Expression of HLA-class II antigen in gastric carcinomas. Its relationship to histopathological grade, lymphocyte infiltration and five-year survival rate

To investigate whether the expression of HLA-DR antigen in gastric carcinomas is associated with the survival rate, we studied 70 cases of gastric carcinoma using a monoclonal antibody. Forty-seven cases (67%) stained positively, including 31 differentiated carcinomas, and 16 undifferentiated carcinomas. A close correlation was found between expression of HLA-DR antigen and differentiation of the tumor cells. Marked lymphocyte infiltration was seen in the HLA-DR antigen positive cancers. In advanced gastric cancers, the 5-year survival rate of patients with HLA-DR antigen positive cancers was significantly higher (67.5%) than that of patients with HLA-DR antigen negative cancers (40%). The data suggest that the expression of HLA-DR antigen in gastric carcinomas may reflect the degree of tumor cell differentiation, and influence the host immune response and prognosis.

Determination of the tooth mobility change during the orthodontic tooth movement studied by means of Periotest and MIMD (the mechanical impedance measuring device for the periodontal tissue)

Two mechanical devices were selected to attempt to assess any changes in tooth mobility when orthodontic force was applied. A Periotest (PT) for assessing mobility and a mechanical impedance measuring device (MIMD) were the instruments chosen to diagnose the changes in the periodontal condition. The relative mobility of four canines after orthodontic tooth movement manipulation was assessed over a 4-week period. Both devices were able to detect very small changes in tooth mobility and could follow the changes during tooth movement. According to the Periotest unit, the tooth mobility changes were not within the clinically abnormal range, despite the initial retraction load from a sectional arch, applied in a horizontal direction with about 150 gm for each tooth. In all instances, the contiguous maxillary first premolar had been removed 1 to 2 months before force application. The tooth mobility observed in this investigation could be different from that caused by periodontal disease or traumatic injury. Just after orthodontic tooth movement manipulation, the Periotest values (PTV), as measured on the Periotest, of tooth mobility decreased and the resistance as measured by the mechanical impedance measuring device (MIMDM) was increased. Thus, initially, there is a greater resistance to movement with decreased mobility. After the experimental period of 4 weeks, there was an increase in the mobility, as measured by the Periotest and the mechanical resistance decrements were observed. However, the Periotest units showed some different changes occasionally that did not seem to reflect the state of tooth movement. This needs to be investigated further over a longer period of time. On the basis of the results obtained, it does appear that it is feasible to use these devices to determine mobility changes in patients at various stages of orthodontic treatment.

[Aneurysm of the diverticulum of the ductus arteriosus]

Aneurysm of the diverticulum of the ductus arteriosus in adult is rare, with only 37 cases reported so far in the literatures. A 18-year-old male was admitted for abnormal tumor shadow in the scout chest X-ray film. Ductal aneurysm was preoperatively diagnosed by chest CT scan, MRI, UCG, and angiography, and was confirmed by the intraoperative findings. In this patient, narrow isthmus and ductus diverticulum were supposed to be contributing factors for aneurysm formation. The aneurysm was approached through a posterolateral thoracotomy and aneurysmal orifice was closed with a trimmed dacron graft under partial femoro-femoral cardiopulmonary bypass. Postoperative course was uneventful.

Association between expression of sialosyl-Tn antigen and intestinalization of gastric carcinomas

We examined immunohistochemically the expression of sialosyl-Tn antigen (STN) in 137 primary gastric carcinomas. In the non-neoplastic mucosa, STN was expressed in all goblet cells, most absorptive cells and Paneth cells of intestinalized tubules, whereas it was not seen in the gastric mucosa proper. We evaluated the association between the mucin-histochemical findings of intramucosal carcinomas and the STN-expression. STN was expressed in 8 of 20 undifferentiated-type carcinomas, all of which were mucin-histochemically of the gastric type. STN was expressed in 25 of 51 differentiated-type carcinomas, among which it was expressed in 3 of 12 gastric-type, 11 of 17 intestinal-type and 11 of 22 mixed-type adenocarcinomas. The extent of STN expression in the intestinal-type adenocarcinomas was significantly higher than in gastric-type adenocarcinomas and undifferentiated-type carcinomas, and that seen in mixed-type adenocarcinomas was significantly higher than in the gastric-type adenocarcinomas. We also examined STN expression in early and advanced carcinomas. As the depth of carcinoma invasion progressed, the extent of STN expression was significantly higher and its incidence was significantly higher. Our findings suggest that STN expression reflects intestinalization of the gastric mucosa, and that a kind of intestinal metaplasia occurs in progressing gastric carcinoma cells.

UDP glucuronosyltransferase gene expression is involved in the stimulation of ascorbic acid biosynthesis by xenobiotics in rats

Wistar-Shi (genotype +/+), heterozygous Gunn (j/+) and homozygous Gunn (j/j) rats was injected intraperitoneally with 3-methylcholanthrene (3MC) dissolved in corn oil. In rats of all genotypes the hepatic concentration of UDP glucuronosyltransferase (UDPGT) mRNA was increased at 48 and 96 h after the treatment with 3MC. Hepatic activity of 4-nitrophenol UDPGT was increased by 3MC in Wistar-Shi rats and heterozygous Gunn rats but not in homozygous Gunn rats. Urinary ascorbic acid excretion increased 72 and 96 h after the injection with 3MC in Wistar-Shi and heterozygous Gunn rats but not in homozygous Gunn rats. Ninety-six hours after the injection with 3MC, the hepatic concentration of ascorbic acid in Wistar-Shi rats was 90% higher than that in the corresponding control group, whereas in heterozygous and homozygous Gunn rats the increases were 70 and 30%, respectively. Wistar-Shi rats and homozygous Gunn rats were also injected daily for 3 d with sodium phenobarbital. In rats of both genotypes, the activity and hepatic concentration of chloramphenicol-UDPGT mRNA and liver and urine ascorbic acid concentration were increased by sodium phenobarbital. The data indicate that the stimulation of the expression of both the 4-nitrophenol and chloramphenicol UDPGT genes plays a key role in the ascorbic acid biosynthesis induced by 3MC and sodium phenobarbital.

Stabilization of alpha-helix in C-terminal fragments of neuropeptide Y

To elucidate the alpha-helix-stabilizing effect of amino acids at the helical ends, we prepared analogs of C-terminal fragments of neuropeptide Y (NPY) containing an alpha-helical part. The helix-stabilizing tendency of N-terminal amino acid in NPY (12-36) was found to be as follows: Thr > Ser > Gly > Gln > Cys > Asn > Asp > Val > Phe > Glu > Lys > Tyr > Ala = Trp > His > Arg, suggesting the importance of end capping. The capping effect was not evident when N-termini in NPY (11-36) and NPY (13-36) were replaced. Under the same conditions as those for the receptor binding, [Thr12]NPY (12-36) had about 4-fold higher alpha-helix content than [Arg12]NPY (12-36). However, there was no apparent relationship between the helix content and binding affinity to the Y2 receptor.

Micturitional disturbance in progressive supranuclear palsy

Detailed micturitional histories were taken from nine patients with progressive supranuclear palsy (PSP), and eight of them (89%) had micturitional symptoms including urinary incontinence in seven. Urodynamic studies were performed in six patients and the results were as follows. Three had residual urine of 100 ml on average. Four had detrusor hyperreflexia and one had a low compliance cystometrogram. One had detrusor-sphincter dyssynergia. Motor unit analysis of external sphincter was performed in four patients and two had neurogenic changes. The results were compared with our previous findings in Parkinson's disease and in striato-nigral degeneration (SND), and we found that a severe degree of micturitional disturbance in PSP seems to be as common as in SND, especially in the urinary storage phase, and more frequent than in Parkinson's disease. Supranuclear types of pelvic and pudendal nerve dysfunctions seemed to be mainly responsible for micturitional disturbance in PSP.

[A case of coronary artery bypass grafting (CABG) with acquired tracheobronchomalacia]

Acquired tracheobronchomalacia is often overlooked because the symptoms are similar to those of chronic obstructive lung disease. A 55-year-old man underwent an emergency CABG because of unstable angina pectoris. CABG was performed uneventfully. On the third day after operation, severe cough and dyspnea were persisted, followed by the episode of ventricular fibilliration. Cardiopulmonary resuscitation was necessary. CT scan of the chest showed crescent narrow deformity from the lower trachea to the right main bronchus. Bronchoscopic examination revealed 90% stenosis of the trachea during coughing, and edematous tracheal mucosa. Acquired tracheobronchomalacia is an illness of the middle-aged and the elderly and tends to be progressive. Recently, because the patients for CABG have become older, tracheobronchomalacia should be taken into consideration.

A model of in vivo cell proliferation of adult T-cell leukemia

We have made a model of in vivo cell proliferation of leukemic cells from adult T-cell leukemia (ATL) patients using severe combined immunodeficiency (SCID) mice. Peripheral blood mononuclear cells (PBMC) or lymph node cells (LNC) depleted of B cells and monocytes were intraperitoneally injected into SCID mice treated with antimurine interleukin-2 receptor (IL-2+) beta chain monoclonal antibody (MoAb)(TM-beta 1), followed by daily injection of human recombinant IL-2 until 60 days after cell injection. SCID mice injected with ATL cells from 6 of 8 ATL patients were found to have the tumor or leukemia 5 to 7 weeks after the inoculation of cells. Serum levels of soluble form of human IL-2R alpha chain (Tac) were markedly elevated in such mice. The cells recovered from the mice injected with leukemic cells from four different ATL patients had the same cell surface phenotype as that of original leukemic cells which were CD4+Tac+. Furthermore, we detected the same integration site of human T-cell leukemia virus type I (HTLV-I) provirus and the same rearrangement pattern of human T-cell receptor (TCR) beta chain gene as those of ATL cells by Southern blot hybridization, indicating that the cells proliferating in SCID mice were derived from the original ATL cell clone. Histologic examination showed that the pattern of the infiltration of ATL cells into various organs in SCID mice was similar to that of an ATL patient. Such a model of in vivo cell proliferation of ATL cells will be useful for the study of the mechanism of neoplastic cell proliferation and for the development of a new and effective treatment of ATL.

Lower urinary tract dysfunction in the anterior spinal artery syndrome

Lower urinary tract function was studied in 10 patients with the anterior spinal artery syndrome. In the acute stage all patients had complete urinary retention. Cystometry in 3 patients showed detrusor areflexia. At a neurologically stable stage 9 patients could void and 1 had urinary retention during the preceding 7 years. Cystometric bladder capacities at first and maximum desire to void were decreased in 8 patients and normal in 2. Detrusor hyperreflexia was noted in 8 patients, a normal bladder in 1 and detrusor areflexia in 1. External urethral sphincter electromyography revealed detrusor-sphincter dyssynergia in 4 patients and normal findings in 6. We conclude that the vesicomotor dysfunction in this syndrome is similar to that of traumatic spinal cord injury except that bladder sensation is preserved. The latter finding indicates that at least some of the bladder sensation travels via the posterior columns of the spinal cord.

Micturitional disturbance in radiation myelopathy

Detailed micturitional histories and urodynamic studies were performed in five patients with radiation myelopathy. All patients had micturitional symptoms that were irritative in five and obstructive in four, and four had urinary incontinence. Urodynamic studies showed that three patients had residual urine of 158 ml on average. Cystometry showed that four patients had detrusor hyperreflexia and one had low compliance cystometrogram. External sphincter electromyography showed that four patients had detrusor-sphincter dyssynergia. These results indicated that micturitional disturbance seemed to be common and severe in storage as well as evacuation function. The main responsible sites of lesions seemed to be supranuclear parasympathetic and somatic nervous systems regulating the lower urinary tract. Two of three patients who underwent combination of steroid pulse therapy and hyperbaric oxygen therapy experienced improvement of micturitional disturbance and other neurological deficits.

Facilitation of transmitter release from mouse motor nerve terminals by stannous chloride

Although a mixture composed of 30 microM stannous chloride (SnCl2) and 75 microM tartaric acid (TA) facilitates neuromuscular transmission in the frog, the mixture had no effect on the endplate potential (e.p.p.) in the rat. The present study has been undertaken to determine whether the responses of the mouse (mammalian) to SnCl2 are different from those of the frog (amphibian). The mixture had no effect on the resting potential or the membrane resistance of the muscle fiber. The mixture did not change the e.p.p. amplitude, but TA (75 microM) significantly decreased it. The mixture increased the quantal content of the e.p.p., but TA decreased it. The mixture raised the frequency of the miniature endplate potential (m.e.p.p.) in the high potassium-medium. In normal saline, both the mixture and TA decreased both the m.e.p.p. frequency and its amplitude. These results suggest that SnCl2 itself facilitates the transmitter release from nerve terminals in the mammalian as well as in the amphibian species.

Propylene glycol-induced skeletal muscle excitation

The effects of propylene glycol (PG) on frog nerve-muscle preparations were examined to determine whether it has an effect on neuromuscular transmission and, if so, to elucidate the mode of the action. PG (5%, v/v) increased the twitch tension to over twice the control value. PG at concentrations above 0.2% significantly increased the amplitude of the endplate potential. PG (1%) raised the frequency of the miniature endplate potentials and increased their amplitude. These results show that PG both facilitates transmitter release from the nerve terminals and raises the acetylcholine sensitivity of the muscle endplate.

Opsoclonus showing only during eye closure in hereditary cerebellar ataxia

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[Mitral valve re-replacement for a patient with multiple myeloma]

Mitral valve re-replacement was successfully undertaken in a 70-year-old female patient with primary tissue failure of mitral bioprosthesis and multiple myeloma (MM) through right lateral thoracotomy with minimum dissection. Considering the post-operative anti-coagulant therapy, bioprosthesis was chosen in this complicated case. Patients with MM usually show a bleeding tendency associated with abnormally elevated IgG which covers the surface of coagulation factors. Safety range of serum IgG concentration in the patients with MM who require open heart surgery, have not defined yet. Excessive serum IgG leads the coagulation disorder and organ perfusion problem because of increase of blood viscosity. Those problems become serious when the serum IgG concentration exceed 2,500 mg/dl. (1) Only if serum IgG level below 2,5000 mg/dl, valve replacement will be able to perform safely with minimum dissection through the thoracotomy for patients with MM. (2) Bioprosthesis might be optionally chosen in such case (3). In case of serum IgG level over 2,500 mg/dl, preoperative plasma ex-change should be recommended.

Acetabular development after closed reduction of congenital dislocation of the hip

We reviewed the serial radiographs of 54 hips in 47 children treated by closed reduction for congenital dislocation of the hip and followed to at least 14 years of age, to determine the causes of acetabular dysplasia. We excluded hips with femoral head deformity or residual subluxation and compared the results with those from a control series of unaffected hips of patients with unilateral CDH. Acetabular development after the age of 11 or 12 years was significantly worse in Severin group III than in Severin group I hips on the affected side or Severin group III in unaffected control hips. One of the causes of acetabular dysplasia at maturity was found to be impairment of acetabular development after 11 or 12 years of age. This may be attributable to impaired secondary ossification in the acetabular rim. Our findings emphasise the importance of continuing the follow-up of patients treated for congenital dislocation of the hip until full skeletal maturity.

Studies on phosphorylated transcriptional regulator (NarL) for E. coli nar operon by 31P-NMR spectroscopy

The sequential transphosphorylation from autophosphorylated nitrate-sensing protein (NarX) to the transcriptional regulator protein (NarL), both operating in signal transduction to control the expression of the respiratory nitrate reductase (nar) operon in E. coli, was demonstrated with an in vitro reconstructed system to function similarly to other bacterial two-component regulatory systems. Over-expression system established by means of the pT7 promoter/polymerase provided both NarX and NarL proteins to reconstruct the in vitro transphosphorylation system. The phosphorylated NarL was detected, and the unstable phosphorylated group was directly assigned to acyl phosphate in the in vitro system by 31P-NMR spectroscopy.

Micturitional disturbance in multiple system atrophy

Detailed micturitional histories and urodynamic studies were conducted to investigate the micturitional disturbance in multiple system atrophy (MSA). Eighty-six patients with MSA comprised of 14 with striatonigral degeneration (SND), 42 with olivopontocerebellar atrophy (OPCA) and 30 with Shy-Drager syndrome (SDS). The results were as follows. Micturitional symptoms were noted in over 90% of patients with each type of MSA. Dominant symptoms were irritative ones in SND and OPCA, and a combination of irritative and obstructive ones in SDS. Micturitional symptoms in SDS appeared earlier than those in SND or OPCA. The degree of micturitional disturbance was severer in SDS than in SND or OPCA. Micturitional disturbance tended to become worse as the disease progressed. The responsible sites of lesions of micturitional disturbance seemed to be supra- as well as infranuclear lesions of the pelvic and pudendal nerves in MSA. Infranuclear lesions were more prominent in SDS than in SND or OPCA. Follow-up studies of some of the patients with SDS and OPCA suggested that the responsible sites of pelvic nerve lesions changed from supra- to infranuclear lesions during the course of disease.

Augmentation of in vitro cytolytic activity of LAK cells with heated ATL-derived cell lines

Three adult T-cell leukemia/lymphoma-derived cell lines, MT-2, MJ, and HUT102, were investigated to determine how they responded to hyperthermia, lymphokine-activated killer (LAK) cells, or a combination of both in vitro. All three cell lines showed a similar sensitivity to LAK cells, but revealed varying degrees of sensitivity to hyperthermia (MT-2 < MJ < HUT102) by 51Cr release assay. Hyperthermia did not cause immediate cell death as determined by the trypan blue exclusion test, but did cause substantial decreases in the numbers of heated cells within 2 days. The density of the cells began to increase thereafter, which was consistent with the results of the experiments labeling the cells with 3H-TdR after hyperthermia. When the cells were heated at 39-43 degrees C for 1-3 hr and then interacted with various LAK cell/ATL cell (E/T) ratios at 37 degrees C for 4 hr, total cytolysis of the cells increased in a synergistic and/or additive manner over that of the cells without hyperthermia. Prolonged incubation of the cells at high temperature did not necessarily cause a large increase in the interaction of LAK cells after hyperthermia. This augmentation of cytolysis by LAK cells after hyperthermia was not seen in normal peripheral lymphocytes. These results suggest that the combination therapy of hyperthermia and LAK cells may be more specific, useful, and effective for treating malignant lymphoma.

Immunohistochemical, quantitative immunoelectron microscopic, and DNA cytofluorometric characterization of chemically induced rat malignant fibrous histiocytoma

Malignant fibrous histiocytoma (MFH) was induced in rats by injection of 9,10-dimethyl-1,2-benzanthracene. Using cell suspensions prepared from the heterotransplanted nude mouse tumor as immunogen, a monoclonal antibody, (MAb), MEP-1, against fibroblastlike MFH tumor cells was generated. In the primary rat tumors and transplanted rat or nude mouse tumors, MEP-1 reacted specifically with the fibroblastlike cells but not with the histiocytelike cells or xanthoma cells. Anti-rat macrophage MAbs RM-1 and TRPM-3 did not stain the fibroblastlike cells, but both were reactive with the histiocytelike cells. Double stainings with both MEP-1 and RM-1 or TRPM-3 did not detect any double positive cells. Immunoelectron microscopy using these MAbs showed that the fibroblastlike cells were the major cell component of the primary and transplanted rat tumors and that their cell membrane was stained positively with MEP-1, but not for RM-1 or TRPM-3. By the double staining method using a MAb against prolyl 4-hydroxylase beta and MEP-1 or TRPM-3, this enzyme was demonstrated in MEP-1-positive cells but not in TRPM-3-positive cells. Results obtained by DNA cytofluorometry with 4,6-diamidino-2-phenylindole dihydrochloride staining or by the combined method of DNA cytofluorometry and indirect immunofluorescence, using MEP-1, RM-1, and TRPM-3, indicate that MEP-1-positive cells are neoplastic cells of rat MFH having proliferation activity. In the transplanted nude mouse tumors, no differentiation of MEP-1-positive rat tumor cells into histiocytelike cells was detected, and all histiocytelike cells were immunostained by F4/80 and most of them were positive for M5/114. These results suggest that fibroblastlike cells and intermediate cells are tumor cells of 9,10-dimethyl-1,2-benzanthracene-induced rat MFH showing differentiation toward fibroblasts and that histiocytelike cells are infiltrated macrophages.

Kinetic changes and experimental carcinogenesis after Billroth I and II gastrectomy

To determine the risk of gastric remnant cancer according to the type of surgical reconstruction, the distal two-thirds of the glandular stomach was resected in male Wistar rats, followed by gastroduodenostomy (Billroth I anastomosis) or gastrojejunostomy (Billroth II anastomosis). No carcinogens were given and the animals were killed 50 weeks after operation. No cancers developed in 22 rats undergoing Billroth I gastrectomy, but five of 24 with Billroth II anastomosis had adenocarcinoma (P < 0.05). All carcinomas were confined to the stoma. Animals with Billroth II anastomosis had a more advanced grade of mucosal atrophy at the stoma, with a higher incidence of cystic dilatation, submucosal adenocystic proliferation and pseudopyloric metaplasia (P < 0.05). Cell kinetics in the stomal mucosa after Billroth II gastrectomy showed an increased cell count in the proliferative zone, longer duration of S phase and increased cell cycle time (P < 0.05). These results suggest that Billroth II gastrectomy carries a greater risk of cancer than the Billroth I procedure.

[A case of brain abscess due to Streptococcus sanguis in association with multiple pulmonary arteriovenous fistulas]

A case is reported here of brain abscess due to Streptococcus sanguis in association with multiple pulmonary arteriovenous fistulas. A 19-year-old male who had been diagnosed in 1988 as pulmonary arteriovenous fistulas was admitted to our hospital for repeated epistaxis, headache, and vomiting. A brain abscess which was diagnosed using various roentogenologic examinations, worsened despite conservative therapy. Additional surgical drainage was performed; S. sanguis was isolated from the drainage fluid. After drainage, clinical symptoms gradually improved with no subsequent neurological deficits. We have formulated the following hypothesis regarding the mechanism of abscess formation in this case: S. sanguis invaded from a ruptured nasomucosal vein, forming a septic emboli in the blood flow, which passed through a pulmonary arteriovenous shunt and led to the formation of a brain abscess which established a metastatic presence in the cerebral tissue.

Inhibition of peritoneal tumor-cell implantation: model for laparoscopic cancer surgery

A serious concern in applying laparoscopic surgery to malignancies is the possibility of tumor spillage and seeding. We developed a model of peritoneal tumor implantation using a murine bladder tumor cell line, MBT-2. Anesthetized C3H male mice underwent mock laparoscopy with or without peritoneal disruption and instillation of tumor cells via a 16-gauge angiocatheter, and the effect of heparin and the pentapeptide Gly-Arg-Gly-Asp-Ser (GRGDS) on tumor cell adherence and growth was evaluated. Animals were divided into six groups: Group 1 = tumor cells only; Group 2 = peritoneal disruption + tumor cells; Group 3 = heparin + tumor cells; Group 4 = peritoneal disruption + heparin + tumor cells; Group 5 = GRGDS + tumor cells; and Group 6 = peritoneal disruption + GRGDS + tumor cells. In all animals, a greater tumor burden was noted at the sites of peritoneal disruption. Moreover, 50% and 63% of animals in Groups 1 and 2 developed tumors compared with 17% and 31% of those in Groups 3 and 4, respectively. There was significantly more tumor at the sites of peritoneal disruption in the "tumor only" groups than in those that received heparin (mean tumor volume 32.32 mm3 in Group 2 v 2.77 mm3 in Group 4; p < 0.05). The GRGDS-treated groups showed a trend toward decreased number and size of tumors compared with the tumor only groups, although the differences were not statistically significant. These findings imply that prophylactic irrigation with substances that decrease cell adherence may prevent tumor implantation after accidental intraoperative tumor spillage.

[Slow eye movements (slow saccades) in Wilson's disease]

Slow eye movements or slow saccades are relatively rare conditions in Wilson's disease where selective impairments of saccades are observed. The authors have a case of Wilson's disease showing a defect of saccades in all directions, with the complete preservation of smooth pursuit eye movements. T2-weighted images revealed abnormalities of signal intensity in bilateral pontine tegmentum, besides putaminal and thalamic lesions commonly seen in the previous reports. A rather selective disturbance of saccade eye movements due to the pontine tegmentum is consistent with the concept, as yet mainly based on experimental work on animals, of an anatomical segregation of the brainstem pathways for smooth pursuit eye movements, saccades, and vestibular and optokinetic patterns. Whereas the basal brainstem, especially basal pons, subserves smooth pursuit eye movements, saccades and reflex-like eye movements are mediated by the pontine tegmentum. The authors' case offers a support that dissociating eye movement disorders are due to the restricted lesions mentioned above.