Efficacy of nutritional therapy for active Crohn's disease

We investigated the effect of nutritional therapy with an elemental diet (ED) for active Crohn's disease. One hundred and thirty-nine patients with Crohn's disease were enrolled in this study. Remission was judged to be present when the International Organization of Inflammatory Bowel Disease score was < or = 1 and the CRP and ESR values were within the respective normal ranges. An amount of 30kcal per 1kg of ideal body weight (IBW) per day was administered enterally, and the effect on the induction of remission in relation to various patient background factors, such as disease type, history of bowel resection, and the presence/absence of complications, was determined. An excellent remission rate was achieved in those patients to whom an adequate amount of ED could be administered. Remission rates were lower in the patient groups with any of the following complications: stenotic bowel lesions, abdominal masses, fistulas, and anal lesions. Even in those groups in which stenotic lesions or abdominal masses were present, when adequate amounts of ED could be administered, the remission rate did not differ from that in the groups without these complications. The remission rates in the groups with and without fistulas at any site, including fistulas in the anal region, were 40.0% and 82.5%, respectively, with remission being considerably easier to achieve in the patients without fistulas. Similarly, remission was difficult to achieve when anal lesions were present. These results suggest that, for active Crohn's disease, nutritional therapy with ED ( > or = 35kcal/kg IBW) should be enthusiastically administered, and in patients in whom the presence of complications necessitates therapy for 3 months or more, this point be considered to indicate a possible surgical approach.

Sebaceous carcinoma of the vulva

Extraocular sebaceous carcinoma (SC) is a rare tumor usually found on the head and neck. A 78 year old Japanese female who had an asymptomatic vulvar tumor is reported here. The excised specimen showed SC with metastasis to the inguinal lymph nodes. This is the fourth reported case of SC arising from female genitalia, and the second case that apparently arose from the labia minora. Contrary to the previously reported cases, tumor cells in the present case had abundant glycogen. Thus, differential diagnosis of SC from metastatic renal cell carcinoma is difficult morphologically because both of them have glycogen and lipid. Intraepidermal invasion of tumor cells has been reported in SC, but a suspected lesion of this phenomenon in the present case was proved to be histiocytic infiltration by immunohistochemistry using anti-CD 68 antibody.

Varied effects of thoracic irradiation on peripheral lymphocyte subsets in lung cancer patients

To investigate the influence of thoracic irradiation on immunological competence in patients with lung cancer, we examined the changes in peripheral blood lymphocyte subsets in 15 patients before and after radiation therapy by two-color flow cytometry techniques. After radiation therapy, the percentage and the absolute number of CD4+CD45RA+ cells (naive T cells) and CD56+ and/or CD16+ cells (NK cells) decreased. The percentage of CD4+human leukocyte antigen-DR(HLA-DR)+ cells (activated CD4T cells) and CD8+HLA-DR+ cells (activated CD8T cells) increased, although the absolute number did not change significantly. Naive T cells may be more selectively damaged than memory T cells by thoracic irradiation, through their recirculation behavior. The reduction of natural killer (NK) cells is disadvantageous for anti-tumor immunity. The percentage of HLA-DR positive T lymphocytes was significantly increased, and thus the possibility of HLA-DR enhancement by irradiation cannot be excluded. Therefore, thoracic irradiation has numerous varied effects on the immunological system of lung cancer patients.

Simultaneous evaluation of nitric oxide synthesis and tissue oxygenation in rat liver allograft rejection using near-infrared spectroscopy

Near-infrared (NIR) spectroscopy was applied to rat liver allografts for assessing nitric oxide (NO) synthesis and tissue oxygenation as a means of monitoring the rejection response following liver transplantation. Orthotopic liver transplantation was performed in rats, which were assigned to three groups as follows: group 1, a syngeneic combination (lewis to Lewis); group 2, an allogeneic combination (ACI to Lewis); and group 3, an allogeneic combination treated with 15-deoxyspergualin. NIR spectroscopy was performed on the grafts in recipients, and the relative changes in nitrosyl-Hb (NO bound to erythrocyte hemoglobin), oxy-Hb, and oxidized cytochrome oxidase (Cyt.aa3) were obtained. The level of nitrosyl-Hb was significantly elevated from postoperative day (POD) 3 in group 2 compared with that in group 1, which remained constant (P < 0.05). In group 3, the elevation was significantly suppressed. These data indicate that the alloimmune response is associated with a dramatic change in NO synthesis in grafted livers. In a separate experiment, NO synthesis was also increased after long cold preservation (24 hr) in syngeneic liver transplants. However, the increase was transient and subsided on POD 3. Levels of oxy-Hb and oxidized Cyt.aa3 in group 2 were significantly decreased when parenchymal disorder was confirmed histologically (POD 6 and 8), compared with those in group 1, which remained constant (P < 0.05). In group 3, both of these levels showed improvement. Thus, our NIR spectroscopy technique was shown to be capable of assessing simultaneously both the immune response and the degree of immune-induced destruction of allograft tissue following liver transplantation through monitoring of NO synthesis and tissue oxygenation.

Cytotoxicity of anti-c-erbB-2 immunoliposomes containing doxorubicin on human cancer cells

We have examined the selective cytotoxicity of immunoliposomes containing doxorubicin (chemoimmunoliposomes, CILs) targeting the c-erbB-2 gene product (gp185) or gp125. Anti-gp185 and anti-gp125 CILs were prepared by conjugation of doxorubicin-containing liposomes with monoclonal antibodies SER4 (IgG) and HBJ127 (IgG) respectively. Both CILs bound to human SKBr-3 breast cancer cells and MKN-7 human gastric cancer cells, which express both antigens in high density. The IC50 of anti-gp185 CILs on protein synthesis by SKBr-3 cells was respectively 2- and 25-fold lower than that of anti-gp125 CILs and unmodified liposomes. Furthermore, anti-gp185 CILs significantly inhibited neither the phytohaemagglutin response of normal lymphocytes nor protein synthesis of gp185-negative T24 bladder cancer. Quantitative analysis of cell-associated doxorubicin revealed that, compared with anti-gp125 CILs, anti-gp185 CILs required, respectively 4.5 and 4.3 times less doxorubicin association in SKBR-3 and MKN-7 cells, for 50% cytotoxicity. In addition, flow cytometric analysis showed that both SKBr-3 and MKN-7 internalised more anti-gp185 CILs and processed them more efficiently than anti-gp125 CILs. These results suggest that anti-gp185 CILs act selectively against gp185-expressing cancer cells and that gp185 is a more sensitive antigen for CIL cytotoxicity associated with endocytosis activity.

Development of a rat model for orthotopic liver transplantation for hepatocellular carcinoma

BACKGROUND

Surgical resection is of limited benefit in hepatocellular carcinoma accompanied by severe liver cirrhosis or multicentric hepatic cancer. The long-term survival of patients with advanced hepatocellular carcinoma after transplantation is quite poor. We have studied the characteristics, natural course, and cause of diethylnitrosamine-induced liver cancer in rats and have shown it to be a good model of liver cancer in human beings. Therefore we performed orthotopic liver transplantation (OLT) in rats with diethylnitrosamine-induced liver cancer to study the patterns of recurrence.

METHODS

Diethylnitrosamine 100 parts per million in drinking water was administered daily for 4 months to male inbred LEW rats. A laparotomy was performed 120 or 134 days after commencing the oral diethylnitrosamine to confirm the induction of cancer confined grossly to the liver. The livers were resected, and orthotopic transplantation with livers of normal LEW rats was performed.

RESULTS

By day 150 all the rats in the non-OLT group died of intraabdominal hemorrhage caused by spontaneous rupture of liver cancer (mean survival time +/- SD, 138.2 +/- 5.3 days; n = 14). However, the OLT (day 120) group recovered their body weight comparatively early after transplantation and survived a maximum of 218 days until death from recurrence (203.8 +/- 21.3 days; n = 4). A significant extension in survival time was observed (p < 0.01). In autopsies performed at the time of death, metastatic liver cancer was observed in the transplanted livers with two showing metastases to the lung. The cause of death was cancer in all the rats. However, the OLT (day 134) group all died of major complications of severe pneumonia and disseminated intravascular coagulation within 2 weeks of OLT (141.3 +/- 5.0 days; n = 4).

CONCLUSIONS

After liver transplantation to rats with hepatocellular cancer confined to the liver, recurrence was observed at a comparatively early stage in all transplant recipients. Although a significant prolongation of survival was noted, they all died of cancer. The timing of transplantation is also an important factor. This experimental liver transplantation model of progressive rat liver cancer will be useful in the study of primary liver cancer in human beings.

Production and characterization of monoclonal antibodies against human natriuretic peptide receptor-A or -B

Monoclonal antibodies (mAbs) against human natriuretic peptide receptor-A (NPR-A) or NPR-B were produced using NPR-expressing Chinese hamster ovary (CHO) cells and soluble chimeric NPRs consisting of the extracellular domain of each receptor fused to Fc region of human IgG. Three anti-NPR-A mAbs, designated as A144, A397 and A416, bound to human NPR-A but not to NPR-B, while an anti-NPR-B mAb B136 reacted with human NPR-B but not with NPR-A. Competition analysis with the anti-NPR-A mAbs revealed that two mAbs, A144 and A416, recognize an identical or the adjacent site of the receptor and that A397 is directed against another epitope. No anti-NPR-A mAb affected binding of atrial natriuretic peptide (ANP) to NPR-A, while the anti-NPR-B mAb B136 inhibited binding of C-type natriuretic peptide (CNP) to NPR-B. Inhibition of the ligand-binding by B136 is specific in that the mAb showed no effect on the binding of ANP to NPR-A. B136 also blocked CNP-mediated intracellular cGMP accumulation in NPR-B-expressing cells. These results suggest that the region recognized by B136 may be related to the ligand-binding region of NPR-B. NPR-A- and NPR-B-expressing cells were selectively detected by immunostaining using the mAbs. These findings demonstrate that the mAbs will be useful to elucidate the role of the natriuretic peptides and their receptors in normal and disease states in humans [correction of human].

[Giant cell interstitial pneumonia in a metal grinder with an abnormally high level of serum CA19-9]

Interstitial pneumonia and recurrent pneumothorax developed in a 48-year-old man who had worked as a metal grinder. He died of respiratory failure despite having received antibiotics and steroids, and despite having undergone pleural sclerosis therapy. Giant cell interstitial pneumonia was diagnosed; innumerable bizarre giant cells engulfing black granules were found within the alveoli. The results of high-energy dispersion X-ray microanalysis indicated that the patient had hard metal pneumoconiosis associated with tungsten in the black granules. When he was admitted to the hospital, his serum CA19-9 and SLEX concentrations were abnormally high (2600 and 200 ng/ml, respectively). Immunohistochemical analysis of lung tissue was done with anti-CA19-9 and SLEX antibodies. CA19-9 staining revealed strong bronchialization and squamous metaplasia in contrast to type II hyperplasia. SLEX staining showed strong type II hyperplasia. Further investigations will be needed to determine the mechanism of elevated tumor-associated carbohydrate antigens in serum.

Evolution of three patterns of intra-alveolar fibrosis produced by bleomycin in rats

In pulmonary fibrosis, it is known that fibrotic changes develop in the intra-alveolar spaces and that intra-alveolar fibrosis can be classified into three patterns, namely intra-alveolar buds, mural incorporation and obliterative changes. In order to clarify the evolution of intra-alveolar fibrosis, immunohistochemical studies of extracellular matrix proteins and electron microscopic observations were made of the lungs of rats given a single intratracheal instillation of bleomycin. All three patterns of fibrosis developed in this model. Intra-alveolar buds changed into globular lesions with dense collagen deposition, the surface of which was covered by alveolar epithelium. Electron microscopy revealed that the buds often contained spiraling collagen fibrils and numerous microfibrils, but not mature elastic fibres, beneath the regenerating epithelial lining cells; the epithelial basement membranes were discontinuous. In contrast, mural incorporation and obliterative changes were associated with alveolar structural remodeling. Electron microscopically, these lesions had bundles of normal collagen fibrils, small elastic fibers, and continuous epithelial basement membranes. These results indicate that: (i) intra-alveolar buds, that become intra-alveolar collagen globules, with an unusual extracellular matrix, do not contribute to alveolar structural remodelling; and (ii) areas of mural incorporation and obliterative changes have the usual type of extracellular matrix and are essential for alveolar structural remodelling.

Inspiratory activity responses to lung inflation and ventral medullary surface cooling of glossopharyngeal nerve (stylopharyngeal muscle branch) and its motoneuron distribution in the rat

Inspiratory (I) discharges of the phrenic (Phr) and glossopharyngeal (stylopharyngeal muscle branch, IX) nerves were compared in the urethane anesthetized, vagi-intact and artificially ventilated rat in which respiratory rhythm was generated in synchrony with cyclic changes in airway pressure (P(aw)) produced by a ventilator. Observations were made during respiratory suppression due to excess lung inflation and bilateral cooling of the ventral medullary surface (VMS). In the control condition, regular rhythmic I bursts appeared at low baseline P(aw) phase (lung deflation) and ceased when P(aw) increased (lung inflation) in each ventilator cycle. Increase in baseline P(aw) (P(aw) > 8 cmH2O, excess lung inflation) suppressed the initiation of rhythmic I discharge. However, threshold baseline P(aw) for suppressing I bursts was higher in the IX than in the Phr nerve, and regular rhythmic I activity remained in the IX even after cessation of Phr bursts. During VMS cooling, I bursts disappeared first in the Phr and subsequently in the IX nerve and emerged always first in the IX during recovery. The results suggest that I activity of the IX (stylopharyngeal) motoneurons, which are located in the rostral part of the nucleus ambiguus, are less suppressed than that of Phr motoneurons by vagal afferents arising probably from slowly adapting pulmonary stretch receptors or by a reduction in respiratory drive from VMS. These differential responses of Phr and IX motoneurons may be ascribed to differences in activation or inhibition processes between two motoneuron groups despite both being driven by a common rhythm generator.

Combination therapy with mucosal protective agent for the eradication of Helicobacter pylori

OBJECTIVE

To investigate the effect of plaunotol in combination with proton-pump inhibitors on Helicobacter pylori eradication in patients with gastric ulcer.

PATIENTS AND METHODS

We studied 65 H. pylori-positive gastric ulcer patients. They were randomly assigned to five treatment groups: omeprazole (group I, n = 8), lansoprazole (group II, n = 13), lansoprazole+plaunotol (group III, n = 12), lansoprazole+clarithromycin (group IV, n = 16) and lansoprazole+plaunotol+clarithromycin (group V, n = 16). Ulcer status was diagnosed by endoscopy and H. pylori status by culture, histology, a urease test and a urea breath test at baseline, and after 8 and 12 weeks. The clearance and eradication rates were compared in each group.

RESULTS

The healing rates in groups I-V were 100, 92, 100, 100 and 100%, respectively; clearance rates were 0, 23, 42, 50 and 75%, respectively; and eradication rates were 0, 0, 8, 38 and 69%, respectively.

CONCLUSION

Combination therapy with plaunotol is efficacious for the eradication of H. pylori in gastric ulcer patients.

[MR imaging of infected spondylodiskitis: interval signal change in vertebral body (including enhanced image of vertebral body)]

A retrospective evaluation of MRI was carried out in 22 patients with spondylodiskitis. Low signal intensity on T1-weighted images and high or low signal intensity on T2-weighted images were observed. Sixteen patients underwent follow-up examinations after the initial examination. Various signal changes in the vertebral body were recognized. The longer the period of follow-up, the less abnormal the signal intensity became on both T1- and T2-weighted images. Several cases showed no change in signal intensity. In all of 17 patients re-examined after injection of Gd-DTPA, infected vertebral bodies were enhanced. We classified the enhancing patterns of infected vertebral bodies in three types: A) homogeneous, B) homogeneous with strong enhancement adjacent to the end plate, C) inhomogeneous. Pyogenic spondylodiskitis tended to show patterns A or B, and tuberculous spondylodiskitis pattern C. The enhancement effect disappeared after normalization or remission of laboratory findings. In two cases, the enhancement effect remained even after laboratory findings became normal. Contrast MRI was useful for understanding infectious state.

Hepatitis C virus infection and genotypes in Japanese hemophiliacs

Liver function and antibodies to hepatitis C virus and to human immunodeficiency virus-1 were examined in 195 Japanese patients with hemophilia. One hundred and seventy-three were positive for antibody to HCV and 61 for antibody to human immunodeficiency virus-1. In 63 patients, we examined HCV genotypes according to the double polymerase chain reaction method. Forty cases (63%) were infected with hepatitis C virus with a single genotype, including type 1a in five, type 1b in 21, type 2a in seven and type 2b in seven; 16 (25%) were infected with double genotypes, including types 1a + 1b in 14, types 1b + 2a in one and types 1b+2b in one; and four (6%) were infected with triple genotypes, including types 1a + 1b + 2b in two. Genotype could not be determined in three patients by this method. In the 191 nonhemophiliac patients with chronic hepatitis C, HCV genotyping was as follows: type 1a in 0, type 1b in 121, type 2a in 40 and type 2b in 10 of 171 cases (89.5%) with single infection and types 1b + 2a in five and types 2a + 2b in one of six (5.5%) with double infection. In the remaining 14 patients, genotype could not be determined. Frequent transfusion of domestic and/or imported coagulation factor concentrates probably caused the high incidence of HCV infection with rare or mixed genotypes in Japanese hemophiliacs.

Proton pump inhibitors for Helicobacter pylori eradication in patients with peptic ulcer

We investigated the effects of omeprazole or lansoprazole on peptic ulcer healing, eradication of Helicobacter pylori (Hp) and abdominal symptoms. A prospective, randomized study was performed for the administration of omeprazole or lansoprazole. Hp-positive peptic ulcer patients (n = 86) were randomly assigned to two groups. Gastric ulcer patients received omeprazole 20 mg once daily or lansoprazole 30 mg once daily for 8 weeks. Duodenal ulcer patients were given omeprazole 20 mg once daily or lansoprazole 30 mg once daily for 6 weeks. Endoscopy was performed at baseline, at the end of therapy, and 4 weeks after stopping therapy. The colony factor units (CFUs) of Hp in biopsy specimens were examined. The CFUs of Hp in gastric and duodenal ulcer were significantly decreased at 4 weeks after stopping lansoprazole therapy. We conclude that Hp eradication by combined use of lansoprazole with antibiotics appears to be a promising therapy.

Susceptibility of insulin to proteolysis in rat lung homogenate and its protection from proteolysis by various protease inhibitors

The objective of this study was to determine the stability of insulin in rat lung homogenate and to confirm the effectiveness of various protease inhibitors for insulin delivery from the lung. The stability of insulin in rat lung homogenate was compared with that in the small intestine. Insulin was rapidly degraded in lung homogenate similarly to degradation in the small intestinal homogenate. The effects of various protease inhibitors on the degradation of insulin were studied in the lung. Protease inhibitors such as Na-glycocholate (Na-GC; 10 mM), aprotinin (10 mg/ml), soybean trypsin inhibitor (STI; 10 mg/ml) and bacitracin (20 mM) effectively reduced insulin degradation in lung homogenate. The rank order of effectiveness for decreasing the insulin hydrolysis in lung homogenate was bacitracin > aprotinin > STI > Na-GC. In addition, a slight correlation was observed between the in situ pulmonary absorption of insulin and its stability in vitro in the lung homogenate in the presence of various protease inhibitors. These findings suggest that the coadministration of protease inhibitors would be useful for improving the stability of insulin in the lung.

Number and dendritic morphology of retinal ganglion cells that survived after axotomy in adult cats

Retinal ganglion cells (RGCs) of adult cats were labeled by injection of diI into the proximal stump of completely transected optic nerves. Approximately 2% to 5% of the RGC population appeared viable 2 months after these axotomies, based on diI retention. The morphological type and dendritic arbor of these surviving RGCs were examined after intracellular injections of Lucifer Yellow into diI-labeled RGCs. Postaxotomy survival rate was much higher for alpha-like cells than for beta-like cells. However, in one of four retinas examined, a large number of RGCs seemed to survive axotomy, and among these, beta cells survived at an unusually high rate. Dendritic arbors of surviving RGCs were also examined after intracellular injection of horseradish peroxidase. Some dendrites of these RGCs lacked branches and were thin in caliber. Other dendrites displayed many spiny processes and bulbous swellings. Essentially, these results confirm the previous suggestion that alpha cells survive axotomy longer than beta cells. The ability of alpha cells to regenerate axons may thus be attributable to their relatively high resistance to axotomy. The atypical dendritic profiles seen after optic nerve transection may reflect either degeneration or regrowth of dendrites.

Abnormalities in elastic fibers and other connective-tissue components of floppy mitral valve

Histologic, immunohistochemical, and ultrastructural studies were performed on 12 floppy mitral valves, 4 mitral valves showing focal myxomatous changes without prolapse, and 3 normal mitral valves. All floppy mitral valves were thickened by deposits of proteoglycans and also showed diverse structural abnormalities in collagen and elastic fibers. From these observations we conclude that (1) the structure of all major components of connective tissue in floppy mitral valves is abnormal; (2) alterations in collagen and accumulations of proteoglycans are nonspecific changes that may be caused by the abnormal mechanical forces to which floppy mitral valves are subjected because of their excessively large surface area; (3) the presence of excessive amounts of proteoglycans may interfere with the normal assembly of collagen and elastic fibers; (4) abnormalities of elastic fibers resemble those in other conditions characterized by structural dilatation or tissue expansion; and (5) alterations in elastin could result from defective formation, increased degradation, or both.

Sensitive detection of circulating hepatocellular carcinoma cells in peripheral venous blood

BACKGROUND

This study was performed to develop a sensitive method for the detection of circulating hepatocellular carcinoma (HCC) cells in peripheral blood, in advance of the diagnosis of distant metastasis of HCC by conventional means.

METHODS

Peripheral blood (5 ml) samples were obtained from 64 patients with HCC and from 48 control subjects (31 patients with benign liver disease, 8 with metastatic liver cancer, and 9 with normal liver function). To identify HCC cells in peripheral blood, liver-specific human alpha-fetoprotein (hAFP) mRNA was amplified from total RNA extracted from whole blood by reverse transcriptase-polymerase chain reaction.

RESULTS

Human alpha-fetoprotein mRNA was detected in 23 blood samples from the HCC patients (23/64, 36%), in 17 patients in whom there was no clinical evidence of distant metastasis. In contrast, there were no control patients whose samples showed detectable hAFP mRNA in the peripheral blood. The presence of hAFP mRNA in blood seemed to be correlated with the stage (by TNM classification) of HCC, the serum hAFP value, and the presence of intrahepatic metastasis, portal vein thrombosis, and/or distant metastasis.

CONCLUSIONS

Reverse-transcriptase polymerase chain reaction is a very sensitive method for detecting circulating HCC cells. With this technique, important information for the management of HCC can be acquired, such as the indications for orthotopic liver transplantation in HCC patients. Moreover, use of this detection method may encourage investigation of the mechanism of metastasis in HCC.