[Surgical removal of right atrial myxoma with severe hypoxemia caused by right to left shunt through persistent foramen ovale]

A 41-year-old woman was referred to our hospital due to dyspnea and cyanosis. Echocardiography revealed a right atrial tumor with right to left shunt through PFO. There was no evidence of pulmonary embolism from the tumor. The tumor was removed under cardiopulmonary bypass and PFO was closed. The patient is doing well now.

The direct visualization of structural array from laminin to dystrophin in sarcolemmal vesicles prepared from rat skeletal muscles

It has been biochemically shown that dystrophin and alpha- and beta-dystroglycan form an oligomeric complex which links laminin, a component of the basement membrane, to components of the subsarcolemmal cytoskeleton in skeletal muscle fibers. In the present study the dystrophin-glycoprotein complex and its structural relationships to laminin and subsarcolemmal cytoskeleton were ultrastructurally examined in crude surface membranes prepared from rat skeletal muscles. Sarcolemmal vesicles within crude surface membranes were identified and characterized by fine protrusions on their outer surface and electron-dense materials or patches associated with the inner surface. These two components were seen to be in register with each other across the sarcolemma. The fine protrusions were immunolabeled by anti-alpha-dystroglycan and reassociated with exogenous laminin. Immunolabeling in combination with laminin reassociation demonstrated that the electron-dense materials contained dystrophin at laminin-binding domains of the membrane. In addition, they were often associated with very fine filaments. These results provide morphological evidence for the biochemically proposed model of molecular array of dystrophin complex from the basement membrane to the subsarcolemmal cytoskeleton.

Regulation of tissue plasminogen activator production in cultured human fetal mesangial cells

Glomerular fibrin deposition is thought to be one of the factors causing progressive glomerular injury and may be related to defective intraglomerular fibrinolysis. Recently, it was shown that tissue plasminogen activator (t-PA) is produced by mesangial cells and is associated with degradation of the extracellular matrix. This study was designed to clarify the factors regulating t-PA production in human mesangial cells. The levels of t-PA activity, t-PA antigen and t-PA inhibitor-1 (PAI-1) antigen were estimated in the supernatants of cultured human fetal mesangial cells incubated for 72 h with thrombin, IL-Ibeta, IL-6, IL-10, and transforming growth factor-beta (TGF-beta). The t-PA activity was measured by an amidolytic assay, and the levels of t-PA antigen and PAI-1 antigen were also measured by enzyme-linked immunosorbent assay. Thrombin increased t-PA activity and TGF-beta decreased it in parallel with t-PA antigen level, although these agents did not affect the synthesis of PAI-1. Incubation with IL-1beta, IL-6 and IL-10 did not change the t-PA activity. It was concluded that the release of t-PA from human fetal mesangial cells was stimulated by thrombin and inhibited by TGF-beta in parallel with that of t-PA antigen. These factors may participate in the glomerular fibrin deposition and the accumulation of extracellular matrix.

Studies on blood compatibility of terpolymers composed of methyl methacrylate, methoxypolyethyleneglycol methacrylate, and dimethylsiloxane methacrylate

Terpolymers composed of methyl methacrylate (MMA), polydimethylsiloxane methacrylate (PDMSMA), and methoxypolyethyleneglycol methacrylate (MPEGMA), having different compositions were synthesized. Platelets were not adsorbed onto terpolymer surfaces composed of 50 wt% MMA, 25 wt% PDMSMA and 25 wt% MPEGMA, while on terpolymers with the other compositions, platelet adsorption and fibrin clot were observed. It was shown that PDMS segment was predominant on these terpolymer surfaces via XPS. Receding contact angles of terpolymers, on which no platelet was observed, showed intermediate values between PDMS- and MPEG-rich surfaces. It was suggested that these terpolymers had blood compatibility.

Cytokine expression during orthotopic corneal allograft rejection in mice

PURPOSE

The acquisition of cell-mediated immunity against donor antigens has been shown to be associated with rejection of orthotopic corneal allografts, but the mechanisms that cause corneal allograft destruction in grafted tissue remain obscure. To determine which T-cell subsets infiltrate graft tissue and cause graft rejection, cytokine expression was examined in corneal tissue after orthotopic corneal allograft.

METHODS

BALB/c mice received orthotopic corneal allografts from either syngeneic BALB/c or allogeneic C57BL/6 donors. At 1 or 4 weeks after grafting, the mice were euthanatized, and their corneas were removed. Corneal tissue was frozen, homogenized, and placed in phosphate-buffered saline (PBS). Each sample consisted of five corneas in 500 ml PBS. After centrifugation, the supernatant was collected, and the concentration of the following cytokines was measured by enzyme-linked immunosorbent assay: interleukin (IL)-1alpha, IL-2, IL-4, IL-10, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha.

RESULTS

Significantly increased amounts of proinflammatory cytokines (IL-1alpha and TNF-alpha) were detected in supernatants from all grafted corneas (both syngeneic and allogeneic) at 1 week after grafting. At 4 weeks after grafting, supernatants from normal corneas, corneas with syngeneic grafts, and corneas with accepted corneal allografts contained undetectable amounts of IL-2 and IFN-gamma, whereas supernatants from corneas with rejected corneal allografts contained significant amounts of IL-2 and IFN-gamma. There were no significant differences in the amounts of IL-4 or IL-10 among all samples. Histologic examination confirmed the expression of IL-2 and IFN-gamma in rejected corneal allografts.

CONCLUSIONS

Because IL-2 and IFN-gamma are secreted primarily by T-helper type 1 (Th 1) cells, whereas IL-4 and IL-10 are secreted by T-helper type 2 (Th 2) cells, these results indicate that Th 1-type cytokines, rather than Th 2-type cytokines, contribute to the rejection of orthotopic corneal allografts in graft tissue.

Cimetidine reduces impairment of cellular immunity after cardiac operations with cardiopulmonary bypass

OBJECTIVE

Depressive effects of cardiopulmonary bypass on cell-mediated immune responses may lead to postoperative infectious complications. We previously reported that cimetidine reduced postbypass depression of the cytotoxic activity of natural killer cells. This study evaluated cimetidine as an agent to preserve cellular immunity after cardiac operations.

METHODS

In a prospective randomized study, 20 patients were divided into two groups of equal size. Cimetidine-group patients received 400 mg of cimetidine intravenously before bypass and a 33 mg/hr intravenous infusion of cimetidine after the operation, continuing until the fifth postoperative day. Control-group patients received conventional perioperative therapy. Lymphocyte subsets, natural killer cell activity, percentage of CD56+CD16+ (percentage of natural killer cells), and percentage of CD11b+CD8+ (percentage of suppressor T lymphocytes) were measured perioperatively.

RESULTS

Although temporary postoperative reductions in percentages of CD3+, CD4+, and CD56+CD16+ cells were observed in both groups, CD8+ percentages on postoperative day 1 and CD11b+CD8+ percentages on postoperative days 1 and 3 in the cimetidine group were significantly lower compared with those in the control group (p = 0.01,p = 0.004, andp = 0.02, respectively). Temporary postoperative reduction of natural killer cell activity was also observed in both groups, but the natural killer cell activity on postoperative day 1 in the cimetidine group (17.1%) was significantly higher (p = 0.02) than that in the control group (8.20%).

CONCLUSIONS

Cimetidine counteracts depressive effects of cardiopulmonary bypass on cell-mediated immunity and may possibly reduce postoperative susceptibility to infection.

[Surgical stabilization of multiple rib fractures successfully achieved with the use of long metalic plates]

Surgical stabilization of multiple rib fractures in 5 male patients was successfully achieved with the use of orthopedic A-O metalic plates, which are called reconstruction plates. In each patient, we prevented deformity of the rib cage and flail chest which frequently occurs after multiple rib fractures. Three of these patients received emergency operations because of severe hemopneumothorax and flail chest due to crushing injuries to the chest. They were treated by the standard thoracotomy, hemostasis of intrapleural bleeding, and stabilization of fractured ribs with reconstruction plates, in addition two of the patients underwent a single lobectomy to control the pulmonary hemorrhage. Another two patients were treated with mechanical ventilation and closed-tube thoracotomy following the chest trauma because their thoracic bleeding from drainage tubes was tolerable. But flail chest and respiratory insufficiency did not improve, in spite of positive controlled ventilation as a mode of internal pneumatic stabilization. Then surgical stabilization of the fractured ribs with these plates was carried out ten to twelve days after the accidents in each case. All patients tolerated the surgical procedures well and were successfully removed from the respirator, demonstrating complete stability of the chest wall. The long metal reconstruction plates with many perforations were very useful for the external fixation of segmentary fractured ribs as an external brace. This was because they were long enough to cover the whole length of the fractured ribs and moderately soft enough to be appropriately bent or twisted by hand at the time of operation. Moreover a number of holes in it allowed the suture to pass through the plate and rib, avoiding displacement of the prosthesis. This is the first report which describes the usefulness of orthopedic reconstruction plates for the stabilization of multiple rib fractures.

Mitogen-activated protein kinase and p70 ribosomal protein S6 kinase are not involved in the insulin-dependent stimulation of cAMP phosphodiesterase kinase in rat adipocytes

To elucidate the mechanism of anti-lipolytic action of insulin in rat epididymal adipocytes, we explored the potential mechanism that might be involved in the hormone-dependent stimulation of cAMP phosphodiesterase (PDE) kinase. PDE kinase was assayed in a cell-free system. Both wortmannin and LY294002, highly specific inhibitors of phosphatidylinositol 3-kinase, almost completely blocked the hormonal effect not only on PDE kinase but also on mitogen-activated protein (MAP) kinase. Neither PD98059, a specific inhibitor of MAP kinase, nor rapamycin, a potent inhibitor of insulin-dependent stimulation of p70 ribosomal protein S6 kinase (p70S6K), had inhibitory effect on that of PDE kinase. These results are consistent with the view that (i) insulin-activated PDE kinase as well as MAP kinase and p70S6K are localized downstream of phosphatidylinositol 3-kinase, (ii) PDE kinase is distinct from either MAP kinase or p70S6K and (iii) PDE kinase does not exist downstream of either MAP kinase or p70S6K. It is suggested that PDE kinase and MAP kinase or p70S6K may be localized in separate branches of the cascade of insulin action. The branching point of the cascade could be either at or below the level of phosphatidylinositol 3-kinase.

Absence of mutations in the analysis of coding sequences of the entire transforming growth factor-beta type II receptor gene in sporadic human breast cancers

The transforming growth factor-beta (TGFbeta) binds the type II TGFbeta growth factor receptor (TGFbetaRII) to inhibit the growth of most epithelial tissues. Most human colon and gastric cancers with microsatellite instability (MI) have frameshift mutations in polynucleotide repeats within the TGFbetaRII coding region; these mutations truncate the receptor protein and disable the serine/threonine kinase to produce TGF-beta resistance. To further investigate the type, frequency and tissue distribution of TGFbetaRII gene mutations, in this study, we examined 36 sporadic breast cancers. We previously produced eight intron based primer pairs for mutational analysis of the entire coding region of the TGFbetaRII gene. Using these primers, we developed protocols for polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) analysis of PCR products from genomic DNA samples of 36 breast cancer patients and we tested them for microsatellite instability (MI) at eight microsatellite loci. One case demonstrated MI (2.8%) and we found no mutations. These and other recent data indicate that TGFbetaRII mutations are essentially confined to colon and gastric cancers with MI. The narrow spectrum of tissues containing RII mutations illustrates the complexity of genetic checkpoints in human carcinogenesis.

Immunohistochemical study of sulfatide expression in gastric carcinoma: alteration of sulfatide expression

Immunohistochemical staining using a specific monoclonal antibody against sulfatide was performed to examine cellular localization of sulfatides in normal human gastric mucosa and in various types of gastric carcinoma. In normal gastric mucosa without Helicobacter pylori infection, both epithelial and glandular cells were densely stained with anti-sulfatide antibody. Sulfatide staining was more abundant in the apical area of normal epithelium compared with cytosol or basolateral areas. This tendency was stronger in the antrum than the gastric body and was more intensified in glandular cells of the pyloric glands. The levels of sulfatide expression were decreased in papillary and well-differentiated adenocarcinomas compared with normal mucosa, were markedly attenuated in moderately differentiated adenocarcinomas, and were very low in poorly differentiated adenocarcinomas. The polarity of the stains was preserved in gastric cancers that exhibited differentiated tissue organization. The levels of sulfatide expression were highly variable in signet ring carcinoma cells. The cancer cells that expressed sulfatides did not show any polarity of staining.

Absence of mutatins in the analysis of coding sequences of the entire transforming growth factor beta type II receptor gene in sporadic humangastric cancer using genomic DNA and intron primers

Mutations in the transforming growth factor beta type II receptor (TGFbetaRII) gene have been detected in several human cancers that represent the phenotype of genomic instability. To establish a basis for diagnosis of cancer patients, we previously determined the exon-intron organization of the TGFbetaRII gene. The results indicated that TGFbetaRII protein is encoded by 567 codons in 7 exons. In this study, we further determined the nucleotide sequences surrounding these 7 exons and designed 8 sets of intron-based primers to examine the entire coding region of the TGFbetaRII gene. By using these primers, we screened for mutations of the TGFbetaRII gene in DNAs of 32 sporadic gastric cancer patients in whom one case showed MI+ (3.1%) at two loci. We found no mutations, and these data support other recent evidence that TGFbetaRII mutations rarely occur except in colon and gastric tumors with MI.

Systemic lupus erythematosus associated with transverse myelitis and parkinsonian symptoms

A 31-year old woman developed transverse myelitis after 10 years remission since she was first diagnosed as systemic lupus erythematosus. Although pulse methyl prednisolone resolved her myelitis, Parkinson-like symptoms developed subsequently after reduction of steroid. Treatments including apheresis did not improve her Parkinson-like symptoms such as rigidity, akinesia, impairment of speech and mask-like facial expression. Levodopa was effective as a symptomatic therapy. Orally administered cyclophosphamide eventually led her to remission and withdrawal from levodopa. Her clinical course and the absence of other possible causes prompted us to conclude that Parkinsonian symptoms as well as transverse myelitis may have developed as manifestations of central nervous system lupus.

[A case of aneurysm of the descending thoracic aorta associated with Behçet's disease]

A 66-year-old male with Behçet's disease admitted again with hemoptysis. He underwent the resection and direct closure of descending aortic aneurysm 3 years ago, followed without the use of steroid. Chest CT scanning demonstrated a recurrent aneurysm of the descending aorta which was could not be detected on the previous CT only 23 days before. In the current operation, we performed resection, direct closure and wrapping of the aneurysm. The pathological examination showed a true aneurysm of Behçet's disease. The patient is free from recurrence for 17 months since the operation under steroid therapy.

[Study of diarrhea-inducing strains of Escherichia coli mainly isolated in Kanto area between June and September 1996]

A total of 21,609 faecal specimens obtained from patients with diarrhea mainly in Kanto area between June and September 1996 were investigated to identify the causative pathogens for diarrhea. One-hundred fifty-seven strains of Escherichia coli of 29 different O-serotypes were isolated as the causative pathogens, which were previously recognized to induce severe abdominal cramps and diarrhea. Of these, 114 strains, in which the possibility of enterohemorrhagic E. coli due to their O-serotypes was predicted, were examined for the producibility of Vero toxins. Twenty-six (76.5%) of the 34 strains of E. coli O157 produced the Vero toxins, and other 8 strains were the non-producers. Twenty of the 26 producers produced both VT1 and VT2, whereas the other 6 strains produced VT2 only. Furthermore, 4 strains of E. coli O26, and 1 strain each of E. coli O125 and O126 produced Vero toxins. Thirty-two of the 114 strains, isolated from the patients with diarrhea and selected as the enterohemorrhagic E. coli according to the specific O-serotypes, were actually confirmed produce Vero toxins. Thirty-four strains of E. coli O157 tested were susceptible to all antibiotics such as ampicillin, doxycylin, levofloxacin, fosfomycin, chloramphenicol and polymyxin B, and no strains resistant to levofloxacin, polymyxin B and fosfomycin were found.

Reversible limbic encephalitis caused by ovarian teratoma

A 19-year-old woman developed memory loss followed by psychosis, coma, convulsion, and central hypoventilation requiring mechanical ventilation. MRI of the brain showed minimal changes, and SPECT imaging revealed a small region of increased uptake in the cortex. Intravenous acyclovir and high-dose corticosteroids were administered without any effect. An extensive work-up revealed an elevated serum alpha-fetoprotein (AFP) concentration and the presence of an ovarian tumor. Following resection of the tumor, an immature teratoma by pathology, the patient had significant recovery of her cognitive function with some psychotic sequela. Serum anti-neuronal antibody (anti-Hu) was negative both by immunohistochemistry and by Western blot analysis. A rare combination of paraneoplastic limbic encephalitis and brainstem encephalitis was the suspected diagnosis. Because the tumor contained a neuronal component, we propose an immunologic cross-reaction as the pathomechanism, but the lack of a specific antibody may suggest cell-mediated rather than globulin-mediated immunity.

[Renal lesions of rats induced by antibodies to cultured rat glomerular epithelial cells and mesangial cells]

Renal lesions of rats induced by antibodies to cultured rat glomerular epithelial cells (GEC) and mesangial cells (GMC) were studied. Antibodies to cultured rat GEC and GMC were produced by immunization of rabbits with GEC and GMC respectively. The rats injected with anti-GEC antibody showed a small amount of urinary protein, glomerular deposition of rabbit IgG and subepithelial dense deposits observed by electron microscopy. Proteinuria was suppressed in the rats in which complement was depleted with cobra venom factor. Western blot analysis demonstrated a band of 200 KD in GEC lysates reacted with anti-GEC antibody. The rats injected with anti-GMC antibody showed little urinary protein, glomerular deposition of rabbit IgG and mesangial dense deposits. Western blot analysis demonstrated two bands of 43 and 14 KD in GMC lysates reacted with anti-GMC antibody. These data showed that the injection of anti-GEC antibody or anti-GMC antibody induced similar lesions to passive Heymann nephritis and anti Thy 1.1 nephritis. This study suggested that antigenicity of structural glomerular cells is important as the antigens of glomerulonephritis.

Expression of gelatinase A, tissue inhibitor of metalloproteinases-2, matrilysin, and trypsin(ogen) in lung neoplasms: an immunohistochemical study

Lung cancer is a heterogeneous tumor in terms of clinical and biological behavior, and its aggressiveness depends on its invasive and metastatic properties. Matrix metalloproteinases and serine proteinases are believed to play a crucial role in invasion and metastasis of malignant tumor cells. In the present study, the authors evaluated immunohistochemically the expression of gelatinase A; tissue inhibitor of metalloproteinases-2 (TIMP-2), an inhibitor of gelatinase A; matrilysin; and trypsin(ogen) in 67 lung tumors from a variety of histological types including 17 squamous cell carcinomas, 16 adenocarcinomas, 15 small cell carcinomas, and 12 carcinoids. Interestingly, normal bronchial, bronchiolar, and alveolar epithelial cells expressed gelatinase A, TIMP-2, matrilysin, and trypsin(ogen) at varying frequencies and intensities. Bronchial smooth muscle cells and cartilage cells expressed gelatinase A alone, whereas endothelial cells, fibroblasts, and macrophages expressed gelatinase A and TIMP-2. Gelatinase A was expressed at high levels in most lung tumors examined (47% to 80%). TIMP-2 was also expressed at high levels except in the small cell carcinomas, which showed TIMP-2 expression at a lower frequency (60%) compared with other types of lung tumors (80% to 100%). Although matrilysin was expressed by tumor cells of all the histological types at various frequencies (13% to 63%), its expression was most common in adenocarcinomas. Expression of trypsin(ogen) was observed almost exclusively in adenocarcinomas (56%); other types of lung tumors expressed trypsin(ogen) far less frequently (0% to 12%). The present results, taken together with those of previous studies, suggest that gelatinase A is associated with malignant behavior of all the types of lung tumors, whereas its activity may be controlled by the endogenous inhibitor TIMP-2. The aggressive clinical behavior of small cell carcinoma may be attributable, at least in part, to a loss of the inhibitory effect of TIMP-2, as a significant proportion of these tumors showed negative or low levels of TIMP-2 expression. Matrilysin and trypsin(ogen) expressions are unlikely to be correlated with the aggressiveness of lung tumors. The expression of trypsin (ogen) may rather reflect the differentiation of adenocarcinoma cells toward normal airway epithelial cells.

[Peripheral carcinoid tumor of the lung presenting as a solitary mass shadow on a chest roentgenogram and diagnosed by CT-guided percutaneous needle biopsy]

A 59-year-old woman was referred to our clinic because a solitary mass shadow (2.5 cm in diameter was seen in the left lower lung field on a chest roentgenogram. Transbronchial biopsy via a fiberoptic bronchoscope did not yield a definitive diagnosis. Examination of a specimen obtained by CT-guided percutaneous needle biopsy revealed that the tumor consisted of small cells proliferating in a solid, tubular, pseudoglandular, and follicular pattern, which suggested the diagnosis of carcinoid. A left lower lobectomy was performed, and several hilar and mediastinal lymph nodes were also removed. The tumor cells did not show pleomorphism of nuclei, mitotic activity, or necrosis. Grimelius and immunohistochemical stains for chromogranin. A, neuron-specific-enorase, synaptophysin, and serotonin were positive. These findings confirmed the diagnosis of carcinoid CT-guided percutaneous needle biopsy can be useful for the diagnosis of peripheral carcinoid and other peripheral lung tumors.

Thrombin stimulates production of transforming growth factor-beta by cultured human mesangial cells

Fibrin formation within the glomeruli occurs in various forms of human and experimental glomerulonephritis and it may play an important role in progressive glomerular injury. Transforming growth factor-beta (TGF-beta) has been shown to participate in the glomerular accumulation of extracellular matrix in glomerulonephritis. We investigated whether thrombin, an important coagulation factor, could modulate the production of TGF-beta by cultured human mesangial cells (HMC). TGF-beta levels in the culture supernatants were measured by ELISA using a specific antibody. The TGF-beta concentration was significantly increased by incubation of HMC with thrombin in a time-dependent manner. The stimulating effect of thrombin on TGF-beta was inhibited by addition of hirudin (a natural thrombin inhibitor) and argatroban (a synthetic thrombin inhibitor). In addition DFP-inactivated thrombin, which has no enzymatic activity, did not stimulate TGF-beta production. A protein kinase C inhibitor (H7) and a tyrosine kinase inhibitor (herbimycin A) also inhibited thrombin induced TGF-beta production. These findings suggested that thrombin may modulate the synthesis of TGF-beta via protein kinase C- and tyrosine kinase-dependent mechanisms in cultured HMC. Thus thrombin may participate in the accumulation of extracellular matrix in glomeruli through the augmentation of TGF-beta production.

A case of Sjögren's syndrome associated with Sweet's syndrome

We report a case of Sjögren's syndrome whose clinical course had been indolent until the patient presented with Sweet's syndrome (acute febrile neutrophilic dermatosis). This patient showed renal failure and renal tubular acidosis. Sweet's syndrome resolved within 3 weeks without corticosteroid therapy. Renal biopsy findings were consistent with interstitial nephritis. His renal manifestations responded to corticosteroid therapy and the renal function remained stable during 6 years follow-up without recurrence of Sweet's syndrome. Although close association of both syndromes is already known, in our case Sjögren's syndrome may have been exacerbated by occurrence of Sweet's syndrome.

[Study on the morphological changes in the placenta of rats administered nitric oxide synthase inhibitor]

To clarify the roles of nitric oxide synthase (NOS) during pregnancy, histopathological changes in the placenta were observed after the administration of an NOS inhibitor [NG-nitro-L-arginine methyl ester (L-NAME)] to rats. L-NAME was infused subcutaneously from day 12 of gestation at stable concentrations of 3mg/day (group B) or 25mg/day (group C) until day 18 when the placentae were removed. The mean systolic blood pressures in groups B and C were higher than in the controls (group A). By both light and electron microscopy, morphological changes were observed and compared to those of human placenta in preeclampsia. In groups B and C, light microscopy showed that giant cells were vacuolated, degenerated and decreased in number. In the labyrinth, the stroma was extremely edematous, and the intervillous space and fetal vessels were narrowed. Electron microscopy showed that micro-fibrin clots were deposited on the maternal surface of trophoblasts. The endothelial cells of fetal vessels were irregular in shape. In group B the endothelial cells and intermediate filaments were increased. These findings suggest that decreased NO production may cause changes similar to those found in preeclampsia. Treatment with NOS inhibitor may be used in an animal model for preeclampsia.

Selective determination of chloride and bromide ions in serum by cyclic voltammetry

Voltammetric determination of chloride and bromide ions in serum was made using a one-body type Ag electrode, whose surface was covered with a dialysis membrane for preventing interference from proteins. This determination was based on measurement of the charge of the reduction wave of silver halide formed on the Ag electrode surface in a halide ion solution during a cathodic potential sweep. In this method, depending on the potential sweep range, the charge of the reduction wave of AgI, AgI + AgBr, or AgI + AgBr + AgCl can be measured. Here, the method was used to determine the chloride and bromide ions in artificial serum. Linear concentration ranges were 1.0 x 10(-2)-2.4 x 10(-1) M for chloride ions and 5.0 x 10(-3)-1.8 x 10(-2) M for bromide ions. The correlation coefficient was 0.999 in each case. The relative standard deviation for chloride ion (1.0 x 10(-1) M) was 1.9% (n = 10), and that for bromide ion (1.5 x 10(-2) M) was 2.5% (n = 10). Bromide ions at a relatively high concentration as the component of serum had no effect on the determination of the chloride ion in the serum. This method is thus useful for the selective determination of chloride and bromide ions in serum.

Tissue factor pathway inhibitor production by human mesangial cells in culture

Fibrin formation within the glomeruli has been observed in various forms of human and experimental glomerulonephritis and it may play an important role in progressive glomerular injury. Furthermore it has been hypothesized that glomerular fibrin deposition may occur through activation of either the intrinsic or extrinsic coagulation pathway. It has been demonstrated that a procoagulant activity (PCA) which is compatible with tissue factor is present in the glomeruli and becomes increased in human proliferative glomerulonephritis and in animal models of nephritis. Tissue factor pathway inhibitor (TFPI) regulates the extrinsic pathway of blood coagulation through its ability to inhibit tissue factor activity. TFPI is present in plasma and in platelets, and it is now thought to be produced mainly by endothelial cells. We examined whether human mesangial cells (HMC) could produce TFPI and attempted to clarify regulatory factors which affect TFPI production. Cultured HMC were used and TFPI in the cell supernatants was measured by ELISA using a specific antibody. Cultured HMC showed the production of TFPI. Immunoblot analysis revealed 40 kD protein of TFPI. The concentration of TFPI was significantly increased following the incubation with thrombin and heparin, including low molecular weight heparin, in a dose- and time-dependent manner. However, fetal calf serum, phorbol myristate acetate, lipopolysaccharide, IL-1 beta and tissue factor did not stimulate TFPI synthesis. Our data show that cultured HMC have the ability to produce TFPI which inhibits fibrin formation. It is possible that thrombin-induced enhancement of TFPI synthesis may be caused by the autoregulatory system of blood coagulation and that with heparin it may represent another anticoagulatory effect of heparin.

Identification and characterization of basal and cyclic AMP response elements in the promoter of the rat hexokinase II gene

Hexokinases catalyze the phosphorylation of glucose and initiate cellular glucose metabolism. Hexokinase II (HKII) is the principal hexokinase isoform in skeletal muscle, heart, and adipose tissue. Isoproterenol and exogenous cyclic AMP (cAMP) increase HKII gene transcription in L6 myotubes. Various segments of the HKII promoter that direct the expression of the chloramphenicol acetyltransferase reporter gene were transfected into L6 myotubes to identify basal and cAMP response elements. The 5'-flanking region that extends 90 base pairs upstream of the transcription start site includes a CCAAT box and a cAMP response element (CRE); both contribute to basal promoter activity and each provides an independent, maximal response to cAMP. An inverted CCAAT motif, or Y box, located just upstream of the CCAAT box, contributes to basal promoter activity but is not involved in the cAMP response. Homo- and heterodimers composed of the CRE-binding protein and activating transcription factor-1 bind specifically to the CRE. The Y box and the CCAAT box specifically bind the factor NF-Y (also known as CBF).

Analysis of the signaling pathway involved in the regulation of hexokinase II gene transcription by insulin

The hexokinases, by converting glucose to glucose 6-phosphate, help maintain the glucose concentration gradient that results in the movement of glucose into cells through the facilitative glucose transporters. Hexokinase II (HKII) is the major hexokinase isoform in skeletal muscle, heart, and adipose tissue. Insulin induces HKII gene transcription in L6 myotubes, and this, in turn, increases HKII mRNA and the rates of HKII protein synthesis and glucose phosphorylation in these cells. Inhibitors of distinct insulin signaling pathways were used to dissect the molecular mechanism by which HKII gene expression is induced by insulin in L6 myotubes. Treatment with wortmannin, an inhibitor of phosphatidylinositol 3-kinase (PI 3-kinase), or with rapamycin, an inhibitor of the pathway from the insulin receptor to p70/p85 ribosomal S6 protein kinase (p70(s6k)), prevented the induction of HKII mRNA by insulin. In contrast, treatment with PD98059, an inhibitor of mitogen-activated protein kinase activation, had no effect on insulin-induced HKII mRNA. In addition, rapamycin blocked the insulin-induced expression of an HKII promoter-chloramphenicol acetyltransferase fusion gene transiently transfected into L6 myotubes, whereas PD98059 had no such effect. These results suggest that a phosphatidylinositol 3-kinase/p70(s6k)-dependent pathway is required for regulation of HKII gene transcription by insulin and that the Ras-mitogen-activated protein kinase-dependent pathway is probably not involved.

Inverse relation of serum Helicobacter pylori antibody titres and extent of intestinal metaplasia

AIMS

To clarify the relation between the serum titre of anti-Helicobacter pylori (H pylori) antibody and the extent of intestinal metaplasia of the gastric mucosa.

METHODS

The serum anti-H pylori IgG titres of 95 asymptomatic individuals (mean age 65 years) undergoing an annual health examination were measured and compared with the extent of intestinal metaplasia (absent, moderate, or extensive), determined by examination of multiple endoscopic mucosal biopsy specimens. Serum pepsinogen I (PGI) levels, as a marker for gastric atrophy, were also measured.

RESULTS

The prevalence of seropositivity for H pylori antibody was high (> 80%), regardless of the extent of metaplasia. However, there was a negative association between the extent of metaplasia and the anti-H pylori titre: 75% of the subjects in the group without metaplasia had high (3+) antibody levels, as did 43% with moderate, and 37% with extensive metaplasia (absent v extensive). The inverse relation between the titre and the extent of metaplasia was evident when examined in those with normal PGI (> 30 ng/ml), whereas no such relation was apparent in subjects with low PGI (< or = 30 ng/ml).

CONCLUSIONS

The anti-H pylori titre correlates inversely with the extent of intestinal metaplasia, particularly in subjects with less marked gastric atrophy.

Deterioration of urinary findings after tonsil stimulation in patients with IgA nephropathy

We studied whether urinary findings are affected by stimulation of tonsils in patients with IgA nephropathy. In 62 patients with IgA nephropathy and 20 patients with other renal diseases tonsils were stimulated by an ultra short wave for 10 min. Changes in amount of urinary protein, urinary sediment, blood leucocyte count, concentrations of serum IgA and serum secretory IgA were evaluated after tonsil stimulation. Forty of 62 patients with IgA nephropathy (65%) showed deterioration of urinary findings after the stimulation compared with 6 of 20 patients with other renal diseases (30%). The deterioration was significantly more frequent in IgA nephropathy than in other renal diseases (p <0.005). Previous episodes of gross hematuria following upper respiratory tract infections had occurred in 17 of 40 patients who showed deterioration of urinary findings after tonsil stimulation (43%) as against in 4 of 22 without deterioration (18%). The level of serum secretory IgA was higher in patients who showed deterioration of urinary findings after tonsil stimulation than in those who did not show it. Though tonsil stimulation increased blood leucocyte count it did not affect the concentrations of serum IgA or secretory IgA. It is concluded that tonsil stimulation often deteriorates urinary findings in patients with IgA nephropathy; therefore chronic tonsillitis may play a part in the pathogenesis of IgA nephropathy.

Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical echo amplitudes

Accurate diagnosis of fatty liver using ultrasonography was attempted based on the difference between the echo intensities of the liver and kidney determined from ultrasonic histograms. Livers were then classified as having fatty infiltration, normal histology, or intermediate histology based on CT ratios established previously in earlier work comparing non-contrast-enhanced liver and spleen. The hepatorenal difference was significantly greater in the fatty liver group than in the normal liver group (8.9 +/- 2.0 dB vs 2.5 +/- 4.5 dB, p < 0.001). When a hepatorenal difference of > or = 7.0 dB was taken as the criterion, this method had a sensitivity of 91.3%, a specificity of 83.8%, and an accuracy of 86.7% for the diagnosis of fatty liver. Thus, quantitative ultrasonic diagnosis of fatty liver can be performed using echo intensity histograms.

Tissue Factor Pathway Inhibitor Production by Human Mesangial Cells in Culture

Fibrin formation within the glomeruli has been observed in various forms of human and experimental glomerulonephritis and it may play an important role in progressive glomerular injury. Furthermore it has been hypothesized that glomerular fibrin deposition may occur through activation of either the intrinsic or extrinsic coagulation pathway. It has been demonstrated that a procoagulant activity (PCA) which is compatible with tissue factor is present in the glomeruli and becomes increased in human proliferative glomerulonephritis and in animal models of nephritis. Tissue factor pathway inhibitor (TFPI) regulates the extrinsic pathway of blood coagulation through its ability to inhibit tissue factor activity. TFPI is present in plasma and in platelets, and it is now thought to be produced mainly by endothelial cells. We examined whether human mesangial cells (HMC) could produce TFPI and attempted to clarify regulatory factors which affect TFPI production. Cultured HMC were used and TFPI in the cell supernatants was measured by ELISA using a specific antibody. Cultured HMC showed the production of TFPI. Immunoblot analysis revealed 40 kD protein of TFPI. The concentration of TFPI was significantly increased following the incubation with thrombin and heparin, including low molecular weight heparin, in a dose- and time-dependent manner. However, fetal calf serum, phorbol myristate acetate, lipopolysaccharide, IL-1β and tissue factor did not stimulate TFPI synthesis. Our data show that cultured HMC have the ability to produce TFPI which inhibits fibrin formation. It is possible that thrombin-induced enhancement of TFPI synthesis may be caused by the autoregulatory system of blood coagulation and that with heparin it may represent another anticoagulatory effect of heparin.

Case report: malignant haemobilia detected in the gallbladder--retrograde cholangiographic findings

Haemobilia caused by gallbladder cancer is a rare condition and cholangiography rarely detects gallbladder haemorrhage because cancer cells or blood clots obstruct the cystic duct. We describe a patient with haemobilia caused by gallbladder cancer, in whom retrograde cholangiography showed a cast-like filling defect in the common bile duct and, in addition, several string-like defects in the gallbladder. The string-like defects appeared to be streams of clotted blood flowing towards the common bile duct in this case of relatively minor haemorrhage.

Regulation of hexokinase II gene transcription and glucose phosphorylation by catecholamines, cyclic AMP, and insulin

The hexokinases, by converting glucose to glucose-6-phosphate, help maintain the downhill gradient that results in movement of glucose into cells through the facilitative glucose transporters. GLUT4 and hexokinase (HK) II are the major transporter and hexokinase isoforms in skeletal muscle, heart, and adipose tissue, wherein insulin promotes glucose utilization. To understand whether hormones influence the contribution of phosphorylation to cellular glucose utilization, we investigated the effects that catecholamines, cyclic AMP (cAMP), and insulin have on HKII gene expression in cells representative of muscle (L6 cells) and brown (BFC-1B cells) and white (3T3-F442A cells) adipose tissues. Isoproterenol or the cAMP analog 8-chlorophenylthio-cAMP selectively increase HKII gene transcription in L6 cells, as does insulin (Printz RL, Koch S, Potter LP, O'Doherty RM, Tiesinga JJ, Moritz S, Granner DK: Hexokinase II mRNA and gene structure, regulation by insulin, and evolution. J Biol Chem 268:5209-5219, 1993), and cause a concentration- and time-dependent increase of HKII mRNA in both muscle and fat cell lines without changing HKI mRNA. Isoproterenol and insulin also increase the rate of synthesis of HKII protein and increase glucose phosphorylation and glucose utilization in L6 cells.

[Clinical usefulness of helical-scanning CT for the evaluation of arteriosclerotic carotid lesions]

We examined arteriosclerotic carotid lesions in 76 patients using helical scanning CT (HES-CT), and evaluated the clinical usefulness of this method. A high speed slip-ring X-ray CT system was used. Scanning of the neck was performed for a 30 second period following intravenous bolus injection of non-ionic contrast medium, while couch top movement was 2.0 mm/sec. Multiplannar reconstruction images (MPR-image) and 3-dimensional surface images (3D-image) were reconstructed from the continuous raw data. MPR-images offered axial, coronal and sagittal images in which the lesion could be seen from any direction, and 3D-images that could be freely rotated were obtained by using a track ball and monitor. Eighteen cases were also evaluated by conventional angiography. Excellent HES-CT images were obtained in 73 cases, showing occlusion in 13, stenosis in 34, plaques without calcification in 15 and plaques with calcification in 74 vessels. A good correlation was obtained between HES-CT and angiogram in most cases, and in 6 cases, HES-CT was superior in the detection of stenosis, because it enabled us to observe the lesion from various directions. These results suggested that HES-CT was a minimally invasive, useful diagnostic method for the evaluation of arteriosclerotic carotid disease.

Regulation of hexokinase II and glycogen synthase mRNA, protein, and activity in human muscle

Insulin regulates the activity of key enzymes of glucose metabolism in skeletal muscle by altering transcription or translation or by producing activity-altering modifications of preexisting enzyme molecules. Because of the small size of percutaneous muscle biopsies, these phenomena have been difficult to study in humans. This study was performed to determine how physiological hyperinsulinemia regulates the activities of hexokinase (HK), glycogen synthase (GS), and GLUT-4 in human skeletal muscle in vivo. We determined mRNA abundance, protein content, and activities for these proteins in muscle biopsies before and after a hyperinsulinemic clamp in normal subjects. HK I, HK II, GS, and GLUT-4 were expressed in muscle. HK II accounted for 80% of total HK activity and was increased by insulin from a basal value of 2.11 +/- 0.26 to 3.35 +/- 0.47 pmol.min-1.mg protein-1 (P < 0.05); HK I activity was unaffected. Insulin increased GS activity from 3.85 +/- 0.82 to 6.06 +/- 0.49 nmol.min-1.mg-1 (P < 0.01). HK II mRNA was increased 3.3 +/- 1.3-fold (P < 0.05) by insulin infusion. HK I, GS, and GLUT-4 mRNA and protein were unaffected. Because insulin infusion increased HK II but not GS mRNA, we conclude that HK II and GS may be regulated by insulin by different mechanisms in human skeletal muscle.