected in human whole skin or dermis. The enzymatic properties of LTA4 hydrolase isolated from human keratinocytes and peripheral leukocytes were similar. Their activities were inhibited by bestatin and captopril, and they were completely absorbed by anti-human LTA4 hydrolase antibody. By immunoblotting analysis using this antibody, LTA4 hydrolase was detected as a 70-kDa protein in human epidermis and HSC-1 and was found to be similar to the enzyme detected in peripheral mononuclear leukocytes. In human dermis, LTA4 hydrolase was barely detected by Western blotting. On the other hand, LTA4 hydrolase was demonstrated in the cytoplasm of keratinocytes in the epidermis, and in fibroblasts, infiltrating and endothelial cells in the dermis of normal human skin by immunohistochemical analysis using the immunoperoxidase method. These results suggest that LTB4 can be generated from LTA4 by LTA4 hydrolase in keratinocytes as well as fibroblasts, infiltrating and endothelial cells in the dermis of human skin.

Adult T-cell leukaemia/lymphoma featuring a large granular lymphocyte leukaemia morphologically

A 70-year-old man from an endemic area of human T-cell lymphotropic virus type I (HTLV-I) developed rapid generalized lymphadenopathy and abdominal tumours. The white blood cell count was 198.3 x 10(9)/l with 93% lymphocytes, 66.3% of which expressed large granular lymphocytes (LGLs). Bone marrow and lymph nodes were also infiltrated by LGLs. Surface markers were positive for CD4, CD25 and HLA-DR, and negative for CD3, CD8, CD16, CD56 and CD57. A monoclonal integration of HTLV-I proviral DNA was demonstrated on these LGLs by Southern blot hybridization analysis. This fact indicates that some adult T-cell leukaemia/lymphoma may morphologically present LGL leukaemia.