Desmosomal dissolution in Grover's disease, Hailey-Hailey's disease and Darier's disease

Proteins involved in the formation of desmosomes and simpler adherens junctions were studied in three types of non-immune acantholytic diseases; specifically, four cases of Grover's disease (GD), one case of Hailey-Hailey's disease (HHD) and one case of Darier's disease (DD), and these were compared to two cases of immune-mediated acantholytic disease pemphigus vulgaris (PV). The proteins studied included: 1. The intracellular desmosomal proteins, desmoplakin I and II and plakoglobin; 2. The intercellular desmosomal proteins, desmoglein and CD44; and 3. vinculin, which is a major intracellular protein of the simpler aherens junctions. In GD, HHD and DD, immunostaining showed a loss of desmoplakin I and II and plakoglobin from the desmosomes, and a diffuse staining in the cytoplasm. In contrast, in pemphigus vulgaris, these proteins seemed intact and were localized to dot-like spots on the cell surface. Also, desmoglein, and CD44 were slightly affected in GD, and moderately affected in HHD and DD. Absence of desmosomal attachment plaques, the lack of labeling with desmoglein in the affected desmosomes and a diffusion of the labels into cytoplasm were demonstrated with electron microscopy using an immunogold technique. In PV, desmoglein III is one of the target antigens for the autoantibodies in this disease and was only partially preserved in a small number of lesional cells, while CD44 was mostly preserved. Vinculin was intact in GD, HHD and DD, but was lost in PV. This study, our previous work, and that of others, suggest that: 1. In GD, HHD and DD, the proteins of the desmosomal attachment plaque are primarily affected; 2. In PV, the intercellular glycoproteins are primarily involved; and 3. Simple adherens junctions are intact in GD, HHD and DD, but are damaged in PV.

Junctional proteins of keratinocytes in Grover's disease, Hailey-Hailey's disease and Darier's disease

Alterations of junctional structures in non-immune mediated acantholytic diseases (Grover's, Hailey-Hailey's and Darier's diseases) were examined using monoclonal antibodies against desmosomal attachment constituents (desmoplakin I & II and plakoglobin), desmosomal intercellular cement glycoprotein (desmoglein), protein of adherens junction (vinculin), and protein of gap junction (43Kd connexin). Universal cell surface (transmembrane) glycoprotein CD44 was also studied. In acantholytic foci of these diseases, attachment plaque proteins had dissolved and diffused into the acantholytic cells. The normal dotted linear pattern of immunostaining on the cell membrane was totally lost. In contrast, CD44 was well preserved on the cell membranes of acantholytic cells. Adherens junction and gap junction proteins were mostly preserved. Acantholytic cells of pemphigus vulgaris were similarly studied. In these cells, desmosomal attachment plaque proteins were very well preserved, while intercellular cement substance (desmoglein), adherens junctional proteins (vinculin), and gap junction protein (connexin) were totally absent, either on the cell membrane or in the cytoplasm. Electron microscopy confirmed an early dissolution of attachment plaque. Internalized desmosomal structures were seldom found in acantholytic cells of non-immune diseases. It was concluded that the primary event in acantholysis in these three diseases is the dissolution of desmosomal attachment plaque.

Leptosins I and J, cytotoxic substances produced by a Leptosphaeria sp. Physico-chemical properties and structures

Leptosins I and J, belonging to a series of epipolythiodioxopiperazines, have been isolated from the mycelium of a strain of Leptosphaeria sp. OUPS-4 attached to the marine alga Sargasssum tortile. Their relative stereostructures have been elucidated by chemical and spectral evidence. These compounds exhibited significant cytotoxic activity against cultured P388 cells.

[Small cell carcinoma of the prostate]

Small cell carcinoma of the prostate is a rare disease, since only about 50 cases in the English literature and two cases in Japanese literature have been reported. Here we report a case that is the youngest ever described in the literature. A 24-year-old man was referred to our hospital with right dull lumbago and dysuria. He had the same symptom for one and half year before referral. IVP showed right non-visualizing kidney and left hydronephrosis. Form abdominal CT scans and cystoscopic findings a retrovesical tumor was highly suspicious. Transperineal needle biopsy specimens revealed an undifferentiated malignant tumor. His serum Neuron Specific Enolase (NSE) and LDH were remarkably high and whole body CT scan and upper GI tract examination demonstrated no lesion. He developed ileus and underwent exploratory laparotomy and colostomy was constructed. There was a large mass arising from the prostate which invaded into the peritoneal cavity, and multiple metastases were seen on the omentum and mesenteric lymph nodes. Specimens from the mass arising from the prostate and lymph nodes revealed small cell carcinoma pathologically. A panel of antibodies were used to seek potential tumor markers and to identify substances produced by the tumor cells including enzymes, cytoskeletal components and hormones. And stains were positive for the NSE and chronogranin. An intensive anti-cancer chemotherapy with VP-16 and CDDP was done with minor response (MR) and the serum tumor marker, LDH and NSE, decreased markedly. However, he had expired on the 58th hospital day.(ABSTRACT TRUNCATED AT 250 WORDS)

A clinicpathological study of hepatocellular carcinoma in Nagasaki, south-western Japan: the association of hepatitis B and C viruses

Hepatocellular carcinoma (HCC) is one of the most prevalent cancers in Japan as well as Southeast Asia and Africa. On 89 patients with HCC in the Nagasaki City area were performed serological examinations and histopathological studies. The number of HBsAg positive and anti-HCV positive was three (3%), HBsAg positive and anti-HCV negative 21 (24%), HBsAg negative and anti-HCV positive 58 (65%) and HBsAg negative and anti-HCV negative seven (8%). These results strongly suggest that HCV infection is a more important factor in the development of HCC than HBV infection. The HBsAg negative and anti-HCV positive group showed a higher mean age and a higher male to female ratio than the HBsAg positive and anti-HCV negative group. Histological examinations showed no differences between these two groups. In addition, all cases were complicated with chronic hepatitis (CH) or liver cirrhosis (LC) in adjacent liver tissue. These findings suggest that CH and LC seem to play an important role in the pathogenesis of HCC.

Comparison of the prophylactic usefulness of epirubicin and doxorubicin in the treatment of superficial bladder cancer by intravesical instillation: a multicenter randomized trial. Kobe University Urological Oncology Group

A multicentric randomized trial was conducted for the purpose of investigating the prophylactic efficacy of intravesical epirubicin instillation following transurethral resection of superficial bladder cancer in comparison with the efficacy of doxorubicin. The patients were centrally randomized into 2 groups and received 19 intravesical instillations of epirubicin or doxorubicin at 30 mg/30 ml physiological saline twice a week for 4 weeks and then once monthly for 11 months. A total of 150 patients with Ta and T1 superficial bladder cancer were entered in the trial, and 114 were evaluable. The nonrecurrence rates determined for each group at 1 and 2 years by the Kaplan-Meier method were 92.8% and 88.6%, respectively, for the epirubicin group and 86.4% and 81.7%, respectively, for the doxorubicin group. The differences between the two groups were not statistically significant. The main side effects encountered in this study were symptoms of bladder irritation such as micturitional pain, pollakisuria, and hematuria. The respective frequencies of those symptoms were 10%, 15.0%, and 5.0% in the epirubicin group and 14.8%, 14.8%, and 0 in the doxorubicin group. These results suggest that epirubicin is a useful drug, comparable with doxorubicin, for intravesical instillation chemotherapy in the prophylactic treatment of superficial bladder cancer.

Prolongation of rat cardiac allograft survival by a monoclonal antibody: anti-rat intercellular adhesion molecule-1

A mouse monoclonal antibody 1A29, which binds to the rat intercellular adhesion molecule-1 (ICAM-1), was studied for its effect on cardiac allograft survival. Expression of ICAM-1 was detectable only on vascular endothelium in normal heart, but was induced on myocardium associated with interstitial mononuclear cell infiltration during acute rejection. Treatment with monoclonal antibody 1A29 for 10 days after transplantation in 15 rats significantly prolonged allograft survival (mean(s.d.) 18(2) days; P < 0.001), as compared with 15 isotype-matched control monoclonal antibody (mean(s.d.) 10(1) days) recipients. Five-day treatment with monoclonal antibody 1A29, when started at 5 days after transplantation (the time for which acute rejection is ongoing), also significantly extended the survival (mean(s.d.) 12(1) days; P < 0.01) in seven rats. On histological examination, treatment with monoclonal antibody 1A29 reduced the degree of T-cell infiltration of both CD4+ and CD8+ subsets, and greatly reduced myocardial necrosis, vascular injury and intravenous thrombi. These results indicate that an anti-ICAM-1 monoclonal antibody can be used to prevent or treat acute rejection in the rat cardiac allograft model and suggest that human ICAM-1 is an important target for immunosuppression in clinical organ transplantation.

A monoclonal antibody against carbohydrate moiety of rat gastric surface epithelial cell-derived mucin

A monoclonal antibody (MAb), designated RGM11, was generated against mucin purified from the surface epithelial layer of rat gastric mucosa. RGM11 reacted with the purified mucin which had been attached to the ELISA well. This reaction was inhibited by the oxidation of the ELISA well with periodate, indicating the carbohydrate moiety of the mucin molecule to be the epitope of RGM11. Treatment of the ELISA well with galactose oxidase also reduced the reaction with this MAb, thus suggesting the peripheral galactose and/or N-acetylgalactosamine residues of the carbohydrate moiety of mucin are involved in the epitope structure. Histochemical observation indicated that this MAb was able to stain the formalin fixed-paraffin embedded sections of rat and was positive to the surface mucous cells of corpus and antral region of the stomach and the villus epithelium of the duodenal mucosa, but other organs and tissues of rat so far examined were all negative to this MAb. These results indicate that this newly established MAb, labelled RGM11, might be useful to estimate the physiological changes in gastric surface mucous cells and the role of surface epithelial cell derived mucus in the gastric mucosal defense mechanisms.

1 alpha,25-dihydroxy vitamin D3 modulation of HLA-DR mRNA induced by gamma-interferon in cultured epithelial tumor cell lines

Using three cultured epithelial tumor cell lines, we investigated and analyzed the effects of gamma-interferon (gamma-IFN) and 1 alpha,25-dihydroxy vitamin D3 (1,25-(OH)2D3) on the levels of HLA-DR (alpha) mRNA and HLA-DR (beta) mRNA by Northern blot analysis. After treatment with gamma-IFN alone, the levels of the mRNA increased. Treatment with both gamma-IFN and 1,25-(OH)2D3 at the same time resulted in a significant decrease in the levels of mRNA in K-TL-1, IK-TL-2, and M-TL cells as compared to those induced by gamma-IFN alone.

Effect of immunization with anti-idiotypic antibody to melanoma antigen on lung metastasis in mice

To determine whether the pulmonary metastases of melanoma cells could be inhibited, C57BL/6 mice were immunized with an anti-idiotypic antibody, 7C4, corresponding to a mouse melanoma antigen. Three groups of mice were compared: 1) 7C4-immunized group which received an injection of 100 micrograms of 7C4 in Freund's complete adjuvant (FCA) subcutaneously on day -21 followed by intraperitoneal injections of the same dose on days -14 and -7,2) adjuvant-treated control group administered with only FCA, and 3) untreated control group. On day 0, 5 x 10(5) of BL6 cells were injected into the caudal vein of all mice. Two weeks later, they were sacrificed and their lungs were removed. The number pulmonary metastatic colonies present on the lung surface were counted and compared among the groups. The length of survival days was also compared. The 7C4-immunized group showed an average of 166 +/- 44 colonies as compared to more than that of 300 colonies in each control groups, and a significant difference was observed (P < 0.01). The immunized group survived significantly longer than the control group (Greenwood's formulation) on day 23 (P < 0.01). Thus the immunization with 7C4 effectively inhibited lung metastasis of melanoma cells. These findings suggest that vaccination with anti-idiotypic antibody to tumor antigen is effective on inhibiting tumor metastasis.

Flow cytometric DNA analysis of vascular soft tissue tumors, including African endemic-type Kaposi's sarcoma

Vascular tumors of the soft tissue display a wide spectrum of histologic features and biologic behavior. Flow cytometric DNA analysis was performed on 40 vascular tumors, including nine African endemic-type Kaposi's sarcomas, nine angiosarcomas, seven hemangiopericytomas, six glomus tumors, and nine capillary hemangiomas. Six of the nine angiosarcoma cases (67%) and one of the seven hemangiopericytomas cases (14%) were aneuploid. All benign vascular tumors and Kaposi's sarcomas were diploid. Clinically, five of the six angiosarcoma patients with aneuploidy died within 2 to 28 months, while the remaining patient, who had the smallest tumor (2 x 1 cm), survived more than 4 years after the initial diagnosis was made. All three angiosarcoma patients with diploidy died within 10 to 14 months. One hemangiopericytoma patient with aneuploidy died within 1 month. No cases of benign tumor recurred. These results suggest that most vascular tumors, which generally follow a benign clinical course, were diploid and that the majority of those with a poor outcome were aneuploid. However, flow cytometrically assessed DNA ploidy has no prognostic value in angiosarcomas or hemangiopericytomas.

A case of cytophagic histiocytic panniculitis with sicca symptoms and lupus nephritis

A 48-year-old Japanese woman presented with many subcutaneous nodules. The skin was purplish in color and tender; the nodules were scattered over the entire surface. Histological findings of biopsy specimens from the nodules indicated septal panniculitis comprised of histiocyte and/or macrophage infiltrates, often with erythro- and/or leukophagocytosis. Phagocytic cells were OKM1 (CD11b), MT1 (CD43), LeuM3 (CD14), and histiocyte antigen positive, indicating the presence of histiocytes and/or macrophages. The patient had sicca symptoms, positive homogenous, speckled pattern ANA (x320), and diffuse proliferative lupus nephritis.

Electron microscopic X-ray microanalysis of metals deposited in oral mucosa

A 35-year-old woman exhibited bluish-brown discoloration of her buccal mucosa suggesting malignant melanoma. Histopathological examination revealed that the pigment was not melanin but caused by metal deposits. Electron microscopically, metallic particles were located on the lamina densa of basal laminae at mucosal epithelium, nerve fibers, and blood vessels and on the microfilaments of elastic fibers as well as in macrophages and fibroblasts. Electron microscopic point X-ray microanalysis revealed that these metallic particles were composed of Ag, Se, Fe, Co, Cu, and S. Analysis suggests that these metals were derived from dental amalgam and that the discoloration was caused by amalgam tattoo.

[Statistics on operations at Hara Genitourinary Hospital (1971-1991)]

The statistical analysis of the inpatients and operations in our department from April, 1971 to March, 1991 revealed a total of 9,170 operations. One of the biggest changes in treatment is a marked increase in closed surgery. This includes endourological surgeries; transurethral resections of prostate and bladder tumor (TUR-P, TUR-Bt), percutaneous nephrolithotripsy (PNL), transurethral uretero-lithotripsy (TUL) and extracorporeal shock-wave lithotripsy (ESWL). From 1976 to 1980 there were 721 open surgical procedures (71.0% of cases) and 295 closed procedures (21.0% of cases). This ratio has now been reversed completely. From 1986-1991, there were 342 open procedures (8.2% of cases) and 3808 closed procedures (91.8% of cases). The main reason for this change was the introduction of the new techniques PNL, TUL and ESWL. Other important observations include: The incidence of emergency operations was higher in this private institution than that seen in non-private hospitals. From 1986, there was an increase in the use of PNL and TUL for the management of urinary calculi, and from 1988, ESWL has overtaken PNL and TUL in the treatment of this condition. Recently the limitations of ESWL have been appreciated and the value of a combined approach to therapy, for selected cases, is being recognized. A total of 238 ileal or ileocecal conduits were created with good results. A low complication rate has been observed with preservation of renal function.

Cytokeratin Polypeptide Profile of Merkel Cells in Human Fetal and Adult Skin: Difference of Expression of Cytokeratins in Epidermal and Dermal Merkel Cells

The origin of Merkel cells is uncertain, although current evidence by immunohistochemical keratin marker studies favors an epidermal derivation. We studied the expression of keratin species in Merkel cells of human fetus and adult using 19 anti-keratin antibodies. Epidermal and dermal Merkel cells contained not only simple epithelium-type but also some stratified epithelium-type keratins. Interestingly, expression of some keratins was different between epidermal and dermal Merkel cells, for example, AN3 (50, 58 kD) and CKB1 (50 kD) recognized epidermal Merkel cells, but not dermal Merkel cells. These results suggest that surrounding keratinocytes influence the expression of cytokeratins in Merkel cells or that dermal Merkel cells undergo a modification from keratin-producing epidermal Merkel cells to a more neural cell type by the association with nerve endings in the upper dermis. On the other hand, certain cytokeratin polypeptides recognizable with Ks19.1 (40 kD), CK5 (45 kD), and CAM5.2 (52.5 kD) were expressed in both epidermal and dermal Merkel cells. The expression of simple epithelium-type keratins in Merkel cells remained even after the epidermal basal cells gradually lost their expression.

Synthesis and antifungal activities of a series of (1,2-disubstituted vinyl)imidazoles

A series of vinylimidazoles containing a hetero atom such as sulfur or oxygen at a beta-position of the vinyl group was prepared and the antifungal activities were tested. It was found that sulfur-substituted derivatives such as (E)-1-[2-(methylthio)-1-[2-(pentyloxy)phenyl]ethenyl]-1H-imidazole (5a-5) and (E)-1-[1-[2-(hexyloxy)phenyl]-2-(methylthio)ethenyl]-1H-imidazole (5a-6) showed excellent antifungal activities against dermatophytes and yeast cells. The stereochemistry of the hydrochloride salt of 5a-5 was determined by X-ray crystallography. The structure-activity relationships were discussed.

[A case of systemic lupus erythematosus with the central nervous system manifestations (CNS-lupus) mimicking herpes simplex encephalitis (HSE)]

A 21-year-old male with SLE developed seizure, loss of consciousness and focal signs referable to involvement of the front-temporal brain regions. MRI (magnetic response imaging) image revealed high signal areas in the temporal lobes. By these findings, herpes simplex encephalitis (HSE) was suspected at first. But neither isolation of herpes simplex virus nor HSV specific IgM by ELISA was detected. Acyclovir administration by intravenous infusion was'nt effective but corticosteroid pulse therapy was effective. The level of anticardiolipin antibody was very high. Finally, the diagnosis of CNS-lupus with HSE-like characteristics was made in this case.

[Suppression of gamma-interferon induced HLA-DR antigen expression on normal and transformed keratinocytes by 1,25 (OH)2 vitamin D3]

Recently, it has been shown that 1,25 (OH)2 Vitamin D3 (VD3) shows growth inhibition and enhances differentiation of keratinocytes in vitro. To elucidate the further effect of VD3 on keratinocytes, we studied the effect of recombinant human gamma interferon (IFN-gamma) and VD3 on the expression of HLA-DR antigen and MHC class I antigen on 3 normal and 6 transformed keratinocytes by means of FACS analysis. IFN-gamma (500 JRU/ml, 72 hr) induced the expression of HLA-DR antigen on 3/3 normal keratinocytes, 3/4 trichilemmoma and 1/2 squamous cell carcinoma cell lines. When these cells were cultured with both IFN-gamma and VD3 at the same time, the expression of HLA-DR antigen was significantly decreased. Sequential treatment of these cells with IFN-gamma and VD3 (each 72 hr), or vice versa, showed significant suppression of HLA-DR antigen expression. The fluorescens intensity of class I antigen was increased after IFN-gamma treatment, however, this effect is inhibited when the cells were treated with combination of IFN-gamma and VD3.

[Normolipemic xanthoma developed on alopecia lesion on a SLE patient--histological study]

A 30-year-old SLE patient developed a xanthoma on her alopecia lesion. Histological examination showed typical lupus changes including immunofluorescence stainings. In addition, there were numerous xanthoma cells existed through the dermis, interlobular spaces of subcutaneous fat tissue, perivascular areas of small blood vessels, and subendothelial spaces and inside of intraluminal thrombosis of subcutaneous small arteries. These xanthoma cells contained granular materials in their cytoplasm. Histochemically, these materials are diastase resistant P.A.S. (+), immunoglobulin (+), Sudan BB (+), Sudan III (+), Nile blue (pinkish red), and yellowish orange autofluorescence suggesting that they are lipofuscin or lipid peroxidation products. Further histological findings showed destruction of sebaceus glands and peri-glandular++ infiltration of lymphocytes and histiocytes. These histiocytes contained phagocytic neutral lipid droplets in their cytoplasm. Very small lipid peroxides were also seen on surface and/or cytoplasm of infiltrating lymphocytes existing not only peri-lobular area but also intraluminal area of blood vessels. The marker profile of these infiltrating lymphocytes are B-cell predominant admixed with some CD8(+) T-cells. These data suggest that the mechanism of developing xanthoma is initiated by immune-complex deposition on basal lamina of sebaceus glands, followed by destruction of sebaceus glands by lympho-histiocytic cells infiltration with some antigen presenting and/or effector cells, and finally xanthoma cells were developed by phagocytosis of lipid peroxides caused by macrophage-derived oxygen radicals. Interestingly, our data suggest that the lipid peroxides, which may act as photosensitizer, may leave the skin and may enter the small vessels carried by lymphocytes. Furthermore the xanthoma cells may also enter the circulation through the small arteries.

An investigation of cytokeratin expression in skin epithelial cysts and some uncommon types of cystic tumours using chain-specific antibodies

The differentiation state of skin epithelial cysts and some uncommon types of epithelial skin tumours was investigated by immunohistochemical staining, mainly using cytokeratin (CK) polypeptide-specific monoclonal antibodies. Samples of interfollicular epidermis, hair follicles and eccrine sweat glands were included as reference tissues. The CK reactivity in epidermoid cysts and milia is not restricted to CKs involved in epidermal-type differentiation, i.e. CK1, 5, 10 and 14, but in addition CK16, a hyperproliferative keratinocyte marker is suprabasally expressed. CK1 and 10 are other prominent suprabasal markers, while CK14 seems to be preferentially expressed in the basal cell layer. Of the non-epidermal CKs, only CK4 was focally or more extensively detected in about 50% of the cases. In terms of CK reactivity, keratinization of trichilemmal cysts corresponds to the keratinization of the anagen-phase hair follicle in the isthmus. The CK reactivity is again restricted to CK1, 5, 10, 14 and 16. However, the CK1 as well as CK10 reactivity is subject to serious limitations, since both CKs were only convincingly observed in foci of terminal differentiation. Eccrine hydrocystoma obligatorily expresses a complex CK set, including CK7, 8, 14, 18 and 19. This CK set perfectly corresponds to the CK composition observed in acini of eccrine sweat glands. In addition, a discontinuous CK4 and 16 reactivity was seen in about 50% of the sites, while CK1 and 10 displayed a strictly focal appearance. On the other hand, syringoma produces in its distinct structures, a CK pattern reminiscent of the one observed in eccrine sweat gland ducts and includes CK1, 5, 10, 14, 16 and 19.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical study of extracorporeal shock wave lithotripsy for 1000 patients with renal and ureteral stones]

Using a Dornier HM3 lithotripter, we treated 1,000 patients with renal and ureteral stones from April, 1986 to July, 1989. They consisted of 612 solitary stones (pelvic stones, 152; calyceal stones, 167; ureteral stones, 293), 265 multiple stones and 123 staghorn calculi (complete, 48; partial, 75). The overall rate of the auxiliary procedure was 59.3% (pre-operative, 47.9%; post-operative, 11.4%). Pre-operative procedure included 430 catheterizations, 26 percutaneous nephrostomies (PNSs) and 23 pyelograms . Post-operative procedure included 69 transurethral lithotripsy , 21 PNSs, 26 percutaneous nephrolithotripsy (PNLs), 6 meatotomy , 5 chemolysis and 1 open surgery. 484 (68.3%) in 709 good follow-up cases were stone-free at the time of 3 months since the first extracorporeal shock-wave lithotripsy (ESWL). Complications were pain (34.8%), fever (4.3%), pain & fever (8.5%), subcapsular hematoma (0.1%) and ureteral obstruction (0.1%). Thus, ESWL is considered to be a useful means for renal and ureteral stones and in the case of large stone the combination therapy with PNL is more effective than ESWL-monotherapy.