Simple method for quantifying disorientation of myofiber in endomyocardial biopsy specimens using an image analyzer

The disarray of cardiac myofibers was morphometrically evaluated in biopsy specimens, obtained from patients with hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD), chronic phase myocarditis and controls. Microphotographs of myocardium were taken at a final magnification of x 250. For each segment of myofibers, the longitudinal direction was traced on a transparent sheet, and the angle of the traced direction to the baseline was measured by an image analyzer. The standard deviation of the angles was used as an indicator of myofiber disarray. The histograms showed a narrow variation in the control group, but a wide variation in the patients with HCM, HHD and chronic phase myocarditis. The mean value of standard deviations of myofiber angles in HCM was significantly larger than that in the other groups. In HCM, the standard deviation of the myofiber angle proved to correlate positively with IVST/LVPWT (the thickness ratio of interventricular septum to the left ventricular posterior wall) (r = 0.70, p < 0.05), and also with LVEDP (left ventricular end-diastolic pressure) (r = 0.66, p < 0.05). In conclusion, the image analyzer serves as a simple and useful tool in quantifying the disorientation of myofibers and estimating the correlation between the histological and clinical findings.

Expression of cytokine genes and presence of enteroviral genomic RNA in endomyocardial biopsy tissues of myocarditis and dilated cardiomyopathy

Viral infection, especially by enteroviruses, has been considered to be the most common cause of myocarditis, which may progress to dilated cardiomyopathy (DCM). Although the mechanism of progression remains uncertain, a cytokine-associated injury of myocytes has been proposed. Using reverse transcriptase polymerase chain reaction (RT-PCR), we examined the expression of interleukin 1 beta (IL-1 beta), IL-6, IL-8 and tumour necrosis factor alpha (TNF-alpha) and the presence of enteroviral genomic RNA in endomyocardial biopsy tissues obtained from patients with myocarditis and DCM. We examined endomyocardial biopsy tissues obtained from 6 patients with myocarditis, 21 with DCM and 15 with non-infectious cardiac diseases as controls. In patients with myocarditis, endomyocardial biopsy was performed twice at an interval of 1 month to 8 years after the onset of myocarditis. We used RT-PCR to detect IL-1 beta, IL-6, IL-8 and TNF-alpha genes expression and nested RT-PCR (nRT-PCR) to detect enteroviral genomic RNA. IL-1 beta, IL-6, IL-8 and TNF-alpha genes were expressed in 100% (6/6) and enteroviral genomic RNA in 67% (4/6) of myocarditis patients at the first biopsy. At the second biopsy, IL-1 beta, IL-6, IL-8 and TNF-alpha genes were expressed in none, 50% (3/6), 67% (4/6) and 67% (4/6), respectively, and enteroviral genomic RNA in 67% (4/6). Four patients with myocarditis, in whom IL-8 and TNF-alpha genes and enteroviral genomic RNA were detected, progressed to DCM at the second biopsy. IL-1 beta, IL-6, IL-8 and TNF-alpha genes were expressed in none, 24% (5/21), 38% (8/21), 57% (12/21) of DCM patients, respectively. Enteroviral genomic RNA was detected in 43% (9/21) of DCM. Neither cytokine expression nor enteroviral genomic RNA were detected in the controls. the high incidence of cytokines, especially IL-6, IL-8 and TNF-alpha, expression in myocarditis and DCM, which might be induced by enteroviral infection, suggests that cytokines play an important role in myocytic damage leading to DCM.

Enzymic synthesis of lacto-N-triose II and its positional analogues

N-acetylhexosaminidase from Nocardia orientalis catalysed the synthesis of lacto-N-triose II glycoside (beta-D-GlcNAc-(1-3)-beta-D-Gal-(1-4)-beta-D-Glc-OMe, 3) with its isomers beta-D-GlcNAc-(1-6)-beta-D-Gal-(1-4)-beta-d-Glc-OMe (4) and beta-D-Gal-(1-4)-[beta-D-GlcNAc-(1-6)]-beta-D-Glc-OMe (5) through N-acetylglucosaminyl transfer from N,N'-diacetylchitobiose (GlcNAc2) to methyl beta-lactoside. The enzyme formed the mixture of trisaccharides 3, 4 and 5 in 17% overall yield based on GlcNAc2, in a ratio of 20:21:59. With p-nitrophenyl beta-lactoside as an acceptor, the enzyme also produced p-nitrophenyl beta-lacto-N-trioside II (beta-D-GlcNAc-(1-3)-beta-D-Gal-(1-4)-beta-D-Glc-OC6H4NO2-p, 6) with its isomers beta-D-GlcNAc-(1-6)-beta-D-Gal-(1-4)-beta-D-Glc-OC6H4NO2-p (7) and beta-D-Gal-(1-4)-[beta-D-GlcNAc-(1-6)]-beta-D-Glc-OC6H4NO2-p (8). In this case, when an inclusion complex of p-nitrophenyl lactoside acceptor with beta-cyclodextrin was used the regioselectivity of glycosidase-catalysed formation of trisaccharide glycoside was substantially changed. It resulted not only in a significant increase of the overall yield of transfer products, but also in the proportion of the desired compound 6.

Case report: reversal of severe leukopenia by granulocyte colony-stimulating factor in anorexia nervosa

Recent attempts to reduce weight by patients with anorexia nervosa have sometimes led to life-threatening hematologic complications. This report describes an instance in which a patient with anorexia nervosa and pancytopenia drastically improved with treatment that included administration of granulocyte colony-stimulating factor. The patient had lost 27 kg of body weight within 8 months. Even after admission, the blood cell count continued to decrease rapidly as follows: platelet, from 244 x 10(3)/microliters to 44 x 10(3)/microliters; erythrocyte, from 4.04 x 10(6)/microliters to 2.58 x 10(6)/microliters; and leukocyte, from 4.8 x 10(3)/microliters to 1.6 x 10(3)/microliters (granulocyte, 0.8 x 10(3)/microliters). Complications included pneumomediastinum, pneumothorax, purpura, petechiae, hepatomegaly, fever, gangrenous stomatitis, and somnolence. Bone marrow aspiration disclosed absence of fat cells, marrow hypoplasia, and infiltration of the mature lymphocytes. Intravenous hyperalimentation, blood transfusion, gamma-globulin, and antibiotics were administered, but leukopenia and fever remained. However, administration of recombinant human granulocyte colony-stimulating factor dramatically reversed the leukopenia and fever. With careful nutrition therapy, the patient's blood cell count and bone marrow normalized by the time of discharge. It was concluded that severe hematologic disorders may occur in patients with anorexia nervosa, and advanced treatment may be required to save the patient's life.

Neuropathology of HTLV-I-associated myelopathy--a report of two autopsy cases

A neuropathological analysis was performed in two autopsy cases of HTLV-I-associated myelopathy. The thoracic spinal cords were most severely affected and the histopathological findings consisted of mononuclear cell infiltration, marked destruction of myelin and axons and astrocytic gliosis. More than half the infiltrated cells were positive for pan-T cell marker; B cells were sparse in the parenchyma and subarachnoid spaces. CD4 and CD8 positive cells were found in the early stages of the lesions. CD8, however, predominated over CD4 in the other stages. It appeared that a chronic inflammatory process had started at the middle to lower thoracic cord and had extended gradually in both directions. The middle thoracic spinal cord is known to have the poorest blood supply, and the horizontal distribution of inflammatory cells at this region correlated with the most distal supply of the anterior spinal artery.

A new cell line (XTY) from a tumor of Xenopus laevis

A new cell line (XTY) was derived from a tumor of a female Xenopus laevis. This cell line has been proliferating in standard amphibian culture medium for more than 4 years (470 generations) and has a doubling time of 75.5 h at 25 degrees C. The cells aggregate into large groups, and their stellate morphology and the expression of desmin demonstrated by immunocytochemistry suggest that their origin is not epithelial.

Origin of so-called mesothelioma of the atrioventricular node. An immunohistochemical study

To determine the origin of a mesothelioma of the atrioventricular node, immunohistochemical studies that used various antibodies, including the antibody against mesothelial cells, were performed on a mesothelioma of the atrioventricular node in a case. The lining cells of the tubules that composed the tumor were negative when tested with anti-mesothelial cell antibodies. Carcinoembryonic antigen was negative, but the secretory component was positive. Serotonin and calcitonin were positive in a few cells. We concluded that a mesothelial origin was unlikely, and it was suggested that the tumor was of an entodermal origin.

Morphometric comparison of mitochondria and myofibrils of cardiomyocytes between hypertrophic and dilated cardiomyopathies

We performed an ultrastructural, morphometric comparison of mitochondria and myofibrils of cardiomyocytes using endomyocardial biopsy specimens in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Biopsies came from the right ventricular side of the interventricular septum in nine patients with HCM, nine with DCM, and nine controls with arrhythmia and/or ST depression. Morphometric analysis was carried out using electron microscopic photographs and an image analyser. Mitochondria were significantly greater in number and smaller in size in HCM than in the control group. In DCM, the size of mitochondria was also significantly smaller than in the control group, although their number was similar to that of the control group. No statistically significant difference was found regarding the size of mitochondria between HCM and DCM. The percentages of both mitochondrial and myofibrillar areas in cytoplasm were smaller in the DCM than the HCM and control groups, though no difference was seen between the latter two. The ratio of mitochondrial area to myofibrillar area was almost the same in each group. These results suggest increased mitochondrial function to match hypertrophic cardiomyocytes in HCM, and decreased mitochondrial function and cardiomyocytic contractility in DCM.

Histological changes in cardiac hemochromatosis improved by an iron-chelating agent. A biopsy case

Cardiac dysfunction and ECG abnormalities were demonstrated in a 51-year-old woman suffering from secondary hemochromatosis in sideroblastic anemia. Hemosiderin deposition in vacuolized and disarrayed myocytes was disclosed by microscopic examination of the first biopsy specimen of endomyocardial tissue. Three months after administration of deferoxamine mesylate, an iron-chelating agent, the clinical findings were improved. The second endomyocardial biopsy revealed marked depletion of hemosiderin deposition in the myocytes, and improvement of myocyte vacuolization and disarray. Ultrastructurally, the highly electron-dense granules in the myocytes were also decreased in number and density. X-ray microanalysis revealed a prominent peak of Fe in the granules. In a liver specimen obtained by needle biopsy 5 months after the second endomyocardial biopsy, marked hemosiderin deposition still remained.

Forssman antigen expressed on lymph node cells of MRL/MpJ-lpr/lpr mice is of a glycoprotein nature

This paper reports the nature of abnormally expressed Forssman (F) antigen in the lymph node cells of MRL/MpJ-lpr/lpr, autoimmune mice, and also reports its autoantibody in sera. By acetylation study of the F antigen with [14C]acetic anhydride, we concluded that the F antigen was not a glycolipid but a glycoprotein. Several bands of F-active glycoproteins were identified on a nitrocellulose sheet after purification by an anti-F antibody affinity column. Hemolysis of SRBC by some sera from MRL/MpJ/lpr/lpr was inhibited by purified F glycoprotein and also by F glycolipid. The antibody in the serum, however, seemed to be more specific for F glycoproteins than F glycolipid, but the opposite was the case for rabbit anti-F glycolipid antibody. No significant difference of the SRBC hemolysis levels was observed between the sera from MRL/MpJ-lpr/lpr and its congenic MRL/MpJ-+/+ mice.

[Glomerulocystic kidney: report of two autopsy cases]

We reported two cases of glomerulocystic kidney (GCK). Case 1 was a 35-day-old male who was born at 38 weeks of gestation and weighed 1750 g at birth. He showed chromosomal aberration and surface anomaly, and was diagnosed as having pentalogy of Fallot. There were no signs of renal disturbance. At autopsy, subcapsular cysts composed of dilated Bowman's capsules were found. Case 2 was a 63-year-old man. He suffered from mild cerebral infarction at the age of 45. At the age of 51, he was diagnosed as having chronic glomerulonephritis and began hemodialysis at the age of 55. He died of uremic lung at 63. Diffuse dilatation of Bowman's capsules were found in the renal cortices. In the liver, proliferation and cystic dilatation of interlobular bile ducts were noted. The patients with GCK without any severe disease in other organs show no or stable symptoms in the early period of life, but later developed severe renal insufficiency.

Antimyristoylation of the gag proteins in the human immunodeficiency virus-infected cells with N-myristoyl glycinal diethylacetal resulted in inhibition of virus production

The gag proteins of human retroviruses such as human immunodeficiency virus (HIV-1) are specifically myristoylated in their amino termini (1, 2, 3). N-myristoyl glycinal diethylacetal (N-Myr-GOA) and other N-Myr-compounds (N-Myr-Gly-GOA, N-Myr-Gly-Gly-GOA and N-Myr-Gly-Gly-Gly-GOA) were newly synthesized and investigated for activity of antimyristoylation of these gag proteins and for influence on viral replication. Of the N-Myr-compounds tested, N-Myr-GOA most severely inhibited the protein myristoylation; N-Myr-Gly-GOA also inhibited it, but moderately. Furthermore, it was observed that N-Myr-GOA at 20 microM caused noticeable inhibition (about 80%) of the production of mature HIV in the HIV-1-infected MT-4 cells. In this system, N-Myr-GOA substantially inhibited more than 90% of the N-myristoylation of p17 gag protein produced in the HIV-1-infected MT-4 cells. These results suggest that the N-myristoylation of p17 gag protein of HIV-1 may be essential in its structural assembly or maturation.

[A new edentulous model maintained at body temperature]

We have produced a new edentulous model, which is maintained at the human body temperature, for higher grade model practice and pre-clinical education. A soft material, its thickness based on the value of the oral mucosa, covers the surface of this model. It takes 4 minutes to reach the body temperature after turning on the switch, and it consumed about 9 watts per hour. This new model is useful for teaching clinical characteristics of impression materials in which the setting time is influenced by the temperature. Improvements are under consideration to fit some thermal and pressure sensors to the buccal and labial parts to make a more sophisticated patient simulator.

[Hepatic reticuloendothelial failure: report of a young heavy-drinker case]

A 27-year-old-male with hepatic reticuloendothelial failure was reported. He was proved by laparoscopy as having alcoholic liver cirrhosis. In spite of the absence of hepatic colloid uptake, hepatobiliary scan with Tc-99m HIDA and Ga-67 citrate produced satisfactory liver images.

Antibodies to an NH2-terminal myristoyl glycine moiety can detect NH2-terminal myristoylated proteins in the retrovirus-infected cells

Novel antibodies were raised against a synthetic NH2-terminal myristoyl glycine moiety which is characteristic of N-myristoyl-proteins. Antisera raised against N-myristoyl-Gly-hemocyanin reacted with N-myristoyl-Gly-[125I]albumin. The immunoreaction was competed for by albumin conjugated with N-myristoyl-glycine, while underivatized albumin had no effect. Of the [3H]myristate-labeled proteins detected, pp60v-src, which is a transforming protein of Rous sarcoma virus, and p19gag and p17gag, which are core proteins in the human T-cell leukemia virus and the human immunodeficiency virus, were identified as N-myristoylated proteins by the radioimmunoprecipitation analyses with the antibody.

Antimyristoylation of gag proteins in human T-cell leukemia and human immunodeficiency viruses with N-myristoyl glycinal diethylacetal

N-Myristoyl (N-Myr-) glycinal (aminoacetoaldehyde, GO) diethylacetal (A), which is abbreviated as N-Myr-GOA, and other N-Myr-compounds (N-Myr-Gly-GOA, N-Myr-Gly-Gly-GOA, and N-Myr-Gly-Gly-Gly-GOA) were newly synthesized and then employed for NH2-terminal antimyristoylation of structure proteins in the human T-cell leukemia virus (HTLV-I) and the human immunodeficiency virus (HIV). The protein myristoylation of structure proteins p19gag, of HTLV-I, and p17gag, of HIV, was determined separately, using radiolabeled myristic acid, in vitro. The radiolabeled proteins, after immunoprecipitation with an antiserum to adult T-cell leukemia (ATL) or the anti-p17gag monoclonal antibody of HIV, were identified as p19gag of HTLV-I and p17gag of HIV by fluorography after SDS-polyacrylamide gel electrophoresis (SDS-PAGE). The protein myristoylation was resistant to NH2OH-treatment. Of the N-Myr-compounds tested, N-Myr-GOA remarkably prevented the myristoylation of p19gag and p17gag, but N-Myr-Gly-Gly-GOA and N-Myr-Gly-Gly-Gly-GOA did not.

Prevention of horizontal transmission of hepatitis B: efficacy of hepatitis B immunoglobulin and vaccine in an institution for the handicapped

In a Japanese institution for the handicapped with confirmed continuous outbreaks of hepatitis B virus (HBV) infection by horizontal nosocomial transmission, 29 susceptible subjects (8 institutionalized children and 21 medical staff) were injected intramuscularly with anti-human HBs immunoglobulin (HB Ig) and subcutaneously with HB vaccine. All cases acquired HBs antibody after injection of HB Ig and seropositivity for HB after the third inoculation of HB vaccine was 78.6%. No new case of HB occurred among the study population throughout the period investigated. This suggested the effectiveness of HB Ig and HB vaccine in the prevention of horizontal nosocomial transmission of HBV.

Cervical catecholamine-secreting paraganglioma in the pterygopalatine fossa

A 25-year-old man was admitted for examination to determine the cause of hypertension. High levels of noradrenaline in plasma and urine were seen, suggesting that the patient had an adrenal or extra-adrenal pheochromocytoma. However, whole-body scintigraphy using the isotope of [131I] meta-iodo-benzylguanidine (131I-MIBG) failed to find the presence of a catecholamine-secreting tumor. The highest level of noradrenaline was detected in plasma obtained from the left jugular vein after selective venous collections through femoral catheterization. Both the computed tomography and cerebral angiography showed a hen-egg-sized tumor located in the left pterygopalatine. After surgical removal of the tumor, high blood pressure and the levels of noradrenaline in plasma and urine were significantly decreased. Histopathological diagnosis was paraganglioma (catecholamine-secreting paraganglioma). The patient with cervical catecholamine-secreting paraganglioma is the first case where the tumor was isolated and located in the pterygopalatine fossa.

Acute pancreatitis with cytomegalovirus infection

An autopsy case of necrotizing pancreatitis with cytomegalovirus (CMV) infection is reported. A 50-year-old housewife was admitted because of malignant choroid plexus papilloma of the fourth ventricle. Serum amylase transiently elevated during irradiation and chemotherapy for brain tumor, one month before death. The patient died of a respiratory failure. At autopsy focal necrosis was mainly observed in the peripancreatic adipose tissue and occasionally in the parenchyma of the tail. Fibrosis and inflammatory infiltration was found around the necrosis and interstitium. Cytomegalic cells with intranuclear inclusions and/or cytoplasmic granules were observed frequently in the acini near the necrosis. Immunohistological study revealed CMV antigen in the cytomegalic cells. Herpesvirus-type particles were observed in the nucleus and cytoplasm of the cytomegalic cells. CMV infection of the acini are thought to cause necrotic changes in the pancreas.

Significant regression of the tumor combined with the high level of plasma cortisol by low-dose administration of O, p'-DDD in a case with Cushing's syndrome caused by adrenocortical carcinoma

The effect of o, p'-DDD on a functioning adrenocortical carcinoma is described. A 52-year-old woman, who had a huge adrenocortical carcinoma and pulmonary metastasis, was treated by a low-dose administration of o, p'-DDD, which reduced the tumor size. The excretion of urinary 17-OHCS was decreased, whereas plasma cortisol was not decreased but rather increased. This was considered to be caused that o, p'-DDD functioned as a cytotoxic factor which did not improve the states of hyperkalemia, hyperglycemia and hypertension. This suggested that monitoring to measure multiple steroids in addition to plasma cortisol and urinary 17-OHCS was useful for recognizing the general conditions of patients with adrenocortical carcinoma receiving o, p'-DDD therapy.