Immunoreactivity to M2 proteins in antimitochondrial antibody-negative patients with primary biliary cirrhosis

Although antimitochondrial auto-antibodies are characteristically present in the serum of patients with primary biliary cirrhosis (PBC), there is a discrepancy between the positivity for antimitochondrial antibody (AMA) and that for anti-M2 auto-antibody. In an attempt to explain the discrepancy, this study investigates the relationship between the AMA titre, determined by indirect immunofluorescence, and immunoreactivity to four inner mitochondrial membrane proteins (M2 proteins) with molecular weights of 70, 50, 47, and 40 kDa in 129 patients with PBC. Antimitochondrial antibody positivity was identified in 114 (88%) of 129 patients with clinically and histologically confirmed PBC. There were no significant differences between the AMA-negative and AMA-positive groups in clinical characteristics or histologically determined disease stage. Immunoblot analysis showed that all patients had anti-M2 auto-antibodies to one or more of the four M2 proteins. Nine (60%) of the 15 AMA-negative patients had antibodies to only one M2 protein (either 70 or 47 kDa). In contrast, 34 (53%) of the 64 patients with high AMA titres (> or = 1:320) had antibodies to all four M2 proteins. There was a significant rank correlation between the AMA titre and the number of antibodies to M2 proteins (P < 0.01). These findings indicate that the AMA titre is not influenced by the immunogenicity of M2 proteins but by the number of M2 proteins that elicit an antibody response and that decreased immunoreactivity to M2 proteins may induce AMA negativity in PBC serum samples.

Marked retention of indocyanine green and sulfobromophthalein with chronic persistent hepatitis

A hepatitis B virus (HBV) carrier with marked retention of indocyanine green (ICG) and sulfobromophthalein (BSP) was admitted to our hospital for assessment of liver function. On admission, he was asymptomatic and blood chemistry tests showed normal values for transaminases and bilirubin. Serum hepatitis B surface antigen (HBsAg) and antibody to hepatitis B e antigen (anti-HBe) were positive. A history of drug abuse or alcoholism was denied. Dye excretion tests revealed marked retention of ICG (R15 = 70%) and BSP (R45 = 23%). Histopathological examination of a liver biopsy specimen obtained during laparoscopic observation showed chronic persistent hepatitis (CPH). Familial research of the patient failed to prove the existence of dye excretory defect in his siblings. Usual cases of CPH due to continuous HBV infection do not show such severe disturbance of organic anion transport. This pattern of the dye excretory defect with CPH has not been reported. Although the relationship between this dye excretory defect and HBV infection is unclear, the existence of the constitutional dye excretory defect due to abnormal organic anion transport in the liver might be considered.

[A case of asymptomatic common carotid artery occlusion with the persistent proatlantal intersegmental artery]

A case of asymptomatic common carotid artery occlusion with direct vertebrocarotid anastomosis (proatlantal intersegmental artery) in a 70-year-old male is reported. Despite the acquired left common carotid artery occlusion, there was no demonstrable neurologic deficits that would occur by the involvement of the area supplied by the occluded carotid system. Cerebral angiography revealed, in addition to efficient collateral circulation from the contralateral carotid system through the anterior communicating artery, a collateral channel from the left vertebral artery to the ipsilateral external carotid artery via the proatlantal intersegmental artery. These collateral circulations were indicated to be important in prevention of possible grave neurologic consequences. The proatlantal intersegmental artery, though rarely visualized by ordinary cerebral angiographic procedures, was thus demonstrated to be capable of serving as a collateral channel of potential usefulness in the event of severe intracranial hemodynamic alterations, including acquired common carotid artery occlusion.

Aggressive repeat liver resection for hepatic metastases of colorectal carcinoma

Although hepatectomy for liver metastases from colorectal carcinoma is an effective treatment, recurrence in the liver is still the most common site after hepatectomy. Thirty patients underwent hepatectomy for hepatic metastases and 17 of them had recurrence in the remnant liver during the following 12-year period. Six of the 17 patients underwent a removal of isolated hepatic recurrences. Two of the six patients underwent a third hepatectomy, and three patients underwent partial lung resection on a total of five occasions. There were no operative deaths while complications after a third hepatectomy contributed to a high morbidity rate of 40 per cent. The mean length of survival of the six patients was 28.5 months from the second hepatectomy. The prognosis of the six patients who underwent a repeat hepatectomy was significantly better than that of patients with unresectable recurrence after an initial hepatectomy (p less than 0.01). The overall 5-year survival of 29 patients excluding one in-hospital death was 44.7 per cent. Our results reveal that aggressive removal of isolated and resectable recurrent disease has the potential to improve the prognosis of selected patients with metastatic cancer.

Results of extensive surgery for liver metastases in colorectal carcinoma

Hepatic resections were performed during the past 13 years on 31 patients with hepatic metastases from colorectal carcinoma. Of the 31 patients, 22 underwent lymph node dissection of the hepatic hilus. Ten patients underwent removal of recurrent lesions in the liver, lung, adrenal gland and brain after initial hepatic resection. The overall 5-year survival rate was 45 per cent. The outcome for six patients who underwent repeat hepatectomy after an initial hepatectomy was significantly better than for nine patients with unresectable recurrence (P less than 0.01). Six of the 22 patients who underwent lymph node dissection had nodes positive for tumour. Two of the six patients underwent repeat hepatectomy and are alive after 49 and 66 months. Three- and 4-year survival rates of patients with positive lymph nodes were both 40 per cent. Repeat hepatectomy and dissection of hilar lymph nodes improves prognosis in selected patients with hepatic metastases of colorectal cancer.

Portal vein thrombosis after splenectomy successfully treated by an enormous dosage of fibrinolytic agent in a short period: report of two cases

Portal vein thrombosis (PVT) after splenectomy in a patient with portal hypertension occurs with unusually high frequency. Recently, two patients with PVT following splenectomy were treated by fibrinolytic therapy with an enormous dosage of urokinase (UK) in a short period. PVT was quickly dissolved without side effects and the patients are now doing well without any recurrence of PVT. Therefore, when there is no evidence of bowel infarction, fibrinolytic therapy with an enormous dosage of UK over a short period is deemed to be both effective and essential as a conservative therapy for PVT.

Visual load of working with visual display terminals--introduction of VDT to newspaper editing and visual effect

In the Japanese newspaper industry, since the late 1970s, computerization has been started in large scale. The system, called Computerized Typesetting System (CTS), has been introduced. With this system, all information in the newspaper is input into a computer, called up on a cathode ray display (CRT) to edit, and then output to film or printing plates by CTS. Thus, the work of newspaper production has undergone a major transformation from industrial work to clerical work. It was reported that newspaper production staff working with VDTs complained more than staff working with the older key system about visual and physical problems which affected their job and their daily life. The complaint rates were highest for editors, who used VDT constantly throughout the day. This study was performed to clarify the health impact of VDT use and to prevent health disorders caused by the introduction of CTS. It is concluded that 5 m corrected vision and sphere refraction of CTS workers who used CTS over 2 or 4 hr daily, significantly became worse in a year after the introduction. Therefore, it is indicated that the control of CTS work time is important to prevent the visual disorder.

A case of melena caused by a hepatic aneurysm ruptured into the intrahepatic bile duct in a patient with allergic granulomatous angiitis

A 46 year old woman was admitted to our institute in June, 1987 with an attack of asthma, as well as remittent fever and leukocytosis accompanied by hypereosinophilia. She was found to have melena from an unknown source upon gastrointestinal examination. Four low-density areas were found in the liver on computed tomography and one of the intrahepatic foci formed a large extrahepatic abscess communicating with the intrahepatic duct on tubography. Resection of the four hepatic segments, including the large abscess, and cholecystectomy were performed. Healed necrotizing arteritis was histopathologically observed in the resected liver specimen, with the four low-density areas on CT scan having all been necrotic foci. One of them formed an intrahepatic biliary fistula and rupture of a hepatic aneurysm into a biliary duct was found to be the cause of melena. Although eosinophil infiltration and extravascular granuloma were not observed, a diagnosis of allergic granulomatous angiitis was made from the characteristic clinical course, systemic vasculitis and peripheral blood eosinophilia. To the best of our knowledge, this is the first report of intrahepatic duct perforation most probably being caused by hepatic aneurysm rupture in a patient with allergic granulomatous angiitis.

A three-dimensional method for calculating currents induced in bodies by extremely low-frequency electric fields

A user-friendly, numerical program has been developed to permit the calculation of induced currents in modeled bodies of human and infrahuman subjects. The program is based on a charge-simulation method (CSM), and it takes into account the three-dimensional (3-D) character of the extremely-low-frequency (ELF) electric field and of the models to be exposed. The principle of the method is to simulate a 3-D object, for example, an animal model, by a combination of several parts (blocks) having simple geometric forms such as a sphere, a cylinder, or a cone. This approach permits easy preparation of input data on the dimensions of the blocks and their positions in a 3-D arrangement. Other input data, such as the coordinates of the contour points and the imaginary values of charges inside objects, which are necessary in the calculations by CSM, are produced automatically by selecting an appropriate "level" for each block, according to its importance. To simulate parts having irregular shapes, special blocks may be added. In one series of experiments, induced currents were calculated for a baboon model in various postures: standing upright, positioned on four legs, and sitting on the floor. Calculated currents, the total induced current in particular, agreed very well with experimental values. Local currents in parts of the baboon models were more variable, ranging from 5% to 17% of measured values in the case of induced currents in the head. Some problems with this method, such as the effect of the dimensions of blocks or the choice of block levels, are discussed.

Immunohistochemical and histometrical studies of the human thymus with special emphasis on age-related changes in medullary epithelial and dendritic cells

Age-related changes in medullary epithelial and dendritic cells in the human thymus were examined quantitatively using immunohistochemistry and histometry. The material used was thymic biopsy specimens obtained from 105 patients during cardiac surgery, none of whom had immunological abnormalities. By using keratin and tissue polypeptide antigen markers to identify epithelial cells and S-100 protein and LN-2 markers to identify dendritic cells, the numbers of these cells in the medulla were counted morphometrically. The relative proportions of the cortex, medulla, Hassall's bodies, perivascular space, connective tissue and fatty tissue were evaluated using a computer image-analysis system and the respective relative volumes were calculated. Our results indicate that the number of medullary dendritic cells/mm2 and the relative volume of cortical thymocytes decrease steadily up to the age of 40 years, whereas no major change was found in the number of medullary epithelial cells/mm2.

[Roentogenologic pathologic evaluation of allograft rejection in heart-lung transplantation--an experimental study in Japanese monkey]

Experimental heart-lung transplantation was carried out in Japanese Monkey (Macaca fuscata). Twelve monkeys survived two to thirty-three days. Pathologic examination of the lung was performed at the time of open lung biopsy and autopsy. Postoperative chest roentogenogram was also studied in seven monkeys. In the early postoperative period, central cloudiness and enhancement of the interstitial change were observed, which started from the second or third postoperative day and reached their peak between the fifth and eighth postoperative day. Pathological study revealed no obvious monocyte infiltration in the lung of this stage. Two types of pulmonary rejection were observed, one is alveolar and vascular rejection. The other is vascular type of rejection, which started as early as in the twelfth postoperative day in a case. In the former, consolidation of the lung was noticed and useful in the diagnosis, but in the latter, no distinct change was observed in plain chest roentogenogram.

ELF electromagnetic environment in power substations

This paper presents a theoretical analysis of electromagnetic environments in power substations in service. A new analytical method is developed and applied to magnetic field calculations in 187-kV and 66-kV substations. Experimental results verify that the method offers a good prediction of the magnetic field profiles in the substations except for the areas where localized field sources exist. The analytical results show that the magnetic field strength depends to a great extent on how the load powers distribute on individual lines and buses, that the magnetic fields in substations have a three-dimensional characteristic, and that the predominant field component depends on the position of interest. Moreover, it is suggested that objects placed in substations are exposed not only to magnetic fields of high strength in comparison to those in houses or near the distribution networks but also to fields with several percent of harmonic distortion.

Detection of anti-cerebral autoantibodies in schizophrenia and Alzheimer's disease

Autoantibodies to cerebrum were investigated in the sera from schizophrenia, Alzheimer's disease and healthy subjects by indirect immunofluorescence method. Four patterns of staining were observed: type A (neuronal cell), type B (blood vessel), type C (nucleus) and type D (glia and miscellaneous cell). Among rat, guinea pig and rabbit cerebrum, rabbit cerebrum proved best (low non-specific binding and high sensitivity) for the detection of circulating autoantibodies to cerebrum. With schizophrenia, 13 out of 46 cases (28.3%) were positive for autoantibodies to neuronal cells and 6/13 of those were not absorbed by liver acetone powder. With Alzheimer's disease, 25/63 (39.7%) were positive for autoantibodies to neuronal cells and 6/25 were not absorbed by liver acetone powder.

Reticular meshwork of the spleen in rats studied by electron microscopy

The reticular meshwork of the rat spleen, which consists of both fibrous and cellular reticula, was investigated by transmission electron microscopy. The fibrous reticulum of the splenic pulp is composed of reticular fibers and basement membranes of the sinuses. These reticular fibers and basement membranes are continuous with each other. The reticular fibers are enfolded by reticular cells and are composed of two basic elements: 1) peripheral basal laminae of the reticular cells, and 2) central connective tissue spaces in which microfibrils, collagenous fibrils, elastic fibers, and unmyelinated adrenergic nerve fibers are present. The basement membranes of the sinuses are sandwiched between reticular cells and sinus endothelial cells and are composed of lamina-densalike material, microfibrils, collagenous fibrils, and elastic fibers. The presence of these connective tissue fibrous components indicates that there are connective tissue spaces in these basement membranes. The basement membrane is divided into three parts: the basal lamina of the reticular cell, the connective tissue space, and the basal lamina of the sinus endothelial cell. When the connective tissue space is very small or absent, the two basal laminae may fuse to form a single, thick basement membrane of the splenic sinus wall. The fibrous reticulum having these structures is responsible for support (collagenous fibrils) and rebounding (elastic fibers). The cells of the cellular reticulum--reticular cells and their cytoplasmic processes, which possess abundant contractile microfilaments, dense bodies, hemidesmosomes, basal laminae, and a well-developed, rough-surfaced endoplasmic reticulum, and Golgi complexes, which are characteristic of both fibroblasts and smooth muscle cells--are considered to be myofibroblasts. They may play roles in splenic contraction and in fibrogenesis of the fibrous reticulum. The contractile ability may be influenced by the unmyelinated adrenergic nerve fibers that pass through the reticular fibers. The three-dimensional reticular meshwork of the spleen consists of sustentacular fibrous reticulum and contractile myofibroblastic cellular reticulum. This meshwork not only supports the organ but also contributes to a contractile mechanism in circulation regulation, in collaboration with major contractile elements in the capsulo-trabecular system.

Distribution of Ito cells in experimental hepatic fibrosis

Ito cells (FSC) have been thought to be collagen-producing cells with regard to hepatic fibrosis. We have found that desmin, a structural protein of muscular intermediate filaments, is found in the cytoplasm of FSC, even in negative vitamin A-autofluorescence FSC, by using immunocytochemical techniques. In the present study, numbers of FSC produced by the administration of heterogeneic serum or carbon tetrachloride were detected in fibrous and non-fibrous areas of hepatic lobules by using a morphometrical analyser. After 8 weeks of intraperitoneal injections of heterogeneic serum into rats, FSC in fibrous septa increased in number and the increase continued to 12 weeks-although the numbers of FSC in non-fibrous areas and in controls given homologous serum did not change during the experiment. In the case of rats administered CCl4 once, FSC in fibrous areas increased in numbers after 48 h through 72 h, although the number of FSC in non-fibrous areas and in controls did not change. The results, with an apparent increase in numbers of FSC in fibrous areas and no change in non-fibrous areas, showed the possibility of hyperplasia due to cell division of FSC in the new fibroplastic areas.

Serum capacity to solubilize immune complexes (ICSC) in patients with insulin-dependent diabetes mellitus

Immune complex solubilizing capacity (ICSC) of sera obtained from patients with insulin-dependent diabetes mellitus (IDDM) was assayed by the spectrophotometric method. In 17/32 IDDM sera, ICSC was significantly low. The value of ICSC was only weakly correlated with serum CH50 (r = 0.42). Six sera out of 28 showed a high serum immune complex level and low ICSC. The results with these 6 cases suggest the possibility that circulating antigen-antibody complex might be insoluble in vivo. The precise characterization of these 6 patients' autoantibodies was obtained with immunofluorescence tests. Interestingly, 2 of these sera were positive for islet cell surface antibodies (ICSA) and AtT-20 cell (ACTH secreting cell) surface antibodies.

Immunocytochemical detection of desmin in fat-storing cells (Ito cells)

Desmin is a smooth muscle protein consisting of intermediate filaments. It is also present in other cell types. We obtained desmin antibodies from New Zealand white rabbits which were immunized with desmin following its extraction from chicken gizzard smooth muscle. By immunocytochemical methods, the antibody stained the Z-line of rat skeletal myofibrils and produced only one band with chicken gizzard desmin by immunoblotting. The antibody was specific for desmin, but was not tissue-specific. Wistar rat liver was studied by indirect immunoperoxidase and immunofluorescent methods using the antibody. Cells which reacted were diffusely distributed in the hepatic lobule, had stellate shape, bore elongated cytoplasmic extensions and contained few fat droplets. The fat droplets increased in size and amount after administration of vitamin A, and contained vitamin A as determined by ultraviolet exposure and gold impregnation. The fat-containing cells did not phagocytose carbon particles after injection of colloidal carbon and were, therefore, classified as fat-storing cells (Ito cells).

[Study of cefamandole in neonatal purulent meningitis caused by E. coli (author's transl)]

Cefamandole (CMD) was intravenously drip infusion administered at daily dose of 400 mg/kg to the neonate with purulent meningitis caused by E. coli which was resistant to ABPC. In clinical application, CMD was evaluated as effective, although 6 mg/kg/day of GM given concomitantly. No adverse effect and abnormal laboratory findings were observed. This study would support the clinical usefulness of CMD in severe neonatal infection especially like meningitis.

[On the chronic toxicity of labetalol (AH-5158); a combined alpha-and beta-adrenoceptor-blocking agent (author's transl)]

Chronic toxicity and recovery tests of labetalol hydrochloride, alpha-and beta-adrenoceptor blocking agent, were carried out using male and female Wistar strain rats. The drug was orally administered at 50, 100 or 200 mg/kg/day for 9 months. In all the drug-treated groups, increase in salivation was observed from immediately after to 15 minutes after dosing through treatment period. Suppression of body weight gain was observed in male rats in the 200 mg/kg/day group. Food comsumption tended to be higher in all the drug-treated groups than in the control group. Similar trend was seen also in water comsumption, and increase in urine volume was noted in the groups treated with 100 and 200 mg/kg/day. In the serum biochemical examination, dose-dependent elevation in potassium level was noted in all drug-treated groups, but the values were within the range of physiological variation. In the 100 and 200 mg/kg/day groups, an increase was observed in the absolute heart weight and in its relative weight against body weight. Major abnormalities found in histopathological findings were; swelling of parenchymatous cells in liver and kidney, swelling of fibers and swelling or proliferation of interstitial cells in cardiac and skeletal muscles, and congestion in spleen. No notable abnormality was found in any examination item in the recovery test.

[On the subacute toxicity of labetalol (AH5158): a combined alpha-and beta-adrenoceptor blocking agent (author's transl)]

Subacute toxicity and recovery tests of labetalol hydrochloride, alpha- and beta-adrenoceptor blocking agent, were carried out using male and female Wistar strain rats. The drug was orally administered at 50, 150, 450 or 1000 mg/kg/day for 1 month. In all the drug-treated groups, increase in salivation was observed from immediately to 15 minutes after dosing through the treatment period. Eight of the 10 males and 9 of the 10 females in the group treated with 1000 mg/kg/day died of intoxication. Suppression of body weight gain was observed in male rats in the 450 and 1000 mg/kg/day groups and in female rats in the 1000 mg/kg/day group. In the 150 mg/kg/day and higher dose groups, water consumption showed a tendency to increase as compared with that of control group. Increase in urine volume was observed in female rats in the 450 mg/kg/day group. In the serum biochemical examination, slight elevation in potassium levels was noted in the 150 and 450 mg/kg/day groups. In histopathological findings, some abnormalities were found in the groups treated at 150 mg/kg/day and higher. Major abnormalities found in organs were; congestion and hypremia of various organs due to vasodilation, swelling of parenchymatous cells in liver and kidneys, and loose arrangement and change in the thickness of muscle fibers in cardiac and skeletal muscles. None of these abnormal findings was found in any examination in recovery tests.

[On the acute toxicity of labetalol (AH-5158), a combined alpha-and-beta-adrenoceptor-blocking agent (author's transl)]

Acute toxicity studies in labetalol were performed using mice, rats and rabbits, An oral administration of labetalol produced an increase in salivary secretion due to local irritation. Death followed convulsions by large doses of labetalol. Pathological examinations suggested that the cause of death by labetalol was circulatory disturbances due to the damage of heart muscles and a subsequent respiratory paralysis. Parenteral LD50 showed almost the same values among mice (50 mg/kg iv, 117 mg/kg ip), rats (66 mg/kg iv, 115 mg/kg ip) and rabbits (43 mg/kg iv). However, species difference was seen in oral LD50 values which were enormously large as compared with iv LD50 values.

[On the toxicity of CT-1341 evoked by long-term administration. III. Subacute toxicity of alphadolone acetate and solvent contained in CT-1341 (author's transl)]

Subacute toxicity of solvent adjuvant, alphadolone acetate and solvent, 20 per cent Cremophor solution contained in CT-1341 was studied by using rats of both sexes. Alphadolone acetate and Cremophor solution were intraperitoneally injected every day for a period of one month. Total rats tolerated to daily administration of 60 mg/kg of alphadolone acetate or of 20 ml/kg of 20 per cent Cremophor solution, without showing significant changes in body weight curves and food intake. No change was observed in blood cells and in biochemical data of blood and urine as compared with control. Rats subjected to daily administration of 60 mg/kg of alphadolone acetate presented slight patho-histological changes such as swelling of cells of the liver and kidneys, and also cell infiltration of pericapillary tissues of the lung.