A follow-up study of resected stomach cancer patients with special emphasis on the incidence of second primary cancers

The causes of death in long-term survivors of stomach cancer after a gastrectomy have been investigated in a follow-up study of 320 such patients, with special focus on the postoperative development of a second primary cancer. The five- and 10-year overall survival rates of early stomach cancer patients were 87.5 and 75.8%, respectively, and of advanced stomach cancer patients, 44.2 and 37.5%, respectively. A multivariate analysis identified the patient's age and stage of cancer at the time of diagnosis as separate prognostic factors for overall survival. During the observation period, 15 (4.7%) patients developed a second primary cancer, so that no significantly elevated risk of developing a second primary cancer was demonstrated. During the same observation period, however, 48 (15%) of the patients died of a non-cancerous disease, 12 succumbing to an acute myocardial infarction and/or heart failure. Given these results, it is felt that continued follow-up of long-term stomach cancer survivors should be pursued to prevent or impede the development of a non-cancerous disease and/or a second primary cancer, so that the life of such former patients can be prolonged.

Correlation of GM-CSF mRNA in bronchoalveolar fluid with indices of clinical activity in sarcoidosis

BACKGROUND

Granulocyte-macrophage colony stimulating factor (GM-CSF) has several proinflammatory effects, some of which potentially favour granuloma formation. Its mRNA expression by the inflammatory cells recovered from lungs of patients with pulmonary sarcoidosis has been previously reported. In this study an association between GM-CSF expression and manifestations of the disease was explored.

METHODS

GM-CSF mRNA was detected by reverse transcription polymerase chain reaction in the cells of bronchoalveolar lavage (BAL) fluid of 20 patients with pulmonary sarcoidosis.

RESULTS

GM-CSF mRNA expression was positive in 15 of 20 patients with sarcoidosis. Fourteen of the 15 patients with positive mRNA expression had worsening or unchanged disease during the year preceding this study, on the basis of radiographic or physical findings, or both, whereas all five "negative" patients were judged to be improving. Similarly, serum levels of angiotensin converting enzyme, the proportion of lymphocytes in BAL fluid, and the CD4+/CD8+ ratio of lymphocytes in BAL fluid were significantly higher in the positive patients.

CONCLUSIONS

There was an association between the presence of GM-CSF mRNA in the cells in BAL fluid and other indices of disease activity in sarcoidosis.

Two independent macrophage receptors for acetylated high-density lipoprotein

We previously demonstrated that acetylated human high-density lipoprotein (acetyl-HDL) was recognized by a scavenger receptor of rat sinusoidal liver cells (Murakami, M., Horiuchi, S., Takata, K. and Morino, Y. (1987) J. Biochem. (Tokyo) 101, 729-741). The present study describes the interaction of acetyl-HDL with rat peritoneal macrophages in vitro. Acetylation of HDL enhanced its cell-association by 2-fold and cellular degradation by > 25-fold. The cell-association of [125I]acetyl-HDL was effectively inhibited by unlabeled acetyl-HDL (> 85%), whereas the inhibition by HDL or acetylated human low-density lipoprotein (acetyl-LDL) was partial (60% and 50%, respectively). However, when both HDL and acetyl-LDL were present, the cell-association of [125I]acetyl-HDL was effectively inhibited by > 80%, a level identical or closely similar to that by acetyl-HDL. The cellular degradation of [125I]acetyl-HDL was effectively suppressed by acetyl-LDL whereas the effect of HDL was much weaker. These findings indicate that acetyl-HDL is endocytosed by both the HDL receptor and the scavenger receptor for acetyl-LDL in which the ligands bound to the latter might be subjected to lysosomal degradation.

[A case of interferon-alpha-induced pneumonitis]

We report a case of interferon-alpha-induced pneumonitis. A 61-year-old man was diagnosed as having recurrence of renal cell carcinoma and treated with 3 x 10(6) unit of interferon-alpha daily for 8 weeks. On the 55th injection, he presented with a high fever and mild dyspnea, and his chest CT films revealed diffuse reticulonodular shadows in both lung fields. We suspected interstitial pneumonitis due to interferon-alpha, and started steroid therapy. He showed rapid improvement of symptoms and diffusing capacity, and the pulmonary infiltrates in his chest CT were markedly reduced. Transbronchial lung biopsy (TBLB) revealed slightly thickened alveolar walls and small granulomatous-like lesions. These granulomatous-like lesions showed marked accumulation of macrophages. To our knowledge, this is the first report of interferon-alpha-induced pulmonary injury in Japan.

Acute rise in serum immunoglobulin E concentration in pulmonary thromboembolism

Events mediated by immunoglobulin E (IgE) may be related to platelet activation and aggregation, and there may be an association between IgE and pulmonary thromboembolism (PTE). Fourteen patients with PTE were studied with regard to serum concentrations of IgE, IgA, IgG, IgM, fibrinogen, and D-dimer and with regard to blood neutrophil, lymphocyte, platelet, and eosinophil counts during acute and recovery phases. The serum IgE concentration increased during the acute phase to 402 +/- 310 IU/ml and decreased afterwards in all patients. The increase in serum IgE concentration lagged a few days behind that of the serum D-dimer concentration, indicating later IgE production than thrombus formation and lysis. Infarction and pleural fluid accumulation developed in patients with a high initial serum IgE concentration. These results indicated a relationship between serum IgE concentration and the pathophysiology of PTE. Serum IgE may be an indicator of the severity of PTE and provide insight into its pathogenesis, thereby facilitating the diagnosis of PTE.

[Studies on the responsiveness of alveolar T cells to proliferative stimuli and on surface antigens]

Lymphocyte alveolitis which can be detected by bronchoalveolar lavage is a characteristic feature of pulmonary sarcoidosis and has been thought to be a latent or preceding pathogenetic process of granuloma formation in the lung. To explore the mechanism of this lymphocyte accumulation, the capacity of alveolar T cells obtained from patients with pulmonary sarcoidosis to release interleukin-2 (IL-2) was assessed and compared with that of autologous peripheral blood T cells. Contrary to previous reports, spontaneous production of IL-2 by unstimulated alveolar T cells was not observed. When stimulated with phytohemagglutinin (PHA), alveolar T cells released considerable amounts of IL-2, however, still less than blood T cells. We next measured intracytoplasmic free calcium ion concentrations ([Ca2+]i) which are intimately related to cell activation triggered by proliferative stimuli. Alveolar T cells in patients with pulmonary sarcoidosis showed lowered responses of [Ca2+]i than blood T cells when stimulated with PHA, thus, demonstrating PHA-hyporesponsiveness at the second messenger level. Meanwhile, [Ca2+]i response of alveolar T cells stimulated with anti-CD3 antibody was higher than that of blood T cells. To investigate mechanisms underlying this unique responsiveness of alveolar T cells, we first examined cell surface expression of alpha beta T cell receptor (TCR). Flow cytometric analysis showed reduced expression of TCR by alveolar T cells compared with blood T cells, a phenomenon commonly called modulation. Since modulation of TCR/CD3 molecular complex is reportedly associated with T cell hyporesponsiveness to lectins, modulation appeared to account, in part, for the reduced IL-2 release by PHA-stimulated alveolar T cells. On the other hand, the present study revealed that memory T cells were dominant among alveolar T cells. This fact also seemed to be responsible for contrasting responses of [Ca2+]i to PHA and anti-CD3 antibody mentioned above, since mitogenic response of memory T cells coincide well with [Ca2+]i response of alveolar T cells. Interestingly and importantly enough, both modulation and memory T cell-dominancy in alveolar T cells were also observed in normal subjects. Accordingly, these findings suggest that responsiveness of alveolar T cells to mitogenic stimuli observed for patients with sarcoidosis is a feature shared by alveolar T cells in health and disease. Thus, present study revealed characteristics of alveolar T cells in general taking advantage of investigation of IL-2 production by alveolar T cells in sarcoidosis.

Release of tumor necrosis factor-alpha from human alveolar macrophages is decreased in smokers

It is known that smoking affects the development and maintenance of certain types of granulomatous lung diseases. To explore this mechanism(s), we measured tumor necrosis factor (TNF)-alpha concentrations in the culture supernatants of lipopolysaccharide (LPS)-stimulated alveolar macrophages (AMs) in 13 healthy nonsmokers, 13 healthy smokers, 13 nonsmoking sarcoid patients, and 16 smoking sarcoid patients. We found that the capacity of smokers' AMs to release TNF-alpha was significantly decreased both in the normal and sarcoid groups. We also confirmed the previous observation that there was an exaggerated TNF release in patients with pulmonary sarcoidosis. These results indicate a significant role of TNF-alpha in the pathogenetic mechanisms of pulmonary sarcoidosis and suggest the possible involvement of TNF in the mechanisms by which smoking modulates local immune phenomena.

A case of Walker-Warburg syndrome with uncommon findings. Double cortical layer, temporal cyst and increased serum IgM

We report a Japanese boy with the Walker-Warburg syndrome. He had typical clinical features, including type II lissencephaly, congenital muscular dystrophy and an ocular abnormality associated with previously undescribed findings, a double cortical layer and an isolated cyst evident on magnetic resonance imaging, and an increased level of serum IgM. We speculate that the inner layer of the cortices in this case represents a layered heterotopia under the cerebral cortex.

[Alveolar macrophages and granuloma formation]

We measured intracytoplasmic free calcium ion concentration ([Ca3+]i) of alveolar macrophages (AMs) in order to elucidate the mechanism(s) of lipopolysaccharide (LPS)-hyperresponsiveness of AMs in patients with sarcoidosis at the second messenger level. Resting [Ca2+]i was higher in patients with sarcoidosis than in normal subjects. [Ca2+]i increase responses were also elevated in patients with sarcoidosis when AMs were stimulated with either anti-CD14 (a LPS/LPS-binding protein complex receptor) antibody, anti-CD64 (Fc gamma receptor I), antibody or platelet activating factor. After incubation with interferon-gamma, resting [Ca2+]i and increase in [Ca2+]i induced by anti-CD14 antibody stimulation were higher in patients with sarcoidosis as compared with values before incubation. Thus, these data suggest that activation of AMs at the second messenger level induced by IFN gamma, at least in part, accounts for LPS-hyperresponsiveness in sarcoidosis.

Lack of linkage between atopy and locus 11q13

Atopy as defined in terms of IgE responsiveness was reported to be controlled by a single gene in British families, and this concept was further supported by a significant linkage between atopy and restriction fragment length polymorphism (RFLP) detected by a DNA probe specific to chromosome 11q13. To confirm this observation in a Japanese population, segregation and linkage analyses were done in four large families. Although segregation patterns of atopy were in agreement with the pattern of autosomal dominant inheritance, there was no significant linkage between atopy and locus 11q13. Alterations in the definitions of atopy did not affect the results. These findings suggested the presence of heterogeneity in genetic elements of atopy, even though atopy may be determined mainly by a single dominant gene.

Abnormalities in platelets and vascular endothelial cells induced by glycated lipoproteins

We studied the effects of glycated lipoproteins of low- and high-density (LDL and HDL) on platelets and vascular endothelial cells. After pretreatment for 5 minutes at 37 degrees C, the thrombin-induced synthesis of thromboxane B2 in washed platelets was significantly increased by glycated LDL as compared with native LDL (198.9 +/- 16.2 vs 90.3 +/- 29.4 ng/10(9) platelets, n = 8, p less than 0.01). Platelet aggregation was also increased by glycated LDL as compared with native LDL. After treatment with platelet-rich plasma for 5 hours at 37 degrees C, these values were suppressed by native HDL vs the control (buffer), but not by glycated HDL. Abnormalities in the release of 6-keto prostaglandin F1 alpha and lactate dehydrogenase from vascular endothelial cells were also induced by glycated LDL and/or HDL. These observations suggest that abnormalities induced in platelets and vascular endothelial cells by glycated lipoproteins may play an important role in the development of atherosclerosis in patients with diabetes mellitus.

Functional upper airway obstruction. Psychogenic pharyngeal constriction

A 15-year-old boy, known to have asthma, developed acute inspiratory airway obstruction with marked stridor. Spirometry indicated extrathoracic airway obstruction and a bronchofiberoptic examination disclosed narrowing in the hypopharynx. After administration of sedatives, the stridor suddenly disappeared. Psychotherapy decreased the frequency of subsequent stridor attacks. It is suggested that psychogenic pharyngeal constriction may have caused the upper airway obstruction with respiratory distress.

[Case report of collagen lung in SLE presenting with cough variant asthma: relation between the localization of responsible receptors and cough]

A 27-year-old nonsmoking woman complained of cough and chest oppression for two years since an episode of pneumonia. Clinical tests showed decrease in FEV1.0 during attacks of coughing and evidence of bronchial hypersensitivity. While these events fitted the picture of bronchial asthma, the nonwheezing cough suggested cough variant asthma. Antinuclear antibody and anti-ds DNA antibody were increased and leukopenia was recognized, suggesting the diagnosis of systemic lupus erythematosus (SLE). Bronchoalveolar lavage showed lymphocytic alveolitis and decreased T4/T8. These results were suggestive of collagen lung induced by SLE. Inhalation challenge with capsaicin and rapid intravenous injection of lobelin and alinamin indicated that peripheral c-fiber receptors were involved in the induction of coughing. We conclude that the peripheral lesion of collagen lung stimulates the peripheral c-fiber receptors, leading to cough variant asthma.

Administration of α1-Proteinase Inhibitor Ameliorates Bleomycin-induced Pulmonary Fibrosis in Hamsters

The effect of alpha 1-proteinase inhibitor (alpha 1Pi) administration on the acute lung injury and subsequent fibrosis induced by bleomycin (BLM) was examined in hamsters. Pulmonary lesions were quantitatively reduced in alpha 1Pi-administered BLM-treated (BLM-alpha 1Pi) animals compared with animals treated by BLM alone (BLM-control) at both 7 days (acute stage) and 30 days (fibrotic stage) after BLM treatment. Analysis of intraalveolar cells from bronchoalveolar lavage (BAL) fluid revealed that neutrophils and lymphocytes were significantly decreased in the BLM-alpha 1Pi animals at 7 days after BLM treatment and that 30 days after BLM treatment macrophages as well as neutrophils and lymphocytes were remarkably decreased in the BLM-alpha 1Pi animals. The elastase activity in supernatants of BAL fluid during 7 days following BLM treatment was detected, but there was no difference between the two groups. In vitro studies on neutrophil responsiveness to stimulation of BAL fluid at 3 days after BLM treatment revealed noticeable chemotaxis and generation of superoxide anion of isolated neutrophils, but alpha 1Pi did not show any inhibitory effects on neutrophil responsiveness. We suggest that alpha 1Pi administration ameliorates pulmonary fibrosis preceded by acute lung injury induced by BLM treatment in hamsters and that the inhibitory effects of alpha 1Pi on lung injury may not be brought about by altered elastase activity, chemotaxis, or superoxide generation in neutrophils. Alternative mechanisms are discussed.

Prognostic value of nuclear DNA content and expression of the ras oncogene product in lung cancer

We evaluated the prognostic significance of nuclear DNA content by flow cytometry and ras oncogene expression in paraffin-embedded sections of tumors obtained surgically from 112 non-small cell lung cancer patients. Sixty-five (77%) of the 84 tumors had DNA aneuploid patterns that were statistically higher in adenocarcinoma than in squamous cell carcinoma. Of the 91 patients analyzed immunohistochemically using anti-ras Mr 21,000 protein (p21) monoclonal antibody rp-35, positive reactions (weak and strong) were observed in 56% of squamous cell carcinomas and 68% of adenocarcinomas. A better 5-yr survival rate was observed in the DNA diploid group (61%) than in the DNA aneuploid group (35%) (P less than 0.01). Patients with p21-negative tumors survived significantly longer (5-yr survival rate of 64%) than did those with p21-weak tumors (38%, P less than 0.05) or those with p21-strong tumors (12%, P less than 0.01). Cox's multivariate analysis showed that DNA ploidy, ras p21 expression, and the stage of the disease were significant prognostic factors for survival. However, the DNA content was not a major independent prognostic factor in adenocarcinoma. The intensity of ras p21 expression was not correlated with nuclear DNA content. These results suggest that DNA content or enhanced ras p21 expression may be different biological markers indicating the malignant potential of lung tumors.

Pulmonary tuberculosis in the HIV-positive patients

Tuberculosis associated with human immunodeficiency virus (HIV) infection continues to represent a serious medical and public health problem. Physicians' awareness of this entity is important because the diagnosis requires a high index of suspicion. A continuing increase in the cases of tuberculosis associated with HIV infection is predicted unless extensive efforts are directed toward detection of this dual infection and implementation of effective tuberculosis preventive therapy and treatment programs.

Myocardial metastasis from primary lung cancer: myocardial infarction-like ECG changes and pathologic findings

Myocardial metastasis from neoplastic disease is often clinically unapparent, and very difficult to diagnose. Of 151 consecutive autopsies of lung cancer patients, cardiac metastases were found in 67 patients (44.4%). Myocardial metastasis was found in only 8 patients (11.9%). ECG of patients with myocardial metastasis revealed ST-T wave changes and various types of arrhythmia. ST-T wave changes were observed in 4 with myocardial metastasis, and in 6 without myocardial metastasis (pericardial metastasis alone). ST-T wave changes is not a specific finding of myocardial metastasis. Two very rare cases with myocardial metastasis showing progressive ST segment elevation with a QS pattern are presented. The appearance of ST segment elevation with a QS pattern in clinically stable lung cancer patients without cardiac symptoms suggestive of myocardial injury indicates the possibility of myocardial metastasis. Myocardial metastasis is often elusive, thus careful observation of ECG changes is of primary importance for the antemortem diagnosis.

[Morphological changes in the pleura caused by intracavitary administration of bleomycin]

We administered bleomycin to the intrapleural cavity of hamsters and observed acute and chronic histological changes of visceral pleura using light and electron microscopies. At 7 days after bleomycin challenge, we could find out the pleural thickening with infiltration of inflammatory cells, and then formation of pleural fibrosis at 28 days. However, in our study there was no abnormal findings of the lung parenchyma in morphology and intraalveolar cells, and lung distensibility. The dose (10-20 units/kg body weight) used in the study did not cause the abnormal changes in the parenchyma, although pleural thickening occurred. We suggest that intracavitary bleomycin administration is safely used for the treatment of malignant pleural effusion.

Enhanced expression of CD2 antigen on lung T cells

CD2 molecules not only function in the adhesion of T cells to other cell types but also in the activation of T cells via an alternative pathway. To investigate the possible roles of CD2 molecules in the activation and accumulation of lung T cells, using monoclonal antibodies and a flow cytometer we evaluated CD2 antigen expression on lung and blood lymphocytes in 10 normal subjects, 30 patients with pulmonary sarcoidosis, 7 patients with interstitial pneumonia associated with collagen vascular disease, 5 patients with farmer's lung disease, and 8 patients with Crohn's disease. The mean fluorescence intensity (MFI) of CD2 on lung T cells obtained by bronchoalveolar lavage (BAL) was significantly higher than that on blood T cells in all study groups except the control group. In patients with pulmonary sarcoidosis this enhancement of the expression of CD2 antigen was observed only on CD4+ T cells. Since ligands for CD2 are present on immunocompetent cells of other types in the local pulmonary milieu, these results suggest that increased expression of CD2 molecules could facilitate the communication and interaction of lung T cells with their environment in the lung and thereby possibly contribute to the local accumulation of T cells.

[A comparative study between cefpirome (CPR) and ceftazidime (CAZ) in respiratory tract infections]

Efficacy and safety of a new injectable cephem antibiotic, cefpirome sulfate (hereafter, CPR), against respiratory tract infections were examined and compared with those of a control drug, ceftazidime (hereafter, CAZ). As a rule, CPR 0.5 g twice a day, 1.0 g twice a day, or CAZ 1.0 g twice a day (hereafter CPR 0.5 g group, CPR 1.0 g group, and CAZ group) was administered for 14 days and the following results were obtained. 1. The total number of cases was 470 (155 cases in the CPR 0.5 g group, 160 cases in the CPR 1.0 g group, and 155 cases in the CAZ group). Among them 390 cases were subjected to analyses of clinical efficacy by the efficacy evaluation committee (131 cases in the CPR 0.5 g group, 131 cases in the CPR 1.0 g group and 128 cases in the CAZ group). 2. Efficacy rates determined by the efficacy evaluation committee were 82.4% (108/131) for the CPR 0.5 g group, 81.7% (107/131) for the CPR 1.0 g group, and 83.6% (107/128) for the CAZ group. Efficacy rates determined by the physician in charge were 82.0% (105/128) for the CPR 0.5 g group, 80.5% (99/123) for the CPR 1.0 g group, and 88.5% (108/122) for the CAZ group. No statistically significant difference was observed among the 3 groups. In evaluation of equivalency, clinical efficacy for the CPR 0.5 g group and the CPR 1.0 g group determined by the clinical efficacy evaluation committee was proved to be statistically equivalent to that for the CAZ group. 3. In patients with pneumonia, efficacy rates determined by the efficacy evaluation committee were 87.1% (61/70) for the CPR 0.5 g group, 80.7% (71/88) for the CPR 1.0 g group, and 78.9% (56/71) for the CAZ group. Efficacy rates determined by the physician in charge were 85.3% (58/68) for the CPR 0.5 g group, 80.7% (67/83) for the CPR 1.0 g group, and 86.2% (56/65) for the CAZ group and no statistically significant difference was observed among the 3 groups. In patients with chronic respiratory tract infection, efficacy rates determined by the efficacy evaluation committee were 77.0% (47/61) for the CPR 0.5 g group, 83.7% (36/43) for the CPR 1.0 g group, and 89.5% (51/57) for the CAZ group. Efficacy rates determined by the physician in charge were 78.3% (47/60) for the CPR 0.5 g group, 80.0% (32/40) for the CPR 1.0 g group, and 91.2% (52/57) for the CAZ group. No statistically significant difference was observed among the 3 groups.(ABSTRACT TRUNCATED AT 400 WORDS)

[A long-term follow-up case of sarcoidosis with fibrosis and silicotic nodules in the lung]

An autopsy case of a 70-year-old woman with sarcoidosis followed up for 16 years is reported. She was admitted for examination of bilateral hilar lymphadenopathy on chest X-ray film and uveitis in 1971. Sarcoid granuloma was revealed by Daniels lymph node biopsy. After steroid therapy, bilateral hilar lymphadenopathy and uveitis disappeared. However, small nodular shadows appeared in bilateral lower lung fields on chest X-ray film in 1973. Gradually small nodular shadows increased and reticular shadows appeared. In 1980, chest X-ray film revealed fibrotic change in the bilateral lung fields and giant bulla in the left upper lung field. She developed acute pneumonia and died of acute progression of chronic respiratory failure in 1987. Autopsy revealed sarcoid granulomas and honeycomb lesions in bilateral lungs and also silicotic nodules near the sarcoid granuloma in the upper lobes. This case suggests that inhaled mineral particles may play an important role in the development of pulmonary fibrosis in sarcoidosis.

[Genetic factors and smoking habits]

To investigate whether genetic factors are involved in the maintenance of smoking habits, we examined restriction fragment length polymorphisms of cytochrome P-450 gene (P450 IIB1), one of the metabolizing enzymes of nicotine. The presence or the absence of polymorphic bands detected after digestion with Bam HI or Msp I was not related to smoking habits, the subjective degree of fondness for smoking and the subjective strength of addiction to smoking. Thus, we found no evidence for the involvement of this gene or adjacent gene(s) in the determination of smoking habits.

Long-term low-dose administration of erythromycin to patients with diffuse panbronchiolitis

Although diffuse panbronchiolitis (DPB) has carried a poor prognosis, long-term low-dose administration of erythromycin (EM) is very effective. We administered EM at a daily dose of 400-600 mg to 19 DPB subjects for more than 2 months. Sixteen subjects were relieved from productive cough and dyspnea, and their chest X-ray pictures were improved. We performed a pharmacokinetic study of EM in 11 DPB subjects (8 responders; 3 nonresponders) after the long-term low-dose administration. The maximal serum and sputum levels of EM were below the MICs of clinically pathogenic H. influenzae and P. aeruginosa which were often isolated from the sputum of DPB patients. No difference was observed in the absorption of EM between responders and nonresponders. The results suggested that DPB patients might respond favorably to EM due to mechanisms other than antibacterial activity. Individual variation in the absorption of EM was observed. As EM was effective at very low serum and sputum levels, it was suggested that even 200 mg/day of EM would be effective in DPB patients who had high serum and sputum EM levels and it was necessary to monitor the concentrations of EM in serum and sputum for the treatment of DPB to determine the appropriate dose of EM individually.

[Consequences of DNA damage and the relationship between respiratory diseases in childhood and in adult hood]

The purpose of this study was to test the hypothesis that lung injury at an early postnatal age results in respiratory disease in later life. One mg/g body weight of bromodeoxyuridine (BrdU) was injected intraperitoneally in suckling rats on day 6 after birth. The animals were sacrificed at 2 and 8 wk of age. Although the lungs of BrdU-treated animals at 2 wks of age were similar to those in the control animals, the BrdU-treated animals at 8 wks of age had an abnormal enlargement of airspace and an increased compliance. The results show that lungs injured cytogenetically in early postnatal life may develop pulmonary functional and structural abnormalities in later life.

Expression of granulocyte-macrophage colony-stimulating factor mRNA by inflammatory cells in the sarcoid lung

T lymphocytes and alveolar macrophages accumulating in the lower respiratory tract of patients with pulmonary sarcoidosis are known to be activated to produce several cytokines, presumably leading to granuloma formation within the lung. We hypothesized that these cells produce colony-stimulating factors (CSFs), which have been shown to affect the proliferation and function of monocyte-/macrophage-lineage cells. To test this hypothesis, we tried to detect mRNA encoding CSFs in cells obtained by bronchoalveolar lavage using a reverse transcription-polymerase chain reaction. Granulocyte-macrophage CSF (GM-CSF) mRNA was detected in five of six patients with pulmonary sarcoidosis, whereas it was detected in none of the five normal controls. Macrophage-CSF mRNA was detected in all subjects examined, and interleukin-3 mRNA in none. These results suggest some relation of GM-CSF to sarcoid lesion formation.

Modulation of accessory molecules on lung T cells

Stimulation of T cells via the CD3/TCR complex is associated with the reduced expression of accessory molecules, a phenomenon called modulation. To investigate whether the modulation is implicated in the pathogenic mechanism of pulmonary disease, we determined the MFI of CD3, CD4 and CD8 on lung and blood lymphocytes in ten normal subjects and 54 patients with various pulmonary and extrapulmonary diseases. Although there were no significant differences in MFI of these accessory molecules on lung lymphocytes among the groups, MFI of CD3 on lung lymphocytes was significantly decreased compared with that on blood lymphocytes in all groups, demonstrating the modulation of CD3 on lung lymphocytes. Since it has been shown that T cells whose CD3/TCR is modulated are hyporesponsive to various mitogenic signals, our observation seems to represent another aspect of the mechanism whereby the local pulmonary milieu maintains the autoregulation of immune response.

[A case report of the pathognomonic relationship between idiopathic interstitial pneumonia and silicosis]

A 67 year-old male complaining of cough and exertional dyspnea was hospitalized for evaluation of an abnormal chest shadow. Chest X-ray films revealed bilateral diffuse nodular shadows, honeycombing in the lower lung fields and pleural thickening suggestive of idiopathic interstitial pneumonia. He had worked as a boilerman and painting using various materials. Transbronchial lung biopsy did not reveal silicotic nodules or asbestos bodies. Analytical electron microscopic study demonstrated amounts of free silica without other elements and asbestos fibers. This case suggests a pathognomonic relationship between idiopathic interstitial pneumonia and silica inhalation.

[The serial changes of antibody production, macrophage migration inhibition test (MIT) and histopathologic examination in an experimental hypersensitivity pneumonitis in rabbits]

We developed a hypersensitivity pneumonitis model by sensitizing rabbits intratracheally (IT) twice after two subcutaneous sensitizations (SS), and investigated the serial changes in the production of antibody against micropolyspora faeni (Mf), macrophage migration inhibition test (MIT), and histopathologic features. On the third day after the last IT, the proportions of neutrophils in bronchoalveolar lavage fluid (BALF) increased. The antibody levels of Mf specific-antigen in BALF decreased transiently, but those in serum began to increase. The number of AFC in spleen increased rapidly. Histopathologic examination revealed alveolitis and prominent acute pneumonia. On the seventh day after the last IT, the proportion of lymphocytes in BALF, the antibody levels of Mf specific-antigen in BALF, the number of AFC in BALF, and the percent inhibition of MIT were highest. Histopathologic features were characterized by the formation of prominent epithelioid granulomas. On the fourteenth day after the last IT, these features returned to the state of untreated group. These results indicate that the lesions in this HP model are formed by both type III and type IV immune reactions (Coombs-Gall). It was concluded that the seventh day after the last IT was most appropriate for the study of pathophysiology of human HP.

Cloning and nucleotide sequences of NADH-putidaredoxin reductase gene (camA) and putidaredoxin gene (camB) involved in cytochrome P-450cam hydroxylase of Pseudomonas putida

Pseudomonas putida PpGl, which carries the CAM plasmid encoding enzymes involved in the degradation pathway of D-camphor, can utilize D-camphor as a sole carbon source. Cytochrome P-450cam and related enzymes participate in the early oxidation steps of D-camphor degradation metabolism. We cloned from a HindIII DNA library of PpGl a 2.9 kbp CAM segment which carries the major part of camA gene encoding NADH-putidaredoxin reductase and the entire camB gene encoding putidaredoxin. The 2.9 kbp CAM segment was adjacent to the 4.27 kbp HindIII CAM segment which has been previously cloned (Koga et al. (1986) J. Bacteriol. 166, 1089-1095). Thus, the total 7.17 kbp HindIII CAM directed all the genes responsible for early steps of D-camphor degradation, i.e. 5-exo-hydroxycamphor dehydrogenase (camD gene), cytochrome P-450cam (camC), NADH-putidaredoxin reductase (camA), and putidaredoxin (camB). These cam genes form an operon, camDCAB, and are under negative control by the gene camR located immediately upstream from the camD gene. The total number of amino acids deduced from the nucleotide sequence is 422 for putidaredoxin reductase, and 106 for putidaredoxin.

[A case of pulmonary sarcoidosis with calcification in the lung]

A 35 year-old male farmer presented with complaints of productive cough and sputum. The chest X-ray films showed reticulonodular shadows bilaterally in the upper and middle lung fields, segmental infiltration in the right lung, and no BHL. Tuberculin reaction was negative. Serum angiotensin converting enzyme level was 26.5 IU/ml. Precipitating antibodies for Thermophilic actinomycetes and M.f. were negative. BAL showed moderate lymphocytosis (24.3%), and CD 4/8 was 1.67. A biopsy specimen of right scalene lymph node showed epithelioid cell granulomas and TBLB epithelioid cell granulomas and spot-like calcification. Pulmonary sarcoidosis with calcification in the lung is very rare.

Measurement of catecholamines, their precursor and metabolites in human urine and plasma by solid-phase extraction followed by high-performance liquid chromatography with fluorescence derivatization

A high-performance liquid chromatographic method is described for the determination in human urine and plasma of catecholamines, their precursor and metabolites [amino compounds (norepinephrine, epinephrine, dopamine, normetanephrine, metanephrine, 3-methoxytyramine and L-DOPA), acidic compounds (3,4-dihydroxymandelic acid, 3,4-dihydroxyphenylacetic acid, vanillylmandelic acid and homovanillic acid) and alcoholic compounds (3,4-dihydroxyphenylethyleneglycol and 4-hydroxy-3-methoxyphenylethyleneglycol)]. Urine (0.5 ml) containing 3,4-dihydroxybenzylamine and 4-hydroxy-3-methoxycinnamic acid (internal standards) is deproteinized with perchloric acid, and the resulting solution is fractionated by solid-phase extraction on a strong cation-exchange resin cartridge (Toyopak IC-SP S) into two fractions (amine fraction and acid-alcohol fraction), which include 3,4-dihydroxybenzylamine and 4-hydroxy-3-methoxycinnamic acid, respectively. Plasma (0.7 ml) is deproteinized in the presence of 3,4-dihydroxybenzylamine (internal standard) in the same manner, and the resulting solution is directly used as an acid-alcohol fraction, while an amine fraction is obtained as for urine. Each fraction is subjected to the previously established ion-pair reversed-phase chromatography with post-column derivatization involving coulometric oxidation followed by fluorescence reaction with 1,2-diphenylethylenediamine. The detection limits, at a signal-to-noise ratio of 5, of the compounds measured in urine are 300 pmol/ml for the two mandelic acids, 2-7 pmol/ml for the other acidic and alcoholic compounds, 12 pmol/ml for L-DOPA and 0.6-2 pmol/ml for the other amino compounds; the corresponding values for plasma samples are 80, 0.5-3, 10 and 0.6-3 pmol/ml, respectively.

Interleukin 1 production by alveolar macrophages is decreased in smokers

To evaluate the mechanism by which cigarette smoking suppresses pulmonary immune responses, we determined the capacity of alveolar macrophages (AM) to produce interleukin 1 (IL-1 in 32 normal subjects and in 40 patients with pulmonary sarcoidosis. The amount of IL-1 released from LPS-stimulated AM from smokers was significantly decreased compared with that in nonsmokers in both normal and sarcoid groups. The addition of indomethacin to the cultures in 18 normal subjects and in 22 patients with pulmonary sarcoidosis yielded similar results, thus excluding the possibility that this difference resulted from a difference in the amount of cyclooxygenase metabolites released in the culture supernatants. Similar results were obtained by enzyme-linked immunosolvent assay. Because IL-1 is thought to induce the accumulation of T cells at the site of disease and contribute to local cellular and humoral immunity of the lung, our data suggest that the reduced capacity of AM to release IL-1 in smokers affords partial protection against the initiation of immune responses in the lung and the development of granulomatous lung diseases.

Simultaneous high-performance liquid chromatographic determination of catecholamine-related compounds by post-column derivatization involving coulometric oxidation followed by fluorescence reaction

A highly selective and sensitive high-performance liquid chromatographic method for the determination of catecholamines (norepinephrine, epinephrine and dopamine) and related compounds (L-DOPA, normetanephrine, metanephrine, 3-methoxytyramine, 3,4-dihydroxymandelic acid, 3,4-dihydroxyphenylacetic acid, homovanillic acid, vanillylmandelic acid, 3,4-dihydroxyphenylethylene glycol, 4-hydroxy-3-methoxyphenylethylene glycol and 4-hydroxy-3-methoxyphenylethanol) with a post-column technique involving coulometric oxidation followed by fluorescence derivatization is described. These compounds, 3,4-dihydroxybenzylamine and ferulic acid are separated within 35 min by ion-pair reversed-phase chromatography using acidic buffers (pH 3.1) with methanol-acetonitrile (3:2, v/v) gradient elution, and then oxidized by a commercial coulometric detector to the corresponding o-quinones, which are converted into fluorescent derivatives by reaction with 1,2-diphenylethylenediamine. The detection limits (signal-to-noise ratio = 3) on-column are 1.5-4 pmol for the two mandelic acids, 600 fmol for L-DOPA and 20-70 fmol for the others.

[A case of pulmonary sarcoidosis with CD8 positive cell dominant alveolitis]

A 55-year-old woman was admitted for examination of bilateral hilar lymphadenopathy. Serum angiotensin converting enzyme was not elevated, but gallium-scan revealed an increased uptake in both lung hilus. The percentage of lymphocytes in the bronchoalveolar lavage fluid (BALF) was elevated (28.9%), and the proportion of OKIa1 positive cells was also elevated (50.5%). However, the ratio of cluster differentiation (CD) 4/8 was inverted at 0.5. Microscopic examination of the mediastinal lymph nodes revealed epithelioid cell granulomas without ceasation, and a diagnosis of sarcoidosis was made. Immunohistochemical examination of the lymph nodes showed predominancy of CD8 positive cells. Patients with pulmonary sarcoidosis having a low CD4/8 ratio in BALF are extremely rare in the early stage of sarcoidosis. The inverted CD4/8 ratio was of interest in regard to the pathogenesis of sarcoidosis.

CD8+ cell-dominant alveolitis in pulmonary sarcoidosis

A 55-year-old woman had bilateral hilar lymphadenopathy and retinouveitis. Microscopic examination of a biopsy specimen from a mediastinal lymph node revealed noncaseating epithelioid cell granulomas. Since granulomatous diseases of infectious origin and sarcoid reaction were reasonably excluded, she was diagnosed as having pulmonary sarcoidosis. Bronchoalveolar lavage findings were atypical in that the ratio of helper T cells to suppressor T cells (CD4/8 ratio) was 0.5 in two separate examinations, despite a moderately increased proportion of lymphocytes. Immunohistochemical examination of the lymph node also showed a predominancy of suppressor T cells. The inversion of the CD4/8 ratio suggests the presence of heterogeneity in the immunoregulatory mechanism in pulmonary sarcoidosis and may have a prognostic significance.

Interleukins in pulmonary sarcoidosis. Dissociative correlations of lung interleukins 1 and 2 with the intensity of alveolitis

To investigate whether interleukins are involved in the formation of alveolitis in pulmonary sarcoidosis, interleukin-1 (IL-1) production by LPS-stimulated alveolar macrophages (AM) and interleukin-2 (IL-2) production by PHA-stimulated lung and blood T-cells were determined in 35 untreated patients with pulmonary sarcoidosis. The amount of IL-1 produced by AM (BAL IL-1) was significantly increased in patients with pulmonary sarcoidosis compared with that in 18 control subjects. BAL IL-1 showed a significant positive correlation with the intensity of alveolitis assessed by the proportion of lymphocytes in bronchoalveolar lavage fluid (BALF) and the absolute number of lymphocytes per milliliter of BALF. However, the amount of IL-2 produced by lung T-cells (BALT IL-2) showed a significant negative correlation with the intensity of alveolitis. BALT IL-2 was significantly lower than the amount of IL-2 produced by blood T-cells (PBT IL-2). There was no correlation between PBT IL-2 and the intensity of alveolitis. These results suggest that IL-2 contributes to the formation and maintenance of alveolitis in pulmonary sarcoidosis, whereas IL-2 production by lung T-cells is suppressed to down-regulate the enhanced immune processes at the site of disease. The possibility that this hyporesponsiveness of lung T-cells to PHA has resulted from the modulation of the T3-T cell receptor complex remains to be determined.

Plasma cells in the bronchoalveolar lavage fluid of a patient with eosinophilic pneumonia. Morphologic proof of local production of antibodies

We describe a case of eosinophilic pneumonia in which plasma cells appeared in bronchoalveolar lavage fluid (BALF). A 49-year-old man presented with wheezing, lung infiltrates, peripheral eosinophilia, and extremely high IgE levels in serum and BALF. A differential count of BALF revealed 56.6 percent lymphocytes and 1.3 percent plasma cells. The appearance of plasma cells suggests local maturation of B cells and represents a morphologic proof of local production of immunoglobulins. The increased number of lymphocytes suggests their role in B cell differentiation via the lymphokine network.

Association of HLA-DR with sarcoidosis. Correlation with clinical course

HLA-DR typing was performed in 58 Japanese patients with sarcoidosis. We found a significantly increased frequency of HLA-DRw52 (p less than 0.0007; pc less than 0.009) and DR5J (p less than 0.004; pc less than 0.05). (Corrected probability value is given as pc.) In 34 of 58 patients the disease resolved spontaneously. There was no significant difference between the frequency of DRw52 and the resolution rate of disease. The frequency of DR5J was increased significantly in the unresolved cases. Our results also suggest that DRw52 is concerned with onset of sarcoidosis and DR5J antigen has an effect on the clinical course of this disease.