Case report: varicella-zoster virus myelitis--serial MR findings

The authors describe a 32-year-old male in whom herpes zoster of the left upper extremity was complicated by the development of cervical myelitis. Contrast enhancement and abnormal signal intensity on T1 and T2 weighted images was seen at C1-C6 levels in the spinal cord and medulla. There was also slight enlargement of the cord at these levels. On serial MR imaging the degree of enhancement changed from marked to none with corresponding clinical improvement.

Altered TCR ligands affect antigen-presenting cell responses: up-regulation of IL-12 by an analogue peptide

When examining the effects of analogue peptides on changes in response patterns of a human Th0 clone DT13.2 that recognizes a peptide fragment (18RSLRTVTPIRMQGG31) derived from a group I allergen in Dermatophagoides farinae in the context of HLA-DQ6 (DQA1*0102/DQB1*0602), we found that replacement of the 21st residue Arg to Lys resulted in a significant increase in IFN-gamma production, with no remarkable changes either in proliferative response or IL-4 production, at high doses of the peptide. Selective enhancement of IFN-gamma production by the analogue peptide was accompanied by an increased production of IL-12, which was suppressed by an anti-IL-12 Ab down to the level of IFN-gamma production induced by the wild-type peptide. On the contrary, co-incubation with neutralizing Abs to IFN-gamma and IFN-gamma receptor did not affect IL-12 production, indicating that increased production of IL-12 stimulated by the analogue peptide was not due to an effect of IFN-gamma from T cells. Peptide-induced up-regulation of CD40 ligand expression at high peptide concentrations showed no difference between the wild-type and analogue peptides. These data collectively indicate that certain T cell/APC interactions mediated through TCR and altered TCR ligands affect APC responses and that signals transmitted to APC are as indispensable as those to T cells in determining T cell response patterns.

Altered TCR ligands affect antigen-presenting cell responses: up-regulation of IL-12 by an analogue peptide

When examining the effects of analogue peptides on changes in response patterns of a human Th0 clone DT13.2 that recognizes a peptide fragment (18RSLRTVTPIRMQGG31) derived from a group I allergen in Dermatophagoides farinae in the context of HLA-DQ6 (DQA1*0102/DQB1*0602), we found that replacement of the 21st residue Arg to Lys resulted in a significant increase in IFN-gamma production, with no remarkable changes either in proliferative response or IL-4 production, at high doses of the peptide. Selective enhancement of IFN-gamma production by the analogue peptide was accompanied by an increased production of IL-12, which was suppressed by an anti-IL-12 Ab down to the level of IFN-gamma production induced by the wild-type peptide. On the contrary, co-incubation with neutralizing Abs to IFN-gamma and IFN-gamma receptor did not affect IL-12 production, indicating that increased production of IL-12 stimulated by the analogue peptide was not due to an effect of IFN-gamma from T cells. Peptide-induced up-regulation of CD40 ligand expression at high peptide concentrations showed no difference between the wild-type and analogue peptides. These data collectively indicate that certain T cell/APC interactions mediated through TCR and altered TCR ligands affect APC responses and that signals transmitted to APC are as indispensable as those to T cells in determining T cell response patterns.

[Role of alveolar macrophages in the pathogenesis of idiopathic interstitial pneumonia]

To clarify role of alveolar macrophages in the pathogenesis of idiopathic interstitial pneumonia (IIP), we studied (1) the localization and expression of monocyte chemoattractant protein-1 (MCP-1) in IIP by immunohistochemistry and in situ hybridization. (2) the role of MCP-1 in macrophage recruitment to be lung, and (3) the clinical usefulness of measuring MCP-1. (1) In IIP, MCP-1 was observed in cuboidal and flattened metaplastic epithelial cells, alveolar macrophages, and vascular endothelial cells. In contrast, no epithelial cells from patients without IIP stained positive for MCP-1, although alveolar macrophages and vascular endothelial cells were labeled. MCP-1 production by epithelial cells in IIP may be caused by the metaplastic nature of the epithelial cells and may be a main cause of the irreversible progression of IIP. (2) MCP-1 levels in bronchoalveolar lavage fluid (BALF) were significantly higher in the IIP, the interstitial pneumonia due to collagen vascular disease (IP-CVD) and sarcoidosis groups than in normal controls. In the IIP group, the MCP-1 level was significantly higher than in any other patient groups. In all three groups of patients, the monocyte chemotactic activity in BALF correlated positively with the MCP-1 levels in BALF, and were neutralized by anti-MCP-1. (3) BALF MCP-1 levels were significantly higher than serum MCP-1 levels in the IIP group, and they were lower in the IP-CVD and non-specific interstitial pneumonia groups. Serum MCP-1 levels reflected the activity of interstitial lung diseases, especially during treatment with corticosteroids. These results indicate (1) that MCP-1 plays a significant role in the recruitment of monocytes into the lung in IIP, (2) that measuring MCP-1 levels both in BALF and in serum may help discriminate IIP from other types of interstitial lung diseases, and (3) that monitoring the serum MCP-1 level may be useful in estimating the activity of interstitial lung diseases.

Crohn's disease associated with colo-bronchial fistula

An 18-year-old female patient with Crohn's disease presented with left lower lobe pneumonia and pleural effusion which were resistant to treatment with antibiotics. Colo-bronchial fistula had not been recognized until she coughed up yellow sputa with feculent odor and developed acute respiratory distress syndrome. This type of fistula is a rare complication of Crohn's disease, but the present case certainly alerts physicians to search for a fistula between the bronchus and gastrointestinal tract when encountering patients with Crohn's disease accompanied by antibiotic-resistant chronic pneumonia.

Expression of inducible nitric oxide synthase and its involvement in pulmonary granulomatous inflammation in rats

Two types of pulmonary granulomatosis were produced in rats by intratracheal instillation of zymosan or silica. In both models, immunostaining with anti-rat monoclonal antibody for inducible nitric oxide synthase (iNOS), ANOS11, showed that the intensity of iNOS immunoreactivity in the inflammatory lesions peaked at 3 days and declined thereafter. Immunohistochemical double staining and in situ hybridization demonstrated the expression of iNOS in neutrophils, monocyte-derived macrophages, and bronchiolar epithelial cells in the pulmonary lesions. Electron spin resonance spectroscopy revealed the production of an excessive amount of nitric oxide (NO) in the pulmonary lesions. Immunostaining with a polyclonal antibody against nitrotyrosine indicated the formation of nitrotyrosine residues in the granulomatous lesions, particularly in the periphery of the lesions, providing indirect evidence for the generation of peroxynitrite anion in the zymosan- or silica-instilled lungs. Administration of N omega-nitro-L-arginine methyl ester or S-methylisothiourea sulfate, which significantly suppressed NO production, resulted in marked reduction of monocyte/macrophage infiltration as well as in inhibition of induction of monocyte chemoattractant protein-1 in the lesions. These data indicate that NO and its more reactive product peroxynitrite anion may be important mediators of granuloma formation in the lung.

Carotid artery disease in patients with retinal artery occlusion

Embolization from the carotid bifurcation has been proposed as the most common cause of central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO). The purpose of this study was to evaluate carotid artery disease in patients with CRAO and BRAO. Using carotid ultrasonography, 17 patients (13 males, 4 females, mean age 68.7 +/- 7.1 years) with CRAO and BRAO were examined for stenotic findings and plaque morphology (homogeneous or heterogeneous) within 7 days after onset. The internal carotid artery (ICA) ipsilateral to the affected side showed a significantly higher incidence of severe carotid stenosis as compared to the non-affected side. The occurrence of heterogeneous plaques in the ICA did not differ between the affected and the non-important affected side. We suspect that severe carotid stenosis in addition to heterogeneous plaques plays an important role in retinal artery occlusion.

A new simple and rapid screening method for variant transthyretin-related amyloidosis

To screen for transthyretin (TTR) related amyloidosis rapidly and reliably, we have developed a new method using a centrifugal concentrator device and electrospray ionization mass spectrometry (ESI-MS). Only 50 microliters of serum is needed for the analysis. After preparation of the samples with anti-TTR antibody they were passed through a 1000 kDa cut off centrifugal concentrator which retained the antibody. By analyzing the obtained filtrate with ESI-MS, variant forms of TTR was detected. TTR (Met30), with a molecular weight 32.0 Da higher than the normal form of TTR, was found in all FAP patients examined. In 3 liver transplanted FAP patients, the abnormal peaks had disappeared. In conclusion, The TTR Met30 mutation was easily detected in serum samples by electrospray ionization mass spectrometry after centrifugal concentration. The proposed method is simple to perform, as no HPLC is required, and offers a possibility to screen populations for TTR related amyloidosis.

Autonomic dysfunction and anemia in neurologic disorders

The effect of autonomic dysfunctions on anemia in various neurological disorders, such as familial amyloidotic polyneuropathy (FAP) Type I, pandysautonomia, and Shy-Drager syndrome was examined. As a control, hemograms of patients with amyotrophic lateral sclerosis (ALS), which is known to be free from autonomic dysfunction, was compared with patients with the above neurological disorders. FAP and pandysautonomia patients showed significant anemia comparable with the severity of the autonomic dysfunctions. Shy-Drager patients exhibited mild anemia. However, in ALS patients, no such anemia was recognized at all even in the end stage of this disease. In pandysautonomia patients, hypoplastic bone marrow was recognized, which was quite consistent with the data previously reported in FAP patients. Human recombinant erythropoietin improved orthostatic hypotension as well as anemia in 4 FAP patients. These results suggest that autonomic dysfunction may be deeply connected with erythropoiesis.

Inhibitory effect of tyrosine kinase inhibitors on antigen-induced tracheal contraction and histamine release in guinea pigs

We examined the effect of two different types of tyrosine kinase inhibitor, herbimycin A and genistein, on antigen-induced tracheal contraction and antigen-induced histamine release from the trachea in sensitized guinea pigs in vitro. Herbimycin A (1-10 microM) and genistein (1-10 microM) significantly inhibited antigen-induced tracheal contraction, compared with control. Additionally, herbimycin A (1-10 microM) and genistein (3-10 microM) significantly inhibited antigen-induced histamine release from the trachea in a concentration-dependent manner, compared with control. On the contrary, herbimycin A and genistein did not suppress acetylcholine- and histamine-induced tracheal contraction. We concluded that herbimycin A and genistein inhibit antigen-induced tracheal contraction without inhibiting smooth muscle contractility, and these inhibitory effects are due to, at least partially, inhibiting histamine release from tracheal mast cells.

Is use of aprotinin safe with deep hypothermic circulatory arrest in aortic surgery? Investigations on blood coagulation

BACKGROUND

The perioperative blood coagulation and fibrinolysis system in patients who underwent aortic surgery under deep hypothermic circulatory arrest with or without aprotinin usage was investigated.

METHODS AND RESULTS

Of 112 patients who underwent aortic surgery between December 1993 and April 1995, 60 had repair under deep hypothermic circulatory arrest. Thirty-nine patients had 2 million U aprotinin in pump priming and had no additional aprotinin. There were 20 patients with aortic dissections and 17 with atherosclerotic aneurysms. Twenty-two patients had left thoracotomy, and 17 had midsternotomy. Surgery consisted of replacement of the ascending aorta in 9 patients, total arch replacement in 11, distal arch replacement in 11, replacement of the descending aorta in 3, and replacement of thoracoabdominal aorta in 5. The control group was 21 patients who underwent operation under deep hypothermic circulatory arrest and retrograde cerebral perfusion but without aprotinin. Blood coagulation and fibrinolysis tests, consisting of activated clotting time, prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin III, plasminogen, alpha 2-plasmin inhibitor, thrombin-antithrombin complex, plasmin inhibitor complex, fibrin degenerative products, and D-dimer complex, were performed at various stages of surgery, before heparin administration, after heparin, 60 minutes and 120 minutes after beginning of the extracorporeal circulation, 1 hour after protamine administration, and 6 hours after protamine. Statistical analysis was performed with Student's t test, chi 2 test, and ANOVA. The amount of bleeding after perfusion was less in the aprotinin group, and bleeding during first 24 hours in the intensive care unit was less. Blood examination revealed that prothrombin time was higher after cessation of cardiopulmonary bypass in the aprotinin group. Thrombin-antithrombin III complex and alpha 2-plasmin inhibitor were higher during and after bypass in the aprotinin group. There was no difference in activated clotting time, activated partial thromboplastin time, fibrinogen, antithrombin III, plasminogen, plasmin inhibitor complex, fibrin degenerative products, and D-dimer complex.

CONCLUSIONS

Clinical advantages of hemostatic effects of low-dose aprotinin and no apparent deleterious effects were demonstrated in patients who underwent aortic surgery under deep hypothermic circulatory arrest with retrograde cerebral perfusion. However, blood coagulation and fibrinolytic studies revealed subclinical hypercoagulation. Therefore, and adequate dose of heparin is required during deep hypothermic circulatory arrest.

[Squamous cell carcinoma of ureter in a patient with functional solitary kidney treated by partial ureterectomy: a case report]

We report a case of squamous cell carcinoma of ureter. A 60-year-old female was referred to our hospital for the right hydronephrosis and the left atrophic kidney. She had been suffering from severe renal dysfunction and had hemodialysis a month earlier. Retrograde and antegrade right pyelography revealed complete obstruction of the right lower ureter about 2 cm in length. Transcutaneous retrograde left pyelography revealed vesicoureteral junction stenosis. After improvement of the renal function by transcutaneous right nephrostomy, the patient underwent right partial ureterectomy. Pathological examination revealed squamous cell carcinoma, grade 2, pT3 in the right ureter. Neither local recurrence nor distant metastasis has occurred for 19 months and the patient retains moderate renal function. We reviewed sixty-four cases of ureteral squamous cell carcinoma in the Japanese literature and discussed the renal parenchymal sparing surgery for the disease.

[Ultrasonographic study of rectal carcinoid tumors]

To compare intraluminal ultrasonographic (ILUS) findings with histological findings of rectal carcinoid tumors, 35 patients with rectal carcinoid tumors were reviewed. The results were as follows: 1) The rectal wall was visualized as a seven- or nine-layer structure by means of ILUS in 81% of the patients. 2) The possibility that the thin hyperechoic third layer above the tumor on ILUS corresponds to the muscularis mucosae and fibrointerstitium above the tumor histologically. 3) In cases with relatively high internal echoes, the amount of fibrointerstitium exceeded that of tumor cells histologically. 4) In cases with nonuniform internal echo patterns, tumor cells were separated by thick fibrointerstitium forming nodular nests.

Small-Angle X-ray Diffraction of Muscle Using Undulator Radiation from the Tristan Main Ring at KEK

Time-resolved X-ray diffraction of muscle has demanded ever-increasing flux into small sample volumes with low beam divergence. Results are reported of static and time-resolved small-angle X-ray diffraction studies on muscle fibers using a hard X-ray undulator installed in the Tristan main ring at KEK, Tsukuba, Japan, as an innovative source of synchrotron radiation more intense and better collimated than that available with the Photon Factory bending-magnet beamline. Static studies used the low divergence of the source to obtain detailed high-quality diffraction patterns of stable muscle states. The diffraction patterns from live skeletal muscles showed the numerous (over 100) meridional reflections. The well collimated beam from the undulator made it possible to clearly resolve, with an angular resolution of ca 700 nm, the closely spaced diffraction peaks arising from the two halves of the thick filaments centred on the M lines in a sarcomere, in addition, the diffraction peaks from the thin filaments on opposite sides of the Z bands could be resolved with an angular resolution of ca 1000 nm. The detailed structure of the meridional pattern defines the nature of the molecular packing in the thick and thin filaments. Time-resolved experiments using a focusing mirror aimed to prove cross-bridge states in striated muscle fibers by collecting X-ray diffraction data at a 0.185 ms time resolution from sinusoidally oscillating chemically skinned rabbit muscle fibers during active contraction and in rigor. When sinusoidal length changes at 500 Hz with a peak-to-peak amplitude of 0.6% of the muscle length were applied to a small fiber bundle, the tension showed a simple elastic response during the length oscillation. In the active muscle the intensity of the 14.5 nm myosin-based meridional reflection changed out of phase with the tension change during the oscillating length change. In contrast, in the rigor muscle it occurred in phase with the tension change. The high time-resolved experiments provide an insight into the coupling between conformational changes and force generation of the actomyosin cross-bridges. These studies provide a preview of the expected gains for muscle studies from the more widespread use of undulator radiation at third-generation synchrotron sources.

Regulation of neutrophil superoxide generation by alpha-tocopherol in human peripheral and umbilical-cord blood

OBJECTIVES

Alfa-tocopherol (VE) inhibits protein phosphorylation and affects protein kinase C (PKC)-dependent superoxide (O2) generation of phagocytic cells. Because umbilical-cord blood contains low concentrations of VE, we studied the effects of VE on stimulation-dependent O2 generation of neutrophils derived from the healthy human peripheral circulation (HPMNs) and the umbilical cord (UCBNs).

METHODS

O2- generation and VE content were assayed by reduction of ferricytochrome c and by HPLC with an electrochemical detector, respectively. Neutrophil-specific annexin protein was identified by an immunological method.

RESULTS

Both types of neutrophils generate significant amounts of PKC-dependent O2-generation, but weak PKC-independent O2-generation, except for opsonized zymosan-stimulated O2- generation in UCBNs. The VE content of UCBNs was similar to that of HPMNs although umbilical-cord blood contains a low concentration of VE. A neutrophil-specific annexin protein was also found in the UCBNs.

CONCLUSION

UCBNs have a greater ability to incorporate VE than HPMNs do, but have similar general characteristics of stimulation-dependent O2-generation to those of HPMNs.

Small-vessel radiography in situ with monochromatic synchrotron radiation

PURPOSE

To evaluate the usefulness of a radiographic system with monochromatic synchrotron radiation to depict small vessels and peripheral secretory ducts.

MATERIALS AND METHODS

Radiography of various organs was tested in 14 anesthetized dogs and pancreatography was performed in an excised human pancreas by using the following system: monochromatic synchrotron radiation with an energy level just above the k absorption edge of iodine as an x-ray source and a high-definition TV system with a high-light-sensitivity image pick-up tube camera coupled with a fluorescent screen as a detector.

RESULTS

This system allowed depiction of small vessels (diameter < 50-100 microns) of the heart (penetrating transmural artery), brain (perforating arteries that arise directly in the circle of Willis), and intestinal organs (vasa recta and their submucosal communications) and of small branches (down to the fifth order) of the pancreatic duct.

CONCLUSION

The synchrotron radiation system may be useful for evaluating microcirculatory disorders and early-stage malignant tumors in various human organs.

Hereditary cerebellar ataxia with Leber's hereditary optic neuropathy mitochondrial DNA 11778 mutation

We investigated a family with optic atrophy which occurred in childhood or early adulthood plus late-onset cerebellar ataxia. The magnetic resonance imaging in the proband revealed cerebellar atrophy. The proband and her brother were homoplasmic for the most common mitochondrial DNA (mtDNA) 11778 mutation associated with Leber's hereditary optic neuropathy (LHON). This study showed further evidence that central nervous system lesions can occur in cases of LHON mtDNA mutation.

[Effect of weight of feature and frequency on recognition of butterfly patterns]

Three experiments are reported which deal with the nature of categorization of natural objects. Stimulus materials were schematic butterfly patterns. Systematic transformations were given to the original pattern to make stimulus instance. In Experiment 1, subjects were given a recognition memory task with recognition ratings. Recognition ratings were found to be related to family resemblance score (FRS: the sum of feature frequency in the category) rather than to transformation or subjective similarity to the original. In Experiment 2, subjects were given the recognition memory task while the FRS was kept constant. Weight of each feature affected recognition ratings differently, when FRS was kept constant. In Experiment 3, subjects were given the same task as in Experiment 2 while the FRS and the component frequency of each feature were kept constant. Again each feature affected recognition ratings differently. These findings suggest that both the frequency and weight of feature itself affect recognition ratings.

Influence of genetic and maternal diabetes in the pathogenesis of visceroatrial heterotaxy in mice

The NOD mouse is known as a spontaneous model of insulin-dependent diabetes mellitus. Fetuses in this strain present anomalies of the viscera, and the incidence increases in fetuses from dams with clinically manifested diabetes. To examine the role of maternal diabetes and the genetical influence in inducing heterotaxy, NOD dams were mated with males of the ICR strain (the original strain of the NOD) and with C57BL/6J sires (not genetically related to the NOD). The frequency of visceroatrial heterotaxy in fetuses from diabetic dams varied with the fetal genotype, being 65% (33/51) in NODxNOD (dam X sire, respectively), 24% (12/50) in NODxICR, and 7% (4/57) in NODxC57BL/6J. The cases with heterotaxy showed a tendency toward right isomerism of the viscera and had severe cardiac defects, such as endocardial cushion defect and double-outlet right ventricle or transposition of the great arteries. The fetal body weight from diabetic dams in each mating was lower than that from non-diabetic dams (P < 0.05), suggesting that maternal diabetes, rather than abnormal situs, is the main determinant for decreased fetal growth. These findings demonstrate that the liability to heterotaxy induced by maternal diabetes is influenced by the fetal genotype.

Acceptability of patients with brain metastases for clinical trials of chemotherapy for metastatic non-small-cell lung cancer

This study was conducted to determine whether patients with brain metastases from non-small-cell lung cancer (NSCLC) should be included in clinical trials of chemotherapy. Patients with metastatic NSCLC and good performance status were studied. The survival of patients with brain metastases was compared with that of patients without brain metastases. Of 100 eligible patients, 22 had brain metastases at diagnosis. The median survival time was poorer in patients with brain metastases than in other patients with metastatic NSCLC (96.5 vs. 181.5 days). However, the difference in survival was not significant on univariate analysis (p = 0.106). Multivariate analysis confirmed that the prognostic value of brain metastases was limited in this sample (p = 0.129). There was little difference in survival curves during the first 8 weeks. Patients with brain metastases who have good performance status and minimal neurologic symptoms can be observed for approximately 8 weeks in clinical trials to determine their response to chemotherapy. However, it is doubtful that patients with brain metastases would be eligible for phase III trials, in which survival is an endpoint.

[Cerebral infarction associated with meningitis]

Among 43 adult patients with meningitis, 8 (18.6%) had cerebral infarction associated with meningitis during their clinical course. The total number of cerebral infarctions was 18. In 4 patients of good outcome (ambulatory in 3 cases and wheelchair in 1 case) with a mean age of 39 years, the number of cerebral infarctions was 1 per patient, and did not increase. In 4 patients of poor outcome (vegetative in 2 cases and died in 2 cases) with a mean age of 68 years, the number of cerebral infarctions was 1 in two cases and 2 in two cases, and later increased in 3 of the cases. Locations of cerebral infarctions were 3 in the striatocapsular lesion, 1 in the posterior limb of internal capsule, 1 in the middle cerebral artery territory, 5 in the tuberothalamic artery territory, 5 in the capsular genu, 1 in the posterior choroidal artery territory, and 2 in the medial striate artery territory. Patients of poor outcome had capsular genu infarction. It was concluded that multiplicity and multiplication of cerebral infarction were markers of the severity of the meningitis.

[A case of Borrmann type 4 gastric cancer successfully treated with MTX and 5-FU therapy through the hepatic artery]

A 73-year-old male was diagnosed as having a Borrmann type 4 gastric cancer with multiple liver metastases. Total gastrectomy (D2) with hepatic arterial cannulation was performed. Hepatic arterial infusion therapy of MTX (50 mg or 100 mg/body) and 5-FU (500 mg or 750 mg/body) was started postoperatively. A total dose of 1,150 mg of MTX and 6,250 mg of 5-FU caused a marked decrease in the volume of liver metastases and the effect remained for 8 months (partial response). Regarding drug concentrations, serum MTX levels rapidly decreased after bolus injection through hepatic artery and corresponded to those of intravenous injection as reported elsewhere. Serum 5-FU levels were maintained as low as 1.2 micrograms/ml during 2-hr continuous infusion and rapidly decreased after the end of the infusion. These results indicate that hepatic arterial infusion therapy of MTX and 5-FU may be safe and feasible for multiple liver metastases of Borrmann type 4 gastric cancer.