[A case of non-invasive pulmonary aspergillosis that rapidly deteriorated]

The pulmonary diseases caused by the Aspergillus species include invasive forms, for example, invasive pulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, and non-invasive pulmonary aspergillosis. Though these forms are defined pathologically by the presence of the Aspergillus species that invades the lung tissue, they are used as clinical entities. We report a case of non-invasive pulmonary aspergillosis which, from the clinical data, appeared likely to be misdiagnosed as the chronic invasive form. A 45 year-old man received chemoradiotherapy for lung cancer as well as undergoing an left upper lobectomy. Two weeks after the surgery the patient developed a cough, high fever and chest pain. Chest radiography and chest computed tomography showed a rapidly enlarging cavity with an internal mass and infiltration in the left lower lung field. A transbronchial biopsy specimen of the cavity wall showed fungal hyphae. Bronchial washing culture grew Aspergillus fumigatus. Itraconazole and amphotericin B were administered, but the patient's condition did not improve. A left lower lobectomy was performed. The histologic findings showed that the fungal hyphae were only on the surface of the cavity wall, and were surrounded by necrosis and widespread inflammatory cell infiltration. No fungal invasion of the viable lung tissue was seen. The area of infiltration revealed an organizing pneumonia without Aspergillus or other organisms. Our final diagnosis was non-invasive pulmonary aspergillosis. There has been no recurrence of the lung cancer or of the pulmonary aspergillosis in the three years since surgery. It is reported that non-invasive pulmonary aspergillosis passes through a period so active that it seems to be the invasive form for its entire clinical course. To avoid confusion in diagnosis, establishment of a comprehensive clinical classification of pulmonary aspergillosis will be needed.

[Pneumonia caused by Nocardia nova]

This is the first clinical report of a case of pneumonia caused by Nocardia nova in Japan. A 52 year-old woman who had received steroids and cyclophosphamide for six years because of polymyositis was admitted to our hospital for further examination. On admission she had a mild cough, and her chest radiography and computed tomography revealed bilateral multiple nodules, some of which were cavitated. She developed a cough productive of yellow sputum and fever up to 38 degrees C. Examination of the sputum revealed a gram-positive branched organism and sputum cultures repeatedly grew Nocardia species. The isolate was identified as Nocardia nova later. Clinical recovery was obtained readily upon treatment with imipenem and trimethoprim methoxazole, though the latter drug was discontinued because of nausea and anorexia. This drug was therefore replaced with oral minocycline, which proved to be ineffective clinically although susceptibility testing of the drug showed positive sensitivity. Minocycline was replaced with clarithromycin, after which chest radiography and computed tomography showed almost total resolution of the infiltrates. Clarithromycin may be an alternative oral agent to sulfonamides or minocycline when these agents are ineffective or not tolerated.

Negative regulation of G(1)/S transition by the candidate bladder tumour suppressor gene DBCCR1

Deletion of all or part of chromosome 9q is the most common genetic alteration in all stages and grades of bladder cancer. DBCCR1 (deleted in bladder cancer chromosome region candidate 1) maps to the chromosome region 9q32-33, a candidate tumour suppressor locus for bladder cancer. Although no mutations of DBCCR1 have been detected in bladder tumours, expression of DBCCR1 is silenced by promoter hypermethylation in 50% of bladder cancer cell lines analysed. Here we sought to provide functional evidence to authenticate DBCCR1 as a tumour suppressor using gene-transfer methods. Exogenous expression of DBCCR1 protein or an HA epitope-tagged fusion protein, HA-DBCCR1 in NIH3T3 cells and human bladder tumour cell lines resulted in suppression of proliferation. Cell cycle analyses in NIH3T3 cells revealed that DBCCR1-mediated growth inhibition was due to an increase in the number of cells in the G(1) phase of the cell cycle. The levels of apoptosis were not altered. These results demonstrate a role for DBCCR1 in cell cycle control, thereby supporting the hypothesis that this is the tumour suppressor gene targeted by 9q32-33 deletion in bladder cancer.

Detection of malignant thymoma in primary tumor and metastatic lesions using 99mTc-tetrofosmin scintigraphy

99mTc-tetrofosmin was developed as a myocardial perfusion imaging agent and can also be used to depict tumors. We have experienced five cases of malignant thymoma delineated on 99mTc-tetrofosmin SPECT. In one case significant activity was clearly detected in the primary tumor and metastatic lesions. In quantitative analysis, similar 99mTc-tetrofosmin and 201Tl-chloride uptake ratios were obtained (1.95+/-0.57 versus 2.27+/-0.85, respectively; n.s.). The ability of 99mTc-tetrofosmin to detect malignant thymoma was comparable to that of 201Tl-chloride. Therefore, 99mTc-tetrofosmin might be a useful tracer for the detection of malignant thymoma, although more studies will be required to evaluate its diagnostic accuracy.

Distribution and behavior of nonylphenol, octylphenol, and nonylphenol monoethoxylate in Tokyo metropolitan area: their association with aquatic particles and sedimentary distributions

Distributions of alkylphenols (APs) [i.e., nonylphenol (NP), octylphenol (OP)], and nonylphenol monoethoxylate (NP1EO) in wastewater effluents, river water, and riverine and bay sediments in the Tokyo metropolitan area were demonstrated. During sewage treatments, NP and OP were efficiently removed from the sewage effluents through activated sludge treatments. Greater removal for NP (93% on average) than OP (84% on average) was consistent with their partitioning behavior to particles in primary and secondary effluents. NP concentrations in the river water samples ranged from 0.051 to 1.08 microg/L with higher concentrations in summer and spring than in colder seasons. In the river water samples, approximately 20% of NP was found in the particulate phase. Organic carbon-normalized apparent partition coefficients (K'OC) for NP (10(5.22 +/- 0.38)) and OP (10(4.65 +/- 0.42)) were 1 order of magnitude higher than those expected from their octanol-water partition coefficients (K(OW)), indicating strong affinity of APs to aquatic particles. Among NP isomers, no significant differences in their K'OC values were suggested. This is consistent with surprisingly uniform isomer peak profiles among the technical standard and all the environmental samples analyzed. NP and OP were widely distributed in the river sediments in Tokyo, and relatively high concentrations (0.5-13.0 microg/g dry) of NP were observed in a long reach (approximately 10 km) in the Sumidagawa River. In situ production of APs in the river sediment was suggested. Seaward decreasing trend in APs concentration was observed from the estuary to the Tokyo Bay. APs were well preserved in a sediment core collected from the bay. The profile shows subsurface maximum of AP concentrations in the layer deposited around the mid-1970s. The recent decrease in AP concentrations can be attributed to the legal regulation of industrial wastewater in the early 1970s.

[Clinical comparison of Chlamydia pneumoniae pneumonia, ornithosis, and Mycoplasma pneumoniae pneumonia]

To elucidate the differences between the clinical aspects of Chlamydia pneumoniae (C. pn) pneumonia and those of two other atypical pneumonias, Chlamydia psittaci (C. ps) pneumonia and Mycoplasma pneumoniae (M. pn) pneumonia, we analyzed the symptoms and laboratory data on the cases of these three types of pneumonia: 46 cases of C. pn pneumonia, 39 cases of C. ps pneumonia, and 131 cases of M. pn pneumonia. C. pn pneumonia was significantly more frequent among the elderly (mean 70 +/- 16 years, p < 0.01) and patients were significantly more likely to be male (76%, p < 0.05). A white blood cell count of over 10,000 was seen in 46% of C. pn pneumonia cases, a higher proportion than those of C. ps pneumonia (15%, p = 0.03) or M. pn pneumonia (18%, p = 0.006) cases. The proportions of patients with these infections who had an elevated GOT or GPT were not significantly different. Maximum body temperature was higher in M. pn pneumonia than in C. pn pneumonia (p = 0.003). Purulent sputa were seen in 44% of C. pn pneumonia cases and 50% of M. pn pneumonia cases, and these rates were higher than that of 13% in C. ps pneumonia cases (p = 0.002, p = 0.004). Dyspnea and anorexia symptoms were the most frequent in C. pn pneumonia cases (24% and 29%, respectively, the highest of all three pneumonias). There were clinical differences between C. pn pneumonia and the other two atypical pneumonias. However, there was some difficulty in differentiating between C. pn pneumonia and typical bacterial pneumonia because mixed infections were common (24%) in C. pn pneumonia cases.

Squamous cell carcinoma of the prostate without evidence of recurrence 5 years after operation

A 54-year-old man underwent radical cystoprostatectomy after prostatic needle biopsy which revealed squamous cell carcinoma of the prostate. However, the positive surgical margin of the pubis suggested residual disease. He received chemotherapy with methotrexate, peplomycin and cisplatin (MPD regimen). He is at present still alive without evidence of recurrence 5 years after the operation. This suggests that MPD chemotherapy is effective for squamous cell carcinoma of the prostate.

Computed tomography screening for lung carcinoma in Japan

BACKGROUND

In Japan, lung carcinoma is the leading cause of cancer-related deaths. Adenocarcinoma accounts for roughly half of all lung carcinomas. Earlier detection of lung carcinoma is expected to reduce mortality rates. Computed tomography (CT) provides higher contrast resolution and greater visualization of chest compartments that are difficult to view with chest radiography, such as the mediastinum. CT further permits the detection of minute peripheral nodules. At present, several institutions and research groups are evaluating the utility of low dose spiral CT for lung carcinoma screening.

METHODS

From September 1993 to December 1998, 1669 individuals underwent a biannual screening program for lung carcinoma. The program included posteroanterior radiograph, sputum cytology, and low dose spiral CT at a for-profit organization: The Anti-Lung Cancer Association (ALCA). A total of 9993 examinations were carried out. The low dose spiral CT parameters used were 120 kvP, 50 mA, 10-mm collimation, and 2:1 pitch.

RESULTS

Peripheral lung carcinoma was detected in 31 of 9993 examinations (0.3%). Of the 31 cases, 24 tumors (77%) were detected by low dose spiral CT but were not visible on standard chest radiography. Twenty-two of the 24 tumors were Stage IA (T1N0M0, according to staging system revised in 1997).

CONCLUSIONS

Low dose spiral CT shows promise for lung carcinoma screening. The effectiveness of the technique for the detection of minute lung lesions remains to be established. Routine use of the technique will require resolution of several issues. These issues include the establishment of CT diagnostic criteria, the development of a diagnostic support system, the establishment of methods for definite diagnosis, and assessments of efficacy.

[Chest radiograph of atypical pneumonia: comparison among Chlamydia pneumoniae. Pneumonia, ornithosis, and Mycoplasma pneumoniae pneumonia]

No report has been found comparing Chlamydia pneumoniae (C. pneumoniae) pneumonia radiographically with other atypical pneumonias, Chlamydia psittaci (C. psittaci) pneumonia and Mycoplasma pneumoniae (M. pneumoniae) pneumonia. We described the chest radiographs of three kinds of pneumonia cases: 46 cases of C. pneumoniae pneumonia, 39 cases of C. psittaci pneumonia, and 131 cases of M. pneumoniae pneumonia. Radiographic shadows were categorized into main shadows and sub-shadows. The main shadows are classified from the viewpoint of the characteristics; air space consolidation(AS), ground-glass opacity(GG), reticular shadow(RS), bronchopneumonia(BP), and small nodular shadows (SN). The size, the site, and the number of the main shadows were also analyzed. In comparison among the three pneumonias, BP was the most frequent in M. pneumoniae pneumonia (0.40/case). AS predominated in C. pneumoniae pneumonia (0.67/case), and GG in C. psittaci pneumonia (0.62/case). The number of main shadows was equal, about 1.4/case in three pneumonias. Large shadows were less frequent in M. pneumoniae pneumonia than C. pneumoniae pneumonia (p = 0.02) and C. psittaci pneumonia (p = 0.01). Main shadows were more frequent in the outer zone in M. pneumoniae pneumonia than C. psittaci pneumonia (p = 0.01), and in the middle zone in C. psittaci pneumonia than in M. pneumoniae pneumonia (p = 0.02). Cases with bilateral main shadows were less common in M. pneumoniae pneumonia (9%) than C. pneumoniae pneumonia(33%, p = 0.001) and C. psittaci pneumonia(30%, p = 0.005). Thickening of bronchovascular bundles as a sub-shadow was most frequently noted in M. pneumoniae pneumonia. Some differences among the three atypical pneumonias were seen in the chest radiograph. However, no specific findings of C. pneumoniae pneumonia were shown radiographically in this study.

Cortex-restricted disruption of NMDAR1 impairs neuronal patterns in the barrel cortex

In the rodent primary somatosensory cortex, the configuration of whiskers and sinus hairs on the snout and of receptor-dense zones on the paws is topographically represented as discrete modules of layer IV granule cells (barrels) and thalamocortical afferent terminals. The role of neural activity, particularly activity mediated by NMDARs (N-methyl-D-aspartate receptors), in patterning of the somatosensory cortex has been a subject of debate. We have generated mice in which deletion of the NMDAR1 (NR1) gene is restricted to excitatory cortical neurons, and here we show that sensory periphery-related patterns develop normally in the brainstem and thalamic somatosensory relay stations of these mice. In the somatosensory cortex, thalamocortical afferents corresponding to large whiskers form patterns and display critical period plasticity, but their patterning is not as distinct as that seen in the cortex of normal mice. Other thalamocortical patterns corresponding to sinus hairs and digits are mostly absent. The cellular aggregates known as barrels and barrel boundaries do not develop even at sites where thalamocortical afferents cluster. Our findings indicate that cortical NMDARs are essential for the aggregation of layer IV cells into barrels and for development of the full complement of thalamocortical patterns.

Prevalence of dementia in the rural village of Hanazono-mura, Japan

We studied the prevalence of dementing disorders in a rural municipality of Japan (Hanazono-mura), using a door-to-door two-phase design. In phase 1, the Hasegawa's Dementia Scale-Revised was applied as a screening test to all subjects aged 65 years and older (n = 201). Among subjects screened positive, 17 were diagnosed with dementia in phase 2. The prevalence (cases/100 aged 65 years and older) was 8.5 for all types of dementia, 3.5 for Alzheimer's disease, 3.0 for vascular dementia, and 2.0 for other dementia (including mixed dementia). The prevalence of dementia was slightly but consistently higher in men than women at all ages. The overall prevalence was higher in women for Alzheimer's disease and in men for vascular dementia.

Magnetic resonance imaging of human mandibular elevator muscles after repetitive maximal clenching exercise

Exercise can enhance the signal intensity (SI) of skeletal limb muscles on T2-weighted magnetic resonance imaging (MRI). The purpose here was to evaluate the effects of repetitive maximal clenching exercises involving the mandibular elevator muscles with T2-weighted MRI. Seven normal volunteers were imaged before and immediately after performing repetitive maximal clenching and at 3, 6, 9, 12, 15, 20 min after the exercise in a 1.5 T GE magnet with spin-echo sequences. SI in the masseter, medial pterygoid and temporalis increased significantly (p < 0.001) and the cross-sectional area (CSA) of masseter increased 10.11% on T2-weighted MRI after exercise. The increased SI and CSA declined approximately to the pre-exercise level in about 20 min after exercise. No SI and CSA changes were found in the inactive neck muscle and no SI changes in the mandibular bone marrow (p > 0.05). The findings suggest that the use of exercise-enhanced MRI might be helpful in the study of the function and dysfunction of muscles in the orofacial region.

Effects of ischemia and H2O2 on the cold stress protein CIRP expression in rat neuronal cells

Expression of CIRP (cold-inducible RNA-binding protein) is inducible at 32 degrees C in cultured fibroblasts. Because ischemia is known to induce expression of heat shock proteins, its effect on the CIRP expression was examined using the rat transient forebrain ischemia model. The isolated rat CIRP cDNA encoded amino acids 100% identical in its sequence to mouse CIRP. Northern blot analysis revealed that the CIRP transcripts were ubiquitously expressed in various tissues. In situ hybridization histochemistry of normal rat brain revealed the expression of CIRP in neurons in the hippocampus and the cerebral cortex among others. In the hippocampus of postischemic rats, CIRP mRNA level decreased from 3-6 h after the onset of reperfusion, while it did not change in the cerebral cortex. When PC12 pheochromocytoma cells were cultured at 32 degrees C, the CIRP mRNA level was increased. The presence of H2O2 in the culture media inhibited dose dependently this induction as well as constitutive expression, suggesting that the effect of brain ischemia on CIRP expression is related to generation of reactive oxygen species. Further studies are necessary to clarify the roles played by cold shock proteins in the hypothermic therapy of brain damages.

Re-assessment of stage I uterine cervical carcinoma according to revised JSGO (1997) staging

BACKGROUND

The Japanese Society of Gynecologist and Obstetrician (JSGO) revised criteria for early uterine cervical cancer.

OBJECTIVE

In this study, we investigated the value of the revised JSGO criteria.

METHOD

Retrospective review was performed for 70 patients with tumors limited to the uterine cervix who were classified stage I under old JSGO criteria.

RESULT

Forty patients were re-classified into stage IA1 and 4 patients into stage IA2. Incidence of lymph-vascular infiltration (LVI) in stage IA1 and IA2 were 5% and 25%. There was one patient with stage IA1 disease who had nodal metastasis and no patients with stage IA2 disease. There were 14 patients with stage IB1 disease and 12 patients with stage IB2 disease. Mortality of patients with stage IB2 disease was 25% and significantly higher than that of patients with stage IA and IB1 disease (P<0.001 and <0.05)

CONCLUSION

Although the revised JSGO criteria for early cervical cancer are acceptable for assessment of patients, the therapy of patients is still controversial. We recommend that patients with stage IA1 and negative LVI should have less radical hysterectomy and patients with stage IA1 with LVI or stage IA2, IB should have radical hysterectomy.

Expression of protein tyrosine phosphatase PTP-RL10 and its isoform in the mouse testis

BACKGROUND

The cytoplasmic-type protein tyrosine phosphatase PTP-RL10/PTPD1/PTP2E contains an ezrin-like domain and associates with the c-Src protein tyrosine kinase. Because tyrosine phosphorylation regulated by protein tyrosine kinases and phosphatases is involved in activation, migration, differentiation and proliferation of various cell types, the expression of PTP-RL10 and c-src in the mouse testis was investigated.

METHODS

Testes of wild-type mice and W/W(v) mutant mice that lack germ cells were analyzed by northern blotting, in situ hybridization histochemistry and reverse transcriptase-polymerase chain reaction for the expression of PTP-RL10, its isoform PTP-RL10b and c-src. Expression in the Sertoli cell lines, TM4 and TAMA26 was also analyzed.

RESULTS

PTP-RL10 transcripts of 5.7kb and 2.9kb in size were detected in the testis. In situ hybridization histochemistry demonstrated that the 5.7kb transcripts were expressed in pachytene spermatocytes and somatic cells including Sertoli cells, in which c-src transcripts were detected. The 2.9kb transcript encoded a novel isoform, PTP-RL10b, that has the catalytic domain but not the domains that associate with c-Src. PTP-RL10b was expressed mainly in the testicular somatic cells. TM4 and TAMA26 cells were found to co-express PTP-RL10, PTP-RL10b and c-src transcripts.

CONCLUSION

PTP-RL10 and its isoform are expressed in the Sertoli cells and are suggested to play roles in spermatogenesis by interacting with c-Src and/or other protein(s).

A model-based interpretation of the biphasic daily pattern of sleepiness

We developed a thermoregulatory model of sleep control based on the hypothesis that non-rapid eye-movement sleep participates in homeostatic thermoregulation. This model successfully reproduced several qualitative features of human sleep/wake cycles during entrained as well as the internally desynchronized states. Among the reproduced features, generation mechanisms of the biphasic sleepiness distribution are studied here in the light of the model structure. Harmonic analysis is employed for this purpose. Through linearizations and confining the harmonics of the masking process to the fundamental component, a simplified representation of sleepiness is obtained. The simplified sleepiness is constructed with the fundamental circadian, the second harmonic components, and the constant (DC). The bimodality of the sleepiness is shown to be made by the second harmonic which is added to the fundamental component. The behavior of their amplitudes and phase positions are investigated under the varied sleep/wake durations and phase differences between the oscillators. Since the sleepiness generated by our model is roughly mimicked by the simplified representation under diverse conditions, this simplification can be regarded as adequate. From the behavior of the constituents of respective harmonic components, the fundamental component is shown to originate from the sleep/wake masking process and the circadian oscillators; the second harmonic from the multiplicative interactions between the circadian oscillators and the sleep/wake masking process. These results indicate that the rhythmic processes are principal constituents of the sleepiness, at least in the steady state.

Homozygous deletion at the 9q32-33 candidate tumor suppressor locus in primary human bladder cancer

Loss of heterozygosity (LOH) on chromosome arm 9q is the most frequent genetic alteration found in superficial and invasive transitional cell carcinoma (TCC) in a previous microsatellite-based deletion mapping study of the bladder and upper urinary tract, indicating the presence of one or more important tumor suppressor genes (TSGs). One of the putative tumor suppressor loci on 9q (DBC1) was mapped to 9q32-33 and the candidate region was localized within a single YAC. We report here a case of superficial papillary TCC, which showed a homozygous deletion encompassing this candidate tumor suppressor region. The region of homozygous deletion spanned the interval between D9S275 and AFMA239XA9 at 9q32-33, and was estimated to be </=6 cM. Although homozygous deletion mapping did not narrow down the candidate tumor suppressor region, this case provides further support for the presence of a TSG for TCC in this chromosomal region. To our knowledge, this is the first report to show homozygous deletion at 9q32-33 in TCC or any other type of human tumor. Genes Chromosomes Cancer 26:171-175, 1999.