[Clinical features of measles pneumonia in adults: usefulness of computed tomography]

The clinical features, chest radiographs and computed tomographic (CT) images were evaluated in 11 cases with serologically proved adult measles complicated with pneumonia (10 were previously healthy and one had sarcoidosis). Pneumonia appeared during the rash period in all cases. Respiratory symptoms were cough (9/11), dyspnea (3/11), and hypoxemia (10/11). Pneumonia manifestations were detected in only 4 cases by chest radiograph; on the other hand, they were seen in all cases by CT scan and consisted of ground-glass opacities (73%), nodular opacities (64%) and consolidation (27%). CT seems to be a useful method to detect measles pneumonia if it is suspected. Measles pneumonia in previously healthy patients had a good prognosis, as the hypoxemia disappeared within 6 days in all cases. The sarcoidosis patient showed prolonged pneumonic shadows and period of hypoxemia. Measles pneumonia occurring in a host with cellular immunodeficiency may have a severe clinical course.

[The long term results of hyperbaric oxygen treatment for macular edema with retinal vein occlusion]

We retrospectively evaluated the effect of hyperbaric oxygen treatment on seventy-nine eyes of seventy cases with cystoid macular edema secondary to retinal vein occlusion. Twenty-three eyes had central retinal vein occlusion (CRVO), and fifty-six eyes had branch retinal vein occlusion (BRVO). Visual acuity improved by two lines or more in 40 eyes (17%) with BRVO, and in 10 eyes (44%) with CRVO immediately after the therapy. Six months or more after treatment, visual improvement persisted in 14 of 30 BRVO eyes (47%), and in only one of 11 CRVO eyes (9%). CRVO showed poor prognosis in the long term compared with BRVO. We speculated that activation of aerobic metabolism might be more important than reduction of vascular hyperpermeability as the therapeutic effect of hyperbaric oxygen, and that hyperbaric oxygen might mainly affect the retinal cells in the marginal zone of the ischemic retina in the macular region.

Management problems in continuous care of male patients with mild hypertension with special reference to alcohol-intake

Forty two male patients with borderline and mild hypertension were followed up for 3.9 years without medication. During this period, all subjects had nonpharmacological interventions including salt restriction, weight reduction, anti-smoking or anti-alcohol instruction, and physical exercise after the established protocol. Comparisons of biomedical data between pre- and post-observation revealed no significant improvements. Although the smoking habit decreased during this period, the drinking habit rarely changed and even significant increase of the total amount of alcohol ingestion was observed. These data indicate great limitation of nonpharmacological intervention in the care of these asymptomatic hypertensive patients for a lifelong base.

Identification of the alpha-subunits of rod and cone transducin in chicken photoreceptor cells

The chicken retina has several types of cone photoreceptor cells, each of which contains a visual pigment, chicken red (iodopsin), green, blue or violet. Although biochemical and photochemical properties of these cone pigments have been well characterized, no information is available about the chicken photoreceptor G-protein, transducin, which couples with the visual pigment to convert a photon signal into a cellular response. To identify alpha-subunits of chicken rod and cone transducins (Tr alpha and Tc alpha, respectively), we produced two site-directed antibodies which discriminate between bovine Tr alpha and Tc alpha. Immunohistochemical studies on chicken retinas revealed that the antibody against bovine Tr alpha specifically stained the rod outer segments. On the other hand, the antibody against bovine Tc alpha uniformly stained the outer segments of the double cones and all types of single cones, while the single cones were immunohistochemically classified into three types by using a combination of antibodies against bovine rhodopsin and chicken iodopsin. Immuno-blot analyses demonstrated that the antibody against Tc alpha recognized a single band of chicken photoreceptor protein, whose molecular weight (42,000) was in good agreement with that of bovine Tc alpha (41,000). The antibody against Tr alpha recognized a protein having the same molecular weight as that of bovine Tr alpha (39,000). These observations strongly suggested that all types of chicken cone cells have a single common Tc alpha (42 kDa) structurally related to bovine Tc alpha, though each cone cell type has a distinct visual pigment.

Evaluation of idiopathic epiretinal membranes by a scanning laser ophthalmoscope

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In vitro and in vivo electrocardiographic evaluation of the novel calcium antagonist monatepil on cardiac conduction system

Effects of monatepil ([(+/-)-N-(6,11-dihydrodibenzo[b, e]thiepin-11-yl)-4-(p-fluorophenyl)-1-piperazinebutyramide]m aleate, AJ-2615, CAS 103377-41-9), a novel calcium antagonist, on the cardiac conduction system were compared by electrocardiography with those of the existing calcium antagonists (diltiazem, verapamil and nifedipine) in isolated rabbit heart preparations in vitro and in anesthetized and conscious dogs in vivo. Monatepil (10(-7) mol/l) prolonged the atrio-His bundle conduction time (AH interval) in the Langendorff perfused rabbit heart, like diltiazem, verapamil and nifedipine. This prolongation was decreased to 1/10 in the presence of 3.6% bovine serum albumin. In anesthetized dogs, monatepil (0.1-1.0 mg/kg i.v.), unlike diltiazem and verapamil, did not prolong AH interval. In conscious dogs, monatepil even at 100 mg/kg p.o. did not affect electrocardiograms. At the high dose of 300 mg/kg p.o., only a slight prolongation of the QT interval was found, but the QTc interval was not affected. Diltiazem at 10 mg/kg p.o. caused a prolongation of the PR interval and a disappearance of QRS waves. In conscious renal hypertensive dogs, repeated administration of monatepil (10 mg/kg/d p.o. for 29 days) had little effect on the conduction system of the heart examined by electrocardiograms, albeit a persistent fall in blood pressure continued throughout the administration period. The above results suggest that monatepil is a highly safe drug in the treatment of hypertension.

Expression of GPIV and N(aka) antigen on monocytes in N(aka)-negative subjects whose platelets lack GPIV

The platelet antigen N(aka) was once considered to be a platelet-specific alloantigen and is carried on platelet membrane glycoprotein (GP) IV. Recent studies suggest that N(aka)-negative subjects lack platelet GPIV. GPIV is an important adhesive receptor and expressed on the surface of monocytes as well as of platelets. In the present study, flow cytometry was used to detect GPIV and N(aka) antigen on the surface of monocytes. N(aka) antigen was expressed on monocytes as well as on platelets in N(aka)-positive subjects (n = 6) (P-GPIV-positive subjects). To our surprise, monocytes of N(aka)-negative subjects (n = 7) (P-GPIV-negative subjects) having no anti-N(aka) antibody in their serum expressed GPIV and N(aka) antigen to almost the same degree as did the monocytes of P-GPIV-positive subjects. Competitive experiments using OKM5 (a monoclonal antibody against GPIV) and anti-N(aka) antibody showed that the epitope of anti-N(aka) antibody on monocytes was very close to that of OKM5. In two P-GPIV-negative subjects having anti-N(aka) antibody in their serum, GPIV and N(aka) antigen were not expressed on the surface of either monocytes or platelets. These results indicate that the GPIV molecules and N(aka) antigen are expressed on the surface of monocytes in the majority of P-GPIV-negative subjects, but that in a very few P-GPIV-negative subjects neither GPIV nor N(aka) antigen is expressed on the surface of their monocytes. We hypothesize that P-GPIV-negative subjects who carry neither GPIV nor N(aka) antigen on their monocytes produce anti-N(aka) antibody as a result of transfusion or pregnancy.

Essential role of the inositol 1,4,5-trisphosphate receptor/Ca2+ release channel in Ca2+ waves and Ca2+ oscillations at fertilization of mammalian eggs

At fertilization mammalian eggs exhibit repetitive rises in the cytoplasmic Ca2+ concentration (Ca2+ oscillations), associated with propagating Ca2+ waves in the initial responses. The Ca2+ oscillation causes cortical granule exocytosis and resumption of second meiosis and affects later embryonic development. Recent studies using a function-blocking monoclonal antibody to the inositol 1,4,5-trisphosphate (InsP3) receptor/Ca2+ release channel demonstrated direct evidence that InsP3-induced Ca2+ release (IICR) from intracellular stores operates at fertilization of the hamster egg and that IICR is essential in the initiation, propagation, and oscillation of the sperm-induced Ca2+ rises. Ca(2+)-induced Ca2+ release (CICR) has also been suggested, but a sensitizing action of Ca2+ on the InsP3 receptor, i.e., Ca(2+)-sensitized IICR, can serve as a regenerative process of Ca2+ release and could be the basis for Ca2+ waves and Ca2+ oscillations. It is now apparent that signal transduction at fertilization is dependent on sperm-stimulated activation of phospholipase C which causes hydrolysis of phosphatidylinositol bisphosphate and production of InsP3, leading to IICR. On the other hand, Ca2+ signaling at fertilization of the sea urchin egg may also involve ryanodine receptor-mediated CICR.

Mutational analysis of the specific priming signal essential for DNA replication of the broad host-range plasmid RSF1010

To analyze the RSF1010-specific priming mechanism, a library of randomly mutagenized ssiA sequences was constructed by chemical synthesis using mixed nucleotide phosphoramidites. Synthetic ssiA sequences with the single base-substitutions were assayed for the SSI activity in E. coli JM109 expressing RepB' primase. It was demonstrated that the activity of ssiA was damaged markedly by single base-substitutions within the possible stem-loop structure and its 3'-flanking region. It is conceivable that these domains are critical in recognition and primer synthesis by RepB' primase.

Sex-related differences of acetohexamide reductase activities in the liver and kidney of various mammalian species

Sex-related differences of acetohexamide reductase activities in cytosol and microsomes from the liver and kidney of the rat, mouse, guinea pig, hamster and rabbit were examined. Among animal species tested, the rat, guinea pig and rabbit exhibited sex-related differences in the activities. The activities in liver cytosol of the rat and rabbit were higher in the females than in the males, whereas the activity in kidney cytosol of the rabbit was higher in the male than in the female. Furthermore, the activities in liver and kidney microsomes of the rat and that in kidney microsomes of the guinea pig were much higher in the males than in the females. It is interesting to note that significant sex-related differences of acetohexamide reductase activities are found in some animal species other than the rat.

A novel polymorphism in glycoprotein IV (replacement of proline-90 by serine) predominates in subjects with platelet GPIV deficiency

To clarify the molecular basis of the deficiency of glycoprotein IV (GPIV) of the platelet surface, we analyzed GPIV cDNA synthesized from platelet RNA of five unrelated Japanese subjects whose platelets did not express GPIV. We confirmed the presence of normal-sized GPIV mRNA in platelets from subjects with GPIV deficiency. The sequence of platelet GPIV cDNA from GPIV deficient subject showed three differences when compared with the published sequence; 1) a replacement of a 478CCT codon for proline-90 by TCT for serine, 2) a four-base insertion in the 3'-noncoding region, and 3) a substitution of A for 79C in the 5'-noncoding region. The replacement of Pro90 by Ser predominates in subjects with GPIV deficiency; that is, four out of five platelets with GPIV deficiency contained GPIV mRNA encoding GPIVSer-90, while all platelets from 17 GPIV positive subjects had GPIV mRNA encoding GPIVPro-90. The sequence of platelet GPIV cDNA which did not encode GPIVSer-90 from a subject with GPIV deficiency revealed no abnormality in the coding region. The four-base insertion in the 3'-noncoding region and the substitution of A for 79C in the 5'-noncoding region seems to be unrelated to the expression of GPIV. The substitution of Ser for Pro90 might alter the GPIV structure or impair GPIV biosynthesis, resulting in a lack of detectable GPIV. This hypothesis remains to be tested.

[Familial cases of spastic paraparesis, mental disturbance and thinning of the corpus callosum]

We reported a family in which two brothers and one sister out of five siblings were affected by a neurological disease showing the following clinical manifestations: 1) intellectual disturbance with relative preservation of memory and orientation probably developed on child food, 2) spastic paraparesis beginning at the age of about 20 years, 3) mild peripheral neuropathy and cerebellar sign. Their clinical courses were stereotyped, and so much the worse in elder patients. Two of them were investigated in detail. Laboratory findings including chromosomal analysis, amino acid analysis and thyroid function were normal. HTLV-1 antibody was negative. Several lymphocytes lysosomal enzymes including beta-hexosaminidase and arylsulfatase A and serum very long fatty acids were also within normal range. CT and MRI showed characteristic thinning of corpus callosum, dominant in anterior portion. However, changes in intensity of white matter in T2 weighted image were not so prominent. In the older patient, more mentally deteriorated, were demonstrated hypoperfusion in the fronto-parietal lobes by SPECT and slow wave bursts dominant in the same region by EEG. Therefore, we considered that the change of corpus callosum was hypoplasia, but not atrophy, and it may provoke dysfunction of relevant nervous system. Family cases of such clinical feature were rare. We could confirm only three families in literatures, all of them were Japanese.

Effects of intravenous iodoacetate and iodate on pH outside rod photoreceptors in the cat retina

PURPOSE

Effects of intravenous iodoacetate (a glycolysis inhibitor) and iodate (a metabolism inhibitor selective to retinal pigment epithelium) on light-evoked alkalinizations and hypoxia-induced acidifications were studied in the dark-adapted cat retina, in vivo, to learn about pH regulation.

METHODS

pH was recorded in the extracellular space surrounding rod photoreceptors with double-barrelled H(+)-selective microelectrodes.

RESULTS

Intravenous infusion of 5 mg/kg iodoacetate-induced alkalinizations in the outer nuclear layer and suppressed both light-evoked and hypoxia-induced pH responses immediately. Iodate injection (30 mg/kg) produced acidifications in the subretinal space and affected light-evoked alkalinizations gradually but not hypoxia-induced acidifications.

CONCLUSIONS

These results suggest that rods glycolysis plays an important role in both light-evoked and hypoxia-induced pH responses. And the retinal pigment epithelium may have little concern with light-evoked alkalinizations except that it plays an important role in regenerating the rhodopsin to be needed for the light responses of photoreceptors. Furthermore, the finding of the intravenous-iodoacetate-induced alkalinization in the outer nuclear layer supports that acid production by rods in the dark is originated from glycolysis to support the dark current. The iodate-induced acidification in the subretinal space indicators that the retinal pigment epithelium might actively transport acids from the subretinal space to the choroid.

Bilateral projections of single retinal ganglion cells to the lateral geniculate nuclei and superior colliculi in the albino rat

Employing fluorescent retrograde double/triple labeling, we investigated bilateral projections of single retinal ganglion cells to the lateral geniculate nuclei (LGN) and superior colliculi (SC) in the albino rat. After separate injections of Fast Blue (FB) and Diamidino Yellow (DY), respectively, into the right and left LGN, a large number of retrogradely-labeled cells were distributed all over the retina contralateral to each injection. Ipsilaterally projecting ganglion cells, which were labeled with one tracer injected into the LGN, were found predominantly in the lower-temporal retinal region; approximately 56% (120-140 cells per retina) of them were further labeled with the other tracer injected into the contralateral LGN. The vast majority of these double-labeled cells were of large type (more than 20 microns in diameter). Similar findings were obtained after separate injections of FB and DY, respectively, into the right and left SC, or respectively, into the right SC and left LGN. After separate injections of FB, DY and rhodamine-B-isothiocyanate, respectively, into the bilateral LGN and unilateral SC, or respectively, into the unilateral LGN and bilateral SC, a number of cells triple-labeled with all tracers were localized in the lower-temporal retinal region; most of them were of large type. Thus, the bilateral projections from the lower-temporal retinal region representing binocular vision in the rat are indicated to be achieved not only by separate populations of ganglion cells each exclusively serving one side of the brain, but also by axon collaterals from single ganglion cells; the ganglion cells projecting bilaterally to the LGN or/and SC are primarily of large type corresponding probably to the Y cell in the cat retina.

Blockade of retinal NMDA receptors by sodium nitroprusside is probably due to nitric oxide formation

Effects of a nitric oxide (NO)-producing agent, sodium nitroprusside, on N-methyl-D-aspartate (NMDA) receptor activation in the cultured retinal neurons of rats were examined. NMDA in a Mg(2+)-free medium evoked inward currents at the resting membrane potential. Inward currents were also evoked by kainate. Sodium nitroprusside markedly reduced the NMDA-induced currents without affecting those induced by kainate. These results suggest the possible existence of a negative feed back system of NO which serves to regulate the activation of NMDA receptors in retinal neurons.

Elevated levels of lung surfactant protein A in sera from patients with idiopathic pulmonary fibrosis and pulmonary alveolar proteinosis

An enzyme-linked immunosorbent assay using monoclonal antibodies to human lung surfactant protein A (SP-A) was applied to sera from patients with lung diseases. We examined whether SP-A appears in the sera of patients with diseases that are known to cause alterations in surfactant composition in bronchoalveolar lavage fluids, and we characterized the SP-A that was found. The level of SP-A in sera from 57 healthy volunteers was 45 +/- 3 ng/ml (mean +/- SEM). The levels in patients with idiopathic pulmonary fibrosis (IPF) (205 +/- 23 ng/ml, n = 32) and pulmonary alveolar proteinosis (PAP) (285 +/- 23 ng/ml, n = 6) were significantly higher than those in healthy control subjects (p < 0.01), whereas those of sarcoidosis (n = 16), pneumonia (n = 14), and tuberculosis (n = 14) were 52 +/- 27 ng/ml, 65 +/- 11 ng/ml, and 49 +/- 23 ng/ml, respectively. Electrophoresis and immunoblotting analysis demonstrated that the fraction isolated from serum of a patient with PAP or IPF by anti-SP-A immunoaffinity column chromatography consisted chiefly of human IgG and IgM, and that it also contained SP-A. Furthermore, IgG was found in preparation of purified human SP-A. SP-A was demonstrated to bind to nonimmune IgG coated onto microtiter wells. Gel filtration analysis revealed that serum SP-A was eluted at fractions of larger molecular size than was the purified SP-A. These findings suggest that SP-A appears in the bloodstream as a complex with immunoglobulin in IPF and in PAP.

Surfactant protein-A concentration in bronchoalveolar lavage fluids of patients with pulmonary alveolar proteinosis

Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of large quantities of lipoproteinaceous materials in alveoli. Surfactant protein A (SP-A) is the predominant phospholipid-associated glycoprotein in pulmonary surfactant and is specific to the lung. The contents of SP-A in bronchoalveolar lavage (BAL) fluids of patients with PAP were measured with an enzyme-linked immunosorbent assay using two monoclonal antibodies to human SP-A to evaluate its usefulness for diagnosis. Concentration of SP-A in BAL fluid in PAP was significantly increased in comparison with that of normal volunteers. The ratio of SP-A to protein in BAL fluid of PAP was at almost the same level as in normal subjects, while the ratio of SP-A to phospholipid in PAP was significantly higher. These results indicate that measurement of BAL fluid SP-A is of clinical value for diagnosis of PAP and should be used as a biochemical diagnostic tool in the clinical laboratory.

Lung adenocarcinoma with type II pneumocyte characteristics

We report a case of primary lung adenocarcinoma with type II pneumocyte characteristics. Electron microscopic examination demonstrated that the tumour cells had well-developed microvilli and cytoplasmic lamellar inclusion bodies. These ultrastructural features are similar to those seen in type II pneumocytes of normal lung tissue. Western blot analysis, using monoclonal antibody against human surfactant protein A (SP-A), clearly demonstrated that the tumour cells expressed human SP-A, which is a major pulmonary surfactant protein produced by type II pneumocytes. These observations suggest that the tumour was derived from a type II pneumocyte.

Effects of ischemia-reperfusion on light-evoked alkalinization outside rod photoreceptors in the cat retina

The effects of ischemia-reperfusion on the light-evoked alkalinization, which reflects the metabolism of rod photoreceptors, were studied in the dark-adapted cat retina in vivo. We recorded the pH value in the extracellular space surrounding rod photoreceptors with double-barreled H(+)-selective microelectrodes. The light-evoked alkalinizations at the outer nuclear layer were diminished during reperfusion after 10-30 min of ischemia which was induced by an increase of the intraocular pressure above the arterial systolic pressure. This result suggests that the rod metabolism might be suppressed during reperfusion after ischemia.

[A case of idiopathic chylothorax]

A 29-year-old female was admitted to our hospital because of right pleural effusion. Chyle was obtained by thoracocentesis. She received conservative therapy, however, the pleural effusion did not decrease. Thoracic duct ligation was performed, and improvement of the chylothorax was observed. Because there was no underlying disease to cause chylothorax, the diagnosis of idiopathic chylothorax was made. Idiopathic chylothorax is a rare disease and only 24 cases have been reported in Japan.

A 3-year follow-up study of ocular hypertension by pattern electroretinogram

A 3-year following-up study of the pattern electroretinogram (PERG) was performed in 15 eyes of 8 ocular hypertensive (OHT) patients. At first PERG recording, the amplitude of the first positive wave P1 was statistically significantly reduced in the OHT patients compared with age-matched controls (p < 0.05). There was no difference in the amplitude of the second negative wave N2 (p > 0.05). At 40 months, the amplitude of both P1 and N2 decreased and the latency of P1 was elongated. Among the changes, the decrease in N2 amplitude was the most drastic (p = 0.0001 compared with the control, p < 0.05, compared with the first recording). Glaucomatous visual field defects developed 5 years after the first PERG recording and 2 years after the reduction in N2 amplitude in 1 patient. Decreased N2 amplitude of the PERG may be an important warning sign predicting the development of glaucoma in OHT patients.

Lung adenocarcinoma with type II pneumocyte characteristics

We report a case of primary lung adenocarcinoma with type II pneumocyte characteristics. Electron microscopic examination demonstrated that the tumour cells had well-developed microvilli and cytoplasmic lamellar inclusion bodies. These ultrastructural features are similar to those seen in type II pneumocytes of normal lung tissue. Western blot analysis, using monoclonal antibody against human surfactant protein A (SP-A), clearly demonstrated that the tumour cells expressed human SP-A, which is a major pulmonary surfactant protein produced by type II pneumocytes. These observations suggest that the tumour was derived from a type II pneumocyte.