Comparison of salt sensitivity of male and female F2 progeny from crosses between WKY and SHRSP rats

1. The present study compared the salt sensitivity of male and female F2 progeny obtained from crosses between Wistar-Kyoto/Izumo rats and stroke-prone spontaneously hypertensive rats (SHRSP A3b/Izm) after salt loading for 7 months. 2. Average systolic blood pressure in male F2 progeny was 10 mmHg higher than that of female F2 progeny at 5 months without salt loading. 3. The blood pressure in male F2 progeny was raised significantly 2 months after salt loading, but there was no further significant change in blood pressure even though salt loading was continued for 5 months. 4. In female F2 progeny, however, a significant change in systolic blood pressure was observed 1 month after salt loading and there was a further significant rise in blood pressure over 6 months. 5. Angiotensin I-converting enzyme and RR1023 loci were strongly linked to systolic and diastolic blood pressures in the male but not the female F2 progeny after salt loading for 7 months. 6. We therefore speculate that the hormonal difference between sexes might influence salt sensitivity in the SHRSP.

[Long-term results and complications of intravesical instillation of bacillus Calmette-Guerin for prophylaxis of bladder cancer recurrence]

Since 1982, we treated 22 patients with superficial bladder cancer via intravesical bacillus Calmette-Guerin (Tokyo 172 strain) for prophylaxis against tumor recurrence. To determine the long-term efficacy and complications of BCG therapy, retrospective analysis was performed. The BCG therapy was initiated one to two weeks after complete transurethral resection of visible tumors. One hundred twenty mg or 80 mg of BCG suspended in 40 ml of 0.9% NaCl solution was instilled into the bladder once a week for 6 times, then monthly for 10 times. Of 22 patients, 10 tumor recurrences were recognized in 4 patients (mean followup 74 months). Recurrent free rate at 5 years was 78.5%. Common side effects were low grade fever and bladder irritability. Although these side effects were self-limiting, 15 patients (68%) refused instillation of BCG before completion of our protocol because of the bladder irritation. No relationship was observed between total dose of BCG instilled and tumor recurrence. Severe side effects such as permanent structural or functional alterations of the bladder or mycobacterial infection of other organs were not observed. Intravesical administration of Tokyo 172 strain of BCG seemed to be safe and useful for long-term prophylaxis of superficial bladder cancer recurrence.

Tumour necrosis factor-alpha and interleukin 4 promote the differentiation of myeloma cell precursors in multiple myeloma

The effects of tumour necrosis factor-alpha (TNF-alpha) and interleukin 4 (IL-4) on peripheral blood mononuclear cells (PBMC) from 36 patients with multiple myeloma (MM), 12 with monoclonal gammopathy of undetermined significance (MGUS) and 21 normal controls, were investigated. In 16/36 patients with MM, monoclonal plasma cells appeared after 4d in cultures containing TNF-alpha and IL-4. These changes were not observed in PBMC from patients with MGUS or from normal controls. These findings suggest that myeloma cell precursors do exist in the peripheral blood of MM patients and differentiate into plasma cells in the presence of TNF-alpha and IL-4. Based on these observations, we think that the variation in the number of myeloma cell precursors in peripheral blood could be used as a prognostic parameter of response to chemotherapy in myeloma patients. In addition, this assay may be useful to distinguish early-stage MM from MGUS.

Cyclic haemopoiesis at 7- or 8-day intervals

We report a patient with severe anaemia and cyclic oscillations of reticulocyte and leucocyte counts, as well as serum iron (Fe), unsaturated iron-binding capacity (UIBC), ferritin, C-reactive protein (CRP) levels and temperature, at regular intervals of 7 or 8 d. After treatment with prednisolone, anaemia was corrected and the cyclic oscillations of these parameters ceased; whereas treatment with indomethacin, recombinant granulocyte-colony stimulating factor (G-CSF) and erythropoietin (Epo) were unsuccessful.

Multiple autoantibody production in a patient with splenic lymphoma

We report on a patient with splenic lymphoma of B-cell origin who developed autoimmune hemolytic anemia (AIHA). IgM lambda M-protein, IgM anticardiolipin antibody (ACA), and lupus anticoagulant (LA) were detected in the serum, and direct Coombs' test showed autoantibodies of the IgG1 and IgG2 subclasses on red blood cells (RBC). In in vitro culture, tumor cells isolated from the spleen produced only IgM ACA, which was enhanced by IL-6 but not by IL-4 or IL-5. The levels of ACA and LA decreased after splenectomy and chemotherapy; the strength of the direct Coombs' test, however, did not change. These findings indicated that in this patient the lymphoma cells produced IgM lambda ACA, but not autoantibodies of the IgG1 and IgG2 subclasses against RBC. It was also suggested that IL-6 might at least partially stimulate the production of ACA.

Impairment of ristocetin-induced platelet aggregation in patients with infective endocarditis

An investigation was carried out on two patients with infective endocarditis associated with reduction of ristocetin-induced aggregation of platelets. The plasma of these patients reduced the aggregability with ristocetin of normal platelets. It is suggested that the patients had certain plasma factors which disturbed platelet aggregation with ristocetin.

Basal high blood pressure cosegregates with the loci on chromosome 1 in the F2 generation from crosses between normotensive Wistar Kyoto rats and stroke-prone spontaneously hypertensive rats

We investigated the linkage between high blood pressure (BP) and microsatellite genotypes in the independently produced F2 progenies between Wistar Kyoto rats (WKY) and stroke-prone spontaneously hypertensive rats (SHRSP) at the age of 2.5, 3 and 5 months before salt loading and after 2 month salt loading. In 2.5, 3 and 5 month-old male and female F2 progenies, blood pressure was significantly higher in homozygotes of the SHRSP allele at the two loci on rat chromosome 1, leukosianine (LSN) and myosin light chain (MYL2), than those of heterozygotes or WKY homozygotes. However, this strong cosegregation was attenuated after salt loading for 2 months. Basal (non salt-loaded) blood pressure strongly cosegregates with the loci on rat chromosome 1 and, therefore, putative gene(s) in this region contribute to the development of basal high blood pressure in SHRSP.

[Effect of combination therapy with sulbactam/cefoperazone and amikacin in the treatment of infectious diseases accompanied by hematological disorders]

We studied the efficacy and safety of a combination therapy with sulbactam/cefoperazone (SBT/CPZ) and amikacin (AMK) on severe infections in the patients with hematological disorders. We administered SBT/CPZ and AMK to 65 patients and analyzed the result of 57 patients, except for 8 drop outs, for evaluation. The overall clinical efficacy of this combination therapy was 64.9% (excellent in 15 patients, good in 22 patients). Thirty seven patients had sepsis and suspected sepsis. The efficacy was 67.6% in these patients. The rate of improvement in the cases (18 patients) with neutrophil counts under 500/mm3 during the administration among 28 patients who had not responded to prior antibiotic treatment was 67.9%. Diarrhea was found in 1 patient as an apparent side effect likely related to this drug regimen. It appears that combination therapy of SBT/CPZ and AMK was a useful regimen in the treatment of infectious diseases complicated with hematological disorders.

Myelodysplastic syndrome with eosinophilia in bone marrow. Gunma Haematology Study Group

Clinical features were investigated in 114 patients with de novo myelodysplastic syndrome (MDS) diagnosed over the past 10 years, and eight cases (7%) were complicated with eosinophilia in the bone marrow. Two patients had refractory anaemia (RA), five had RA with excess of blasts (RAEB), and one had RAEB in transformation. Their bone marrow cells exhibited tri-lineage dysplasia and morphological abnormalities in eosinophils. Cytogenetics revealed major karyotype abnormalities (MAKA) in five patients. Survival durations were significantly shorter than those of other MDS patients. Our study suggests that marrow eosinophilia in MDS is strongly related to the coexistence of MAKA.

Proliferative effect of mevalonate metabolites other than isoprenoids on cultured vascular smooth muscle cells

1. Recent investigations revealed that isoprenoid compounds serve as key substances for cellular proliferation through post-translational modification. Previously we reported that tissues of spontaneously hypertensive rats (SHR) had a lower activity of isoprenoid biosynthesis when compared with the normotensive control rat (WKY). However, cultured vascular smooth muscle cells (VSMC) of SHR showed an enhanced growth rate. These findings led us to investigate further the effect of isoprenoid compounds on VSMC proliferation. 2. When the cells of WKY were stimulated with 5% fetal calf serum (FCS) in the presence of lovastatin, [3H]-thymidine incorporation decreased in a dose-dependent manner and was completely inhibited at 30 mumol/L. Exogenously added mevalonate showed a protective effect against lovastatin (81% protection at 0.1 mumol/L). 3. Fluoromevalonate (Fmev), an inhibitor of mevalonate-PP decarboxylase which converts mevalonate-PP into isoprenoids, showed a dual inhibitory effect. DNA synthesis was partially inhibited at 0.01-1 mumol/L, however at 10 mumol/L there was no detectable inhibition. The inhibitory effect was again observed at concentrations over 10 mumol/L. 4. In the presence of lovastatin and Fmev to block both HMG CoA reductase and mevalonate-PP decarboxylase, exogenous mevalonate dose dependently stimulated [3H]-thymidine incorporation induced by FCS. 5. These data suggest the positive effect of the initial mevalonate derivatives other than isoprenoid compounds on the proliferation of VSMC.

Primary plasmacytoma of generalized lymph nodes: a long survivor

Extramedullary plasmacytomas are occasionally seen in the course of multiple myeloma; however, primary plasmacytomas are unusual. Most of the primary plasmacytomas arise in the upper respiratory system, but a plasmacytoma of the lymph nodes is very rare. A case of a 56-year-old female with primary plasmacytoma in the lower mandibular, cervical, axillary, and para-aortic lymph nodes accompanied by IgA Kappa paraproteinemia is described. After ten courses of combination chemotherapy with cyclophosphamide and prednisolone, she obtained complete response. However, 6 years later, she had a relapse of plasmacytoma in the generalized lymph nodes. She received ten treatments of melphalan-prednisolone and again obtained complete response. She has remained well without chemotherapy or recurrent signs for 9 years. It is considered that conventional chemotherapy can be useful for primary plasmacytoma of generalized lymph nodes.

Ultrastructure of neutrophilic phagosome of autologous platelet in vivo in specific granule deficiency

The ultrastructure of neutrophilic phagosomes containing autologous platelets in vivo from a woman with specific granule deficiency is described. This phagosome formation was observed only when she had developed pneumonia due to Staphylococcus aureus. Therefore, the phenomenon might be induced by severe bacterial infection under an abnormal neutrophilic condition accompanied by specific granule deficiency.

Ultrastructure of plasma cells in a patient with J chain disease

Ultrastructural analysis of plasma cells was performed in a 74-year-old female patient with J chain disease. By electron microscopy, various characteristic findings were observed: lobulated nuclei, multinuclei, single sac loop-like structures, flocculent filament-like substances, nuclear inclusion bodies, cytoplasmic inclusion bodies, and multilamellar bodies. Our prior studies pointed out a poor prognosis in myeloma patients with these findings.

MCNU in the treatment of essential thrombocythemia--a pilot study

The efficacy of a single dose of MCNU 150 mg was evaluated in nine symptomatic patients with essential thrombocythemia (ET). As the platelet counts increased during the following 4 weeks, an extra dose of 100 mg of MCNU was administered to three patients. All patients had thrombotic or hemorrhagic complications. Seven patients responded. The mean platelet count decreased to below 1.0 x 10(12)/l within 5 weeks; it reached its lowest level (0.35 x 10(12)/l) at 6 weeks and became stable at less than 1.0 x 10(12)/l without further therapy for 12 weeks in all patients. Thrombotic and hemorrhagic complications ameliorated within 4 weeks in all patients. Our study indicates that MCNU acts as a platelet-reducing agent in patients with ET.

Change of paraprotein from IgG lambda to lambda chain in myeloma

We describe a unique case of IgG lambda myeloma in which a plasma cell leukemia developed and the paraprotein changed from IgG lambda to lambda chain, the latter inducing fatal renal failure. In addition, J-chain was detected in the cytoplasm of the plasma cell leukemia cells.

[Clinical features and status in multiple myeloma]

Quantitation of peripheral circulating myeloma cell precursors, problems on serum beta 2-microglobulin value which is a prognostic factor in myeloma, and prognostic factors associated with long-term survival in our Japanese myeloma patients are described. Peripheral blood mononuclear cells were cultured in vitro in the presence of various recombinant cytokines and differentiated to plasma cells to quantify peripheral circulating myeloma cell precursors. It has speculated that the variation in the number of myeloma cell precursors in peripheral blood could be used as a parameter of the efficacy of chemotherapy in patients with myeloma. Serum beta 2-microglobulin value increased with age and under alpha-interferon therapy in myeloma, even if M protein decreased, suggesting that its value should be carefully monitored when evaluating the response to alpha-interferon and other chemotherapeutic agents. Of 1,119 Japanese patients with symptomatic myeloma who were newly diagnosed at 16 institutions of the Japan Myeloma Study Group between 1965 and 1981, 38 (3.4%) patients survived for more than 10 years. In comparison with 121 patients who died within 10 years in our institution, younger age, low and intermediate tumor mass, lower plasmacytosis, higher percentages of granulocytes and erythroblasts in bone marrow, and subtype classified as mature or intermediate were strongly correlated with long-term survival.

[Combination therapy with granulocyte colony-stimulating factor (G-CSF) and erythropoietin (EPO) induced prominent granulocyte increase in an elderly case of myelodysplastic syndrome (MDS)]

A 70-year-old man was admitted to our hospital with pancytopenia. He was diagnosed as having MDS (RA), and therapy with subcutaneous S-CSF (100 micrograms/day) was started. His leukocyte count increased from 800/microliters to 1,400/microliters in two weeks. The dose of G-CSF was raised to 200 micrograms/day in the third week, and leukocytes increased to 2,00/microliters. At the fifth week, intravenous EPO (6,000 U x 3 times/week) was added. His leukocyte count increased to 4,000/microliters. EPO therapy was raised to 12,000 U x 3 times/week at the eighth week, his leukocyte count remained at the same level. G-CSF and EPO was stopped at the eleventh week, and leukocytes decreased to the same level as before administration. Throughout the course, his platelet count and reticulocyte count did not change. G-CSF and EPO are known as the stimulators of granuriod and erythroid progenitor, respectively. However, in this case, combination therapy with G-CSF and EPO induced marked increase of granulocytes only. This was an interesting case in relation to the roles of these cytokines in the hematopoietic system.