A late-appearing Philadelphia chromosome in acute lymphoblastic leukemia confirmed by expression of BCR-ABL mRNA

We report two cases of acute lymphoblastic leukemia (ALL) with a late-appearing Philadelphia chromosome (Ph1), confirmed by the expression of BCR-ABL mRNA, using the reverse transcriptase/polymerase chain reaction (RT/PCR) technique. The first patient was a 10-year-old boy with precursor B cell type ALL-L1 (FAB classification). At diagnosis, no metaphase cells were found by chromosome analysis and BCR-ABL mRNA was not observed. At the beginning of relapse, which occurred after 7 months of complete remission, a normal karyotype was observed. At the terminal stage, leukemic cells with Ph1 and BCR-ABL mRNA for the P190 variety were observed. The second patient was a 12-year-old boy with immature T cell type ALL-L1. The metaphase cells showed a 9p- chromosome at diagnosis and Ph1 appeared in addition to 9p- at relapse. Hybrid mRNA for the P210 variety was detected only when Ph1 had developed. The blast cells with Ph1 were derived from the original leukemic clone through clonal evolution, since the same clonal rearrangements of IGH or TCRB were detected in leukemic cells obtained both at diagnosis and relapse in both patients. Thus, in both cases, Ph1 was detected only in the course of ALL along with expression of BCR-ABL mRNA. This observation also confirmed that, as in de novo Ph1-positive ALL, both the P190 and P210 varieties of BCR-ABL mRNA are observed in ALL with late-appearing Ph1.

Expression of vav proto-oncogene by nonhematopoietic trophoblast cells at the human uteroplacental interface

Vav is a signal transducing molecule containing SH2 and SH3 domains and a guanine nucleotide releasing factor-like domain. Its expression is thought to be highly specific for hematopoietic cells. Here we describe the expression of vav transcripts in human nonhematopoietic trophoblasts. By northern blotting, expression of 2.8-kb vav mRNA was detected in human decidual, placental, and chorionic villous tissues and in a choriocarcinoma cell line BeWo. By in situ hybridization, vav mRNA was found to be expressed in the cytotrophoblast shell and columns and in the extravillous trophoblasts in the maternal decidua from the first through third trimesters. Vav mRNA was also detected in villous syncytiotrophoblasts during the second and third, but not the first, trimesters. When 1 microM oligodeoxynucleotide antisense to the vav mRNA was added to the medium, growth of BeWo cells was significantly inhibited. These results suggest that vav plays an important role for successful implantation and placental development by regulating development of trophoblasts.

Gene therapy of hepatoma: bystander effects and non-apoptotic cell death induced by thymidine kinase and ganciclovir

A retroviral vector carrying herpes simplex virus thymidine kinase gene was constructed, and transfected into the psi 2 packaging cells. The replication-defective retrovirus produced by this cell line (psi 2 tkn cells) was transduced into XC rat hepatoma cells, from which a cell line (XCtkn2) highly sensitive to ganciclovir was cloned. Ganciclovir suppressed the growth of XCtkn2 hepatoma and psi 2tkn cells. Both of these HSV-tk-carrying cells treated with ganciclovir showed potent 'bystander effect' on co-culturing with genetically unmodified XC hepatoma cells. In addition, intratumoral injection of XCtkn2 and psi 2tkn cells into the XC hepatomas transplanted in nude mice and subsequent ganciclovir administration suppressed in vivo growth of the hepatomas. Flow cytometry disclosed that the ganciclovir-treatment increased the relative number of XCtkn2 hepatoma and psi 2tkn cells at the G2 phase of the cell cycle. However, the nuclear fragmentation and internucleosomal DNA cleavage were not observed, indicating that the death of XCtkn2 hepatoma and psi 2tkn cells treated with ganciclovir was not apoptotic.

Combined drug therapy with diltiazem, dextran, and hydrocortisone (DDH therapy) for late cerebral vasospasm after aneurysmal subarachnoid hemorrhage: assessment of efficacy and safety in an open clinical study

Late cerebral vasospasm after subarachnoid hemorrhage (SAH) is a disastrous phenomenon for the patients and a definite treatment has not been established. We studied 48 consecutive patients receiving high-dose diltiazem (5 micrograms/kg/min) injection combined with dextran and hydrocortisone to late cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). All but 2 patients underwent surgery within 72 hours after SAH. Diltiazem was continuously given via a central venous line for up to 2 weeks in conjunction with simple cisternal drainage. 5% of dextran solution (500 ml/day) was infused for 7-10 days. Hydrocortisone was given 1,600 mg on the first day, then the dose was gradually decreased over 14 days. Symptomatic vasospasm (SVS) occurred in 5 patients (10.4%), 4 patients recovered, but 1 had severe neurological deficit. A low density area on CT-scan was observed in 2 patients. Thirty patients (62.5%) had good recovery, 10 patients (20.8%) had moderate disability, 3 (6.3%) had severe disability and 3 (6.3%) had vegetative survival. Two patients died of the initial brain damage. There were no severely hypotensive side effects. However, 3 patients showed atrioventricular blockage on electrocardiogram. These side effects subsided after the dose of the drug was decreased or administration was stopped altogether. These findings show that high-dose calcium antagonist diltiazem therapy combined with dextran and hydrocortisone injection is safe and effective for prevention of late cerebral symptomatic vasospasm after SAH.

Antagonistic peptides against human anaphylatoxin C5a

Multivalent synthetic peptides derived from C5a were prepared in order to examine their effects on the C5a receptor (C5aR). Multiple antigen peptide (MAP) of the C5a C-terminal region (MAP61-74) bound to cells expressing C5aR with high affinity. On the other hand, N-terminal peptides (MAP3-16 and MAP12-26) and one with a sequence from the mid-portion of C5a (MAP37-53) did not bind to the cells. In addition, MAP61-74 inhibited Ca2+ mobilization and release of beta-hexosaminidase by C5a from dibutyryl cAMP-activated U937 cells. This Ca2+ mobilization was also inhibited by MAP12-26 and Mono61-74, the monomeric C-terminal peptide. Taken together, these data indicate that C5a binds to the C5aR via its C-terminal region. Furthermore, MAP61-74, a 14mer peptide that has additional amino acids at the N-terminal compared with the C-terminal octapaptide, can bind to C5aR and can be considered an antagonist of C5a which may prove useful as an agent for controlling the allergic response caused by complement activation.

Neuroendocrine tumors of the liver and pancreas associated with elevated serum prostatic acid phosphatase

A 58-year-old man was revealed to have multiple liver tumors with elevated prostatic acid phosphatase (PAP) during a medical examination. The tumors were of neuroendocrine nature, but no abnormal findings were obtained in other organs in which neuroendocrine tumors develop frequently. Repeated transarterial embolization was partially effective. However, the tumors became resistant to the therapy three years later, continued growing and ruptured. Autopsy disclosed neuroendocrine tumors in the pancreas, which were immunohistologically positive for PAP. Neuroendocrine tumors of the pancreas and liver producing PAP are rare; this case is reported with a review of literature.

Expression of Gal beta 1,4GlcNAc alpha 2,6-sialyltransferase and alpha 2,6-linked sialoglycoconjugates in normal human and rat tissues

We performed histochemical studies on normal human and rat tissues using anti-Gal beta 1,4GlcNAc alpha 2,6-sialyltransferase (alpha 2,6-ST) antibody and Sambucus nigra agglutinin (SNA). alpha 2,6-ST and its products were detected in almost all tissues examined. However, the staining intensities varied significantly with different cell types. Some secretory epithelial cells, such as hepatocytes and choroid plexus cells, were vividly stained with either anti-alpha 2,6-ST or SNA. In several cell types the intensity of alpha 2,6-ST staining did not always correlate with SNA stainability. Neurons and gastrointestinal epithelia were rarely stained with SNA, even though they were positive for alpha 2,6-ST. In contrast, the endothelial cells of blood vessels strongly reacted with SNA despite their weak alpha 2,6-ST expression. The precise physiological roles played by alpha 2,6-linked sialylated glycoconjugates have been unclear. However, the findings described here lend further support to their important role in cell growth and differentiation, since immature blood cells, including megakaryocytes in bone marrow, were intensely stained with anti-alpha 2,6-ST and SNA, and SNA reaction products were primarily observed in the basal and suprabasal layers of the stratified epithelia rather than in the more differentiated upper layers. In view of the vivid reactivity of anti-alpha 2,6-ST in the decidual cells of the placenta, it seems likely that alpha 2,6-ST expression is under hormonal control.

[Bronchogenic carcinoma associated with right aortic arch and postaortic left brachiocephalic vein--report of a case]

61-year-old male was admitted to our hospital for surgical treatment of bronchogenic squamous cell carcinoma arising from left B8. The patient had right aortic arch with aberrant left subclavian artery and postaortic left brachiocephalic vein. Intraoperatively, left ligamentum arteriorsus forming vascular ring between the left subclavian artery and the pulmonary artery was found, however the ligamentum arteriorsus was not divided because no symptom of esophago-tracheal compression was observed. The left brachiocephalic vein was located between the ascending aorta and the arterial ligament. The lower lobe of the left lung was resected, and lymph nodes in the left side of the mediastinum were dissected easily because the aortic arch was positioned on the other side. Preoperative assessment of the type of branching and the course of arteries and veins is important for safe operation.

Classification of the ophthalmic artery that arises from the middle meningeal artery in Japanese adults

In a study of Japanese adults, we found that the orbital branch (OB) passing through the superior orbital fissure frequently anastomosed with the lacrimal artery or the ophthalmic artery (12/20). However, the OB passing through the meningo-orbital foramen (mof) only associationaly anastomosed with branches of the ophthalmic artery (4/79). Furthermore, the OB in the orbit, excluding the lacrimal gland as previously reported. We examined 116 cases in which the OB passed through the mof in 129 adult Japanese cadavers (45.0% in 258 sides). The OB passing through the mof was always distributed to the periorbital region and the area that it supplied was limited to the periorbita in about half of those cases. In another half of the cases (58/116), the area supplied included the lacrimal gland.

[Study for clinical usefulness of CEA, TPA, CA15-3 and BCA225 in breast cancer]

CEA, TPA, CA15-3 and BCA225 are the most frequently assayed as tumor markers for breast cancer. The aim of the present study was to reinvestigate the clinical usefulness of these markers in patients with breast cancer (primary: 28, recurrent: 15). In the cases of primary breast cancer, including all stages, positive rates of CEA, TPA, CA15-3 and BCA225 were 18%, 25%, 11% and 18%, respectively, while in the advanced cases of stage III+IV, positive rate of both CEA and TPA increased to approximately 40%. The positive rate of combination assays using four tumor markers was 46% in the cases of primary breast cancer including all stages and was 73% in the cases of advanced primary breast cancer (stage III+IV). In the cases of recurrent breast cancer, the positive rates of CEA, TPA, CA15 3 and BCA225 were 60%, 60%, 67% and 60%, respectively. When all of those tumor markers were used for assays, all of the patients with recurrent breast cancer studied showed elevated serum levels of at least one of these tumor markers. We retrospectively analyzed serum levels of tumor markers in 15 patients who relapsed breast cancer after surgical resection. In 2 patients elevation of some of four tumor markers occurred before the recurrent tumor was detected with RI scintillation and computed tomography. These results suggested that combination assays using CEA, TPA, CA15-3 and BCA225 should be helpful for detecting the recurrence of breast cancer, and also detecting the advanced primary breast cancer.

Expression of leukaemia inhibitory factor (LIF) receptor in human placenta: a possible role for LIF in the growth and differentiation of trophoblasts

Leukaemia inhibitory factor (LIF) is a cytokine that displays multiple activities in various tissues and is essential for blastocyst implantation in mice. In the human uterus, LIF is expressed in endometrial tissue and the decidua. To elucidate the role it plays, the mRNA levels for two LIF receptor (R) subunits, LIF-R and gp130, were examined in human endometrium, placenta and decidua by Northern blot hybridization. The expression of LIF-R gene was detected in the chorionic villus during the first trimester, in term placenta, and at lower levels in the decidua. The expression of LIF-R gene was not detectable in non-pregnant endometrium. The expression of the gp130 gene was detected in all tissues examined. During pregnancy, there was no significant change in the mRNA concentration of LIF-R in the placenta, while that of gp130 increased after the second trimester. The human choriocarcinoma cell line, BeWo, was found to express LIF-R and gp130. LIF inhibited forskolin-induced human chorionic gonadotrophin (HCG)-beta production by BeWo in a dose-dependent manner, and it ameliorated forskolin-induced growth suppression. These findings suggest that LIF plays a regulatory role in trophoblast growth and differentiation during pregnancy in human placenta.

Somatostatinoma of the pancreas associated with von Hippel-Lindau disease

A 39-year-old man was admitted because of lumbago, vomiting and massive gastrointestinal bleeding. Oliguria developed a few days later, which was followed by hyperkalemia and cardiac arrest. Autopsy disclosed multiple renal cell carcinomas with diffuse metastasis to the liver, adrenal gland, psoas muscle and vertebrae. In addition, a somatostatinoma was found in the pancreas. From these findings and past history of cerebellar hemangioblastoma and spinal hemangioma he was diagnosed to have von Hippel-Lindau disease. Von Hippel-Lindau disease with islet cell tumor is very rare and is reported here with a review of literature.

[New tactile sensor for thoracoscopic detection of intrapulmonary nodules]

We have developed a new tactile sensor which can be used for thoracoscopic detection of invisible intrapulmonary nodules. We applied this new device for consecutive ten cases to excise twelve intrapulmonary nodules thoracoscopically from August 1994 to January 1995. In this report, one of ten cases was presented. The patient was a forty-three-year-old female and admitted with an indeterminate nodule on chest X-ray and computed tomography. When the sensor probe quantifying the hardness of objects by the changes in resonance frequency of the sensor (delta f) passed above the nodule, a sudden jump was evoked in delta f curve on the computer screen. The nodule was resected thoracoscopically and proved pathologically to be adenocarcinoma. Thoracoscopic procedure was then converted to open thoracotomy and lobectomy with lymph node dissection was performed.

CAM--a novel immunosuppressive agent

This is an initial study of the immunosuppressive efficacy of CAM, a derivative of mycophenolic acid, in a rat heart allograft model when the major histocompatibility complex was fully incompatible, and its effect in improving heart allograft survival compared with mycophenolate mofetil (MMF, RS-61443). CAM or MMF was administered orally from day 1 following the allografting for 40 days. The median survival times (MST) were 6 days in rats with no immunosuppressive drug (control group; n = 6), 83 days with CAM 10 mg/kg (n = 6), and > 100 days with both 20 mg/kg (n = 7), and 30 mg/kg (n = 10). With MMF, in contrast, MST was 9, 17, 35, days with 10, 20, 30 mg/kg/day, respectively. All grafts in the CAM 30 mg/kg-treated group survived for more than 100 days after grafting, and, furthermore, CAM was also more effective than MMF in prolongation of the heart graft survival in rats at each dose. Rats with long-surviving cardiac allografts (30 mg/kg; CAM) accepted skin grafts from the donor-strain but rejected them from the third-party strain, suggesting that donor-specific tolerance was induced by CAM. In the tolerant rats, proliferative response against donor-type alloantigen was not impaired as compared with naive WKAH rats. In contrast, CML assay showed that T cells obtained from the rats bearing permanently accepted F344 heart grafts had less cytotoxic activity to the donor-type target, and the frequency of CTL precursor against donor-type alloantigen was also reduced.

Mirrorless optical bistability in a semiconductor-doped-glass plate as a result of oblique incidence

A procedure to obtain optical bistability in a third-order nonlinear film (or parallel plate) of low refractive index without any external mirrors is investigated both theoretically and experimentally. If an s-polarized light is incident obliquely at a large angle of incidence on the film, the generation of optical bistability can be expected because of the resulting increase in the reflectivity at the surfaces. Arigorous analysis of the stationary transmission characteristics of the nonlinear film is done for both positive and negative nonlinear coefficients with a plane-wave model. In the experimental demonstration, a CdS(x)Se(1-x)doped glass (Hoya Y-52) plate and a cw Ar(+) laser are used as the nonlinear material and the light source, respectively. It is shown that three operations of optical bistability, optical limiting, and differential gain can be easily obtained through adjustment of the angle of incidence as an initial detuning. The measured nonlinearity is thermal, and the magnitude and sign of the nonlinear refractive index are determined.

Apoptosis and nuclear levels of p53 protein and proliferating cell nuclear antigen in human hepatoma cells cultured with tumor promoters

Anticancer drugs etoposide and mitomycin C increased nuclear p53 protein and decreased proliferating cell nuclear antigen (PCNA) of PLC/PRF/5 human hepatoma cells. These changes were followed by DNA fragmentation and apoptosis. Teleocidin antagonized both apoptosis and alterations of nuclear p53 protein and PCNA induced by these anticancer drugs. In contrast, thapsigargin antagonized only drug-induced nuclear accumulation of p53 protein. Therefore, the inhibition of apoptosis appears not to be the common mechanism of tumor promotion. Both tumor promoters suppressed the increase in nuclear p53 protein, suggesting that an inadequate DNA repair due to the reduced nuclear accumulation of p53 protein might be playing important role in enhancing carcinogenesis.

Takayasu's arteritis in prepulseless stage manifesting lymph node swelling and hepatosplenomegaly

A 17-year-old male had fever of unknown origin (FUO) for 3 months with positive c-reactive protein, lymph node swelling, and hepatosplenomegaly. Biopsy specimens of the liver and lymph node disclosed nonspecific inflammation. Lymph node swelling and hepatosplenomegaly subsided gradually, while vascular murmur and pulselessness appeared. Computerized tomography and magnetic resonance imaging showed thickened arterial wall, while angiography disclosed arterial narrowing. From these findings he was diagnosed to have Takayasu's arteritis. The therapy with prednisolone was effective. Takayasu's arteritis is rarely manifested by hepatosplenomegaly and lymphadenopathy in its prepulseless stage.

Clonal and non-clonal karyotypically abnormal cells in haemophagocytic lymphohistiocytosis

We studied chromosomes in bone marrow (BM) or peripheral blood cells of nine patients with haemophagocytic lymphohistiocytosis (HLH); three of them had a family history of HLH and four others underwent concurrent Epstein-Barr virus (EBV) infection. In addition to a large population of normal mitotic cells, karyotypically abnormal clonal cells were found in two patients, abnormal clonal cells and a nonclonal (single) abnormal cell in one, and nonclonal abnormal cells in three. All the six patients with chromosome abnormalities died of progressive disease; one of them also had EBV infection and EBV-associated clonal proliferation. Two of three patients with EBV infection and only normal mitotic cells in BM completely recovered from the disease. Although HLH did not show histological and/or haematological evidence of a neoplastic disease, clonal chromosome abnormalities and the fatal clinical outcome found in some of the patients suggest that the disease may be heterogenous and include malignancy. HLH patients with karyotypically abnormal clonal cells in BM should warrant more intensive chemotherapy than that presently being applied to them and should be considered as candidates for BM transplantation.

Changes in kinetic properties of oxytocin receptors in longitudinal muscle membranes of rat uterus during gestation

Receptors of oxytocin were found to occur in the membrane fraction obtained from longitudinal muscle of pregnant rat uterus. The affinity of the membrane receptor for oxytocin increased through an increase in the association rate and a decrease in the dissociation rate during gestation. The membrane oxytocin receptor concentrations rose almost three-fold from Day 15 to Day 21. A transition of oxytocin receptors from a single class of independent sites to site-site interacted multiple binding sites, which most likely exhibit positive cooperativity during the last seven days of gestation, was observed. These results suggest that changes in the dynamics of uterine oxytocin receptors also play an important role in the onset of labor.