[A case of large cell carcinoma of the lung arising from the inner surface of a pulmonary bulla and complicated by hematoma]

A 64-year-old man with a history of smoking was admitted to our hospital, because he was noted to have a solitary mass lesion at the apex of the right lung on a chest roentgenogram. Eight months before admission, he had come to our hospital because of hemoptysis. At that time, however, no abnormal shadow was seen on his chest roentgemogram, except for multiple bullae at both apexes. Based on chest CT findings on admission, the tumor appeared to be a hematoma growing inside the bulla. The resected tumor was found to contain a large amount of coagulated blood in the bulla. Histopathological examination of the bulla revealed a proliferation of large atypical cells from the inner surface of the bulla toward the inner space. Thus, the diagnosis was large cell carcinoma within the wall of the pulmonary bulla, the inside of which was filled with hematoma. We believe that the hematoma in the bulla allowed us to make an early diagnosis, and thus to succeed in curing the patient.

White matter hyperintensity in neurologically asymptomatic subjects

Recent advances in magnetic resonance imaging (MRI) technology have had a great impact on the delectability of minute, asymptomatic lesions of the central nervous system. The clinical significance and treatment modes of these lesions, such as white matter hyperintensity (WMH) lesions detected by T2 MRI, remain controversial. To address these problems, we retrospectively evaluated WMH lesions in relation to clinical parameters for 240 neurologically asymptomatic persons who had visited a hospital for a medical check-up of the brain. Proton and T2-weighted MRI were obtained using a 0.5 T superconducting MR imager using the spin echo technique with a repetition time (TR) of 2800 msec. An echo delay times (TE) of 40 msec was used for the proton MRI, and a TE of 100 msec was used for the T2-weighted MRI. The images were visually analyzed according to a four-point grading system. The MRI findings were correlated with clinical parameters including age, gender, presenting symptoms, and hypertension. The overall frequency of WMH increased with age. Grades 2 and 3 of WMH were more frequent in aged persons, whereas the occurrence of grade 1 WMH remained relatively constant across age groups. Based on multiple regression analysis, age was the most significant variable influencing the frequency of WMH, followed by hypertension. These results imply that WMH lesions may simply be a phenomenon of aging, or may be an indicator of prepathologic state in an ischemic brain.

Laparoscopic retrieval of disconnected ventriculoperitoneal shunt catheters: report of two cases

Two patients previously treated with ventriculoperitoneal shunt for hydrocephalus had the distal catheters disconnected, and they migrated to the free peritoneal cavity. The signs and symptoms of increased intracranial pressure occurred as a result of mechanical failure of the shunt system. Both patients successfully underwent a laparoscopic retrieval of the catheters using endoscopic grasping forceps, and revision of the ventriculoperitoneal shunt by inserting the new catheters into the peritoneal cavity was performed through a small entrance for the laparoscope. Recently, conventional laparotomy has been often replaced by laparoscopic surgery, and general surgeons are well familiar with the laparoscopic procedures. The significant advantage of this procedure is the ability to explore the entire peritoneal cavity for both diagnosis and treatment, and it is by far a less invasive approach than conventional laparotomy. The present report describes the laparoscopic procedure for removal of the migrated catheters and discusses its advantages over conventional laparotomy.

Significant correlation between connective tissue growth factor gene expression and skin sclerosis in tissue sections from patients with systemic sclerosis

The role of some growth factors and cytokines in the pathogenesis of systemic sclerosis (SSc) has been suggested. In particular, the contribution of transforming growth factor beta in the progression of skin sclerosis is suspected. Connective tissue growth factor (CTGF) was originally identified in human umbilical vein endothelial cells, and a recent study has revealed that human skin fibroblasts produce CTGF after stimulation with transforming growth factor beta. In the present study, the distribution of CTGF gene expression in tissue sections from patients with SSc was investigated by digoxigenin-labeled in situ hybridization. Strong CTGF mRNA signals were observed in the fibroblasts in sclerotic lesions, especially in the deep dermis, of the skin specimens from patients with SSc, whereas there was no expression in the skin from normal controls. The number of fibroblasts with positive hybridization signals was more abundant in the dermis from the sclerotic stage than in that from the inflammatory stage. Our findings indicate a correlation between CTGF gene expression and skin sclerosis and support the hypothesis that transforming growth factor-beta plays an important role in the pathogenesis of SSc, because transforming growth factor beta is the only inducer for CTGF identified to date.

[A case of complex brain anomaly with arachnoid cyst treated well by cyst-cisternal shunt]

A rare case of complex anomaly, composed of schizencephaly, polymicrogyria, heterotopic gray matter, agenesis of the septum pellicidi and arachnoid cyst at the right middle cranial fossa was encountered. A 38-year old man, complaining of epileptic seizure, was admitted to our department. His past history included cerebral palsy. Plain skull roentgenogram showed protrusion of the right temporal bone and thinning of the ipsilateral sphenoidal wing. CT revealed arachnoid cyst and parietal crest surrounded by cortical layer on the right side. MRI also demonstrated the arachnoid cyst, parietal crest and agenesis of septum pellicidi. MRI, especially proton density weighted image, well demonstrated cortical layer surrounding the parietal crest, right opercular polymicrogyria and left heterotopic gray matter. The crest was diagnosed as schizencephaly. The arachnoid cyst was treated by cyst-cisternal shunt with a silicone tube (Sapporo shunt) after fenestrating the cyst. The tube was inserted into the sylvian fissure from the cyst and sutured to the inner wall of the cyst. Despite slight intratumoral hemorrhage in the CT at 1.5 months after the operation, the cyst markedly decreased in size. As to the diagnosis of the brain anomaly, MRI gives extremely useful information. Particularly for the diagnosis of anomalies of migration of neuronal cells, MRI, especially proton density weighted image, has been regarded as an indispensable examination. In the operation of subarachnoid cyst, to maintain the flow between the inside of its cyst and the basal cistern, cyst-cisternal shunt with a silicone tube had satisfactory results.(ABSTRACT TRUNCATED AT 250 WORDS)

[Change of the cognitive function after open heart surgery]

The changes of cognitive function after open heart surgery was examined using the Hasegawa's Dementia Scale (max. 30 points) in 47 patients with average age of 61.7 years. The patient's score was obtained preoperatively, and 1st and 7th postoperative days. Patients with postoperative scores above 24 points were classified as Non-Decline group, and those below 23 points as Decline group; comparative analyses were done on the relationship between various perioperative factors on both groups. Anesthesia was induced with low-dose fentanyl and isoflurane-nitrous oxide in oxygen. The average operating time was 331 minutes, and the cardiopulmonary bypass time was 108 minutes with normothermia. There were 31 Non-Decline cases, and 16 (34%) Decline cases on the 1st and 5 (10 %) on the 7th postoperative day. The largest decrease in the Decline group was seen on the 1st postoperative day, and there were 4 cases of dementia. The factors in which a significant difference was observed between the 2 groups were age, amount of transfusion, extubation time, preoperative complications and postoperative cardiac index, and these was not related to the operation or ECC time. Moreover there were high incidences of postoperative complications, especially LOS, in the Decline group. It was concluded that one of the largest contributing factors of abnormality of the cognitive function postoperatively was age, and other factors such as pre- and postoperative general conditions of the patients, especially cardiac function, might also be related. The length of hospitalization in the cases of decreased cognitive function was longer.

The warm temperature acclimation-related 65-kDa protein, Wap65, in goldfish and its gene expression

cDNAs encoding a warm temperature acclimation-related protein (Wap65) were cloned from the muscle and hepatopancreas cDNA libraries of the warm temperature-acclimated goldfish Carassius auratus, and their nucleotide sequences containing 5'- and 3'-noncoding regions together with their polyadenylation signal were determined. The deduced amino acid sequence of Wap65 was 31% homologous to rat hemopexin. However, goldfish Wap65 lacked a few possible glycosylation sites and presumed functional histidine residues, implying that it may have different functions from hemopexin. Wap65 contained a leader peptide of 30 amino acids and a mature protein region of 415 amino acids. Southern blot analysis demonstrated that the protein is expressed by a single copy gene in the goldfish haploid genome. In RNA blot analysis using isolated cDNA clones, a single transcript of about 2.0 kilobases was detected in the hepatopancreas but not in brain, muscle, or hemocytes. The abundancy of this transcript markedly increased in the hepatopancreas as a result of warm temperature acclimation. Electrophoretic analysis of plasma proteins revealed a good correlation of plasma Wap65 levels to those of the corresponding transcript in the hepatopancreas, suggesting that serum Wap65 concentrations are regulated mainly by transcript levels in the hepatopancreas via the secretion process.

[Systemic and regional myocardial distribution of 123I-BMIPP in normal subjects]

We estimated the systemic and left ventricular (LV) regional myocardial distribution of 123I-BMIPP (beta-methyl-p-iodophenyl-pentadecanoic-acid) in normal subjects (n = 13, mean age 43.9). In planar studies, the count ratios of heart, lung and liver to mediastinum were 2.63, 1.28 and 3.80 in the early images, and 2.23, 1.20 and 2.26 in the delayed images, respectively. The uptake in liver was almost identical with that in heart in the delayed images. In SPECT studies, the regional relative counts in anterior, septal, posterior and lateral LV walls were 100, 98, 96 and 108 (%) in the initial images, and 100, 98, 99 and 107 (%) in the delayed images, respectively. The regional relative uptake was significantly higher in the lateral wall than those in the other parts of LV walls in both images. The relative counts in the basal, mid- and apical portions were 100, 111 and 87 (%) in the initial images, and 100, 113, 92 (%) in the delayed images, respectively. These results suggest that the myocardial regional distribution of BMIPP is not always uniform even in normal subjects. Thus, it is necessary to interpret with caution in the light of these findings, especially for detect in a myocardial lesion in an early phase of cardiomyopathy or a mild myocardial ischemia.

Macrophage colony stimulating factor inhibits experimental liver metastases from colon cancer

This study investigated the inhibitory effect of human macrophage colony stimulating factor (hM-CSF) on experimental liver metastases. Murine colon cancer cell lines C-26 and C-36 were each injected into the spleen of BALB/c mice and the number of subsequent liver metastases was counted. An optimal dose (3,000U/body/day) of hM-CSF to inhibit liver metastases was identified. Additionally, hM-CSF (3,000U/body/day) administration for 7 days before and after the injection of the same cancer cell lines was investigated. The mean number of liver metastases decreased significantly in the hM-CSF group compared with the saline group. These results suggest potential therapeutic benefit for the use of hM-CSF in the adjuvant treatment of liver metastases.

Hypoplasia of the internal carotid artery associated with spasmodic torticollis: the possible role of altered vertebrobasilar haemodynamics

We describe an unusual case of hypoplasia of the left internal carotid artery associated with an anomalous origin of the ipsilateral middle cerebral artery in a patient with spasmodic torticollis. Collateral circulation to the territory of the middle cerebral artery was through the vertebrobasilar circulation, and the left vertebral artery was dilated and compressing the ventrolateral aspect of the cervicomedullary junction, as evidenced by MRI. We believe this to be the first report of unilateral hypoplasia of the internal carotid artery associated with spasmodic torticollis. Compression of the left accesory nerve by the dilated vertebral artery as a result of altered haemodynamics was thought to cause spasmodic torticollis.

T-cell receptor gene structures of HLA-A26-restricted cytotoxic T lymphocyte lines against human autologous pancreatic adenocarcinoma

We isolated two cytotoxic T lymphocyte (CTL) lines, which were independently obtained by mixed lymphocyte-tumor cell culture from tumor-infiltrating lymphocytes of a patient with pancreatic adenocarcinoma. Both lines behaved identically in all the functional aspects tested and appeared to be HLA-A26-restricted. We analyzed their T cell receptor (TCR) gene structures, including V-(D)-J junctional sequences, which are unique to each T-cell clonotype and contribute to TCR diversity. Each line consisted of a clonal T-cell expressing V alpha 18 and V beta 7. The alpha chain gene was composed of V alpha 18/J alpha F/C alpha and the beta-chain gene, of V beta 7.1/D beta/J beta 1.4/C beta 2. The sequences were all in-frame and therefore should yield functional transcripts. The junctional sequences were identical between the two lines. These data suggested that the two CTL clones having the same CDR3 had descended from a common precursor lymphocyte. The clonal expansion of CTL lines with the identical CDR3 implies that they are directed against the same tumor antigen, which seemed to be immunologically dominant in the specific interaction between the CTL and the autologous pancreatic adenocarcinoma.

Autoantibodies to pyruvate dehydrogenase complex in patients with systemic sclerosis. Possible role of anti-E1 alpha antibody as a serologic indicator for development of primary biliary cirrhosis

OBJECTIVE

To determine the prevalence and clinical significance of anti-pyruvate dehydrogenase complex (anti-PDC) antibodies in systemic sclerosis (SSc).

METHODS

Serum samples from patients with limited cutaneous SSc (n = 81) or diffuse cutaneous SSc (n = 63) were examined for anti-PDC antibodies by enzyme-linked immunosorbent assay (ELISA) and immunoblotting.

RESULTS

IgG- and/or IgM-isotype anti-PDC antibodies were demonstrated by ELISA in 26 of 144 patients with SSc (18%). By immunoblotting, 19 patients had IgG anti-PDC antibodies. Among these patients with IgG anti-PDC antibodies, antibody to the E1 alpha subunit was significantly associated with the presence of laboratory abnormalities typical of primary biliary cirrhosis (PBC).

CONCLUSION

Antibody to the E1 alpha subunit of PDC may be a serologic indicator for the development of PBC in patients with SSc.

[Mitral valve plasty for better long term results]

Between July 1991 and January 1995, 74 patients with pure mitral valve regurgitation (MR) underwent mitral valve plasty (MVP) at out institute. Our procedure includes chordal replacement of the anterior leaflet with PTFE sutures (42 patients). There were one hospital death (1.4%) and two late deaths (2.7%) in this series. Only 2 patients (2.7%) needed valve replacement after unsatisfactory repair during the same operation. Late postoperative doppler echocardiographic study (mean follow-up, 12.0 months) showed less than mild regurgitation in 66 patients (95.7%) of 69 patients who are alive. In April 1993 we decided to complete the repair with no or only trivial regurgitant flow by intraoperative transesophageal echodoppler study (TEE). The results have remarkably improved. Late postoperative echodoppler study revealed less than mild reguritant flow in all 49 patients having undergone mitral valve repair with no or trivial regurgitation by intraoperative TEE. It is clear than the TEE study has contributed to the better quality of mitral valve plasty, and we believe that it is important for better long term results to complete mitral valve plasty with no or only trivial regurgitant flow.

Growth regulation in scleroderma fibroblasts: increased response to transforming growth factor-beta 1

We investigated the responses of normal and scleroderma fibroblasts to various growth factors, especially transforming growth factor-beta 1 (TGF-beta 1). The effects of various growth factors on [3H]thymidine incorporation in normal and scleroderma fibroblasts were examined. [125I]-labeled platelet-derived growth factor (PDGF)-BB binding in scleroderma and normal fibroblasts was examined both in the presence and absence of TGF-beta 1 (1 ng/ml). Cytoplasmic protein was isolated and analyzed by Western blotting. Total RNA from fibroblasts was also isolated and analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) using specific primer sets. Mitogenic responses to TGF-beta 1 (0.33-1 ng/ml) in seven scleroderma fibroblast strains were significantly greater than those in normal controls. [125I]-PDGF-BB binding to scleroderma fibroblasts was increased after TGF-beta 1 stimulation. The increased response to TGF-beta 1 was shown to be mediated through PDGF-like protein induction; TGF-beta 1-treated scleroderma fibroblasts produced greater amounts of 36-kD PDGF-like protein, which was reported previously as connective tissue growth factor (CTGF), than did TGF-beta 1-treated normal fibroblasts. TGF-beta 1 treatment also upregulated PDGF-alpha receptor expression in scleroderma fibroblasts but not in normal dermal fibroblasts. mRNA expression of CTGF and PDGF-alpha receptor was correlated with the above protein expression. These observations suggest that the increased growth response to TGF-beta 1 in scleroderma fibroblasts is mediated through the induction of CTGF and PDGF-alpha receptor.

Cytokine-producing mammary carcinomas in transgenic rats carrying the pX gene of human T-lymphotropic virus type I

In two lines of transgenic rats (pX rats) from WKAH and F344 strains and carrying the human T-lymphotropic virus type I pX gene, undifferentiated mammary carcinomas developed predominantly in females starting at about 5 months of age, and there was massive infiltration of granulocytes in the tumor tissue. The incidence of the tumor reached about 40% when the rats were 12 months old. mRNAs of both pX and host genes Gro and MIP-2, which are granulocyte chemoattractants of the interleukin 8 family, were highly expressed in the tumor tissue. Since expression and point mutation of several oncogenes and the antioncogene were not demonstrated, hitherto unidentified novel oncogenic pathways may be transactivated by the pX transgene in these pX rats.

In vivo biological behavior of a water-miscible fullerene: 14C labeling, absorption, distribution, excretion and acute toxicity

BACKGROUND

Water-soluble fullerenes have recently been shown to exhibit considerable in vitro biological activity including cytotoxicity, site-selective DNA cleavage and inhibition of HIV protease. To assess the potential of these compounds as drugs, studies on the in vivo behavior of fullerenes are needed. We therefore set out to synthesize a radiolabeled, water-soluble fullerene, in order to obtain data on the oral absorption, distribution and excretion of this class of compounds.

RESULTS

We synthesized a 14C-labeled water-soluble [60]fullerene using dipolar trimethylenemethane, which undergoes cycloaddition to [60]fullerene. When administered orally to rats, this compound was not efficiently absorbed and was excreted primarily in the feces. When injected intravenously, however, it was distributed rapidly to various tissues, and most of the material was retained in the body after one week. The compound was also able to penetrate the blood-brain barrier. Acute toxicity of the water-miscible fullerene was found to be quite low.

CONCLUSIONS

Although the water-soluble fullerenes (and possibly their simple metabolites) are not acutely toxic, they are retained in the body for long periods, raising concerns about chronic toxic effects. The fact that fullerenes distribute rapidly to many tissues suggests that they may eventually be useful to deliver highly polar drugs through membranes to a target tissue, however, and they may even have applications in the delivery of drugs to the brain. Recent advances in fullerene synthetic chemistry may also make it possible to control fullerene absorption/excretion profiles in the future.

Dependence of collateral and small airway resistances of CO2 and volume in dog lobes

We examined the hypothesis that collateral channels were identical within small airways and ducts, therefore both should respond similarly to chemical and mechanical stresses. A double lumen catheter was wedged into a segmental bronchus of the dog and humidified air or 10% CO2 in air (Vs) flowed at a segmental bronchial pressure (Pb) of 2 cm H2O. A small circular area about 1 cm diameter was peeled from the wedged segment and covered with a capsule glued to the surrounding pleura for measuring either a small airway flow (Vsaw) or capsule pressure (Pcap). Collateral resistance (Rcoll) and small airway resistance (Rsaw) were calculated as Rcoll = Pb/(Vs-Vsaw), Rsaw = (Pb-Pcap)/Vsaw, respectively. Hypocapnia (air) resulted in increases in Rcoll and Rsaw, while hypercapnia (10% CO2) generally had the opposite effect. Gcoll and Gsaw both increased linearly with lung volume (VL). The pattern of the responses of Rsaw closely paralleled those of Rcoll to local hypercapnia and hypocapnia, and to changing VL, implying that the major sites of resistance along collateral channels and along the airways are functionally and structurally similar.

Laparoscopic minilaparotomy Billroth I gastrectomy with extraperigastric lymphadenectomy for early gastric cancer using an abdominal wall-lifting method

Laparoscopic gastrectomy with extraperigastric lymphadenectomy for early gastric cancer has never been performed because of technical difficulties attributable to the lack of appropriate techniques, the high cost of laparoscopic instruments, and the need for numerous disposable stapling devices. In order to solve these problems, we have designed a method of laparoscopic minilaparotomy using an abdominal wall-lifting method, and a patient with early gastric cancer (depth of submucosa) underwent by this laparoscopic minilaparotomy distal gastrectomy with extraperigastric lymphadenectomy. During his postoperative recovery, the patient requested no narcotic analgesic, and was discharged on postoperative day 14.

[Macrophage colony-stimulating factor in patients with rheumatoid arthritis]

Macrophage colony-stimulating factor (M-CSF) is a cytokine involved in the development and proliferation of the monocyte/macrophage lineage cells. M-CSF has also been reported to participate in the induction of osteoclasts, and may be important in the destruction of bone and cartilage and the periarticular osteoporotic changes seen in patients with rheumatoid arthritis (RA). We developed a new ELISA technique to measure M-CSF levels in synovial fluid with high sensitivity and reproducibility. The mean M-CSF level in the synovial fluid of patients with RA was 1.38 +/- 0.56 ng/ml, and that of patients with osteoarthritis (OA) was 0.67 +/- 0.13 ng/ml. In contrast, serum levels of M-CSF in patients with RA and in normal controls were 1.32 +/- 0.50 ng/ml and 0.90 +/- 0.09 ng/ml, respectively. These differences were both statistically significant. Since serum M-CSF levels correlate with inflammatory signs obtained from examination of blood, they indicate the general condition of patients with RA. Synovial fluid M-CSF levels increase even in the early phase of RA and remain high despite drug therapy, which suggests that they reflect the condition of affected joints including joint spaces and inflamed synovia more directly than do the levels of serum M-CSF. Measurement of the M-CSF level in the synovial fluid may be useful in the diagnosis, clinical evaluation, and assessment of the effects of treatment in patients with RA.

[Arrhythmias, autonomic function and spectral analysis of heart rate variation in patients with stable chronic pulmonary disease]

Autonomic function, the frequencies of arrhythmias, and outcome were studied in patients with stable chronic pulmonary disease (n = 67. Old tuberculosis, n = 35. Chronic pulmonary emphysema, n = 32) and in age-matched healthy elderly. The frequencies of arrhythmias were computed and spectral analysis was done with data obtained from 24-hour Holter ECG monitoring. The minimum heart rates of the patients were high. The minimum heart rate fell at night in the controls, but not in the patients. The patients had more PVCs than the controls, however sudden death due to arrhythmias did not occur. The LF/HF ratios obtained by spectral analysis of heart rate were lower in the patients than in the controls. There were no significant differences in age, respiratory rate, arterial blood gases, pulmonary-function tests, arrhythmias, or in the hourly distribution of the minimum heart rate between patients who died within 3 years and those who lived for more than 5 years. However, the LF/HF ratio in those who died was significantly lower than in the other groups. These results suggest that functional disturbance of the autonomic nervous system is related to outcome in patients with stable chronic pulmonary disease.

[Myocardial structural proteins in cor pulmonale. Analysis by two-dimensional electrophoresis]

Changes in cardiac structural proteins caused by cor pulmonale were studied with two-dimensional electrophoresis. Sprague-Dawley rats were exposed to an oxygen-poor gas mixture (10% O2/90% N2) for three weeks. These rats (the hypoxic group) were compared to a control group that was kept in room air. Hemoglobin, hematocrit, and right ventricular systolic pressure were greater in the hypoxic group than in the control group. After the third week, desmin content of both ventricular muscles had increased in the hypoxic group, and was significantly greater in the hypoxic group than in the control group. The contents of other cardiac structural proteins did not change. These data suggest that increases in desmin are caused by adaptation of the myocardium to pressure overload associated with pulmonary hypertension. However, increases in the desmin content of the left ventricular muscle might be caused by volume overload, humoral factors, or might be a direct effect of hypoxemia.

Laparoscopic Billroth I gastrectomy for gastric ulcer: technique and case report

A laparoscopic distal gastrectomy with gastroduodenostomy (Billroth I) was performed on a patient with intractable gastric ulcer. The patient was a 56-year-old man, complaining of severe epigastralgia, who had a 10-year history of peptic ulcer. Gastroscopy had revealed a UL-IV gastric ulcer on the lesser curvature at the angle of the stomach and a deformity of the bulbus. A diagnosis of intractable gastric ulcer was made, and the patient underwent laparoscopic distal gastrectomy and gastroduodenostomy. On postoperative day 1, he was able to walk. On postoperative day 4, he started on a clear liquid diet and was discharged on postoperative day 14.

Ultrasound measurement of skin thickness in systemic sclerosis

Sclerotic skin change in systemic sclerosis (SSc) usually accompanies increased skin thickness. In order to quantify the cutaneous changes and to clarify the changes in the 'uninvolved' skin in systemic sclerosis (SSc), we measured the skin thickness on the chest, the forearms and the hands of 79 patients with SSc and 81 healthy controls with a B-mode ultrasound (30 MHz) apparatus. The thickness of the 'uninvolved', as well as the 'involved' skin in patients with SSc was significantly greater than that of healthy controls. Increased skin thickness on the forearms and/or the hands showed a 64.6% sensitivity and a 100% specificity for SSc. These results indicated that the skin which appears to be 'uninvolved' in patients with SSc is already pathologic, as shown by increased thickness. Moreover, measurement of skin thickness may be beneficial in the diagnosis of this disease at an early stage.

Long-term effects of radioiodine on thyrotrophin receptor antibodies in Graves' disease

OBJECTIVE

Graves' disease is recognized as an organ-specific autoimmune disorder caused by the presence of TSH receptor antibodies. The long-term effects of 131I treatment for Graves' disease on TSH receptor antibodies have not previously been studied. We have measured the TSH-binding inhibitory immunoglobulin (TBII) index and thyroid stimulating antibody (TSAb) activity in patients with Graves' disease following treatment with 131I.

DESIGN

A retrospective study.

PATIENTS

Two hundred and twenty-five patients with Graves' disease who were treated with 131I 1-13 years earlier were studied (1 year: 27 patients; 2-5 years: 42 patients; 6-9 years: 79 patients; 10-13 years: 77 patients).

MEASUREMENTS

The TBII index was measured as the percentage 125I-TSH bound to pig thyroid membranes and TSAb activity as the amount of cAMP produced by cultured FRTL-5 cells.

RESULTS

TBII was detected in 78% of patients prior to 131I administration. Following 131I administration, the incidence of positive TBII was 85% at the end of the first year decreasing to 40, 19, and 17% at 2-5, 6-9 and 10-13 years, respectively. The frequency of a positive TSAb was 74% at the end of the first year, and also decreased to 49, 27 and 29% at 2-5, 6-9 and 10-13 years, respectively. At more than 2 years after 131I therapy, the frequencies of hyperthyroidism in TBII and TSAb positive patients were 42% (19/45) and 30% (19/63), respectively, which were significantly higher than those in TBII and TSAb negative patients (8%: 12/153 and 8%:11/131, respectively). The frequency of hyperthyroidism after 131I treatment in patients with negative TBII before treatment (7%:2/29) was significantly lower than that (29%:30/102) in patients with positive TBII before treatment.

CONCLUSIONS

These results indicate that (1) the TBII index and TSAb activity decreased over a period of more than 2 years after 131I therapy for Graves' disease, and (2) the TBII index before treatment may influence the long-term outcome of 131I therapy.

[Hypersensitivity pneumonitis induced by dust from an automatic bed cleaner]

A 49-year-old woman used an automatic bed cleaner on October 18, 1990. Eight hours later, she was admitted to a hospital complaining of coughing and fever. The chest X-ray film showed small granular shadows in both lower lung fields. After a few days of antibiotic therapy, these symptoms had disappeared. She used the bed cleaner again on the afternoon of November 15, 1990. The next day, she was admitted to our hospital because of coughing and fever. An environmental provocation test with the bed cleaner induced the same symptoms. Dust from the bed cleaner stimulated her lymphocytes. Hypersensitivity pneumonitis from the dust of a bed cleaner was diagnosed.