Secretory IgA-mediated basophil activation. II. Roles of GTP-binding regulatory proteins and phosphatidylinositol 3-kinase

Secretory IgA (sIgA) is the most abundant Ig isotype in mucous secretions in the upper and lower airways, where basophils exert effector functions during allergic inflammation. We recently demonstrated that immobilized sIgA on Sepharose beads is capable of inducing basophil degranulation ( approximately 15% of total histamine). To investigate the detailed mechanisms of this degranulation, we established in this study a new assay system for sIgA-mediated basophil activation. Immobilized sIgA on a plastic surface induced strong histamine release ( approximately 50% of total histamine) comparable to anti-IgE, and we analyzed the nature of basophil signal transduction by sIgA using various inhibitors. sIgA-induced basophil histamine release was inhibited completely by pertussis toxin, but anti-IgE-induced release was not affected. sIgA-mediated release was also inhibited by phosphatidylinositol 3-kinase (PI 3-kinase) inhibitor, wortmannin. These results strongly suggest that sIgA activates basophils via an IgE-independent novel mechanism involving both Gi protein and PI 3-kinase.

Allelic loss at 1p34, 13q12, 17p13.3, and 17q21.1 correlates with poor postoperative prognosis in breast cancer

Allelic losses of tumor suppressor genes (TSGs), or the chromosomal regions harboring them, in tumor DNA may become useful postoperative prognostic indicators. To examine whether specific allelic losses might correlate with postoperative survival in a 5-year prospective follow-up, we tested tumors from a cohort of 264 breast cancer patients for allelic losses of 18 microsatellite markers representing either a known TSG or a region where genetic alterations are frequent in breast tumors. Patients whose tumors had lost an allele at 1p34, 13q12, 17p13.3, or 17q21.1 had significantly higher risks of postoperative mortality than those whose tumors retained both alleles at those loci (at 1p34, a 5-year mortality rate of 29% among patients with losses vs. 7% with retentions, P = 0. 0008; at 13q12, 31% vs. 10%, P = 0.0062; at 17p13.3, 24% vs. 13%, P = 0.026; and at 17q21.1, 31% vs. 13%, P = 0.0047). Furthermore, combined losses at 13q12 and 17p13.3 increased the predicted postoperative mortality risks by a factor of 9.6 (5-year mortality rate of 42% vs. 5% with retentions, P = 0.0001), and combined losses at 1p34 and 17p13.3 raised the predicted postoperative mortality risks by a factor of 8.6 (27% vs. 3%, P = 0.0064). We conclude that allelic losses at these loci can serve as negative prognostic indicators to guide postoperative management of patients. Genes Chromosomes Cancer 26:134-141, 1999.

Alleic variants of human melatonin 1a receptor: function and prevalence in subjects with circadian rhythm sleep disorders

The human melatonin 1a (hMella) receptor gene was screened for mutations using genomic DNA samples from patients with circadian rhythm sleep disorders and control subjects by single strand conformational polymorphism analysis (SSCP). We found seven mutations, two of which predict amino acid changes R54W and A157V, respectively. The prevalence of the R54W variant and that of the A157V variant were several times more common in non-24-h sleep-wake syndrome subjects than among control subjects, although the incidence was not significant in our study group. When expressed in COS-7 cells, the R54W mutant receptor exhibited significantly reduced B(max) and slightly enhanced affinity (reduced K(d)) compared to the wild type receptor, while the A157V variant receptor showed similar binding characteristics to the wild type. The identification of variants in the hMella receptor will provide a useful tool for analyzing genetic predisposition toward various diseases related to melatonin function and to clarify the physiological role of melatonin receptors in humans.

Transluminal repair of an infrarenal aortoiliac aneurysm by a combination of bifurcated and branched stent grafts

Transfemoral endovascular repair with a combination of bifurcated and branched stent grafts enables aortoiliac reconstruction with internal iliac perfusion preserved. We report a case of successful endovascular repair of aortoiliac aneurysm with use of a bifurcated and branched stent-graft.

Total hip arthroplasty after failed intertrochanteric valgus osteotomy for advanced osteoarthrosis

Thirty hips that had undergone conversion total hip arthroplasty because of failed intertrochanteric valgus osteotomy for advanced osteoarthrosis were analyzed clinically and radiographically for more than 2 years. The average followup after total hip arthroplasty was 7 years (range, 2-18 years). The average age of the patients at the time of valgus osteotomy was 42 years (range, 30-63 years). The average age of the patients at the time of conversion total hip arthroplasty was 57 years (range, 43-76 years), and the average period between valgus osteotomy and conversion was 14 years (range, 3-24 years). Perioperative complications in conversion total hip arthroplasties were minimal, and intramedullary reaming was performed easily. Of the 30 conversion total hip arthroplasties, 12 cemented and 18 cementless components were used, respectively. Kaplan-Meier's survival analysis indicated that survivorship of cemented stems was significantly higher than that of conventional cementless stems. Cemented stems are preferable for conversion total hip arthroplasty after failed femoral valgus osteotomy.

Analysis of microsatellite instability, TGF-beta type II receptor gene mutations and hMSH2 and hMLH1 allele losses in pancreaticobiliary maljunction-associated biliary tract tumors

While pancreaticobiliary maljunctions (PBM) are clearly associated with biliary tract tumor development, little is known about their molecular mechanisms. This study was conducted to assess the contributions of microsatellite instability (MSI), mutations of transforming growth factor type II receptor (TGF-beta RII) and insulin-like growth factor type II receptor (IGF RII) genes and loss of heterozygosity (LOH) of hMSH2 and hMLH1 in 23 biliary tract tumors using PCR methods. MSI was detected by 13 markers in 16/23 samples (69.6%). TGF-beta RII mutations were detected in eight of these (50%), and of the IGF IIR gene in two (12.5%). LOH was detected in 4/16 (25%) at the hMSH2 locus, and 2/16 (12.5%) at the hMLH1 locus. No TGF-beta RII mutations or LOH of hMSH2 and hMLH1 were detected in MSI-negative samples. These findings suggest that MSI plays an important role in carcinogenesis of the biliary tract epithelium with PBM cases.

Bone scintigraphy and magnetic resonance imaging after transtrochanteric rotational osteotomy

OBJECTIVE

To assess the ability of bone scintigraphy and magnetic resonance imaging (MRI) to predict the outcome of transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH).

DESIGN

This study was a prospective evaluation of imaging techniques.

PATIENTS AND METHODS

MRI and bone scintigraphy were performed on 20 hips in 18 patients at 3 months after TRO. The radiographic findings at 3 months after TRO, and the MRI and bone scintigraphic findings, were compared with the radiographic findings at final follow-up (mean 39 months).

RESULTS AND CONCLUSIONS

On MRI a low-intensity area or a low-intensity band in the new weight-bearing area extending over the acetabular edge on T1-weighted images was related to the presence of collapse on the radiographs at final follow-up. In hips with an area of absent activity in the new weight-bearing surface on bone scintigraphy, collapse was seen more frequently on radiographs at final follow-up than in hips without this feature. Bone scintigraphy was no more specific than radiography in predicting the outcome after TRO. We consider MRI to be superior to bone scintigraphy in predicting the occurrence of collapse, which is one of the major short-term problems after TRO.

Transcatheter embolization of arteriovenous malformations in Cowden disease

A patient with Cowden disease and multiple arteriovenous malformations (AVMs) that resulted in high output heart failure is described. Cowden disease is a familial syndrome characterized by endodermal, mesodermal and ectodermal dysplasia causing benign and malignant tumors of the skin, breast, gastrointestinal tract, and thyroid gland. Our patient had gastrointestinal polyposis, a right renal tumor, a left lung tumor, an adenomatous goiter, and typical dermatologic findings such as facial papules, acral keratosis, gingival papillomatosis and hemangiomas. AVMs were observed in the pelvis, cervical vertebra, liver, and right supraclavicular area. Transcatheter embolization was performed 7 times for the pelvic AVMs, but the effect decreased with repetition and the patient died of heart failure 2 years after the first embolization. The serum levels of tissue plasminogen activator (t-PA), platelet-derived growth factor (PDGF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and transforming growth factor beta1 were high, suggesting that these angiogenic molecules may play a role in the pathogenesis of AVMs in Cowden disease.

Osteonecrosis of the femoral head associated with pregnancy

A 31-year-old pregnant woman suddenly complained of bilateral hip pain 2 weeks before delivery. She was delivered of triplets by Caesarean section. She had been treated with human menopausal gonadotropin and human chorionic gonadotropin (hMG-hCG) before pregnancy. Radiograms of the hip joint showed collapse of the femoral heads bilaterally. Magnetic resonance imaging revealed a band pattern of low signal intensity for both hips on T1- and T2-weighted images. She had no history of steroid therapy or alcohol abuse. Osteonecrosis of the femoral heads bilaterally associated with pregnancy was confirmed. Pathology of the femoral head showed typical empty lacunae and necrosis of the trabecula.

Failed cementless total hip arthroplasty for osteoarthrosis due to hip dysplasia. A minimum five-year follow-up study

We performed cementless total hip arthroplasty on patients with secondary osteoarthrosis due to hip dysplasia. We conducted prospective radiographic and clinical studies on 75 hips with a minimum five-year follow-up. Aseptic loosening of the Dual geometry Microstructured cup used on the acetabular component was recognized in 2 of 75 hips within five years postoperatively, but neither case required revision. As for the femoral component, within five years of operation, in 9 of 28 (32%) and 11 of 31 (35%) patients, aseptic loosening was recognized in the Omnifit Normalized Smooth surfaced stem (FIT-N) and the Omniflex Normalized Smooth surfaced stem (FLEX-N), respectively, neither of which have a porous coating on their proximal end. Revisions of the stems have been conducted on three FIT-N and two FLEX-N stems. Aseptic loosening was recognized in 2 of 16 Omnifit Microstructured stems (FIT-M) with porous coating, but revisions have not yet been required in these cases. We conclude that stems without a porous surface coating should not be used for cementless total hip arthroplasty.

High levels of hippocampal cholinergic neurostimulating peptide (HCNP) in the CSF of some patients with Alzheimer's disease

Hippocampal cholinergic neurostimulating peptide (HCNP), originally purified from the hippocampus of young rats, enhances the cholinergic development of rat medial septal nuclei in vitro. This report concerns the determination of the HCNP content of the cerebrospinal fluid (CSF) of 173 clinically, and of 22 clinico-pathologically defined patients. A radioimmunoassay was used throughout. The HCNP level was relatively uniform among the clinically defined patients; for almost all non-Alzheimer's patients, the level fell within the range delimited by +/- 2 SD of the mean for all patients taken together, and none of them had a level above this range. By contrast, the early-onset Alzheimer's disease patients could be divided on the basis of their HCNP level into two groups, one with high levels (markedly above the mean +/- 2SD range), and the other with levels similar to those of the other patients. The analysis of the CSF samples obtained postmortem revealed that Group I Alzheimer-type dementia (ATD) patients with clinico-pathologically established diagnoses had a strikingly higher level of HCNP than patients with either Group II ATD or cerebral vascular disease. These results suggest that HCNP is involved in certain pathophysiological alterations associated with dementia, and that its determination may be useful in patient evaluation. Copyright 1998 Lippincott Williams & Wilkins

Histogenetic stereological reconstruction of rat basophilic, clear, and oncocytic neoplastic renal cell lesions using carbonic anhydrase type II-PAS double-stained sections

The histogenesis of 3 types of rat renal cell tumors (basophilic cell, clear cell, and oncocytic) was stereologically analyzed, with particular attention paid to transitions from normal tubules. Early nitrosamine-induced preneoplastic lesions, including dysplastic tubules (altered tubules), epithelial hyperplasias, and small adenomas, were reconstructed using serially sectioned specimens processed for carbonic anhydrase type II (CA) and periodic acid-Schiff (PAS) (CA-PAS) double staining to allow easier distinction of the nephron segments: Proximal tubules had a PAS-positive brush border and were weakly positive for CA in the cytoplasm; distal tubules were PAS negative and weakly positive for CA; collecting ducts were PAS negative and strongly positive for CA. Similarly, cytochrome c oxidase (CytOx) and CytOx-PAS double staining was also applied to confirm the character of oncocytic lesions. All basophilic lesions (7 of 7) showed transition to proximal tubules. Clear cell lesions positive for CA, on the other hand, showed transition to distal tubules in 4 of 9 (44.4%) lesions and to collecting ducts in 4 of 9 (44.4%) lesions, but in only 1 of 9 (11%) to a proximal tubule. All oncocytic lesions (16 of 16), characterized by positivity for both CA and CytOx, showed transition to collecting ducts. The results indicate that the origins of renal cell neoplasia are proximal tubules for the basophilic cell lesions, either proximal or distal tubules for their clear cell counterparts, and collecting ducts for oncocytic lesions.

[Relationship between evolution of ischemic heart disease and changes in lipid profile]

The relationship between the evolution of ischemic heart disease and changes in lipid profile was investigated in 115 of 11,875 patients underwent coronary angiography (CAG). The 115 patients had no significant stenosis on initial CAG and underwent repeat CAG for several reasons. Changes in lipid profile and other coronary risk factors were compared in 30 patients who developed ischemic cardiac events (Group E) and 85 patients who did not (Group NE). Ischemic cardiac events were defined as ischemic chest symptoms with ST-T changes or appearance of significant angiographic stenosis. At initial CAG, smoking was significantly more common in Group E (23.3% vs 4.7%, p < 0.01) and high-density lipoprotein cholesterol was significantly lower in Group E (42 +/- 11 vs 48 +/- 15 mg/dl, p < 0.05). At repeat CAG, smoking continued to be significantly more common in Group E (26.7% vs 10.6%, p < 0.05), and serum cholesterol (219 +/- 36 vs 193 +/- 34 mg/dl, p < 0.01) and low-density lipoprotein cholesterol (141 +/- 33 vs 115 +/- 29 mg/dl, p < 0.01) were also significantly higher in Group E. Multivariate analysis revealed only the increase of serum cholesterol at repeat CAG was a significant factor in the evolution of coronary artery disease (p = 0.026). Two patients from Group E died of cardiac causes within 1 year after repeat CAG but no patients in Group NE died (6.7% vs 0%, p < 0.05). Increased serum cholesterol level is related to the evolution of ischemic heart disease and cardiac death.

Huge localised fibrous tumour of the retroperitoneum

Images

Secretory IgA induces degranulation of IL-3-primed basophils

We examined whether secretory IgA (sIgA), known to mediate eosinophil stimulation, has an effect on basophil functions. An immobilized preparation of sIgA, but not of monomeric IgA, induced histamine release (approximately 15% of total histamine contents) from human basophils in vitro. sIgA-induced basophil histamine release was totally dependent on pretreatment with IL-3. IL-5 and granulocyte-macrophage CSF also primed basophils for sIgA-mediated release. Exogenous divalent ions, i.e., Ca2+ and Mg2+, were essential for sIgA-mediated basophil degranulation, and the degranulation was completed within 45 min. A newly synthesized lipid mediator, leukotriene C4, was also liberated from IL-3-primed, sIgA-stimulated basophils. Enzyme digestion experiments revealed that the (Fc)2 x secretory component portion of sIgA is important for sIgA-mediated basophil activation, but the functional binding sites of sIgA on basophils were surmised to be different from FcalphaR. These observations reveal the novel finding that sIgA is able to stimulate basophils as well as eosinophils. Since sIgA is the most abundant Ig isotype in the secretions from mucosal tissues, and basophils are active participants in allergic late-phase reactions, sIgA-mediated basophil mediator release is potentially involved in exacerbation of the inflammation associated with allergic disorders.

[Proposals for revisions of UICC TNM system (1997)--breast cancer]

The TNM system for classification and staging approved by Union Internationale contro le Cancer (UICC)/TNM Committee is designed primarily for patient care and, in this context, is equally applicable to patients in clinical research, community hospitals, and developing countries. It is clearly evident to all who have been involved that international agreement on the classification of cancer at all anatomical sites is exhilarating, since data from around the world can finally be compared with validity. The UICC believes that the TNM system can fulfil the following five objectives: (1) aid in the planning of treatment; (2) give an indication of prognosis; (3) assist in evaluation of the results of treatment; (4) facilitate the exchange of information between centres; and (5) contribute to the continuing investigation of human cancer. The important questions for planning of treatment (1), however, can not be answered by the information of the clinical TNM stage as the concept in the Japanese Joint Committee. The knowledge of the TNM stage does not yield information of prognostic importance (2). More accurate indices of prognosis can be calculated from multivariate analysis to examine many clinicopathological variables, and biological markers along with patient age and nodal status. The analysis makes the difficulties for the results of treatment due to the large number of combinations with T and N subgroups (3) (4). According to the fifth objective (5) of TNM classification, we would like to propose a more simple and pragmatic classification by classifying patients into those requiring surgical approach and adjuvant therapy.

An unusual course of progressive multifocal leukoencephalopathy in a patient with idiopathic CD4+ T lymphocytopenia

A case is reported of idiopathic CD4+T lymphocytopenia with progressive multifocal leukoencephalopathy and cervical lymph node tuberculosis. A 57 year old Japanese man presented with cervical lymphadenopathy and progressive neurological deficits, and six months later he developed akinetic mutism. He had a persistent severely depressed number of circulating CD4+T lymphocytes in the absence of human immunodeficiency virus infection. T1 weighted MRI showed a diffuse decreased signal intensity limited to the white matter without mass effect. A brain biopsy specimen had a morphology similar to that of progressive multifocal leukoencephalopathy. Polyomavirus antigen was detected in the brain lesion, and viral DNA was identified in nucleated blood cells and urine. Unusually this serious medical condition has lasted for more than three years without remission. To our knowledge this is the first patient with CD4+T lymphocytopenia with progressive multifocal leukoencephalopathy, suggesting that similar opportunistic infections should be considered even in previously normal people.

Gene expression of fucosyl- and sialyl-transferases which synthesize sialyl Lewisx, the carbohydrate ligands for E-selectin, in human breast cancer

The adhesion of circulating cancer cells to vascular endothelium is an important step in the hematogenous metastasis of cancer. Until recently, it has been believed that carbohydrate antigens are expressed on cancer cells, and E-selectin is expressed on endothelial cells to effect this adhesion. We investigated the gene expression of fucosyl-transferase (Fuc-T) and sialyltransferase (ST), which are involved in the synthesis of sialyl Lewisx (s-Lex) in breast cancer by using Northern blot analysis. The concentration of s-Lex in the cancerous portion was increased, compared to that in the adjacent non-cancerous portion. A correlation was found between the concentration of s-Lex and the amount of Fuc-T VI message in 9 cases of breast cancer tissue. Expression of the Fuc-T III message was found in only one case who expressed s-Lea. No expression of the Fuc-T V or VII message was observed. There was no relationship between the concentration of s-Lex and the amount of ST3N and ST4 transcripts. Similar findings were obtained from an analysis using cell lines derived from human breast cancer. When Fuc-T VI gene was transfected to MCF-7 cells, the expression of s-Lex was markedly induced on MCF-7 cells, and the attachment of cancer cells to endothelial cells was enhanced. These findings suggest that Fuc-T VI is chiefly involved in the synthesis of s-Lex on breast cancer cells.

Synovial fluid cartilage metabolism marker concentrations in osteonecrosis of the femoral head compared with osteoarthrosis of the hip

OBJECTIVE

Biochemical aspects of the etiology of articular cartilage degeneration in osteonecrosis of the femoral head have not been investigated extensively. We analyzed biochemical conditions in the hip joint cavity, regarding articular cartilage turnover in osteonecrosis of the femoral head (ONFH).

METHODS

Cartilage metabolism markers in synovial fluid were measured. Synovial fluid (SF) samples were collected from 19 ONFH cases and 17 control hips with osteoarthrosis (OA). Concentrations of carboxy-terminal type II procollagen peptide (pCOL-II-C), matrix metalloproteinase-3 (MMP-3), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured. In addition, concentrations of unsaturated disaccharides of hyaluronic acid (delta di-HA), chondroitin 4-sulfate (delta di-4S), and chondroitin 6-sulfate (delta di-6S) in SF were measured by high performance liquid chromatography.

RESULTS

The mean SF concentration of pCOL-II-C was higher on ONFH than in OA. The mean SF MMP-3 level was higher in ONFH than in OA, while the mean SF TIMP-1 level was the same in the 2 groups. The SF concentration of delta di-HA and the delta di-6S/delta di-4S ratio were higher in ONFH than in OA.

CONCLUSION

Higher concentrations of cartilage metabolism markers in ONFH compared with OA SF suggest elevated cartilage turnover in the former disease.

Scintigraphic evaluation of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. Comparison between scintigraphy, radiography and outcome in 34 patients

Scintigrams and radiographs of 36 femoral heads in 34 patients before and after Sugioka's transtrochanteric rotational osteotomy for osteonecrosis of the femoral head were investigated prospectively. Patients were followed for more than 3 years after the operation. The patterns of early scintigrams made within 3 months of the operation were classified into four categories. All 4 patients with a large cold area evidenced collapse within 1 year despite good recovery of the weight-bearing surfaces immediately after operation on conventional radiograms. Twenty-two hips with no cold area in the femoral head did not demonstrate collapse. Femoral head collapse after rotational osteotomy can be predicted by early postoperative bone scintigraphy.

Long-term outcome in triple-vessel coronary artery disease in medically treated Japanese patients

The long-term outcome in 198 patients with triple-vessel disease (TVD) treated medically was investigated. The patients, who underwent coronary angiography between September 1973 and February 1984, had significant (75% or more) stenotic lesions in all three major coronary arteries. The mean follow-up period was 8.4 years. The 5- and 10-year survival rates were 80.7% and 64.2%, respectively. Cardiac death occurred in 73 patients (36.9%) and nonfatal cardiac events developed in 60 patients (30.9%) during follow-up. When cardiac death and nonfatal myocardial infarction (MI) were defined as cardiac events, the annual attrition rate was 4.7%. There was no difference in survival with regard to the presence or absence of MI, the site of infarction, or the presence of total occlusion. In the AP group, however, the survival rate decreased as the number of totally-occluded arteries increased. In the MI group, the survival rate was not altered by the number of totally-occluded arteries, but was affected by the ejection fraction (EF). The 5-year survival rate was better in patients with good left ventricular function (EF > or = 60%) than in those with impaired left ventricular function (EF < 60%), although the 10-year survival rate was similarly low in both groups. Revascularization such as PTCA or CABG might improve the long-term outcome in patients with TVD.

Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. 43 patients followed for at least 3 years

We reviewed 48 hips in 43 patients 3-7.1 years (average 4.6 years) after Sugioka transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. The average age at operation was 41 years. Thirty-four patients were men and 9 women. Overall results at the final follow-up were satisfactory in 30 hips (62%). Kaplan-Meier's survivorship was 62% at 3 years and 60% at 5 years postoperatively. Six hips for which the ratio of the intact area of the articular surface on the preoperative lateral radiograph was less than 30% showed further collapse. Five hips were converted to bipolar hemiarthroplasties or total hip arthroplasties. Complications, such as varus deformity, subtrochanteric fracture, and ectopic bone formation, occurred in eight hips. Five of them were operated on in the first 2 years of this series. Three of these five operations had unsatisfactory results. We conclude that satisfactory results can be achieved using this osteotomy by maintaining exact surgical technique and by limiting the surgical indications to hips with an intact area of more than one-third of the entire articular surface on the lateral radiograph of the femoral head.

Ras gene point mutations in gallbladder lesions associated with anomalous connection of pancreatobiliary ducts

BACKGROUND/AIMS

The present study was undertaken to investigate possible changes in the K-ras oncogene in patients with gallbladder lesions (carcinoma, adenoma or hyperplasia) in relation to the presence or absence of an anomalous connection of pancreatobiliary ducts (ACPBD).

METHODOLOGY

Gallbladder specimens were obtained from 44 patients with lesions that were either with or without ACPBD, and DNA samples were analyzed using PCR-SSCP. Point mutations in codons 12, 13 and 61 were analyzed by direct sequencing methods with oligonucleotide primers.

RESULTS

The K-ras codon 12 was detected in 83.3% (5/6) of carcinomas the one adenoma tested and in 35.7% (5/14) of hyperplastic lesions with ACPBD, as opposed to only 36.4% (4/11) of carcinomas without ACPBD. The one case of gallbladder adenoma and 11 cases of normal gallbladder without ACPBD studied demonstrated no point mutations in the K-ras oncogene.

CONCLUSIONS

Alteration of the K-ras oncogene appears to be involved in the early stages of gallbladder carcinogenesis when in association with ACPBD. The results further suggest that hyperplasia in cases with ACPBD may be a significant pre-cancerous lesion.

[Clinical analysis of infective endocarditis with aneurysmal formation of the mitral or aortic valve]

Echocardiographic findings, clinical features, and pathophysiology of mitral and aortic valve aneurysms were evaluated in four patients with pathologically proven aneurysms of the mitral and/or aortic valves associated with infective endocarditis. These four were selected from 20 patients hospitalized in our institute from April 1990 to May 1995 because of infective endocarditis. All four patients had received repeated, inadequate antibiotic treatments at other medical institutions prior to admission, and underwent surgical repair because of acute hemodynamic exacerbation associated with aneurysmal perforation. Six aneurysms (three mitral and three aortic valve aneurysms) were detected before surgery, including two by transthoracic echocardiography and four by transesophageal echocardiography. The echocardiographic findings typical of aortic valve aneurysm were: ringed echo at the level of the aortic annulus in the short-axis view; turbulent flow within the ringed echo; and dome formation of the aortic valve that persisted throughout the cardiac cycle. All mitral valve aneurysms were true aneurysms without active inflammatory changes or significant destructive lesions, and were associated with severe infective aortic regurgitation. Histologic examination of the aortic valve in these patients showed active inflammation and extensive destruction, suggesting that these valves were the primary focus of infection. One patient had an aortic valve aneurysm without apparent mitral involvement, indicating that another mechanism had mediated aneurysmal formation. We conclude that: diagnosis of mitral or aortic valve aneurysms in patients with infective endocarditis has important therapeutic implications, and therefore, transesophageal echocardiographic examination should be done in such patients: there are three key echocardiographically diagnostic findings of aortic valve aneurysm as mentioned above; and several unknown factors may contribute to aneurysmal formation of the mitral or aortic valve in patients with infective endocarditis.

Inhibition of sarcolemmal Na+,K+-ATPase activity reduces the infarct size-limiting effect of preconditioning in rabbit hearts

BACKGROUND

The inhibition of sarcolemmal Na+,K+-ATPase activity is closely related to ischemic myocardial cell injury. However, the involvement of this enzyme in preconditioning has not been determined.

METHODS AND RESULTS

We assessed the effect of ischemia on sarcolemmal Na+,K+-ATPase activity. Control and preconditioned rabbits were subjected to 0, 10, 20, 30, and 60 minutes of coronary occlusion. Ten to 60 minutes of ischemia reduced Na+,K+-ATPase activity, whereas preconditioning preserved the activity of this enzyme only during the first 20 minutes of ischemia. To determine whether the preservation of Na+,K+-ATPase activity in the early phase of ischemia contributed to limiting the infarct size, additional rabbits underwent 30 minutes of occlusion followed by 3 hours of reperfusion with or without pretreatment with digoxin, an inhibitor of Na+,K+-ATPase. Infarct size in animals pretreated with digoxin in the absence of preconditioning did not differ from that in controls. It was markedly reduced by preconditioning, whereas digoxin reduced the infarct size-limiting effect. Moreover, preconditioning increased sarcolemmal Na+-Ca2+ exchange activity in rabbits subjected to 20 minutes of ischemia, whereas digoxin diminished this increase.

CONCLUSIONS

Preconditioning preserves the ischemia-induced reduction in sarcolemmal Na+,K+-ATPase activity in the early phase of ischemia in rabbit hearts. Inhibition of Na+,K+-ATPase activity reduces the infarct size-limiting effect of preconditioning with a loss of increased Na+-Ca2+ exchange activity, implying that this preservation is responsible for the cardioprotective effect of preconditioning.

Macrophage activation and migration in interface tissue around loosening total hip arthroplasty components

The bone-cement interface tissue of failed total hip arthroplasty (THA) has inflammatory characteristics, such as the presence of prostaglandin E2 and interleukin 1 (IL-1). We considered that the bone-cement interface tissue could be the site of granulomatous inflammation caused by a foreign-body reaction. It has been demonstrated that inflammatory cytokines and chemokines have an important role in granulomatous inflammation. Bone-cement interface tissue was obtained at revision from nine patients with failed cemented THA, and the role of macrophages was assessed by immunohistochemistry, electron microscopy, and molecular biological techniques. We used the reverse-transcriptional polymerase chain reaction to examine the expression of mRNA for IL-1 alpha, IL-1 beta, tumor necrosis factor alpha (TNF alpha), macrophage inflammatory protein (MIP)-1 alpha, MIP-1 beta, IL-8, and monocyte chemoattractant protein. Polyethylene debris surrounded by macrophages and phagocytosis of debris by macrophages was frequently observed in the interface tissue. Macrophage activation and the production of inflammatory cytokines such as IL-1 and TNF alpha might induce the development of interface tissue. Expression of chemokine mRNAs was also commonly seen, suggesting that this led to recruitment of macrophages into the bone-cement interface tissue. Debris released from implants appears to cause activation of macrophages and the production of inflammatory cytokines and chemokines that induce cellular recruitment into interface tissue. This mechanism might form a vicious cycle that aggravates THA loosening.

K(ATP) channels contribute to the cardioprotection of preconditioning independent of anaesthetics in rabbit hearts

The contribution of ATP sensitive potassium (K(ATP)) channels to the infarct-size limiting effect of preconditioning is considered to be anaesthetic-dependent in the rabbit heart. It has previously been reported that ischaemic preconditioning prevents ischaemia-induced reductions in activities of sarcolemmal adenylate cyclase (AC) and Na+, K(+)-ATPase. Anaesthetic dependency of the role of K(ATP) channels in the preservation of these enzyme activities, induced by ischaemic preconditioning, as well as that induced by activation of A1-adenosine receptors, was examined in rabbits anaesthetized with either pentobarbital or ketamine-xylazine and subjected to 20 min of regional ischaemia. Adenylate cyclase and Na+, K(+)-ATPase activities were lower in the ischaemic than in the non-ischaemic region of the hearts in control rabbits, but not in animals subjected to ischaemic preconditioning, or those pretreated with the A1-adenosine receptor agonist R(-)-N6-(2-phenylisopropyl) adenosine. The protective effects of both ischaemic preconditioning and A1-adenosine receptor activation were prevented by 6 mg/kg, but not 3 mg/kg, of the K(ATP) channel blocker, glibenclamide, in rabbits anaesthetized with pentobarbital, while these effects were prevented by 3 mg/kg of the blocker in rabbits anaesthetized with ketamine-xylazine. Moreover, K(ATP) channel opener, cromakalim, prevented the ischaemia-induced decreases in enzymatic activities in rabbits subjected to either type of anaesthesia. Thus, although the antagonistic effect of glibenclamide is blunted under pentobarbital, compared to ketamine-xylazine anaesthesia, K(ATP) channels contribute to preservative actions independent of the type of anaesthesia in the rabbit heart.

Rapidly destructive arthropathy of the hip in siblings

A case of rapidly destructive arthropathy of the hip in male siblings aged 74 and 76 years is reported. Hip joints of the brothers were destroyed 12 and 4 months after the onset of symptoms, respectively. Results of clinical and laboratory examinations did not show any features of neuropathic, inflammatory, or septic arthropathy. Pathologically in both patients, osteoarthrotic changes with small foci of bone necrosis and nonspecific inflammation and moderate amount of hemosiderosis in the synovium were observed.

Long-term outcome in double-vessel coronary artery disease in Japanese patients

The long-term (average: 10 years) outcome in 220 patients with double-vessel disease (DVD) treated medically was investigated. The patients underwent coronary angiography between September 1973 and February 1984, and significant (75% or more) stenosis was detected in each of two major coronary arteries. These patients showed relatively good 5-year and 10-year survival rates of 94.5% and 87.4%, respectively. Cardiac death occurred in 31 patients (14.1%) and nonfatal myocardial infarction (MI) developed in 16 patients (7.3%) during follow-up. When these were defined as cardiac events, the annual attrition rate was 3.1%. A comparison of the outcome with regard to the presence or absence of MI revealed worse results for the MI group, but no difference was observed between different sites of infarction. There was also no difference in outcome with regard to the presence or absence of lesions in the left anterior descending artery (LAD). In the MI group, patients with impaired left ventricular function (ejection fraction < or = 40%) had inferior survival to those with good left ventricular function. Thus, DVD associated with good left ventricular function had a relatively good outcome when treated medically, while patients with impaired left ventricular function might benefit from revascularization.

Fate of collateral vessels after successful coronary angioplasty in patients with effort angina

OBJECTIVES

The purpose of the present study was to evaluate whether severe restenosis after percutaneous transluminal coronary angioplasty (PTCA) promotes collateral development and whether successful dilation regresses collateral vessels.

BACKGROUND

It is well known that in the presence of severe coronary stenosis, native collateral arterioles mature to small coronary arteries with several layers of smooth muscle cells. However, it remains unclear whether well developed collateral vessels regress after removal of coronary stenosis.

METHODS

The study group comprised 41 patients who underwent elective PTCA for effort angina due to single-vessel disease, followed by repeat PTCA to treat restenosis. We classified the patients into three groups depending on the change in baseline Thrombolysis in Myocardial Infarction (TIMI) flow grade of the ischemia-related artery at initial and repeat PTCA, and we compared the extent of ST segment elevation at 1 min of the first balloon inflation between the two procedures. The average interval from initial to repeat PTCA was 125 days.

RESULTS

The three patient groups comprised group A, 12 patients with decreased flow grade because of severe coronary restenosis; group B, 12 patients with increased flow grade who had severe initial stenosis and relatively mild restenosis; and group C, 17 patients with unchanged flow grade. In the presence of comparable rate-pressure products at initial and repeat PTCA, patients in group A had significantly greater ST segment elevation (p < 0.01) at initial than at repeat PTCA (mean +/- SD 0.42 +/- 0.31 vs. 0.13 +/- 0.22 mV). In group B, ST segment elevation was significantly less at initial than at repeat PTCA (0.13 +/- 0.25 vs. 0.19 +/- 0.17 mV, p < 0.05), and in group C, it was comparable at the two procedures (0.37 +/- 0.32 vs. 0.35 +/- 0.33 mV, p = 0.50).

CONCLUSIONS

These findings indicate that severe restenosis after PTCA promotes collateral development and that successful dilaton regresses collateral vessels during a relatively short period of time.

[The studies of extracorporeal shock wave lithotripsy (ESWL) for pancreatic ductal stones]

30 patients with main pancreatic duct stones were treated by ESWL. In 18 of 22 patients who had not previously undergone endoscopic pancreatic sphincterotomy (EPST) or endoscopic sphincterotomy (EST), the stone fragments disappeared after ESWL. The fragments were removed endoscopically in the remaining 4 cases. Complete clearance was achieved in 8 cases with endoscopically unextractable stones by ESWL. After the ESWL procedure, absolute relief from pain was reported by in 19 of 22 patients with abdominal complaints. Serum amylase levels decreased significantly, and dilatation of the main pancreatic duct (MPD) was reduced. In the medium-term follow-up period, pancreatic exocrine function and endocrine function had a possibility to be preserved. One case of pancreatic cancer and one case of an intraductal papillary tumor of the pancreas were found, indicating that careful observation is necessary even after complete removal of pancreatic stones. In cases of Santorini duct dominant, multiple stones, or stricture of the MPD, ESWL should be combined with EPST and endoscopic stenting for preventing recurrence of acute pancreatitis and pancreatic stones. In conclusion, ESWL is the first choice of treatment for pancreatolithiasis and useful procedure and the limited complications.

Mixed connective tissue disease associated with acute polyradiculoneuropathy

A rare case of mixed connective tissue disease (MCTD) with acute polyradiculoneuropathy is reported. A 23-year-old woman presented with high body temperature, arthralgia and a headache, and developed gait disturbance two weeks later. She had many clinical features common to patients with MCTD. Her neurological manifestations were diagnosed as acute polyradiculoneuropathy based on the clinical picture, combined with supportive ancillary data, including cerebrospinal fluid (CSF) analysis, electrophysiological evaluation, sural nerve biopsy, peroneus brevis muscle biopsy, and magnetic resonance imaging (MRI). Her neurologic deficits, as well as associated laboratory findings, were improved by corticosteroid therapy.

Demonstration of ras and p53 gene mutations in carcinomas in the forestomach and intestine and soft tissue sarcomas induced by N-methyl-N-nitrosourea in the rat

The presence of ras family and p53 gene mutations in rat forestomach, intestine and liver tumors and soft tissue sarcomas induced by N-methyl-N-nitrosourea (MNU) was examined using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) followed by direct sequencing analysis. In the forestomach squamous cell carcinomas (SCC), Ha-ras and p53 mutations were detected in 2 (40%) and 4 (80%) of 5 cases, respectively. The figures for Ki-ras and p53 gene mutations in adenocarcinomas of the large and small intestines were 3 (18.8%) and 5 (31.3%) of 16 cases. Soft tissue sarcomas in different sites were found to have mutations of Ki-ras in 7 (23.3%) and of p53 in 9 (30%) of 30 cases. One forestomach SCC and 2 soft tissue sarcomas had double p53 mutations in different exons. Single cases of forestomach SCC and intestinal adenocarcinoma had mutations in both Ki-ras and p53 genes. No mutations were found in counterpart benign tumors or hepatocellular adenomas. The p53 mutation spectrum revealed preferential clustering within exon 8 for the forestomach SCCs, and exons 5 and 8 for the intestinal adenocarcinomas, whereas the distribution was evenly spread through exons 5 to 8 in soft tissue sarcomas. All the detected ras or p53 mutations were G:C to A:T transitions. These results indicate firstly that specific Ki-ras, Ha-ras and p53 gene mutations in MNU-induced lesions are related to particular alkylation sites (G:C to A:T transitions) and secondly, although not essential, Ki-ras, Ha-ras or p53 gene mutations may be involved in the progression stage of forestomach, intestine and soft tissue neoplasms induced by MNU.

Clinical application of transluminal endovascular graft placement for aortic aneurysms

BACKGROUND

In recent years, transluminal endovascular graft placement techniques have been developed for the treatment of aortic aneurysms. We report our initial clinical experience with endovascular graft placement using a graft developed in our laboratory.

METHODS

The procedure was performed in 20 patients with a diagnosed aortic aneurysm. The graft is constructed from a Dacron cylinder, and the surface of the graft is supported with multiple rings of extraflexible wire. After the compactly folded graft is delivered through the sheath to the predetermined target point, the graft is deployed and then pressed against the vessel by balloon inflation. Straight graft insertion was attempted in 10 patients, bifurcated graft insertion in 8, and branched graft insertion in 2.

RESULTS

Graft placement was successful in 19 of the patients and unsuccessful in 1. There were no cases of graft migration, aneurysm rupture, or graft destruction during a mean follow-up period of 9 months.

CONCLUSIONS

Initial clinical results demonstrated the efficacy and safety of endovascular graft placement using this graft.

Magnetic resonance galactography for a patient with nipple discharge

A new method of galactography using magnetic resonance imaging for a patient with nipple discharge is developed. The method is as follows; coronal T1-weight images are obtained after an injection of contrast medium of 1 mmol/L Gd-DTPA directly into the discharge duct, before and after rapid intravenous infusion of Gd-DTPA. A case of a 29-year-old woman with ductal carcinoma in situ with minimal invasion is reported, in which all portions of the entire discharge duct system is clearly shown as viewed from the surface and the surrounding area is enhanced with Gd-DTPA. The enhanced area is coincidental with the extent of the disease. This magnetic resonance galactography for patients with nipple discharge may be used to supplement conventional mammography and/or galactography especially for the evaluation of the extent of disease, although it is somewhat inferior to mammographic galactography in terms of differential diagnosis of ductal disease.

Vascularized pedicle bone-grafting for nontraumatic avascular necrosis of the femoral head. A 5- to 11-year follow-up

We investigated the results of 31 hips in 26 patients with nontraumatic (n = 20) and steroid-induced (n = 6) avascular necrosis of the femoral head (ANFH) treated with vascularized iliac pedicle bone graft (PBG). The average age at operation was 38.3 years. Three were women and 23 men. The average follow-up was 8.0 years. The Harris hip score prior to operation and at latest follow-up improved from 62 to 83; one hip collapsed and was revised with a bipolar endoprosthesis. At the final follow-up, 19 hips (63%) were clinically rated as good to excellent, 4 fair, and 7 poor. At the final follow-up, 15 of 27 hips (56%) of stage II before operation showed progressive collapse after bone grafting. In steroid-induced ANFH, in three women, 2 of 4 hips showed poor results. These results are only slightly better than those of core decompression and no better than those obtained after decompression and simple nonvascularized grafts to provide support for the subchondral bone. We concluded that vascularized PBG is sometimes indicated for ANFH in an early stage before collapse of the femoral head.

Effect of ethylene thiourea on cultured rat embryos in the presence of hepatic microsomal fraction

To investigate whether teratogenicity of ethylene thiourea (ETU) is due to ETU per se or to its metabolites, rat embryos cultured in vitro were exposed to 10 and 30 micrograms/ml of ETU in the presence or absence of rat liver microsomal fraction (S9mix). In the absence of S9mix, the incidence of morphological abnormalities increased dose-dependently. In the presence of S9mix, abnormal morphogenesis was almost absent in all embryos. These findings suggest that teratogenicity of ETU is due to ETU per se.

Macromotion of the femoral component in artificial hip joint

Macromotion of the femoral component was analyzed in seven loose hips associated with six patients utilizing the manual compression and distraction test. The mean vertical and varus movement of these hips were 6.4 mm and 1.2 degrees, respectively. Out of a total 120 cementless total hip arthroplasties, there was no macromotion in the control group of six patients with moderate to severe thigh pain. There was also no relationship between macromotion and the severity of thigh pain. Micromotion or rotational instability, which could not be analyzed by conventional stress radiograms, may contribute substantially to thigh pain.

Time course of ethylene thiourea in maternal plasma, amniotic fluid and embryos in rats following single oral dosing

Ethylene thiourea (ETU) was administered once orally to pregnant rats on gestation day 12 at a dose of 200 mg/kg, and its concentration-time courses in the maternal plasma, amniotic fluid and embryos were investigated. The ETU concentrations in the maternal plasma and amniotic fluid reached the peak level about 2 hr after dosing, then declined gradually and had disappeared by 48 hr. In embryos, the concentration of ETU peaked at 30 min after dosing and disappeared at 48 hr. The prolonged exposure of the embryos to the high concentration of ETU in the amniotic fluid could be partially responsible for the teratogenic effect of ETU.

Two distinct commonly deleted regions on chromosome 13q suggest involvement of BRCA2 and retinoblastoma genes in sporadic breast carcinomas

BACKGROUND

Frequent allelic losses on the long arm of chromosome 13 in sporadic breast carcinomas suggest that a tumor suppressor gene(s) on 13q is involved in this type of carcinoma. The presence of a familial breast carcinoma susceptibility gene, BRCA2, and the retinoblastoma susceptibility gene (RB) on the same chromosomal arm implies that one or the other, or both, of these genes may be critically affected by those allelic losses.

METHODS

To investigate the possible involvement of BRCA2 and RB in sporadic breast carcinomas, the authors examined allelic losses in 246 breast carcinomas with 14 polymorphic microsatellite markers on 13q12.q14.

RESULTS

Allelic loss was observed in 95 of the 246 sporadic breast carcinomas (39%). Detailed deletion mapping identified two commonly deleted regions. The more proximal of these two segments was located in a 6-cM interval flanked by marker loci D13S289 and D13S267 and containing the BRCA2 gene; the more distal region was located in a 9-cM interval flanked by marker loci D13S328 and D13S172 and containing the RB gene. Allelic loss on 13q was found more frequently in tumors of the solid tubular histologic type (36 of 66; 55%) than in other types (52 of 146; 36%) (P = 0.0096). Furthermore, a significant association was observed between allelic loss on 13q and the absence of progesterone receptor (P = 0.0001).

CONCLUSIONS

The results indicate that BRCA2 and RB are independent targets of allelic loss and that inactivation of either of these genes may play a role in the development of some sporadic breast carcinomas, particularly those of the solid tubular type.

Possible implication of hippocampal cholinergic neurostimulating peptide (HCNP)-related components in Hirano body formation

We have previously demonstrated that hippocampal cholinergic neurostimulating peptide (HCNP)-related components accumulate in almost all Hirano bodies in Sommer's sector of the hippocampus of elderly individuals, and that the number of HCNP-positive Hirano bodies is greater in patients with Alzheimer's disease. Although Hirano bodies occur preferentially in the neuronal processes of the stratum pyramidale of the hippocampus, they can be seen occasionally as small inclusions, intermingled with neurofibrillary tangles and in association with senile plaques. Here we show that the small inclusions are also recognized by an anti-HCNP antibody, and by using immunoelectron microscopy demonstrate that these HCNP-positive inclusions, intermingled with tau protein-positive neurofibrillary tangles and beta-amyloid-positive senile plaques are indeed Hirano bodies. These findings strongly suggest that HCNP-related components may be involved in Hirano body formation.

Twenty years' followup of intertrochanteric osteotomy for treatment of the dysplastic hip

A followup study of more than 15 years of intertrochanteric osteotomy for osteoarthrosis of the dysplastic hip was performed in 52 hips of 42 patients with varus osteotomy and in 58 hips of 53 patients with valgus osteotomy. Varus osteotomy was indicated for predegenerative or early degenerative stages of osteoarthrosis, and valgus osteotomy was indicated for progressive or end stage disease. The average age at time of varus and valgus osteotomies was 25 and 37 years, respectively, and the average followup period was 21 and 20 years, respectively. Using Kaplan-Meier's method (end point, Harris Hip Score < 70 points or salvage operation), the 10- and 15-year survival rates for varus osteotomy were 89% and 87% and for valgus osteotomy were 66% and 38%, respectively. Radiographic measurements of the postoperative acetabular head index and center edge angle in varus osteotomy were better in the group with good results than those in the group with poor results. There were no differences in radiographic measurements between the group with good results and the group with poor results of valgus osteotomy. Intertrochanteric varus and valgus osteotomy delayed the need for total hip arthroplasty in young patients with osteoarthrosis of the dysplastic hip.