Importance of intra-abdominal visceral fat accumulation to coronary atherosclerosis in heterozygous familial hypercholesterolaemia

OBJECTIVES

Hyper-low-density lipoprotein (LDL)-cholesterolaemia is a potent risk factor for coronary atherosclerosis. We have recently demonstrated that a cluster of risk factors including insulin resistance, glucose intolerance, hypertriglyceridaemia, and hypertension based on intra-abdominal visceral fat accumulation are closely related to coronary artery disease. In the current study, we evaluated the relationship between visceral fat accumulation and the severity and distribution of coronary atherosclerosis in familial hypercholesterolaemia (FH).

DESIGN

The effect of visceral fat accumulation on coronary lesions and risk factors in patients with FH was investigated.

SUBJECTS

Thirty-one male patients with heterozygous FH who underwent coronary angiography.

MEASUREMENTS

Abdominal fat distribution was estimated by a cross-sectional computed tomographic scan at the umbilical level. Plasma lipid, glucose and insulin concentrations and blood pressure were measured. A 75 g oral glucose tolerance test was also performed.

RESULTS

The patients were divided into two groups according to the degree of visceral fat accumulation. Fifteen patients had high visceral fat accumulation (High VF group) and 16 patients had normal visceral fat accumulation (Normal VF group). Body mass index (BMI) and subcutaneous fat area were significantly higher in the high VF group. Baseline serum triglyceride was significantly higher and baseline low-density lipoprotein (LDL)-cholesterol and reduction of LDL-cholesterol during treatment were significantly lower in High VF group. Fasting plasma glucose and insulin concentrations, and systolic and diastolic pressures were significantly higher in the High VF group. Significant correlations were found between visceral fat area and the sum of the glucose and insulin concentration during an oral glucose tolerance test. Visceral fat area was significantly correlated with the severity of coronary stenosis index. Distal coronary lesions were significantly more frequent in the High VF group. Moreover, the correlation between the visceral fat area and coronary stenosis index was found to be independent of age, BMI, and subcutaneous fat area by multiple regression analysis.

CONCLUSIONS

Visceral fat accumulation is a potent cardiovascular risk factor in heterozygous FH.

Interferon alpha induces disorder of lipid metabolism by lowering postheparin lipases and cholesteryl ester transfer protein activities in patients with chronic hepatitis C

The effect of recombinant interferon alpha 2a (rIFN-alpha2a) on serum lipoprotein metabolism was assessed in 39 patients with chronic viral hepatitis C. rIFN-alpha2a was administered intramuscularly at a dose of 9 x 10(6) U/d for 2 weeks and then for 3 times a week over 6 months. The serum cholesterol concentration significantly decreased one week after rIFN-alpha2a administration. Approximately 67% of this decrease was attributed to the reduction of high-density lipoprotein (HDL)-cholesterol; a decrease in HDL2-cholesterol was more evident. By contrast, serum triglyceride levels, largely derived from very-low density lipoprotein (VLDL), significantly increased following rIFN-alpha2a treatment. Lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) activities in the postheparin plasma were reduced by 75.7% and by 79.4%, respectively, and decreases in plasma cholesteryl ester transfer protein (CETP) activity and its protein mass were also observed. However, prothrombin time was ameliorated by rIFN-alpha2a, suggesting that the decrease in LPL, HTGL, and CETP activities may not be due to a reduction in protein synthesis by the liver. Simple correlation analysis demonstrated that the changes in LPL activity before and after 2 weeks of treatment with rIFN-alpha2a showed a significant negative correlation with changes in serum triglyceride and VLDL-triglyceride and a positive correlation with changes in HDL-cholesterol and HDL2-cholesterol. These results suggest a major contribution of reduced LPL activity with regard to the lipoprotein disorders. In conclusion, rIFN-alpha2a treatment on patients with chronic hepatitis C causes marked changes in serum lipoprotein metabolism associated with decreases in LPL, HTGL, and CETP activities.

"Best" PEEP during one-lung ventilation

Eight patients were studied under general anaesthesia for elective pulmonary lobectomy to see if intrinsic positive end-expired pressure (PEEPi) would appear or increase in the dependent lung during one-lung ventilation (OLV) or if application of external PEEP equal to individually measured PEEPi would produce better arterial oxygenation, haemodynamic state and oxygen delivery than either zero PEEP (ZEEP) or an external PEEP 5 cm H2O greater than PEEPi. Patients were non-obese, without obstructive airways disease, aged 53-76 yr and ASA < III. They received standardized anaesthesia with fentanyl, 50% nitrous oxide in oxygen and isoflurane; monitoring included radial and fibreoptic pulmonary arterial catheters and intermittent positive pressure ventilation with a tidal volume of 8 ml kg-1, 16 bpm, and an I:E ratio of 1:2. PEEPi was measured during two-lung ventilation (TLV) and OLV, using rapid airway occlusion at end-expiration. There was no PEEPi during TLV, but 2-6 mm Hg of PEEPi appeared during OLV. Applying external PEEP equal to individually measured PEEPi reduced venous admixture and increased PaO2 without a decrease in cardiac index (thus increasing oxygen delivery) compared with ZEEP, but the improvement in pulmonary gas exchange was lost and an additional penalty of reduced cardiac output was imposed when external PEEP was increased to 5 mm Hg above PEEPi.

Increased serum remnant lipoproteins in patients with apolipoprotein E7 (apo E Suita)

Apolipoprotein (apo) E7 was originally identified by Yamamura et al. in subjects with atherosclerotic cardiovascular diseases (J. Clin. Invest. 1984;74:1229). However, the lipoprotein abnormalities associated with apo E7 phenotype have not been elucidated. In the current study, to clarify the physiological roles of apo E7, lipoprotein abnormalities were studied in 12 apo E7 heterozygotes. A total of seven subjects were hyperlipidemic and five subjects were normolipidemic. The apo E phenotype was apo E7/3 in 11 subjects and apo E7/4 in one subject. Polymerase chain reaction revealed that all of the subjects with apo E7 phenotype had the same mutation as that of apo E(Suita) as reported previously (J. Biochem. 1989;105:249). All the hyperlipidemic subjects were over 40 years of age and two of them also had and severe coronary heart disease. Ultracentrifugal analysis revealed that the cholesterol level both in very low density lipoprotein and in intermediate density lipoprotein (IDL) was substantially higher in hyperlipidemic apo E7 heterozygotes, compared with control subjects and that the IDL cholesterol was also increased even in normolipidemic apo E7 heterozygotes. Polyacrylamide gel electrophoresis of lipoproteins showed a midband, which implies the increase of remnant lipoproteins, in 11 subjects out of 12, irrespective of the presence or absence of hyperlipoproteinemia. In two cases, a broad beta pattern was observed similar to that seen in type III hyperlipoproteinemia. Dietary therapy was dramatically effective for the treatment of hyperlipidemia in patients with apo E7. These findings confirm that apo E is crucial for remnant lipoprotein metabolism and that apo E7 is related to the increase in serum remnant lipoproteins, which leads to hyperlipoproteinemia in association with obesity, aging and impaired glucose metabolism.

Severe hemolysis due to artificial chordae displacement

Hemolytic anemia is a well-recognized complication of mechanical heart valve prosthesis but, as yet, has not been reported after mitral valve repair with chordal replacement. We report a case of severe hemolytic anemia after mitral valve repair with chordal replacement and Carpentier-Edwards annuloplasty ring insertion. Progressive prolapse of the anterior leaflet due to the artificial chordae being too long caused recurrent regurgitation which was responsible for the hemolysis. The patient also had idiopathic thrombocytopenic purpura, but successful second mitral valve repair was performed after high-dose gamma-globulin therapy.

Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects

OBJECTIVES

It is well known that obstructive sleep apnoea-(OSA) is frequently associated with obesity. In the current study, we investigated the correlation between abdominal visceral fat accumulation and the presence of OSA in obese subjects.

SUBJECTS

A consecutive series of 37 patients (17 men and 20 women) with primary obesity who were admitted to the Second Department of Internal Medicine. Osaka University Hospital, were investigated Patients with OSA were designated as those whose apnoea index (number of apnoea h-1 of sleep) was more than 5.

MAIN OUTCOME MEASURES

The distribution of body fat was determined using computed tomographic sections. The upper airway dimensions were evaluated with indices obtained by cephalometry in both inspiratory and expiratory phases.

RESULTS

Visceral adipose tissue (AT) area which was measured at the level of the umbilicus, and its ratio to total AT area were both significantly greater in OSA patients as compared with those in non-OSA patients. All subjects whose visceral AT area measured more than 220 cm2 manifested OSA. These two parameters also closely correlated with an increase in apnoea index. A multiple linear regression analysis revealed that the visceral AT area significantly correlated to apnoea index when age, AT mass and lean body mass were taken into account. The fluctuations of the upper airway were significantly greater in the large visceral fat group than in the small visceral fat group.

CONCLUSIONS

These results suggest that visceral fat accumulation is an important risk indicator for OSA in obese subjects.

A comparative study of apoptosis and cell proliferation in infantile and adult fibrosarcomas

The infantile fibrosarcoma, a rare tumor phenotypically similar to the adult fibrosarcoma, frequently has a benign course marked by spontaneous regression. Because biologic mechanisms responsible for this regression remain unexplained, an investigation of the role of apoptotic cell death is warranted. The rate of apoptotic cell death has been compared in five cases each of infantile and adult fibrosarcoma by quantitative estimation of in situ DNA double strand breaks. Although positively stained apoptotic cells are evident in all 10 cases, the apoptotic index is significantly higher in infantile cases (mean 6.6% +/- 0.80) compared to adult cases (mean 0.5% +/- 0.08). The proliferative (MIB-1) index of each specimen has been calculated by immunostaining for cell cycle phase-dependent Ki-67 antigen with MIB-1 antibody. Infantile cases have a significantly lower proliferative (MIB-1) index (mean 0.4 +/- 0.15) than adult counterparts (mean 15.9 +/- 3.76). The relatively benign course of the infantile fibrosarcoma may be due to two factors--a significantly lower proliferative (MIB-1) index coupled with enhanced apoptosis.

[A case report on graft replacement of ruptured aneurysm of the arch and the descending thoracic aorta associated with dense pulmonary adhesion]

A 73-year-old patient had been followed for aortic arch aneurysm of 54 mm in diameter. He was hospitalized complaining of chest and back pain. A chest CT scan showed ruptured aortic arch aneurysm extending to mid-descending thoracic aorta, and an emergent operation was decided. The trachea was intubated with a univent tube providing a movable blocker (System Corporation) which was directed to the left bronchus for differential lung ventilation. The descending thoracic aorta was exposed through the left 4th intercostal thoracotomy just at the site intending to anastomose a prosthetic graft because of dense pulmonary adhesion. The ascending and arch aorta was approached via median sternotomy. Under deep hypothermia and retrograde cerebral perfusion, total arch and descending aortic replacement was performed using an arch graft providing four branch grafts for neck vessels reconstruction and pump perfusion. The patient showed moderate pulmonary bleeding during and after cardiopulmonary bypass, but improved gradually. He was weaned from the respirator on the 13th post-operative day. During extensive thoracic aortic surgery using left thoracotomy combined with median sternotomy, left lung deflation using a univent tracheal tube with a blocker, and circulatory arrest during distal aortic anastomosis, are useful in preventing lethal pulmonary bleeding caused by lung injury under the fully heparinized condition. However, in cases associated with dense pulmonary adhesion, it is important to dissect carefully just a small area necessary to anastomose a graft, and to take elaborate assistant measures.

Atherosclerotic disease in marked hyperalphalipoproteinemia. Combined reduction of cholesteryl ester transfer protein and hepatic triglyceride lipase

Hyperalphalipoproteinemia (HALP) has been regarded as a beneficial state accompanied by a longevity syndrome. However, we reported the cases of markedly hyperalphalipoproteinemic subjects with juvenile corneal opacification. The patients had reduced postheparin hepatic triglyceride lipase (HTGL) activities, and one of them has recently been identified to be homozygous for a missense mutation in exon 15 (D442: G) in the cholesteryl ester transfer protein (CETP) gene. In the current study, to elucidate the clinical significance of and atherogenicity in marked HALP, we determined the incidence of atherosclerotic cardiovascular disease (ACD) in patients with marked HALP and characterized the lipoprotein abnormalities in those who had ACD, focusing especially on CETP and HTGL. The subjects were 201 patients (111 males and 90 females) with marked HALP ( > or = 2.58 mmol/L [100 mg/dL]), 67% of whom were demonstrated to have the CETP gene mutations in the intron 14 splice donor site or in exon 15. Their mean age was 54 +/- 15 years. Plasma levels of total cholesterol, HDL cholesterol, and triglyceride in all subjects were 6.28 +/- 1.78, 3.15 +/- 0.90, and 1.08 +/- 0.53 mmol/L, respectively. Ten of the male patients (9.0%) and two of the female patients (2.2%) had apparent ACD such as myocardial infarction, angina pectoris, and peripheral vascular diseases. Ten patients with HALP who had ACD were identified to be heterozygotes for CETP deficiency. To further clarify the characteristics of marked HALP in patients with ACD, we compared the plasma lipids, lipoproteins, CETP, and HTGL activities between heterozygotes for CETP deficiency who were with and without ACD.

Detection of DNA strand breaks associated with apoptosis in human brain tumors

Apoptosis occurs spontaneously in a wide variety of neoplasms. However, it is difficult to detect apoptotic cells in routine histological sections because the cells undergoing apoptosis die singly and are then rapidly phagocytosed. Since DNA fragmentation is an important hallmark of apoptosis, visualization of DNA strand breaks in tissue sections provides the means for readily identifying apoptotic cells in situ. We have applied an in situ DNA strand break staining procedure for the quantitative estimation of apoptotic cells in surgical specimens of 62 different brain tumours. Positively stained apoptotic cells were observed in 25 (40.3%) cases and their percentage (apoptotic index) ranged from 0.1 to 8.9. Both fragmented and condensed nuclei of apoptotic cells and apoptotic bodies were stained. In addition, we assessed the proliferative activity of each specimen by immunostaining with the MIB-1 antibody (MIB-1 index) which detects the cell cycle phase-dependent Ki-67 antigen. Brain tumours with higher MIB-1 indices showed a tendency to higher apoptotic indices. The results of this study indicate that apoptosis occurs spontaneously in various brain tumours.

[Comparison of airway complications on tracheal extubation in deeply sevoflurane anesthetized versus awake children]

We investigated the incidence of respiratory complications and oxygen saturation level during emergence from sevoflurane anesthesia in children whose tracheas were extubated while they were anesthetized or after they became awake. Thirty children, aged 1-10 years, were studied. Anesthesia was induced with sevoflurane or thiopental and maintained with nitrous oxide, oxygen and sevoflurane. After nitrous oxide was discontinued at the end of surgery, the patients were randomly assigned to two groups: deeply anesthetized extubation group (anesthetized group) and awake extubation group (awake group). In anesthetized group, the patients were extubated while they were administered 1.5% or higher sevoflurane in 100% oxygen. In awake group, extubation was performed while the patients were awake. The incidence of respiratory complications such as apnea, laryngospasm, bronchospasm and arrythmias was not significantly different between the two groups. There was a significantly higher incidence of the airway obstruction but less incidence of cough and breath-holding in anesthetized group. Oxygen saturation level before and after tracheal extubation was not different between the two groups. In conclusion, with proper attention to airway obstruction, it may be possible to extubate while children are deeply anesthetized with sevoflurane.

Increased proportion of plasma apoB-48 to apoB-100 in non-insulin-dependent diabetic rats: contribution of enhanced apoB mRNA editing in the liver

To assess the alteration of apolipoprotein (apo) B mRNA editing in non-insulin-dependent diabetes mellitus (NIDDM), we measured plasma apoB-100 and apoB-48 levels and apoB mRNA editing efficiency in the liver and intestine from GK (Goto-Kakizaki) rats, a genetically NIDDM animal. Male GK rats and control littermates, aged 25 weeks, were used in this study. Ventromedial hypothalamus (VMH)-lesioned control rats were used as hyperinsulinemic models. VMH-lesioned GK rats (GK+VMH) were treated as an insulin-exhausted NIDDM model. Plasma cholesterol and triglyceride levels were increased in GK rats. Very low density lipoprotein (VLDL)-triglyceride and low density lipoprotein (LDL)-cholesterol concentrations were significantly higher in GK rats than in controls. The increase of VLDL-triglyceride was most marked in GK+VMH rats. Plasma apoB-48 levels, quantified by immunoblot, were increased in GK rats. However, apoB-100 levels were minimally elevated in GK rats. Therefore, the apoB-48/apoB-100 ratio was remarkably increased in GK rats. ApoB mRNA editing was analyzed by reverse transcriptase-polymerase chain reaction coupled with dideoxynucleotide chain termination assay. The ratio of apoB-48-type cDNA to apoB-100-type cDNA was significantly increased in the liver from GK rats compared with controls. Although the development of the VMH lesion increased plasma apoB-48 levels, it had no effect on the proportion of apoB-48-type to apoB-100-type cDNA in the liver from both GK and control littermates. ApoB mRNA in the intestine was almost totally edited (approximately 95%). Intestinal apoB-48/apoB-100 cDNA ratio showed no significant difference among the four groups. In conclusion, an enhanced apoB mRNA editing was indicated in the non-insulin-dependent diabetic rats, which might contribute to the increase of plasma apoB-48 levels.

Enhancement of pressor response to intravenous phenylephrine following oral clonidine medication in awake and anaesthetized patients

Clonidine, an alpha 2-adrenergic agonist, augments the pressor response to intravenous ephedrine. If this effect is partly due to clonidine-induced potentiation of alpha 1-adrenoceptor-mediated vasoconstriction, it is also assumed that clonidine would enhance the pressor effect of phenylephrine as an alpha 1-adrenergic agonist. The authors studied haemodynamic responses to intravenous phenylephrine in 80 patients who received either preanaesthetic medication with clonidine approximately 5 micrograms.kg-1 po (clonidine group, n = 40), or no medication (control group, n = 40). Each group was further divided into either awake subjects (n = 20) or subjects anaesthetized with enflurane and nitrous oxide in oxygen (n = 20). Haemodynamic measurements were made at one-minute intervals for ten minutes after phenylephrine 2 micrograms.kg-1 iv was injected as a bolus. The magnitudes of maximal mean blood pressure increases in the clonidine group (26 +/- 7% (mean +/- SD) for awake and 32 +/- 15% for anaesthetized subjects) were greater (P < 0.05) than in the control group (13 +/- 7% for awake and 18 +/- 7% for anaesthetized subjects). However, there was no difference in the pressor effect of phenylephrine between awake and anaesthetized patients in both groups. Oral clonidine preanaesthetic medication, 5 micrograms.kg-1, augments the pressor responses to phenylephrine 2 micrograms.kg-1 iv in awake and anaesthetized patients. These results suggest that the enhancement of the pressor responses to phenylephrine following oral clonidine may be due to clonidine-induced potentiation of alpha 1-adrenoceptor-mediated vasoconstriction. This implies that restoration of blood pressure can be achieved effectively by phenylephrine in hypotensive patients with clonidine premedication.

Visualization of DNA double strand breaks in the gerbil hippocampal CA1 following transient ischemia

To clarify the relationship between delayed neuronal death and apoptosis, we made an attempt to detect DNA strand breaks in the gerbil hippocampal CA1 pyramidal neurons following transient ischemia by an in situ DNA double strand breaks staining. The condensed nuclei of neurons in CA1 were occasionally seen and positively stained 3 days after ischemia. The degenerating dark neurons with condensed nuclei in CA1 markedly increased in number and were clearly stained for DNA strand breaks 5 days after ischemia, whereas normal-looking nuclei remained unstained. No neurons were stained in other hippocampal subfields and dentate gyrus. The present study strongly indicates that the CA1 pyramidal neurons die through an apoptotic process.

Age-related decrease in toe-thumb temperature difference with lumbar epidural anaesthesia

With lumbar epidural anaesthesia, big toe skin temperature increases and is associated with a compensatory decrease of thumb temperature. The purpose of the present study was to examine whether thumb-big toe temperature differences were affected by age. Following the attachment of temperature probes at the digital pad of the right big toe and the right thumb, lumbar epidural anaesthesia at L2/3 was performed in 54 patients with 10 ml lidocaine 1.5%. Big toe and thumb skin temperatures were measured continuously and recorded every minute. Fifteen minutes after epidural injection, the toe temperature increased 6.3 +/- 2.1 degrees C (delta F) from the control value, 29.4 +/- 2.2 degrees C, and the thumb temperature decreased -1.5 +/- 1.0 degrees C (delta H) from the control value, 31.6 +/- 2.8 degrees C. Regression coefficient between delta T15 (toe-thumb skin temperature 15 min after epidural injection) and age was: Y = -0.7X + 8.95 (r = 0.35, P < 0.01; Y = delta T15, X = age). The ratio of delta H to delta F and age was expressed as: Y = 0.51X - 46.57 (r = 0.41, P < 0.01: Y = delta H/delta F, X = age). It is concluded that, in lumbar epidural anaesthesia, the decrease of the thumb skin temperature is reduced with aging.

Structure of the mouse cholesterol 7 alpha-hydroxylase gene

Three overlapping cholesterol 7 alpha-hydroxylasecDNAs were cloned from total mouse liver RNA by a combination of the polymerase chain reaction and mouse liver cDNA library screening. One of the cDNA clones was used to screen a mouse genomic library; three genomic clones were isolated and one of them was fully characterized. The mouse cholesterol 7 alpha-hydroxylase gene spans approximately 10 kb. The gene contains six exons including a 1509-bp open reading frame encoding 503 amino acid residues. The predicted amino acid sequence of mouse cholesterol 7 alpha-hydroxylase showed 93 and 82% identity to the rat and human enzymes, respectively. The transcription initiation site is mapped to 64 bases 5' of the translation initiation codon. Several transcription factor binding sequences are identified in the 5' flanking region of the mouse cholesterol 7 alpha-hydroxylase gene.

Intraoperative angiography in the resection of arteriovenous malformations

Surgical resection of 13 operatively obscure arteriovenous malformations (AVM's) was accomplished with the assistance of intraoperative angiography, which was performed stereographically to provide three-dimensional orientation and was repeated until total resection of the AVM was confirmed. All films obtained were subtracted to improve clarity. The method presented here may be useful for the resection of all types of AVM. Only two patients had residual AVM after the initial operation. No complications attributable to angiography were noted.

Incontinentia pigmenti achromians (hypomelanosis of ITO, MIM 146150): further evidence of localization at Xp11

We report on a girl with apparent hypomelanosis of Ito (ITO); cytogenetic studies disclosed the karyotype 46,X,t(X;10)(p11;q11)mat. We present further evidence that at least one of the genetic forms of ITO is located at Xp11; reviewing the clinical characteristics of patients with incontinentia pigmenti type 1 (IP1) and ITO with X-autosome translocations, we suggest that IP1 and ITO represent allelic forms or a contiguous gene syndrome. Thus, different genetic alterations in this region (Xp11) give rise to ITO or IP1 or borderline phenotypes. We also suggest that all patients with ITO, due to Xp11 mutation, have functional or genetic mosaicisms.

Regulation of hepatic triglyceride lipase by thyroid hormone in HepG2 cells

Hypothyroidism has been reported to be associated with reduced hepatic triglyceride lipase (HTGL) activity. In order to understand the molecular mechanism by which thyroid hormone regulates HTGL activity, effects of triiodothyronine (T3) on HTGL activity, mRNA level, transcription run-on activity, and protein synthetic rate were studied in HepG2 cells. HepG2 cells treated with 1 nM T3 showed an increase in HTGL activity that was first detected at 24 h; HTGL activity continued to increase at 36 h and stayed at the elevated level at 48 and 60 h. At maximal stimulation (48 h), T3-treated cells had the following HTGL activities: 155% in spontaneously released (SR) and 224% in heparin-releasable (HR) HTGL activities (mean levels compared to control). Stimulation of HTGL activity by T3 was dose-dependent and saturable. There was, however, no change in HTGL mRNA level throughout the course of T3 treatment. The effects of T3 were reduced when transcription was blocked by actinomycin D (mean level compared to actinomycin D treatment in the absence of T3: 109% in SR and 127% in HR activities) or translation was blocked by cycloheximide (127% in SR and 122% in HR activities), but HTGL activities were still significantly higher than control. Nuclear run-on assays indicate that T3 did not change the rate of transcription of the HTGL gene. We further determined the rate of HTGL synthesis by measuring the amount of [35S]methionine incorporated into newly synthesized HTGL immunoprecipitated by a monospecific anti-human HTGL antibody. We found that the T3-stimulated increase in HTGL activity was not accompanied by any change in the rate of HTGL biosynthesis. Our experimental data indicate that the T3 stimulation of HTGL activity in HepG2 cells is mediated at posttranscriptional and posttranslational levels. The partial but significant inhibition of the T3 stimulation of HTGL activity by actinomycin D and cycloheximide suggests that the effects of T3 may be mediated by other cellular processes that are more directly regulated by the hormone. This study represents the initial report on the mechanism of HTGL activation by physiological concentrations of thyroid hormone.

Branch retinal artery occlusion following thyroidectomy for papillary carcinoma of the thyroid: report of a case

A rare case of branch retinal artery occlusion (BRAO) following a subtotal thyroidectomy for thyroid cancer in a 58-year-old woman is reported herein. Five days after her thyroidectomy, the patient complained of having had a reduction in visual acuity and visual field loss of the superior nasal side in her right eye since the operation. BRAO was diagnosed following the discovery by funduscopy of inferotemporal branch artery occlusion with retinal edema, hemorrhage, and periarterial sheathing in the right eye. Despite immediately puncturing the anterior camera and massaging the eyeball while administering intravenous anticoagulant therapy, the visual field disturbance remained unchanged. The most common causative factor of postoperative sudden BRAO is reported to be emboli. However, in our case, the most likely cause was the stretching and pressure exerted on the carotid artery with consequent atheromatous plaque formation at the time of thyroidectomy.

A missense mutation (Trp86----Arg) in exon 3 of the lipoprotein lipase gene: a cause of familial chylomicronemia

We have investigated a patient of English ancestry with familial chylomicronemia caused by lipoprotein lipase (LPL) deficiency. DNA sequence analysis of all exons and intron-exon boundaries of the LPL gene identified two single-base mutations, a T----C transition for codon 86 (TGG) at nucleotide 511, resulting in a Trp86----Arg substitution, and a C----T transition at nucleotide 571, involving the codon CAG encoding Gln106 and producing Gln106----Stop, a mutation described by Emi et al. The functional significance of the two mutations was confirmed by in vitro expression and enzyme activity assays of the mutant LPL. Linkage analysis established that the patient is a compound heterozygote for the two mutations. The Trp86----Arg mutation in exon 3 is the first natural mutation identified outside exons 4-6, which encompass the catalytic triad residues.

[Traumatic sinus pericranii. Case report]

The patient was involved in a traffic accident at the age of 1 and the left parieto-occipital scalp was contused without skull fracture. At the age of 5, an extracranial scalp mass was first noticed just beneath the multiple scalp scars. Angiography through the mass revealed that the extracranial mass cavity was connected to the superior sagittal sinus through the emissary veins. The mass located in the subgaleal, epiperiosteal space was totally resected and the connection with the intracranial sinus was closed with bone wax. Histologically, there were many capillaries and some large blood cavities with only one layered endothelium and connective tissue. Therefore, the mass was diagnosed as sinus pericranii and considered to be secondary to previous head trauma because: 1) The patient had a history of head trauma with considerably severe scalp injuries. 2) The extracranial blood sinus was located exactly beneath the traumatic scar. 3) There was no neoplastic tissue histologically. 4) No scalp mass was noticed before the traffic accident. 5) There was an elapsed time between the trauma and the growth of the mass. 6) No scalp nevus such as port-wine stain existed.

Epstein-Barr virus and other herpesvirus infections in Kawasaki syndrome

Epstein-Barr virus (EBV), a possible cause of Kawasaki syndrome (KS), is not pathenogenically associated with KS in Hawaii. The prevalence of EBV capsid antibody in KS patients was found not to differ significantly from that in controls, and the antibody response in those infected with EBV was the same as that in other children similarly infected. No EBV was isolated from acute-phase patients. All patients with capsid antibody at the onset of KS also had Epstein-Barr nuclear antigen antibody: 36 patients developed antibody within 3 months after onset of KS; in 10, EBV infection could have been coincidental with the disease. Cytomegalovirus (CMV) was isolated from 9 patients with KS and 10 controls. A similar number of controls and patients had antibody to human herpesvirus 6 (HHV6); one patient seroconverted. None of the herpes viruses (EBV, CMV, HHV6, varicella-zoster virus, or herpes simplex virus) plays a unique or dominant role in the etiology or pathogenesis of KS in Hawaii.

Lymphoepithelial cystic lesion related to adenocarcinoma in the mediastinum

The authors report here a case of lymphoepithelial cystic lesion (LECL) of unknown origin in the mediastinum, which is closely related to a signet-ring cell adenocarcinoma. A 73-year-old man presented with a mass as revealed on a chest x-ray. During surgical operation, a solid, well-circumscribed and encapsulated 9 X 9 X 8 cm tumor was isolated from the right anterior mediastinum. This tumor had neither undergone metastasis nor invaded into the surrounding tissue and lymph nodes. Light microscopy revealed the tumor to be a signet-ring cell adenocarcinoma. Clinically, the neoplasm was coupled with an elevation in serum CEA level, which promptly returned to normal values following surgical removal. Immunohistochemistry pointed out that the majority of neoplastic cells stained positive for CEA. In addition, LECL of unknown origin was distinguished at the periphery of the tumor. LECL was characterized by microcysts which were lined by columnar epithelial and surrounded by lymphoid tissue with germinal centers. Transition between the neoplastic cells and benign epithelial cells of LECL was evident, showing that the previously mentioned mediastinal adenocarcinoma may be derived from the epithelial elements of LECL. This paper discusses the histogenesis of LECL.

Inhibition of purified human postheparin lipoprotein lipase by beta-adrenergic blockers in vitro

We examined the effects of five beta-adrenergic blockers on the hydrolysis of phosphatidylcholine-stabilized triolein particles by purified human postheparin lipoprotein lipase (PHLpL) in order to evaluate the possible role of direct inhibition as a mechanism of drug-induced hypertriglyceridemia. The relative inhibitory potencies were observed in the following order: propranolol much greater than pindolol greater than metoprolol greater than atenolol greater than nadolol. There was a positive correlation between the octanol/water partition coefficients of these agents and their inhibition of lipoprotein lipase, suggesting that hydrophobicity may be one of the major determinants for PHLpL inhibition. The amount of the beta-adrenergic blockers required to produce 50% inhibition of human PHLpL was much greater than that required to inhibit purified bovine lipoprotein lipase.

Absence of significant RNA-dependent DNA polymerase activity in lymphocytes from patients with Kawasaki syndrome

Kawasaki syndrome, an acute febrile multisystem illness of young children, is a panvasculitis with prominent rheumatic features. Arthritis and pancarditis are frequent during the acute stage; coronary artery aneurysms occur in 20% of cases and the disease is now the leading cause of acquired heart disease in childhood. A microbial aetiology is suggested by the acute febrile self-limited character of the disease, the regular occurrence of epidemic outbreaks at intervals of 2-3 years, and the virtual restriction to young children, consistent with the early acquisition of immunity. Reports of elevated DNA polymerase activity (assumed to be RNA-dependent reverse transcriptase) in cultured lymphocytes from patients with acute Kawasaki syndrome suggest that a retrovirus might be the causative agent. We have measured supernatant DNA polymerase activity in lymphocyte cultures from 49 Hawaiian patients in acute and convalescent stages of Kawasaki syndrome and have been unable to demonstrate significant reverse transcriptase activity or other evidence of involvement of a retrovirus in the aetiology of the disease.

Cholesterol-lowering effect of N-(alpha-methylbenzyl)linoleamide (melinamide) in cholesterol-fed diabetic rats

Cholesterol loading of diabetic rats is known to induce marked hyperlipoproteinaemia, and we have reported that enhancement of the activity of intestinal acyl-CoA:cholesterol acyltransferase (ACAT), one of the key enzymes involved in cholesterol absorption, might play an important role in the development of hypercholesterolaemia in these animals. In the present study, we have shown that treatment with N-(alpha-methylbenzyl)linoleamide (melinamide), a new hypocholesterolaemic drug, caused a substantial decrease of the enhanced intestinal ACAT activity in diabetic rats, but did not affect intestinal cholesterol esterase activity. Furthermore, marked improvement of hypercholesterolaemia in cholesterol-fed diabetic rats occurred concomitantly with the drug treatment. These results suggest that intestinal ACAT activity is closely related to the serum cholesterol level in diabetic rats, and show that melinamide lowers intestinal ACAT activity.

Increased activity of intestinal acyl-CoA: cholesterol acyltransferase in rats with streptozocin-induced diabetes and restoration by insulin supplementation

We examined the activities of intestinal acyl-CoA:cholesterol acyltransferase (ACAT) and cholesterol esterase, enzymes regulating cholesterol absorption, in rats with streptozocin-induced diabetes (STZ-D) to clarify the effect of diabetes on cholesterol absorption. Three weeks after the induction of diabetes, plasma cholesterol levels were slightly but significantly increased in diabetic rats compared with control animals, whereas a far more remarkable increase in plasma cholesterol was observed in diabetic rats when fed an atherogenic diet containing 1% cholesterol, 0.5% cholic acid, and 5% lard. Microsomal ACAT activity in intestinal mucosa was three times higher in diabetic than in control rats. However, no significant difference in the enzyme activity could be detected between diabetic animals fed control chow and those fed the atherogenic diet. Furthermore, insulin supplementation given to diabetic rats caused a reduction of enzyme activity to the levels found in control animals. In contrast, cholesterol esterase activity in rat intestinal mucosa was unaffected by either the induction of diabetes or the atherogenic diet feeding. In conclusion, we disclosed that apparent ACAT activity in intestinal mucosa is elevated in STZ-D rats. Therefore, we postulate that enhancement of CoA-dependent cholesterol esterification in the intestine might be one of the major factors responsible for hypercholesterolemia in diabetes.

Increased compliance of niceritrol treatment by addition of aspirin: relationship between changes in prostaglandins and skin flushing

The relation of plasma levels of prostaglandins to the occurrence of flushing induced by niceritrol was investigated. Niceritrol increased plasma levels of PGE2 (p less than 0.01) and 6 keto-PGF1 alpha (p less than 0.05) in 10 male subjects and aspirin reduced the level of PGE2 (p less than 0.01). Five of 10 subjects had flushing, and aspirin reduced flushing in 4 subjects. On the basis of the above study, we treated 35 hyperlipidemic patients with niceritrol in combination with aspirin, investigating the effect of the treatment of serum lipids and postheparin lipolytic activity. None of the 12 cases given aspirin from the start of the treatment experienced flushing, whereas 9 of the 23 cases not given aspirin experienced flushing, which was suppressed by adding aspirin in prescription in all cases except one. Niceritrol decreased serum cholesterol, triglyceride and atherogenic index. It also increased HDL2 cholesterol and decreased HDL3 cholesterol. The LPL activity in postheparin plasma increased in all cases after niceritrol treatment. In conclusion, aspirin increased compliance of niceritrol by reducing the occurrence of flushing probably due to the decreased levels of prostaglandins, yielding favorable results for the long-term treatment of hyperlipidemia with a sufficient doses of niceritrol.

House dust mite-specific IgE, IgG1, and IgG4 antibodies in patients with perennial rhinitis

Serum samples were obtained from patients with house dust mite-sensitive nasal allergies before and 6 months after immunotherapy, and the level of immunoglobulin (Ig)E, IgG1, and IgG4 antibodies in those sera was determined by the enzyme-linked immunosorbent assay. The present data showed that the mite-specific IgG4 antibodies increased in patients who responded well to immunotherapy but not in those who responded poorly. It was suggested from the present study that IgG4 antibodies seem to act as "blocking antibodies" to reduce the allergic reaction in the target organ, and that an increase of allergen-specific IgG4 antibodies following immunotherapy can be of clinical benefit to patients suffering from mite-specific nasal allergy.

Effects of Staphylococcus aureus on the ciliary activity of the middle ear lining

Our previous investigation using normal guinea pigs disclosed that, like respiratory mucosa, the middle ear lining has ciliary activity, and that this ciliary activity becomes more active as the location becomes more distal to the eustachian tube. In this experimental study, the effects of Staphylococcus aureus on the middle ear lining was examined from functional and morphological viewpoints. In conclusion, the ciliary activity at the entrance to the eustachian tube and that more distal to the tube present a similar pattern of reaction to S aureus in an in vitro system. On the other hand, the ciliary activity of the middle ear lining displays a varying pattern of reaction according to the locations within the tympanic cavity.

Nasal allergen sensitivity and mucosal IgE antibodies

Skin tests, nasal provocation tests, nasal smear tests, and serum-radioallergosorbent tests were performed on 17 patients with perennial allergic rhinitis, who had suffered nasal congestion without receiving any antiallergic treatment. After the above tests, tissue-radioallergosorbent tests (t-RAST) were conducted to determine IgE antibody levels in inferior turbinate mucosal samples taken peroperatively. The results obtained in this study suggest that the allergen sensitivity of the nasal mucosa correlates to some extent with the mucosal IgE antibody level, and that the t-RAST can provide us with objective data about nasal allergen sensitivity.

[A case of fibrous hamartoma of infancy and a review of the Japanese literature]

A case of fibrous hamartoma of infancy in the left axilla of an 18-month-old boy, is reported with some discussion (citations of references). The tumor was situated in the subcutaneous fatty tissue, and its border was unclear. It was removed easily and found to measure 2.5 X 1.5 X 1.5 cm. Histologically, in addition to the three main components, i.e., trabeculae of fibrous tissue, immature mesenchymal cells with a mucoid matrix and interspersed mature fat, a capillary vasoformative proliferation, peripheral nerve fibers and lymph follicle-like structures mingling with and transforming into one another were noted throughout the tumor. On the basis of these findings, immature mesenchymal cells were considered as having very important roles with regard to the histogenesis of fibrous hamartoma of infancy.

Nasal allergy and nasal polyp with special reference to the mucosal IgE antibodies

Immunologic conditions were studied in 8 patients with nasal allergies and nasal polyps and in 20 patients with nasal polyps. The present study showed the following: Nasal polyp mucosa contains a low level of mucosal IgE antibodies; nasal polyp mucosa is devoid of or deficient in the capacity of producing IgE antibodies; the presence of mucosal IgE antibodies in nasal polyp mucosa does not always imply the clinical manifestation of nasal allergies, and the antigen and antibody interaction does not always result in nasal symptoms.

Ciliary activity in patients with nasal allergies

Nasal allergy is a disease ensuing from type-I allergic reactions in the nasal cavity. A correct understanding of this process requires further investigation of the non-allergic pathology present. In the allergic state, the function of the nasal cilia is considered to be involved in the invasion of allergens into the nasal mucosa, and may also be involved with the manifestation and progression of the disease produced. In the present study, we examined the ciliary activity of the nasal mucosa of 35 patients with nasal allergies by using the photo-electric method of Ohashi and Nakai to better understand the non-allergic pathologies present. The nasal cilia of four healthy volunteers served as controls. In addition, a multivalent analysis was made according to quantifying theory I in order to define the effects of various factors on ciliary activity in the nasal mucosa during the allergic state. The following results were found in our present study. Ciliary activity was observed in 32 of 35 patients with nasal allergy. The mean value of the ciliary activity in these patients was 498 +/- 195 beats/min, while that of the normal controls was 753 +/- 46 beats/min. The ciliary activity in the nasal mucosa in the allergic state declined as the morbid period was prolonged; this decline in ciliary activity was relatively great in cases of perennial allergies aggravated by season-specific allergens.

Ciliary activity of the middle ear lining in guinea pigs

Since the middle ear lining is an extension and a modification of the respiratory epithelium, it is conceivable that it has a mucociliary system and plays an important role in clearing the middle ear cavity. It has already been noted in morphological investigations that the middle ear mucosa has ciliated cells. To our knowledge, however, ciliary activity has never been observed directly. In our research, we used the photoelectric method to study ciliary activity of the middle ear mucosa directly and quantitatively. We made special reference to the frequency of ciliary beating at various sites within the middle ear cavity. Ciliary activity was found to exist in the eustachian tube and the middle ear, the same as in other respiratory organs, and this activity was stronger in cells distal to the eustachian tube.

Topical immunology of nasal allergy and mucosal IgE antibodies

In the present study, the in vitro tissue-radioallergosorbent test (t-RAST) was performed in two groups of patients: one with perennial attacks of sneezing, serous hypersecretion and nasal congestion, the other with nasal congestion only. The results obtained were compared with those obtained by a series of conventional allergy tests. We then found that t-RAST provided objective data comparable to those obtained with serum-RAST and that the t-RAST is a reliable means of quantitatively detecting specific IgE antibodies in the nasal mucosa. t-RAST is of special value to diagnosticians because it is able to discern unequivocally and easily those patients with localized nasal allergy.

The ciliary activity of the middle ear lining--functional and morphological observation

Since the middle ear lining is an extension and a modification of the respiratory mucosa, it is conceivable that it has a mucociliary system and it plays an important role in clearance of the tympanic cavity. It was already noted in morphological studies that the middle ear lining had ciliated cells. To our knowledge, however, ciliary activity has never been observed directly. In the present paper, the ciliary activity of the middle ear mucosa was investigated directly and quantitatively by the photo-electric method of Ohashi and Nakai. In this work, special reference was made to the frequency of ciliary beating at various sites within the tympanic cavity. Ciliary activity was found to exist in the Eustachian tube and middle ear same as in other respiratory epithelium and this activity by ciliated cells was more active as their location became more distal to the Eustachian tube. Although the present results are preliminary, the techniques used in this study will provide a new avenue of the investigation of pathological middle ear lining.

The ciliary activity of the middle ear lining in some pathological states

The ciliary activity in some pathological middle ear lining was discussed with special reference to the morphology of the epithelial cells in this paper. The changes in ciliary activity due to in vitro Staphylococcus aureus injection did not practically show any differences between the sites. On the other hand, the time-course changes in ciliary activity after in vivo S. aureus injection were found to differ between the sites. Ciliary activity was rather accelerated at the proximal site, while it was decelerated at the distal site. Few changes but for sporadic small compound cilia were observed at the proximal site, and some inflammatory changes were noted at the epithelium of the distal site. SO2 exposure affected the middle ear lining of rabbits. Fourteen days after 4 week's exposure to SO2, the middle ear lining displayed declined ciliary activity and many signs suggestive of secretory asthenia. In addition, the middle ear lining of rabbits given about 600 mg carbocysteine, both during and 2 weeks after the exposure displayed excellent ciliary activity and normal morphology of the epithelial structure.

Electron microscopic observation of gastric mucosal capillaries in diabetics--relationship between diabetic microangiopathy and complications following gastrectomy

An electron microscopic study was made of the gastric mucosal capillaries (GMC) of diabetic patients. Ultrastructural findings, including diabetic microangiopathy (DMA), and clinical features of these diabetic patients were investigated in relation to anastomotic leakage after gastrectomy. The gastric mucosa of resected stomachs from 12 diabetics and 10 nondiabetics were examined. Ultrastructurally, DMA was demonstrated in the stomachs of diabetics, in which the basement membrane of GMC was thicker. The degree of this DMA in the stomach significantly correlated with the duration of diabetes and the degree of DMA found in the skin, but not with age and fasting plasma glucose (FPG) level. Marked DMA was observed with significant frequency in diabetics with anastomotic leakage after gastrectomy. In our hospital, anastomotic leakage after gastrectomy occurred in 9 out of 53 diabetics. Diabetics with anastomotic leakage had severe FPG, a long duration of diabetes and diabetic retinopathy. It seems reasonable to presume that anastomotic leakage after gastrectomy occurs more frequently in diabetics with ultrastructurally severe DMA, clinically severe FPG and relatively long duration of diabetes.

[Biological and clinical analysis of breast cancer in relation to hormone receptors]

We examined whether or not the presence of hormone receptors (ERC, PRC, and ERN) were related to morphological and functional features in breast cancers. Well-differentiated tumors were more frequently receptor positive while poorly differentiated tumors were generally receptor negative. And labelling index and receptor contents were negatively correlated. There was a significant inverse correlation between the receptor contents and numbers of intracellular organellas in ultrastructural features of breast cancer cells. In LMI tests by 3-M KCl cancer extracts, migration of leucocyte from patients with poorly differentiated tumors were more frequently inhibited than those well differentiated tumors. Patients with receptor positive tumors were more endocrine sensitive and had better prognosis.