Sialylated MUC1 mucin expression in normal pancreas, benign pancreatic lesions, and pancreatic ductal adenocarcinoma

BACKGROUND/AIMS

Pancreatic cancer has the poorest prognosis of all gastrointestinal cancers. Because sialylated mucin influences the biologic behavior of carcinoma cells, we investigated sialylated MUC1 mucin expression in patients with pancreatic ductal adenocarcinoma.

METHODOLOGY

The expression of sialylated MUC1 mucin was examined in 55 pancreatic ductal adenocarcinomas, 2 normal pancreas specimens, 3 chronic pancreatitis specimens, 1 ductal hyperplasia of the pancreas, 3 mucinous cystadenomas, and 2 liver metastases from pancreatic ductal adenocarcinoma. Expression was assessed by immunohistochemistry with a new monoclonal antibody (mAb) (MY.1E12).

RESULTS

Sialylated MUC1 mucin was expressed in the cancer cell membrane in all the ductal carcinomas. The reaction product was seen at the apical aspect of cells when these were in tubule formation. This pattern was also detected in mucinous cystadenomas. However, it was seen diffusely in the cell membrane in single cancer cells or small clusters of cells without tubule formation and in metastatic liver tumors. Namely, invading or metastatic cancer cells expressed this type of mucin throughout the entire cell membrane. The expression of sialylated MUC1 mucin was not observed in specimens from normal pancreas, chronic pancreatitis, or ductal hyperplasia of the pancreas. In normal pancreas and these lesions, expression of sialylated Mession of sialylated MUC1 was limited to acini and secreted mucin.

CONCLUSIONS

Sialylated MUC1 mucin, which is expressed throughout the cancer cell membrane, may be a factor in the metastatic potential of pancreatic ductal adenocarcinoma.

[Effect of adrenaline on vagus nerve reflexes]

INTRODUCTION

Dizziness or syncope may occur during treatment of nasal disease. These symptoms are considered imputable to the vagovagal reflex, which is partly involved in neurogenic syncope. In response to trigeminal nerve stimulation, the vagus nerve causes a sudden fall in heart rate and blood pressure. Elevation in blood adrenaline level during pain or tension was noted, and its effects on vagovagal reflexes were studied.

MATERIALS AND METHODS

Ten cats were used in the experiment. The vagus nerve was exposed on the right side of the neck by making an incision in the trachea, and a platinum electrode was attached to the vagus nerve on nerve's distal side. The head was tilted a 30 degree angle. The cats were divided into control and adrenaline-treated groups, and changes in cerebral blood flow, heart rate, and arterial pressure were compared between the two groups after electric stimulation of the vagus nerve. Cerebral blood flow was measured by the hydrogen clearance method. 1) Control group The vagus nerve was electrically stimulated for 1 minute. 2) Adrenaline-treated group The vagus nerve was electrically stimulated for 1 minute following 30 seconds of intravenous administration of adrenaline.

RESULTS

Cerebral blood flow was significantly decreased in both the control and adrenaline-treated groups after electric stimulation, but the decrease was significantly greater in the latter group at all sites of measurement. Whereas heart rate and arterial pressure were significantly decreased in the control group, these variables in the adrenaline-treated group showed no significant change despite the greater decrease in cerebral blood flow.

DISCUSSION

Heart rate, blood pressure, and cerebral blood flow were all significantly decreased after electric stimulation of the vagus nerve. These changes were considered owing to a fall in blood pressure due to vasodilation resulting from bradycardia and a relative decrease in sympathetic nervous tension resulting from electric stimulation. On the other hand, in the adrenaline-treated group, neither heart rate nor blood pressure showed any significant change, but cerebral blood flow was significantly decreased at all sites of measurement despite an adrenaline load. This contradictory results may be accounted for by the powerful beta 2-activity of adrenaline. The greater decrease in cerebral blood flow in the adrenaline-treated than in the control group can be attributed to decreased peripheral vascular resistance by its beta 2-activity. In the field of otorhinolaryngology the trigeminal region is often involved in the treatment of nasal disorders so that vagovagal reflexes are often encountered. The results of this study counsels caution in the treatment involving the trigeminal region.

Flumazenil antagonizes midazolam-induced airway narrowing during nasal breathing in humans

We measured nasal resistance (Rn) while awake, during midazolam-induced sedation and after antagonism with flumazenil (n = 9). Nasal and oral airflow were measured. Rn was calculated by dividing the difference between maximal nasal mask and oropharyngeal pressures by inspiratory airflow at minimum pharyngeal pressure. During sedation, two subjects developed obstructive apnoeic events and four subjects had snoring events. Each apnoea was ended by mechanisms other than a change in breathing route. After antagonism with flumazenil, apnoeic and snoring events were abolished. Rn during midazolam sedation (median 1.46 (25th percentile 1.00, 75th 2.61) kPa litre-1 s) was significantly greater than before midazolam (0.29 (0.25, 0.48) kPa litre-1 s) and after flumazenil (0.41 (0.25, 0.58) kPa litre-1 s) (P < 0.01 in each subject). We conclude that midazolam increased Rn, sometimes leading to obstruction, and flumazenil abolished this increase in Rn.

Underglycosylation of IgA1 hinge plays a certain role for its glomerular deposition in IgA nephropathy

This study was performed to isolate and investigate the IgA1 that could accumulate in glomeruli (glomerulophilic IgA1). IgA1 was fractionated by the electric charge and the reactivity to Jacalin. Serum IgA1 of IgA nephropathy patients was separated and fractionated using a Jacalin column and subsequent ion-exchange chromatography. The fractions were divided into three groups of relatively cationic (C), neutral (N), and anionic (A). IgA1 was also divided into Jacalin low (L), intermediate (I), and high (H) affinity fractions by serial elution using 25, 100, and 800 mM galactose. The left kidneys of Wistar rats were perfused with 2, 5, or 10 mg of each group of IgA1. The rats were sacrificed 15 min, 30 min, 3 h, or 24 h after the perfusion. The accumulation of each IgA1 in the glomeruli was then observed by immunofluorescence. The IgA1 of the fractions N and H separated by the two methods was definitely accumulated in the rat glomeruli with a similar pattern. The electrophoresis revealed that the macromolecular IgA1 was increased in fraction H compared with other fractions. Therefore, Jacalin high-affinity IgA1(fraction H) was applied on a diethylaminoethyl column and divided into electrically cationic (HC), neutral (HN), and anionic (HA). Only the asialo-Galbeta1,3GalNAc chain was identified in the fraction HN IgA1 by gas-phase hydrazinolysis. Furthermore, the IgA1 fraction was strongly recognized by peanut agglutinin, Vicia Villosa lectins, and antisynthetic hinge peptide antibody. These results indicated that the IgA1 molecules having the underglycosylated hinge glycopeptide played a certain role in the glomerular accumulation of IgA1 in IgA nephropathy.

Epstein-Barr virus study in malignant lymphoma in Sjögren's syndrome

The association of Epstein-Barr virus (EBV) with Sjögren's syndrome (SS) is controversial. Reports suggest there is an increased risk of developing lymphoid malignancy in SS. Among our 425 cases of SS, 17 cases of malignant lymphoma (4%), 16 cases of non-Hodgkin's lymphoma (NHL), and 1 case of Hodgkin's disease were found. We looked for an association between EBV and 14 cases of NHL, 13 cases of B-cell lymphoma, and 1 case of T-cell lymphoma in which tissue specimens were available. Epstein-Barr virus-encoded RNA in situ hybridization study and polymerase chain reaction (PCR) study using primers to detect the Bam HI W fragment of EBV with DNA extracts were positive in 2 NHLs: 1 diffuse, large B-cell-type lymphoma, 1 out of 13 cases (8%) of B-cell lymphoma, and 1 angioimmunoblastic T-cell lymphoma with dysproteinemia. In the Bam HI W PCR study of DNA obtained from the labial small salivary glands of 55 cases with SS, 3 cases (5%) were positive. These 3 cases were not associated with malignant lymphoma. Our study revealed that EBV association in SS did not lead to an increased occurrence.

[Evaluation of the histologic criteria for the diagnosis of Sjögren's syndrome]

OBJECTIVE

The most important diagnostic criterion in Sjögren's syndrome (SS) is considered to be the histologic focus score of the labial salivary glands. The focus score is defined as the number of lymphocytic foci per 4 mm2 of the salivary gland according to the criterion of Chisholm & Mason. On the other hand, in the criteria of the Sjögren's Disease Research Committee of the Ministry of Health and Welfare in Japan it is defined as the number of lymphocytic foci per a lobule of the salivary gland. By setting the limited criteria for SS on the basis of objective signs of both dry eyes and dry mouth, we compared the usefulness of these two diagnostic criteria for the diagnosis of SS in terms of the sensitivity, the specificity and laboratory data.

METHODS

The biopsy of labial salivary glands was performed in 245 patients (230 females and 15 males, with a mean age of 54.9 years) who were suspected of SS in our hospital during the time between 1975 and 1996. Labial salivary glands were histologically assessed and the focus score was calculated according to the criterion of Chisholm & Mason and to that of the Sjögren's Disease Research Committee, respectively.

RESULTS

The average area per a lobule of the salivary gland was 0.70 mm2. According to the limited criteria for SS, the Japanese histologic diagnostic criteria showed a higher specificity (93.3%) and a lower sensitivity (23.5%). The sensitivity of the criterion of Chisholm & Mason was 72.1%, and the specificity was 80.0%. The margin of the lobule was sometimes difficult to be identified because of the fatty change and fibrosis in some salivary glands.

CONCLUSIONS

By comparing the two different histologic criteria using our limited criteria, it was better to use the histologic criterion of Chisholm & Mason as a criterion for the diagnosis of SS than that of the Sjogren's Disease Research Committee of the Ministry of Health and Welfare in Japan in terms of the sensitivity, the specificity and laboratory data.

Determination of Epstein-Barr virus association with B-cell lymphomas in Japan: study of 72 cases--in situ hybridization, polymerase chain reaction, immunohistochemical studies

The association of Epstein-Barr virus (EBV) with B-cell lymphoma was examined in 72 human immunodeficiency virus-negative Japanese patients using the polymerase chain reaction (PCR) on DNA obtained from formalin-fixed paraffin-embedded tissues and an in situ hybridization (ISH) technique. EBV-encoded RNA 1 (EBER-1) was detected in 12 of 72 cases (17%); five of 33 cases (15%) of nodal B-cell lymphomas and seven of 39 cases (18%) of extranodal B-cell lymphomas. Three cases of post-bone marrow transplantation and one case of autoimmune disease (Evans syndrome) were included among seven EBER-1 positive extranodal lymphomas. A combined study of immunohistochemistry and EBER-1 revealed that some L26 positive cells were EBER-1 positive. A DNA band was also observed in 13 of 70 examined cases (19%) (four of 33 cases of nodal B-cell lymphomas (12%) and nine of 37 cases of extranodal B-lymphomas (24%)) in the PCR study using primers to detect the Bam HI-W fragment of EBV. In the immunohistochemical study using a monoclonal antibody to the latent membrane protein 1 (LMP-1) of the EBV, one of the EBV-encoded latent gene products, LMP-1, was expressed in six of 34 cases (18%) of extranodal B-lymphomas, but none of the cases with nodal B-cell lymphomas were shown to be LMP-1 positive. Oncoprotein bcl-2 was examined by immunohistochemistry and found to be expressed in seven cases of nodal lymphomas and three cases of extranodal lymphomas, and two of these nodal cases were EBER ISH positive. In EBV serology, only two cases of nodal and one case of extranodal EBER positive B-cell lymphomas revealed a reactivation pattern. In the PCR study using primers to detect the lymphocyte-determined membrane antigen (LYDMA), the same sized monoclonal bands were observed in case 36 in the PCR products from the nose and skin, suggesting the monoclonal proliferation of the tumor. These findings suggested a low incidence of EBV association with B-cell lymphomas unless patients were in an immunologically impaired condition such as post-organ transplantation or autoimmune diseases.

Dissemination of Epstein-Barr virus associated B-cell lymphoma of the brain after development of immunological incompetence with Evans syndrome

A 54-year-old female with Epstein-Barr virus (EBV)-associated B-cell lymphoma of the brain and Evans syndrome is presented. After treatment of the lymphoma with irradiation to the brain and chemotherapy she developed Evans syndrome with autoimmune hemolytic anemia and thrombocytopenia. Further immunosuppressive treatment for Evans syndrome caused the dissemination of EBV-associated B-cell lymphoma. The dissemination of EBV-associated B-cell lymphoma was confirmed by in situ hybridization with EBV encoded small RNAs (EBER), polymerase chain reaction with Bam HI-W fragment of EBV and lymphocyte determined membrane antigen (LYDMA) and immunohistochemistry with latent membrane protein (LMP). Since only a few cases of lymphomas associated with EBV occurring during autoimmune diseases have been reported, this is an illustrative case.

[Long-term follow-up of 43 patients with Sjögren's syndrome]

OBJECTIVE

To study the long-term outcome in patients with Sjögren's syndrome (SS).

METHODS

We retrospectively studied a cohort of 43 patients with SS; 31 patients with primary SS and 12 patients with secondary SS (6 patients with rheumatoid arthritis, 3 patients with mixed connective tissue disease, 2 patients with systemic lupus erythematosus and 1 patient with systemic sclerosis). Follow-up assessments were performed for 10-20 years following the initial diagnosis.

RESULTS

During follow-up, 29 patients (67%) with SS developed new extraglandular manifestations including: a small amount of monoclonal gammopathy (10 patients), interstitial pulmonary disease (8 patients), malignancy (4 patients developed cancer, 1 patient developed malignant lymphoma), Raynaud's phenomenon (4 patient), peripheral neuropathy (3 patients), renal disease (2 patients), myopathy (2 patients) and others. Statistically significant differences in the salivary gland scintigraphy existed between the progressed group and the stable group at both the initial diagnosis and ten years later. Patients with anti-Ro (SS-A) antibody had a high incidence of salivary gland enlargement, hypocomplementemia, rheumatoid factor and anti-nuclear antibody. The focus scores of the labial salivary biopsy in anti-La (SS-B) antibody positive patients were significantly higher than in patients without this antibody. No statistically significant differences were noted in symptoms and signs between study entry and follow-up.

CONCLUSIONS

Although sicca symptoms involving the eyes and the mouth did not progress in most of SS patients, 67.4% of SS patients developed new extraglandular manifestations during the 10-20 years follow-up period.

[Mediastinal lymph-node carcinoma with no apparent primary lesion]

To determine the clinical characteristics of cases of hilar or mediastinal lymph-node cancer in which the primary lesion was not found; reports of 36 such cases were identified. The patients in those cases comprised 29 men and 7 women, whose average age was 58.4 years. The malignancies were found in hilar lymph nodes in 15 patients, mediastinal lymph nodes in 16, and both hilar and mediastinal lymph nodes in 4; 14 were adenocarcinomas, 4 were squamous-cell carcinomas, and 4 were small-cell carcinomas. The average length of cancer-free survival after surgery was 28.9 months, and the maximum was 9 years. After the affected hilar and mediastinal lymph nodes had been resected the clinical appearance of these patients was the same as if the primary tumor had been removed. We therefore believe that many patients given a diagnosis of cancer with metastases to hilar or mediastinaly lymph nodes and in whom the primary tumor cannot be located in fact have primary cancer of the lymph nodes, and that this condition should be called "primary mediastinal lymph-node carcinoma".

[Ethanol injection therapy to the lung cancer]

Ethanol injection was tried in patients who underwent exploratory thoracotomy. There were 4 males and 1 female, adenocarcinoma in 3 cases, large cell carcinoma in 1 case, and metastatic lung cancer in 1 case. We grasped the lung included the tumor, and injected ethanol directly into the tumor. Maximum dose of injected ethanol was within 10 ml. There were no any complications postoperatively in all patients. Postoperative course was followed by means of chest CT. Three patients whose preoperative cancer stage was early stage gained good results in local control, two patients whose preoperative cancer stage was stage III B in one patient and metastatic cancer rapidly growing in other patient had no effects. Ethanol injection into the lung tumor was easy to perform and safety, and has direct effect in local control of the tumor in especially small sized.

Aggressive natural killer cell lymphoproliferative disorder associated with Epstein-Barr viral RNA

Lymphoproliferative disorder of natural killer cells is a heterogeneous disorder, and an association with Epstein-Barr virus (EBV) is suggested in some cases. A Japanese male presenting with recurrent nasopharyngeal problems developed fever, generalized lymphadenopathy, and hepatosplenomegaly. Separated cells from lymph nodes were shown to have a natural killer (NK) cell, CD2(+), CD3(-), CD16(+), CD56(+), HLA-DR(+) phenotype. A progressive abnormality of hepatic function was associated with hepatorenal failure and death. A serologic study suggested reactivated EBV infection. In situ hybridization (ISH) studies showed Epstein-Barr virus-encoded RNA (EBER)-1 in lymph nodes, with lymphocytes infiltrating the liver and tissue from ethmoid sinus surgery 3 years prior to development of obvious lymphoproliferative disease. Polymerase chain reaction performed on lymph node DNA, using oligonucleotide primers specific for the EBV lymphocyte-determined membrane antigen (LYDMA) gene, revealed a single band, suggesting monoclonal proliferation of the tumor. NK activities of the lymphocytes from the lymph node and peripheral blood were markedly decreased. These findings suggest a close relationship between EBV infection and development of NK cell lymphoproliferative disorder.

Endothelin production in the rabbit collecting ducts of acute renal failure models. An immunohistochemical study

Endothelin 1 (ET-1) production was examined in the rabbit nephron in acute renal failure (ARF) induced by uranyl acetate administration or by clamping the renal artery. Uranyl acetate dissolved in saline was injected intravenously at a dose of 0.8 mg/kg (n = 12). In the ischemic kidney experiment, 60 min of left renal artery clamping was carried out 1 week after removing the right kidney (n = 8). Plasma and urine concentrations of ET-1 were measured 0, 24, and 48 h after treatment, and immunohistochemical studies of renal tissues obtained 48 h after the experiments were carried out using ET-1 monoclonal antibody. The fractional excretion of ET-1 increased from 10 to 89% at 48 h in the uranyl acetate treated group and from 6 to 15% at 24 h in the renal artery clamping group, suggesting the existence of ET-1 secretion from the nephron in both types of ARF. By immunohistochemical examination, strong ET-1 expression was noted only in the collecting ducts. No staining was observed in other parts of the nephron in both types of ARF. The present study indicates that the increased expression of ET-1 probably reflects production by the collecting ducts in both rabbit ARF models.

[Adoptive immunotherapy for pancreatic cancer, using MUC1 specific CTL]

A new therapeutic strategy for pancreatic cancer is needed because of its very poor prognosis. We presented the results of adoptive immunotherapy and new adoptive immunotherapy using MUC1 specific CTL. We expect that these new strategies may help improve the prognosis of pancreatic cancer.

[Analysis of risk factors for development of bronchopleural fistula after pneumonectomy for lung cancer]

Bronchopleural fistulas (BPF) developed in six (7.9%) of 76 patients who underwent a pneumonectomy for treatment of lung cancer. Five patients (18.2%) underwent a right pneumonectomy and one (3.7%) a left pneumonectomy. All patients were male, had squamous cell carcinoma, and were diagnosed as having BPF within one month after pneumonectomy. Their average age was 60.2 years. Univariate analyses related to development of BPF showed that significant risk factors were preoperative infection (Chi-square test; p < 0.001), right pneumonectomy (Chi-square test; p < 0.05), and metastasis to a subcarinal lymph node (Chi-square test; p < 0.05). However, sex, age, operating time, amount of blood loss during surgery, amount of blood transfused during surgery, history of smoking, degree of lymph node dissection, degree of curability, performance of combined resection, histologic type of tumor, tumor size, presence of residual tumor at the bronchial stump, and suturing method were not significant risk factors for development of BPF. Our stepwise regression analysis related to development of BPF showed that preoperative infection, metastasis to a subcarinal lymph node, right pneumonectomy, and combined resection were significant risk factors. Sometimes it is difficult to preserve the bronchial arteries upon the dissection of metastatic subcarinal lymph nodes which tightly adhere to the bronchial sheath. Moreover, after a conventional right pneumonectomy, the bronchial stump protrudes into the pleural cavity and is not covered by any tissue. Ligation of the bronchial arteries or protrusion of the bronchial stump into the right pleural cavity reduces the blood supply to the bronchial stump to a very low level and causes development of BPF. Therefore, we suggest that control of preoperative infection, wrapping of the bronchial stump, and preservation of the bronchial arteries during mediastinal lymph node dissection are important to prevent development of BPF.

Changes in tumor necrosis factor-a and interleukin-1 beta production following liver surgery on cirrhotic patients

BACKGROUND/AIMS

The purpose of this study is to investigate the possible participation of inflammatory cytokine release from macrophages/monocytes following liver surgery on cirrhotic patients in the pathogenesis of postoperative organ failures.

MATERIALS AND METHODS

Postoperative changes in tumor necrosis factor-a and interleukin-1 beta production in peripheral blood monocytes stimulated by lipopolysaccharide were examined in cirrhotic patients with hepatocellular carcinoma undergoing hepatic resections.

RESULTS

Monocytes separated from the blood in cirrhotic patients prior to operation showed a greater ability to produce tumor necrosis factor-a and interleukin-1 beta than those in healthy volunteers. Monocytes in postoperative cirrhotic patients showed a greater ability to produce tumor necrosis factor-a and interleukin-1 beta in the presence of lipopolysaccharide than healthy controls and preoperative cirrhotic patients. In the case of postoperative hepatic failure, tumor necrosis factor-a and interleukin-1 beta production in monocytes showed a remarkable rise along with progression toward hepatic failure.

CONCLUSION

These results indicate that tumor necrosis factor-a and interleukin-1 beta play an important role in the pathogenesis of postoperative liver failures. When there are any stimuli to produce cytokines in monocytes, such as ischemia, significant tissue injury and/or endotoxin, organ failures could develop and progress subsequently.

High prevalence of B-cell monoclonality in labial gland biopsies of Japanese Sjögren's syndrome patients

Patients with Sjögren's syndrome (SS) have an increased risk of developing malignant lymphoma. Although some clinical parameters may herald the imminent onset of lymphoma, few reliable markers are available to predict the progression to a malignant lymphoproliferative disorder. Although there are a number of immunological and serologic features that distinguish SS in Japanese patients, in common with their Western counterparts these patients also have an increased risk of lymphoid neoplasia. Recently we have reported finding a high prevalence (17%) of monoclonal immunoglobulin (Ig) heavy chain gene rearrangements in labial salivary gland (LSG) biopsies of Western SS using the polymerase chain reaction (PCR). In many cases this finding was predictive for the subsequent development of lymphoma. In this study LSG from 50 Japanese SS patients were examined for Ig heavy chain gene monoclonality using PCR to amplify the VDJ region and identified in 7 of 50 (14%) cases. Three patients with monoclonality in the LSG had evidence of lymphoma at extra-salivary gland sites. In one of these the diagnosis of lymphoma was made subsequent to lip biopsy. In the other two lymphoma at extra-salivary gland sites was diagnosed prior to LSG biopsy. The results suggest that the prevalence of Ig heavy chain gene monoclonality in LSG of Japanese SS patients is similar to that in the West, and that neoplastic cells can be identified in LSG as a component of more widely disseminated disease.

[Effect of sevoflurane on release of TNF-alpha and IL-1 beta from human monocytes]

Although isoflurane inhibits TNF-alpha and IL-1 beta release from human monocytes stimulated by LPS in dose dependent fashion, it is unclear whether sevoflurane has the same effects. Therefore, we investigated whether sevoflurane could inhibit TNF-alpha and IL-1 beta secretions from human monocytes stimulated by LPS in dose dependent fashion in vitro. Human monocytes stimulated by LPS were cultured for 3 h in the presence of sevoflurane 1% or 5%. Another group of human monocytes were cultured in the absence of sevoflurane. TNF-alpha and IL-1 beta increased after stimulation of LPS and these increases were not inhibited by sevoflurane in a dose dependent fashion. We conclude that sevoflurane does not inhibit TNF-alpha and IL-1 beta release from monocytes stimulated by LPS.

[Clinical aspects and types of Sjögren's syndrome]

Sjögren's syndrome (SS) is a systemic as well as an organ-specific autoimmune disease, characterized by destructive lymphocytic infiltration of the salivary and lacrimal glands. We divided SS patients into three stages: stage I is glandular SS, stage II is extraglandular SS, and stage III is extraglandular SS with lymphoid malignancy. The lymphoaggressive nature of the disease appears to lead SS patients from stage I to II and from stage II to III. However, stage III patients made up only 5% of SS patients. Many patients remain stable in stages I or II for as long as 10 or 20 years. Therefore, we can assume that there are factors which trigger patients in stages I or II to progress to stages II or III and that only those patients who have such factors progress from stages I or II to stages II or III, respectively. Accumulation in the salivary glands or in the peripheral blood of B cells which have rearrangement of the RF-related germline gene Vg or over-expression of the bcl-2 gene in the lymphoepithelial lesion might be included among these factors.

Smoking promotes insidious and chronic farmer's lung disease, and deteriorates the clinical outcome

Although the prevalence of serum precipitating antibodies for farmer's lung disease (FLD) is lower in smokers than in nonsmokers and FLD predominates in nonsmokers, the affects of smoking on the clinical course of the disease is not known. We compared the clinical findings and the prognosis between 12 smokers (SM-FLD) and 31 non-smokers with FLD (NS-FLD). There was no difference in age, sex, working years on farm, clinical symptoms, laboratory findings, radiographic findings, between the two groups. However, for the type of onset on the first visit for FLD, "acute single episode" type was less common, and "recurrent" and "insidious onset" types were more common in SM-FLD than in NS-FLD (8.3 vs 58.1, 91.7 vs 41.9%, respectively, p < 0.05). Although working status and mask wearing status were not significantly different between the two groups after the diagnosis of FLD, patients with symptoms and/or radiographic abnormalities of FLD of more than 6 months were found more frequently in SM-FLD than in NS-FLD (66.7 vs 19.4%, p < 0.005). And also SM-FLD had more recurrences of FLD than NS-FLD after the initial diagnosis of FLD (1.58 +/- 1.56 vs 0.47 +/- 1.07, p < 0.05). SM-FLD tended to have lower % VC than NS-FLD (73.6 +/- 7.4 vs 88.5 +/- 3.9%, respectively, p = 0.06). Regarding the prognosis, the 10-year survival rates were 70.7% in SM-FLD, and 91.5% in NS-FLD (p < 0.05). These results suggest that smoking may make FLD insidious and chronic, and deteriorates the clinical outcome.

[Lymphoproliferative disorders in patients with Sjögren's syndrome--Vg gene rearrangement and expression of bcl-2 protein]

Sjögren's syndrome (SS) is a unique disease which develops a high incidence of lymphoproliferative disorders (LPD) such as monoclonal gammopathy or malignant lymphoma. In order to elucidate the mechanism responsible for the emergence of monoclonal B cell proliferation at the site of a chronic autoimmune reaction, the rheumatoid factor (RF) related germline gene Vg and expression of the bcl-2 gene in the lymphoepithelial lesion (LEL) were studied. Predominant usage of the Vg or Vg-like genes was found in the peripheral blood leukocytes in SS patients and abundant expression of bcl-2 protein in the lymphocytes in and around the LEL were observed. These results suggest that RF clones were activated resulting into monoclonal proliferation and overexpression of bcl-2 protein play a role allowing the cell to escape a apoptotic cell death resulting into the increased risk of monoclonal proliferation in SS patients.

[Clinical effects and immunological analysis of intraabdominal and intrapleural injection of lentinan for malignant ascites and pleural effusion of gastric carcinoma]

Twenty-one patients with malignant peritoneal or pleural effusions of gastric carcinomas were treated with intracavitary injection of lentinan (LNT). LNT was injected at a dosage of 4 mg/week for 4 weeks. In total, fifteen (71%) of twenty-one patients demonstrated clinical responses. Toxicity caused a high fever in only one case. LAK and ATK activities induced from peritoneal exudate cells (PEC) after culture with autologous tumor and interleukin-2 were examined before and after LNT injection. ATK activity was augmented, but LAK activity was reduced after LNT injection. These results indicate that intracavitary injection of LNT is a useful treatment for malignant effusions, and that LNT augments the induction of cytotoxic T-lymphocytes.

Three cases of idiopathic interstitial pneumonia with bullae seen in schoolteachers

We encountered three patients with chronic interstitial pneumonia with many bullae in the lower lung fields whose lifetime occupation was teaching school. Pathological examination of autopsy lungs of these patients revealed interstitial pneumonia and multiple bullae throughout the lungs, including the lower lobe. Since blackboard chalk has been used as a popular writing material among teachers in Japan, the mineral contents in the lungs of two of the three cases and four control cases with idiopathic interstitial pneumonia (IIP) (whose occupations were not teaching) were analyzed. The amount of deposition of total dust, inorganic dust, non-SiO2 inorganic dust, and calcium was significantly higher in the lungs of two schoolteachers compared with those of the control lungs. The amount of free silica in case 1 and alpha-quartz in case 3 were also significantly higher than in the controls. Two thirds of the chalk produced in Japan is still made from gypsum and involves small amounts of silica and other minerals, in addition to calcium. These findings indicated the deposition of chalk in the lungs of these patients with interstitial pneumonia and multiple bullae.

[The effect of isoflurane on the secretion of TNF-alpha and IL-1 beta from LPS-stimulated human peripheral blood monocytes]

The cytokines such as tumor necrosis factor and interleukin-1 secreted from macrophages/monocytes proved to play important roles in the pathogenesis of endotoxemia, severe pancreatitis and other surgical injuries. However, it is still unclear how inhalational anesthetic agents influence the secretion of these cytokines from macrophages/monocytes. We investigated the effects of isoflurane on TNF-alpha and IL-1 beta secretions from human peripheral blood monocytes stimulated by lipopolysaccharide. TNF-alpha and IL-1 beta secretions increased after LPS stimulation and this increase was inhibited by isoflurane in dose-dependent fashion. The inhibitory action of isoflurane disappeared between 1 and 3 hours after stopping isoflurane inhalation. We concluded that isoflurane could inhibit TNF-alpha and IL-1 beta secretions from peripheral blood monocytes stimulated by LPS in a dose-dependent fashion and that the inhibitory action of isoflurane was reversible.

[Milrinone suppresses TNF-alpha and IL-1 beta release in mouse peritoneal macrophages]

Tumor necrosis factor-alpha (TNF-alpha) exerts a wide spectrum of biological activities and contributes to the pathophysiology of septic shock. We studied whether milrinone suppresses TNF-alpha and IL-1 beta releases from mouse peritoneal macrophages. Mouse peritoneal macrophages were stimulated for 18 hr with lipopolysaccharide and different doses of milrinone. TNF-alpha release was suppressed in a dose-dependent fashion with milrinone, reaching half-maximal inhibition at 30 microM. Release of IL-1 beta was not suppressed with 25 microM of milrinone, but it was suppressed with 250 microM of milrinone. We conclude that TNF-alpha release is suppressed by therapeutically administered milrinone.

[Effects of thromboxane A2 receptor antagonist, KT2-962 on pulmonary hypertensive responses to antigen challenge in isolated sensitized rabbit lung]

We investigated whether KT2-962 (thromboxane H2/A2 receptor antagonist) could attenuate increases in pulmonary arterial and airway pressures after antigen challenge in isolated-perfused sensitized rabbit lungs. Sensitized rabbits were immunized intravenously with human O-N type erythrocytes until the agglutination titer against antigen reached above 1:10,000. Nineteen rabbits were divided into three groups. In N group (n = 9), antigen was challenged into perfusate. In KT2 group (n = 5), 1 mg.kg-1 of KT2-962 was given into reservoir 10 min prior to antigen challenge. In Indo group (n = 5), 5 mg.kg-1 of indomethacin was given into reservoir 20 min prior to antigen challenge. Maximal increase in pulmonary arterial pressure after antigen challenge in N group was significantly higher than that in KT2 group or in Indo group (13.4 +/- 3.3 mmHg, 1.5 +/- 0.5mmHg, 1.5 +/- 0.2mmHg, respectively). Maximal increase in airway pressure in N group was higher than that in KT2 group or in Indo group (2.9 +/- 0.8cmH2O, 0.8 +/- 0.2cmH2O, 0.5 +/- 0.2cmH2O, respectively), but this was not significant. Pharmacological potential of KT2-962 to attenuate pulmonary hypertensive responses was estimated 50 times stronger than that of indomethacin. In conclusion, KT2-962 can exert therapeutic effect on pulmonary hypertensive responses induced by immunological reactions.

Experimental laser anastomosis of the colon. Long-term results and histologic findings after laser closure of colotomies

PURPOSE

Our previous experimental work showed the feasibility of colon anastomosis using laser; however, it also revealed a narrowing tendency after laser anastomosis. Long-term observation of the postoperative course of laser anastomosis was planned to assess this point.

METHODS

Clinical observation and histologic examination of transverse colotomies (average, 21.2 mm) in New Zealand white rabbits (n = 12) closed with a 1,064-nm neodymiumyttrium aluminum garnet (Nd:YAG) laser were carried out up to the third postoperative month, compared with closure of colotomies using a single layer of interrupted sutures of 5-0 Maxon (Davis & Geck, Pearl River, NY) in a control group (n = 12).

RESULTS

Whereas the narrowing tendency was observed up to one month after the operation in the laser group (P < 0.05), it disappeared at three months following the operation without causing abnormal weight loss during the experiment. Simultaneously, there was again a marked decrease in adhesion formation following laser anastomosis (P < 0.01). Collagen fibers were observed earlier in the laser group.

CONCLUSIONS

An earlier commencement of collagen synthesis after laser anastomosis was proved. A narrowing tendency, which was observed from seven days to one month postoperatively, disappeared at three months after laser anastomosis without exerting any effect on growth.

[Changes of respiratory function after lung resection--taking notice of changes during exercise test and anaerobic metabolism]

Changes in the following respiratory functions during exercise test were examined before and after surgery in 31 patients undergoing pulmonary resection: VE, VCO2, and VT at a constant VO2 during exercise; and VO2, VCO2, VE and VT at constant loading (watt). At the level of 300 and 500 ml/min of VO2, VCO2 showed no significant difference before and after the operation but when VO2 reached 700 ml/min. VCO2 showed a significant increase from 542.0 +/- 78.3 ml/min to 595.5 +/- 85.2 ml/min postoperatively (p < 0.05). When exercise load was 45 watt, VE showed no significant difference before and after the operation, but when exercise load was 60 watt, VE showed a significant increase from 30.16 +/- 5.38 L/min to 33.89 +/- 4.69 L/min postoperatively (p < 0.005). These results indicated an early acceleration of ventilation in low load postoperatively. With respect to anaerobic metabolism, AT, oxygen uptake to work rate (delta VO2/delta WR), and our proposed index calculated as an area using the cumulative oxygen uptake were compared pre- and postoperatively. The results indicated that AT decreased significantly from 716.0 +/- 190.8 ml/min to 528.4 +/- 150.7 ml/min (p < 0.001), and delta VO2/delta WR also decreased significantly from 13.5 +/- 4.0 ml/min/W to 11.3 +/- 4.2 ml/min/W (p < 0.05). The index calculated as area showed a significant increase from 4070.2 +/- 3468.8 to 5095.3 +/- 3854.5 (p < 0.05). All these findings indicated that anaerobic metabolism increases postoperatively. Accordingly we conclude that postoperative increase of anaerobic metabolism causes postoperative acceleration of ventilation in low load.