Chronic solitary pulmonary nodule due to unsuspected pulmonary infarction from silent pulmonary embolism

A case of pulmonary embolism showing a longstanding solitary pulmonary nodule is presented. An asymptomatic 57 year-old man with a solitary nodule in the right lower lobe was referred to our hospital. A pulmonary perfusion-ventilation scan following a sudden onset of dyspnoea established the diagnosis of recurrent pulmonary embolism. The nodule gradually disappeared after anticoagulant treatment, indicating that the nodule was pulmonary infarction from silent pulmonary embolism. Although the incidence of pulmonary infarction is low in Japan, this case suggests that pulmonary infarction from silent pulmonary embolism should be considered as one important cause of a solitary pulmonary nodule.

Induction of tolerance in murine autoimmune diabetes by transient blockade of leukocyte function-associated antigen-1/intercellular adhesion molecule-1 pathway

The present study demonstrated that a short-term administration of mAbs against leukocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1) at critical periods resulted in complete protection of autoimmune diabetes in non-obese diabetic (NOD) mice. When these mAbs were administered for only 6 days at 2 wk of age, neither diabetes nor insulitis was observed at 30 wk of age. It appears that the tolerance against beta cell Ag(s) was induced by this transient blockade of the LFA-1/ICAM-1 pathway. Protective suppressor activity was not enough to prevent diabetes because co-transfer of splenocytes from female NOD mice, which had received these mAbs at 2 wk of age, resulted in only a short delay of the diabetic onset caused by adoptive transfer of splenocytes from acutely diabetic NOD mice. Transfer of these splenocytes to young NOD mice could not also abrogate the spontaneous diabetes and insulitis. Furthermore, cyclophosphamide treatment could not abrogate the protection. When splenocytes from the treated NOD mice were transferred to NOD-SCID mice, none of the recipient mice developed significant insulitis and subsequent overt diabetes, suggesting the absence or the inactivation of diabetogenic effector T cells. However, splenic T cells from the insulitis-free NOD mice that had received the mAb treatment preserved proliferative responses to both islet cells and 65-kDa glutamic acid decarboxylase (GAD65) in vitro. These results suggest that a unique peripheral tolerance was induced by the transient blockade of the LFA-1/ICAM-1 pathway in an early age of NOD mice.

Induction of tolerance in murine autoimmune diabetes by transient blockade of leukocyte function-associated antigen-1/intercellular adhesion molecule-1 pathway

The present study demonstrated that a short-term administration of mAbs against leukocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1) at critical periods resulted in complete protection of autoimmune diabetes in non-obese diabetic (NOD) mice. When these mAbs were administered for only 6 days at 2 wk of age, neither diabetes nor insulitis was observed at 30 wk of age. It appears that the tolerance against beta cell Ag(s) was induced by this transient blockade of the LFA-1/ICAM-1 pathway. Protective suppressor activity was not enough to prevent diabetes because co-transfer of splenocytes from female NOD mice, which had received these mAbs at 2 wk of age, resulted in only a short delay of the diabetic onset caused by adoptive transfer of splenocytes from acutely diabetic NOD mice. Transfer of these splenocytes to young NOD mice could not also abrogate the spontaneous diabetes and insulitis. Furthermore, cyclophosphamide treatment could not abrogate the protection. When splenocytes from the treated NOD mice were transferred to NOD-SCID mice, none of the recipient mice developed significant insulitis and subsequent overt diabetes, suggesting the absence or the inactivation of diabetogenic effector T cells. However, splenic T cells from the insulitis-free NOD mice that had received the mAb treatment preserved proliferative responses to both islet cells and 65-kDa glutamic acid decarboxylase (GAD65) in vitro. These results suggest that a unique peripheral tolerance was induced by the transient blockade of the LFA-1/ICAM-1 pathway in an early age of NOD mice.

Radionuclide venography and its functional analysis in superior vena cava syndrome

In addition to imaging, radionuclide venography maybe used for the functional assessment of superior vena cava (SVC) syndrome by applying the indices of transit time (TT), time of half-peak count (TH) and peak count ratio (PC ratio).

METHODS

Ten healthy subjects (Group N) and 107 patients with SVC syndrome (64 symptomatic and 43 asymptomatic) were studied. Images were visually assessed for collaterals or jugular venous reflux and values of the indices were calculated.

RESULTS

The 107 patients were subclassified into three groups according to the images obtained. Collateral circulation was seen in 37 patients (Group C). In 20 patients, jugular venous reflux was observed (Group J). Fifty patients who showed neither collaterals nor reflux were included in Group P. In comparison to Group N [3.6 +/- 0.56 see (sem)], TT values were significantly higher (p < 0.05) for Group J (7.13 +/- 1.16 sec) and Group C (7.00 +/- 0.87 sec). Values of TH were significantly prolonged (p < 0.05) for Group J (23.6 +/- 4.8 sec) and Group C (18.8 +/- 2.2 sec) in comparison to Group N (9.2 +/- 1.5 sec). PC ratio values were higher in all patient groups in comparison to Group N (3.4 +/- 0.57).

CONCLUSION

These indices are potentially useful in the initial diagnosis and post-therapeutic evaluation of SVC syndrome. In the absence of other causes, appearance of jugular venous reflux may be considered a sign of SVC syndrome.

[Image cytometric DNA analysis in bladder tumors]

We studied image cytometric DNA analysis of bladder tumors to evaluate malignant potentials of bladder tumors.

METHODS

Thirty nine samples were obtained by TUR from 37 patients. Nuclear DNA content of all samples were measured by image cytometer and were determined ploidy pattern by DNA histogram.

RESULTS

Of 39 TCC non-diploid pattern was recognized in 50% of grade 1 cases, 73% of grade 2 cases and 100% of grade 3 cases. DNA ploidy was strictly correlated with histological grading in TCC. DNA non-diploid pattern was present in 67% of papillary tumors, 87.5% of non-papillary tumors and 100% in CIS. In diploid pattern 2 of 7 cases with grade 1 and 2 of 4 cases with grade 2 recurred. In non-diploid pattern 1 of 4 cases with grade 1, 4 of 10 cases with grade 2 and 4 of 6 cases with grade 3 recurred. There was no significant correlation between diploid and non-diploid pattern in grade 1, 2, 3.

CONCLUSION

Image cytometric DNA analysis may be useful in addition to the classic and prognostic parameters of stage and grade, especially in TCC. The differences between image analysis system and flow cytometric analysis for DNA measurement were discussed.

Mercury content in the gallstones and bile of Thai people (Chiang Mai and Bangkok) and Japanese

Mercury contents in the gallstones and bile of patients living in Thailand (Chiang Mai and Bangkok) and Japan were studied by neutron activation analysis. The correlation between contents in the gallstones and bile, and the amount of mercury in the diet and environment was investigated by comparing the contents in patients living in three different areas. The content in the bile of the Japanese patients was significantly greater than that of the Thai patients. The distribution of mercury contents in the pigment and rare stones of patients living in Bangkok indicated a bipolarity. However, the distribution of the contents in cholesterol, pigment, and rare stones of Japanese patients did not indicate a bipolarity. Bipolarity would indicate the amount of mercury in dietary foods, and the pollution level of mercury. The mercury contents in the gallstones and bile would reflect the amount of mercury in the diet and environment.

Metabolism of tetramethrin isomers in rat. III. Stereochemistry of reduced metabolites

1. Three main urinary metabolites, two isomers of 3-hydroxycyclohexane-1,2-dicarboximide (3-OH-HPI-1 and 2) and 1,2-tetrahydrodicarboxylic acid (TCDA) were purified from rat treated with (1RS, trans)-tetramethrin [3,4,5,6-tetrahydrophthalimidomethyl (1RS, trans)-chrysanthemate]. 2. To elucidate the mechanism of formation of these reduced metabolites, the stereochemistry of 3-OH-HPI-1, 3-OH-HPI-2 and TCDA was clarified by chemical reactions, spectroanalysis (nmr) and X-ray analysis. 3. The sole difference in configuration between 3-OH-HPI-1 and 3-OH-HPI-2 was found to be the orientation of the hydroxyl group to the cyclohexane ring, and both of these reduced metabolites showed cis-addition of two hydrogens. In contrast, reduction resulted in the trans form with TCDA. 4. These findings indicate the existence of two different reduction reaction mechanisms in the rat.

Maleimidobenzoyl actin: its biochemical properties and in vitro motility

Muscle G-actin treated with the hetero-bifunctional cross-linking reagent m-maleimidobenzoyl-N-hydroxysuccinimide ester (MBS), denoted as MBS-G-actin, is not induced to polymerize into F-actin by salt and myosin subfragment 1 [Bettache, N., Bertrand, R., and Kassab, R. (1989) Proc. Natl. Acad. Sci. USA 86, 6028-6032]. However, the addition of salt and phalloidin together allowed MBS-G-actin to polymerize and the resulting polymer (P-MBS-G-actin) could activate the Mg2+ -ATPase of S-1 [Miki, M. and Hozumi, T. (1991) Biochemistry 30, 5625-5630]. When F-actin was treated with MBS (MBS-F-actin), unlike MBS-G-actin, intercross-links between monomers in F-actin occurred. The MBS-F-actin could activate the Mg2+ -ATPase of heavy meromyosin (HMM): its maximum turnover rate, Vmax, was almost the same as that of native F-actin, but the affinity of HMM for MBS-F-actin in the presence of ATP, Km, was about 3 times higher. Electron microscopy showed that both P-MBS-G-actin and MBS-F-actin had the double stranded structures of F-actin and formed the arrowhead structures when combined with HMM. By in vitro motility assay, the sliding velocities of P-MBS-G-actin and MBS-F-actin were found to be slightly slower than that of native F-actin. But the critical concentration of KCl, over which the sliding movement was not observed, for MBS-modified actins was considerably higher than for native F-actin. When MBS-modified actins were regulated by tropomyosin-troponin complex, they were less sensitive to the Ca2+ concentration for HMM ATPase activation and sliding movement. These results showed that the modification of some of the lysine residues in the actin molecule leads to change in the biochemical properties of F-actin.

Administration of monoclonal antibodies against vascular cell adhesion molecule-1/very late antigen-4 abrogates predisposing autoimmune diabetes in NOD mice

The interaction of vascular cell adhesion molecule-1 and very late antigen-4 (alpha 4 beta 1-integrin) has been recently known to be profoundly involved in the trafficking of lymphocytes from the circulation into the inflammatory tissues. To elucidate the role of these molecules in the development of autoimmune diabetes, the expression of these adhesion molecules on inflamed islets and the effects of administration of monoclonal antibodies to these molecules on insulitis and overt diabetes were evaluated in nonobese diabetic (NOD) mice. Immunohistochemical study revealed the overexpression of vascular cell adhesion molecule-1 on vascular endothelium near or within inflamed islets and alpha 4-integrin on islet-infiltrating mononuclear cells. Either anti-vascular cell adhesion molecule-1 or anti-alpha 4-integrin monoclonal antibody prevented the transfer of diabetes in irradiated NOD mice which received spleen cells from acutely diabetic NOD mice. When both monoclonal antibodies were administrated to NOD mice during 2-30 weeks of age, neither lymphocytic infiltration to islets nor overt diabetes was observed. Furthermore, administration of these antibodies even from 10 weeks of age could inhibit the development of insulitis and diabetes, whereas administration during 2-5 weeks of age could not. Splenocytes obtained from these treated mice showed no significant change of cytokine production and preserved the ability to transfer diabetes into NOD scid/scid mice. This suggests that treatment with antibodies against these adhesion molecules can inhibit insulitis and diabetes without affecting the Th1/Th2 balance or effector T cells. The blockade of vascular cell adhesion molecule-1/very late antigen-4 interaction would be suitable for therapeutical treatment of the predisposing and latent type I (insulin-dependent) diabetic subjects.

Interaction of NADPH-adrenodoxin reductase with NADP+ as studied by pulse radiolysis

The reduction of flavin in NADH--adrenodoxin reductase by the hydrated electron (eaq-) was investigated by pulse radiolysis. The eaq- reduced directly the flavin of the reductase to form a blue semiquinone of the enzyme. Subsequently, the semiquinone decayed by dismutation to form the oxidized and fully reduced forms of the enzyme with a second-order rate constant of 4.4 x 10(4) M-1 s-1. In the presence of equimolar NADP+, the decay of eaq- accompanied an absorption increase at 400 nm, the spectrum of which, formed transiently, is identical to that of NADP radical (NADP.). Subsequently, the transient species decayed concomitantly with the formation of the semiquinone. The rate constant in the formation of the semiquinone was independent of the concentration of the enzyme (6.1 x 10(4) s-1 at pH 7.5). From these results, it is concluded that eaq- reacts with NADP+ bound to the enzyme to form NADP. initially, and subsequently, an electron flows from the NADP. to the flavin by an intracomplex electron transfer. A similar result was obtained in the reaction of CO2- or N-methylnicotinamide radical with the NADP(+)-adrenodoxin reductase complex. These results suggest that the nicotinamide moiety of NADP+ bound to the enzyme is accessible to the solvent and masks the flavin completely.

[Bilateral renal cell carcinoma of von Hippel-Lindau disease associated with von Willebrand disease: a case report]

A 42-year-old man diagnosed with von Willebrand disease 7 years earlier visited his home doctor with a chief complaint of gross hematuria. Abdominal ultrasonography showed bilateral renal tumors. He was referred to our hospital on June 15, 1993. His mother also had von Hippel-Lindau disease and was treated by hemodialysis after bilateral nephrectomy. The examination and imaging revealed bilateral renal cell carcinoma of von Hippel-Lindau disease associated with von Willebrand disease. Partial nephrectomy and enucleation for a small tumor on the right side and enucleations for five tumors on the left side were performed. Histological diagnosis of all tumors were renal cell carcinoma, clear cell subtype, grade 1 approximately 2. The patient has been well without local recurrence or distant metastasis for 16 months since the operation. This is the first case of bilateral renal cell carcinoma of von Hippel-Lindau disease associated with von Willebrand disease in Japan.

Inhalation of pertechnegas: similar clearance from the lungs to that of inhaled pertechnetate aerosol

It has been reported that the inhalation of pertechnegas (TGO3) generated under an atmosphere of 3% oxygen (O2) in argon (Ar) instead of 100% Ar without O2 in the technegas generator, offers a simple but accurate quantification of clearance from the lungs, permitting it to be used in place of 99Tcm-diethylenetriamine pentaacetic acid (DTPA). The disappearance from the lungs of inhaled TGO3 was so similar to that of inhaled pertechnetate aerosol (TcO4) in this study, that there was neither a statistically significant difference in the clearance half-time (t1/2), nor a difference in the lung images between them. Neither TGO3 nor TcO4 inhalation could distinguish smokers from non-smokers using t1/2. When inhaled, TGO3 appears to behave in a similar manner to TcO4 in the lungs and hence cannot be used in place of 99Tcm-DTPA in clinical practice.

Expression of intercellular adhesion molecule 1 on pancreatic beta-cells accelerates beta-cell destruction by cytotoxic T-cells in murine autoimmune diabetes

Intercellular adhesion molecule 1 (ICAM-1) plays an important role in the pathogenesis of insulin-dependent diabetes mellitus (IDDM) by being involved in the extravasation of lymphocytes from the circulation into the inflamed pancreas. However, the mechanism of beta-cell destruction by which expression of ICAM-1 on beta-cells may facilitate adhesion of effector cells still remains to be elucidated. Several lines of evidence suggest that this adhesion molecule is involved in the destruction of pancreatic beta-cells by killer lymphocytes in the NOD mouse, which shows an autoimmune diabetic syndrome similar to that of human IDDM. Immunohistochemical study under light microscopy demonstrated that all of the mononuclear cells infiltrating the islets strongly expressed ICAM-1 and leukocyte function-associated antigen 1 (LFA-1), a counterreceptor of ICAM-1, whereas ICAM-1 expression on islet cells was not apparent. However, immunohistochemical staining under electron microscopy revealed that islet beta-cells adjacent to infiltrating lymphocytes were clearly stained by an anti-ICAM-1 monoclonal antibody (mAb). Flow cytometric analysis showed that the ICAM-1 expression on NOD islet cells and NOD-derived insulinoma cells (MIN6N8a) was inducible by interferon (IFN)-gamma or tumor necrosis factor-alpha. These cytokines had an additive effect on the ICAM-1 induction. Susceptibility of MIN6N8a cells to lysis by a NOD islet-derived CD8+ cytotoxic T-cell clone was greatly enhanced by IFN-gamma pretreatment, and this enhancement was abolished by anti-ICAM-1 and anti-LFA-1 mAbs. When both mAbs were administered into NOD mice with spontaneous or adoptively transferred diabetes, the development of diabetes was significantly prevented.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatic damage induced by perfusion of radical generating azo compound and its inhibition by vitamin E

The damaging effect of perfusion of hydrophilic radical generating azo compound on the liver of normal and vitamin E-deficient rats and its inhibition by antioxidants were studied in order to increase understanding of the action of free radicals on biological tissues. The hepatic damage was evaluated from the release of cytosolic enzymes such as glutamic oxaloacetic transaminase and glutamic pyruvic transaminase, mitochondrial oxidation metabolism and morphological change. Two kinds of hydrophilic azo compounds were used, one which decomposes spontaneously at a uniform rate to generate free radicals and the other which does not. The former induced hepatic damage in a dose-dependent manner, while the latter did not exert any damage. Both endogenous vitamin E in the membranes and a water soluble vitamin E analogue added simultaneously with a radical initiator suppressed the hepatic damage. These results show that the hepatic damage induced by perfusion of radical generating azo compound is caused not by the azo compound itself but by free radicals.

[Clinical results of IV-compa (cisplatin, vincristine, methotrexate, peplomycin and adriamycin) chemotherapy for advanced urothelial cancer]

We have developed a new combination intravenous chemotherapy regimen called COMPA (IV-COMPA). The clinical value of IV-COMPA chemotherapy was evaluated based on the results of 24 patients with urothelial cancers. From October 1989 through October 1993, a total of 24 patients (20 males and 4 females) received IV-COMPA chemotherapy at Tokyo Medical College Hospital and Tokyo Medical College Hachioji Medical Center. All patients had advanced transitional cell carcinoma or adenocarcinoma of the urothelial tract (renal pelvis, ureter or bladder). One course of IV-COMPA was delivered at 2-week intervals and consisted of 30 mg/m2 CDDP on day 4 and 5, 0.6 mg/m2 VCR (Oncovin) on day 1 and 2, 5 mg/m2 MTX on day 2 and 3, 5 mg/m2 PEP on day 1, 2 and 3, 20 mg/m2 ADM on day 4. A few patients received the same regimen without peplomycin called IV-COMA to avoid pulmonary fibrosis. Fifteen patients with surgically confirmed invasive carcinoma were defined by at least 1 of the following criteria: multiple tumors or size greater than 5 cm, grade 3, stage P3 or P4, pN+, pR1, pL1, pV1, or secondary carcinoma in situ. These patients were treated with 2 or 3 corpses of postoperative IV-COMPA chemotherapy to improve prognosis. In this group, 14 of 15 (93%) are alive at a median follow-up of 22 months (range, 8-57 months) and actuarial survival rates of 1 and 3 years were 100%, 90.9%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Retroperitoneoscopic nephrectomy without pneumoperitoneum--experiments in pigs]

Laparoscopic nephrectomy has been performed widely for minimally invasive therapy. However, the procedure of insertion of needles and trocars can cause vascular and intestinal injuries. In addition, pneumoperitoneum using high pressure CO2 gas can cause circulatory and respiratory problems. In order to avoid these problems, we tried retroperitoneoscopic nephrectomy without CO2 gas in 8 kidneys of 4 pigs. A 1.5 cm skin incision was made just below the lowest rib and a small retroperitoneal space was made with the forefinger. The sheath of a 27 Fr rigid nephroscope was covered with a condom balloon and inserted into the retroperitoneal space. Under observing through the nephroscope, the condom was filled with 150-200 ml saline to make a space for the operation. After removing the nephroscope with condom, a scope and trocars were inserted into the space and retroperitoneoscopic nephrectomy was performed. Making the space with condom balloon in the retroperitoneal space was very efficient. The procedures succeeded in 8 and average procedure time was 3 hours. Retroperitoneoscopic nephrectomy without gas is a very attractive minimally invasive technique.

Establishment of a cell line from an adenocarcinoma of the lung producing carcinoembryonic antigen (CEA) and CA19-9

An adenocarcinoma cell line was established from pleural effusion of a 67-year-old woman and designated as TK-SA. The population doubling time of the cells was 100.4 hr. Chromosomal analysis revealed the TK-SA to have human aneuploid chromosomes with a near-triploid mode. Ultrastructurally, the TK-SA was compatible with adenocarcinoma. The cell line was highly tumorigenic. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide dye assay demonstrated resistance of the cell line to Cis-platin (CDDP), Cyclophosphamide (CPM) and Tegafur/Uracil (UFT). High carcinoembryonic antigen (CEA) and CA19-9 levels were similar in patient's serum and conditioned medium.

Plasma copper and antioxidant status in Wilson's disease

It has been demonstrated that the level of serum copper unbound to ceruloplasmin (loosely bound copper) is increased in Wilson's disease, although the total serum copper concentration is usually low, reflecting a low ceruloplasmin level. To assess the contribution of free radical reactions catalyzed by nonceruloplasmin copper to the development of complications in this disease, we investigated copper and antioxidant status in four untreated patients who had hepatic dysfunction with or without hemolytic anemia and made a comparison with five patients controlled on penicillamine therapy and 19 age-matched healthy children. We found that loosely bound copper in plasma measured by the phenanthroline assay was detectable in three of four untreated patients with Wilson's disease, but was not detectable in the patients during therapy or in the healthy controls. Among the various antioxidants, the ascorbate and urate levels were markedly reduced before treatment (mean +/- SD, 23 +/- 16 microM for ascorbate and 90 +/- 59 microM for urate) compared with the values in the patients during treatment with penicillamine (67 +/- 19 and 302 +/- 78 microM, p < 0.05) and in control children (60 +/- 8 and 254 +/- 48 microM, p < 0.05). We also demonstrated that the plasma concentration of allantoin, an oxidation product of uric acid and a possible marker of radical generation in vivo, was markedly elevated in the untreated patients (11.0 +/- 1.8 versus 4.3 +/- 0.5 microM in patients on therapy and 6.5 +/- 0.8 microM in controls, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Technegas versus krypton-81m gas as an inhalation agent. Comparison of pulmonary distribution at total lung capacity

Exactly how the pulmonary distribution of inhaled radioactive gas and Technegas, or ultra-small aerosol particulates, differs from each other, is still uncertain. The authors compared the distribution of inhaled Kr-81 m gas and Technegas in the lungs at total lung capacity in 13 control subjects with no clinical conditions and 13 patients with various chest diseases. In normal lungs, there was no difference in the distribution ratios in the right and left lungs between inhaled Kr-81m gas and Technegas. However, there was a significant difference in the lungs of patients with pulmonary disease. Technegas tended to deposit more in the lung bases than did Kr-81m gas. Despite these statistical differences, they were visually, or qualitatively, similar. From a practical and clinical standpoint, Technegas seems to be useful as an inhalation agent, unless quantitative analyses are required.

Induction of Fos-like immunoreactivity in the rat hypothalamus by an endogenous feeding suppressant (2-buten-4-olide)

Central influence of 2-buten-4-olide (2-B4O), an endogenous feeding suppressant, was studied through immunohistochemical detection of Fos expression in the rat hypothalamus. Animals received 2-B4O (100 or 200 mg/kg i.p.) or saline 2 h before perfusion with 4% phosphate-buffered paraformaldehyde. The hypothalamus was removed and cut into vibratome sections. Immunohistochemical analysis revealed that injection of 2-B4O induced Fos-like immunoreactivity significantly in the paraventricular, dorsomedial and arcuate nuclei and the periventricular and lateral hypothalamic areas. These hypothalamic regions may control feeding under the influences of endogenous 2-B4O.

[Two cases of testicular tumor with brain metastasis]

During the last 8 years, 70 cases of testicular tumor were treated in our department. Of them 2 cases had brain metastasis. Case 1; A 37-year-old male was admitted with the chief complaint of cough. Retroperitoneal lymph node and lung metastases were discovered (stage IIIB, pT4aN1M1). Resected right testis was diagnosed as embryonal carcinoma, teratoma and STGC histopathologically. After 3 courses of PVB (cisplatinum, vincristine, bleomycin) chemotherapy right hemiplegia occurred and computerized tomographic (CT) scan revealed brain metastasis. His general condition degraded rapidly and he died of brain herniation 3 months after orchiectomy. Case 2; A 32-year-old male was admitted because of right testicular swelling and lung metastases (stage IIIB, pTiN0M1). Pathological examination revealed embryonal carcinoma, yolk sac tumor and teratoma. After 4 courses of chemotherapy with cisplatinum (CDDP), vincristine, methotrexate, peplomycin, and etoposide all lung metastases were disappeared. A few months later left hemiplegia by brain metastasis appeared suddenly. Four additional courses of high dose chemotherapy and resection of brain metastasis was performed. Complete remission continued for 13 months. The prognosis of testicular tumor with brain metastasis was very poor. During the last 8 years, 21 cases of testicular tumor with brain metastasis were reported in the Japanese literature. A follow-up study of prognosis in the literature was performed and discussed.

Homocysteine induces iron-catalyzed lipid peroxidation of low-density lipoprotein that is prevented by alpha-tocopherol

Homocystinuria is an inborn error of methionine metabolism that is characterized by the premature development of arteriosclerosis. As one of the major factors in the pathogenesis of arteriosclerosis, modification of low-density lipoprotein (LDL) has received widespread attention by many investigators. In this study, to elucidate the relationship between elevated homocysteine levels and premature arteriosclerosis, we investigated the role of homocysteine in the iron-catalyzed oxidative modification of LDL. When LDL isolated from a healthy subject was incubated with homocysteine and ferric ion, a gradual decrease of polyunsaturated fatty acids (PUFA), formation of thiobarbituric acid-reactive substances (TBARS) and fluorescent substances, and the fragmentation of apoprotein B (apoB) were observed. The extent of oxidative modification was dependent on the concentration of homocysteine. Modification of LDL was suppressed until the remaining alpha-tocopherol concentration reached a critical level. When the alpha-tocopherol content of LDL was increased by 2.6-fold, both the formation of TBARS and the fragmentation of apoB were suppressed. These results suggest that homocysteine might promote iron-catalyzed oxidation of LDL and imply its role for the development of premature arteriosclerosis.

[A case of multilocular cystic renal cell carcinoma diagnosed by pharmacoangiography]

A case of multilocular cystic renal cell carcinoma in a 62-year-old man was reported. He was admitted with complaint of asymptomatic gross hematuria. Abdominal ultrasonography and CT scan revealed multilocular cystic mass at the lower pole of the right kidney. Pharmacoangiography demonstrated tumor stain in the mass clearly. Radical nephrectomy was performed and histological diagnosis was multilocular cystic renal cell carcinoma; cystic type, clear cell subtype, G1 pT2b pV0 pN0. It is relatively difficult to diagnose multilocular cystic renal cell carcinoma but pharmacoangiography was very effective for diagnosis. Renal cell carcinoma related multilocular cyst were relatively rare. Eighty-nine cases reported in Japanese literatures were discussed statistically.

Domain motion in actin observed by fluorescence resonance energy transfer

Actin is composed of two well-separated globular domains which are further subdivided into two subdomains [Kabsch, W., Mannherz, H. G., Suck, D., Pai, E. F., & Holmes, K. C. (1990) Nature 347, 37-44]. Subdomains 1 and 2 constitute the small domain, and subdomains 3 and 4 comprise the large domain. In order to test a hinge bending domain motion in actin such as observed in many kinases, fluorescence resonance energy transfer between two probes attached to each of the two domains was measured by steady-state and time-resolved fluorometers. The adenine base is bound in a hydrophobic pocket between subdomains 3 and 4, and Tyr-69 is located at subdomain 2. In the present study, the adenine moiety was labeled with a fluorescence donor, epsilon ATP, and tyrosine-69 was labeled with the energy acceptor, dansyl chloride. Assuming the random orientation factor k2 = 2/3, the distance between epsilon-adenine moiety and dansyl chloride attached to Tyr-69 in G-actin was determined to be 2.46 nm from steady-state fluorescence measurements. The addition of DNase I did not appreciably change the distance (less than 0.1 nm). The distance decreased to 2.27 nm during polymerization by the addition of phalloidin under physiological salt conditions. On the other hand, time-resolved fluorescence energy transfer measurements have been used to investigate a distribution of distances for a donor-acceptor pair. In G-actin, the mean distance between probes was 2.79 nm with a full width at half-maximum of 3.91 nm, indicating a large number of conformational substates in solution.(ABSTRACT TRUNCATED AT 250 WORDS)

Newly developed ultrasonic aspirator and its application for endoscopic surgery

The authors have developed an ultrasonic aspirator to assist in urologic endoscopic surgery. It appeared that ultrasonic aspiration of bladder tumors was clinically efficient in transurethral surgery. Tumors 1 to 2 cm in diameter could be aspirated completely with this instrument alone. The application of the ultrasonic aspirator, which has also been designed with a coagulating function, to laparoscopic lymphadenectomy was evaluated. A special probe sheath was used to insulate it when using coagulation current. During operation, perivascular fatty tissue was removed safely with the aspirator. In the near future, the ultrasonic aspirator will be one of the most effective tools in laparoscopic surgery.

Quantitative study of local distribution of noncholesterol sterols and cholesterol in gallstones

Quantitative analysis of the local distribution of four noncholesterol sterols, 24-methylene cholesterol, campesterol, stigmasterol, and beta-sitosterol, and of the local distribution of cholesterol in gallstones was performed by mass spectrometry, with D6-cholesterol as an internal standard. The role played by trace amounts of these four noncholesterol sterols in the formation of gallstones was investigated by comparing the amounts of these sterols in different parts of gallstones. It was found that the amounts of the noncholesterol sterols in the inside part were significant greater than the amounts in the outside part of various structural types of gallstones. However, the distribution of the cholesterol did not show such variation. The amounts of noncholesterol sterols distributed locally suggested that these sterols play a role in the formation of gallstones.

Structural similarity of cytochrome c2 from Rhodopseudomonas viridis to mitochondrial cytochromes c revealed by its crystal structure at 2.7 A resolution

The crystal structure of cytochrome c2 from Rhodopseudomonas viridis has been refined using molecular dynamics and restrained least-squares methods to a crystallographic R-factor of 0.216 at 2.7 A resolution. A structural comparison between Rps. viridis cytochrome c2 and the other bacterial cytochromes c2 or mitochondrial cytochromes c indicates that the overall protein foldings are very similar to each other with the exception of the surface loop and terminal region of the polypeptide chain. However, the position and hydrogen-bond pattern of the evolutionarily conserved water molecule buried within the heme binding pocket in Rps. viridis cytochrome c2 are common to those in the mitochondrial cytochromes c. This fact indicates that Rps. viridis cytochrome c2 is structurally more similar to mitochondrial cytochromes c than to the other bacterial cytochromes c2.

Application of an automatic molecular-replacement procedure to crystal structure analysis of cytochrome c2 from Rhodopseudomonas viridis

An automatic molecular-replacement procedure has been applied to solve the crystal structure of cytochrome c(2) from Rhodopseudomonas viridis. The structure was solved on the basis of the structure of tuna cytochrome c as a search model using an automatic processing program system, AUTOMR. The refinements by molecular dynamics and restrained least-squares methods result in a current crystallographic R factor of 0.219 for diffraction data at 3 A resolution.

[Flare response on bone scintigraphy in metastatic prostate cancer]

Seventy-seven cases of prostate cancer were treated for 5 years at our department and all cases were followed by bone scintigraphy and tumor markers. Of these cases on case of flare response on bone scintigraphy was recognized. A 51-year-old man was hospitalized with chief complaint of lumbago. Serum PAP and gamma-Sm levels were 320 ng/ml and 15 ng/ml, respectively. Prostate biopsy revealed moderately differentiated adenocarcinoma. Bone scintigraphy and CT scan demonstrated multiple bone metastases and lymph nodes involvements. Treatment was started with diethylstilbestrol diphosphate (DES). At one month after the initiation of treatment tumor markers fell down to the normal level and lumbago was diminished, but only serum alkaline phosphatase was elevated and bone scintigraphy showed apparent progression of individual lesions (flare response). The treatment was not altered. At the times after 2, 8, 12 and 36 months successful treatment the bone imaging improved with reduced tracer uptake and no new lesions. The flare response is a healing reaction and is followed apparent improvement. In general, serial bone scintigrams accurately depict the activity of bone metastases in the patients of prostate cancer, but between 1 and 3 months after starting treatment the paradoxical "flare phenomenon" should be taken care.

Membrane potential-linked reversed electron transfer in the beef heart cytochrome bc1 complex reconstituted into potassium-loaded phospholipid vesicles

The cytochrome bc1 complex purified from beef heart mitochondria was incorporated into potassium (K+)-loaded phospholipid vesicles by a cholate dialysis method to study the reverse reaction of electron transfer in the complex. The reduction of cytochrome b in the presence of sodium ascorbate was observed on addition of valinomycin to the K(+)-loaded proteoliposomes in a medium containing no external KCl; it was followed by the gradual oxidation. Nigericin accelerated the reoxidation of reduced cytochrome b, indicating that a K+ diffusion potential (negative inside) induced the reduction of cytochrome b. The extent of the cytochrome b reduction depended on the magnitude of the diffusion potential across the liposomal membranes, and its maximal reduction was attained at more than 210 mV of the diffusion potential. It was cytochrome b562 that was reduced during the establishment of the K+ diffusion potential in the presence of ascorbate, and about 90% of cytochrome b562 was estimated to be reduced. Antimycin A and myxothiazol inhibited the diffusion potential-induced reduction of cytochrome b562, and ubiquinone was proved to be essential for the reversed electron transfer. The K+ diffusion potential also induced the partial reduction of cytochrome b566 when cytochrome b562 had previously been reduced with ascorbate plus tetramethyl-p-phenylenediamine. These results were interpreted well based on the Q cycle scheme which assumed the energy-dependent reduction of ubiquinone at center o. Dicyclohexylcarbodiimide, which did not perturb the ability of proteoliposomes to generate the K+ diffusion potential, inhibited the energy-dependent reduction of cytochrome b562 without a significant loss in the catalytic activity of the complex. The half-inhibition was brought about by 200 mol of dicyclohexylcarbodiimide/mol of cytochrome c1. These results strongly suggest the coupling of a proton flow with the reversed electron transfer in the bc1 complex.

[Comparative assessment of the characteristics in various assay kits for prostate specific antigen]

Six kinds of assay kits based on different detecting principle for PSA were evaluated. Polyclonal antibody was used in 2 kits (Eiken, Markit-F) and monoclonal antibody in 4 kits (Ball Elsa, Delfia, Markit-M, Tandem-R). To evaluate their characteristics, sera of 12 female patients, 5 prostatectomized patients and 2 high stage prostate cancer patients were measured by these kits. On the female sera the polyclonal assay kits yielded values higher than the defined minimal sensitive value, but the kits of monoclonal antibody detected nothing. Dilution test of sera with high PSA level showed satisfactory results in every kit but the values of 6 assays were different to each other. For monitoring the recurrence or recrudescence of the prostatic cancer, the monoclonal antibody kits may be preferable to the polyclonal antibody kits. These results showed that we must understand the characteristics of every assay kit which is used clinically.

Electron transfer process in milk xanthine dehydrogenase as studied by pulse radiolysis

The reduction of milk xanthine dehydrogenase by salicylate anion radical (SL-), nicotinamide adenine dinucleotide radical (NAD.), and 1-methylnicotinamide (NMA) radicals was investigated by the use of pulse radiolysis. Reduction of the dehydrogenase with SL- proceeded via two phases. From the kinetic difference spectra obtained, the faster and slower phases of reduction represent that of one of the iron-sulfur centers and of FAD, respectively. The rate constant of the faster phase increased with the concentration of the enzyme, suggesting that the reduction follows a bimolecular reaction of SL- with the iron-sulfur center. In contrast, the rate constant of the slower phase (510 s-1) was independent of the concentration of the enzyme at pH 7.5. In order to elucidate the contribution of the molybdenum site in the reaction, a similar reaction was performed with enzyme modified with oxipurinol. In the modified enzyme, the slower phase was lost, whereas the faster phase was not affected. These results suggest that the slower phase is due to intramolecular electron transfer from the molybdenum center to FAD. On the other hand, NAD. reacted predominantly with FAD of the dehydrogenase to form the neutral semiquinone of FAD with a second order rate constant of 1.4 x 10(7) M-1 s-1 at pH 7.5, whereas a similar reaction in the oxidase, which was converted from xanthine dehydrogenase by proteolytical cleavage, was not observed. This suggests that NAD. transfers an electron via the binding site for NAD+ on the dehydrogenase. In contrast, NMA radical reduced only an iron-sulfur center of the dehydrogenase with a second order rate constant of 6.5 x 10(7) M-1 s-1 at pH 7.5.

[New microwave transurethral hyperthermia for benign prostatic hyperplasia--clinical evaluation]

Several types of hyperthermic apparatuses are employed to treat benign prostatic hyperplasia (BPH). As the prostate surrounds the urethra, we believed that transurethral heating allowed for more efficient and uniform heating. A new effective apparatus for this objective was developed. The size of our hyperthermic apparatus was about 52 x 45 x 20 centimeters and the originating frequency was 2,450 +/- 30 MHz. We used T-type thermocouples as temperature sensors. The transurethral applicator had a cooling system. Thirty patients complaining of obstructive symptoms due to BPH were treated. Hyperthermia was performed 3-6 times for each patients (two times per week). Each procedure was performed for 60 minutes. The temperature was controlled at 39 degrees C on the urethral surface (43 degrees C at prostate). The overall efficacy of this treatment was effective in 23 of the 30 patients (76.7%). In addition, there were no severe complications. As the size of this apparatus was miniaturized, it could be used at the bed side.

[Outpatient ESWL in 500 kidneys]

Between March 1989 and January 1992, 600 cases (636 kidneys) with upper urinary tract stones were treated with ESWL, using a Lithostar. Of these, 78.6% were carried out in our outpatient service, and in the last two years approximately 90% of cases have been treated as outpatient. We evaluated first 500 kidneys, treated with ESWL as outpatient. There were 481 cases involving 500 kidneys (19 bilateral cases). The ages of the 367 men and 114 women ranged from 16 to 77 years. There were 227 kidney stones and 273 ureter stones. Most of the stones were less than 20 mm. The average number of sessions and shock waves for each patient were 1.4 times and 6,988 waves, respectively. While 74% of the patients could be treated in only one session, 9% of them needed 3 sessions or more. Auxiliary measures were needed in 23 cases (D-J stent insertion in 5 cases and ureteral catheterization in 18 cases) and 474 cases (94.8%) were treated by in-situ procedures. At 3 months after treatment, 470 cases were evaluated and the stone-free rates of kidney stones and ureter stones were 70.3% and 84.5%, respectively with an overall stone-free rate of 78.1%. With regard to complications, the rate of the clinic visit because of pain after treatment was observed in 4.6% and higher than 38 degrees C in 2.5%. However, no serious perioperative complications occurred. From these results, outpatient ESWL was considered to be safe and efficient without serious complications.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute renal failure following mannitol infusion]

Mannitol is an osmotic diuretic used in acute oliguric renal failure, acute cerebral edema, and acute glaucoma. It is metabolically inert and is excreted through the kidneys. So once renal function is impaired, mannitol accumulates and the movement of water into the intravascular space with resultant cellular dehydration. Two patients suffered reversible acute oliguric renal failure following mannitol infusion given as treatment for intracranial hypertension. Both patients experienced nausea and vomiting and became increasingly lethargic with edema of general body. Congestive heart failure occurred. Laboratory data showed severe dilutional hyponatremia with hyperosmolality. We successfully treated them with extracorporeal ultrafiltration method (ECUM) and hemodialysis (HD). Some discussions were presented about acute renal failure following mannitol infusion.

[A case of testicular tumor with liver metastases maintaining complete remission for a long period]

A 20-year-old man was admitted with multiple lung, liver and retroperitoneal lymph node metastases from right testicular tumor. The serum hCG level was 170,000 mIu/ml. Orchiectomized right testis showed choriocarcinoma and teratoma pathologically. After 3 courses of chemotherapy of cisplatin, vinblastine and bleomycin, retroperitoneal lymph nodes were resected. Three courses of salvage chemotherapy of VP-16 (etoposide) were performed. The serum hCG level became normal and all metastases disappeared. For 37 months after operation there has been no recurrence of tumor. The 29 cases of testicular tumor with liver metastasis reported in the Japanese literatures during the last 7 years were discussed. The prognosis of testicular tumor with liver metastasis is very poor. However, adequate combination therapy might be effective for the far-advanced testicular tumor.

[A case uterine cervical squamous cell carcinoma successfully treated with preoperative carboplatin-based 5-drug-combined intraarterial infusion chemotherapy]

Preoperative 5-drug-combined intraarterial infusion chemotherapy using carboplatin as a main component was performed in a case of uterine cervical squamous cell carcinoma of Stage IIa. The regimen employed was as follows: carboplatin (100 mg/m2) on Day 4 and 5, vincristine (0.6 mg/m2) on Day 1, peplomycin (5 mg/body) on Day 1, 2, and 3, methotrexate (5 mg/m2) on Day 2 and 3, and doxorubicin (15 mg/m2) on Day 4. These drugs were administered into the right inguinal region through a residual catheter at 3-week intervals prior to operation. After completion of 3 courses, the patient achieved a CR confirmed by pathological analysis and diagnostic imaging followed by extended radical hysterectomy. Side effects observed, especially renal disturbance and myelosuppression, were all tolerable. Intraarterial infusion chemotherapy using carboplatin was thus suggested to be useful against malignant tumors in the gynecological field.

Kinetics of structural changes of reconstituted skeletal muscle thin filaments observed by fluorescence resonance energy transfer

Fluorescence resonance energy transfer was measured between probes attached to Troponin-I and actin in the reconstituted skeletal muscle thin filament. Cys-133 on TnI was labeled with 4-acetamido-4'-maleimidylstilbene-2,2'-disulfonic acid, and Lys-61 on actin was labeled with fluorescein 5-isothiocyanate. A large difference in the efficiency of resonance energy transfer was observed between the presence (0.55) and absence (0.76) of Ca2+, which corresponds to the change in the distance of 0.53 nm and is in good accordance with a previous report (Miki, M. (1990) Eur. J. Biochem. 187, 155-162). The fluorescence titration curve of this reconstituted thin filament was measured versus free Ca2+ concentration under physiological conditions in the presence of 8 mM MgCl2. The transfer efficiency changed sharply between pCa 6.9 and 5.75, with a midpoint at pCa 6.25, suggesting that a conformational change of thin filaments occurs with a highly cooperative mode. The time course of this conformational change was followed by measuring the fluorescence intensity change (energy transfer efficiency change) of the labeled reconstituted thin filament after rapid decrease or increase of free Ca2+ concentration with a stopped-flow fluorometer. When the free Ca2+ concentration was increased in the presence of 5 mM MgCl2, the fluorescence intensity increased (the transfer efficiency decreased) with a rate constant of 530 +/- 170 s-1 at 20 degrees C. On the other hand, when the free Ca2+ concentration was decreased, the fluorescence intensity decreased with a rate constant of 43 +/- 5 s-1. The results indicate that the conformational change observed by fluorescence resonance energy transfer corresponds well to the regulation mechanism by troponin-tropomyosin on the reconstituted skeletal muscle thin filament.

[Recurrence presenting as anuria at 16 years after partial nephrectomy for a pelvic tumor in a solitary kidney: a case report]

A 61-year-old male underwent right partial nephrectomy for a pelvic tumor of a solitary kidney at the former hospital on April 1975. Two years later he had a small bladder tumor and transurethral resection was performed. Since August 1985 he had been followed up in our hospital. On June 1986, the urine cytology showed class V, but neither cystoscopy nor drip infusion pyelography revealed the tumor. On January 1992, he consulted our department with macrohematuria and anuria. Serum creatinine and blood urea nitrogen level were 17.24 mg/ml and 84.1 mg/ml, respectively. Hemodialysis was administered. Retrograde pyelography revealed a defect of tumor at the pyeloureteral junction, and pyuria by ureteral catheterization showed class V cytology. Abdominal CT showed right hydronephrosis caused by the recurrence of pelvic tumor, and right nephrectomy was performed. The histopathological diagnosis was non-papillary transitional cell carcinoma, grade 3 > 2, pT3. He is in good condition with maintenance hemodialysis. In the Japanese literature there were 16 cases of pelvic tumor on the solitary or residual kidneys. In 12 of the 16 cases, kidney sparing treatment was tried and only our case has lived over 10 years. The indication of partial nephrectomy for pelvis tumor was discussed.

Extrahepatic portal vein obstruction in adults detected by ultrasound with frequent lack of portal hypertension signs

Extrahepatic portal vein obstruction (EHPO) was seen in 54 adult patients at the Chiba University Hospital and affiliated hospitals from 1978 to 1991. They were classified according to the background disease (Group A, unknown aetiology; Group B, benign disease; Group C, malignant disease). Among the initial symptoms and signs, abdominal pain was the most frequent in Group A (37%), and symptoms attributable to the primary disease in Groups B (44%) and C (75%). Definite or probable diagnosis was made in 45 of the 54 patients (81.8%) by ultrasound (US) examination carried out because of these symptoms and signs. Signs of portal hypertension were observed in 67% of patients; oesophageal varices were seen in 60%. Extrahepatic portal vein obstruction without portal hypertension signs was characterized by thick extensive hepatopetal collaterals or patency of some intrahepatic portal veins. Extrahepatic portal vein obstruction patients without portal hypertension remained free of its signs for more than 3 years of follow up and, in fact, EHPO without portal hypertension signs was a common occurrence. Emphasis is made on the diagnostic value of US examination which was useful in identifying the relation of clinical manifestation of EHPO to pathophysiology, and on the frequent lack of portal hypertension signs in this disease.

Doppler color flow imaging in the detection and quantitative measurement of the gastroduodenal artery blood flow

The purpose of this article was to investigate the detection rate of gastroduodenal artery blood flow (GDABF), and to measure its velocity and volume flow rate using Doppler color imaging. The GDABF was detected in 40 of 41 (98%) normal subjects with longitudinal scanning and in 36 (88%) with transverse scanning. The velocity of the GDABF was 21 +/- 8 cm/sec (m +/- SD) and the volume flow rate was 67 +/- 20 mL/min. Without color Doppler, the vascular lumina of the GDA was demonstrated in 27 (66%) subjects by longitudinal scanning and in 26 (63%) by transverse scanning. The hemodynamics of the GDA were revealed noninvasively using Doppler ultrasonography in a patient with a malignant islet cell tumor of the pancreas and one with a ductal cell carcinoma of the pancreas.

[Relation between serum PAP (prostate acid phosphatase) and bone scintigraphy in prostatic cancer]

Seventy-seven patients with prostatic cancer were treated at our department in the last 5 years. Of these patients 30 cases were followed by bone scintigraphy and serum PAP. In 27 follow-up scintigraphy procedures changes of bone scintigraphy corresponded to changes in serum PAP levels Changes of PAP levels did not always correspond to changes of scintigraphy, but almost all cases in which the level of PAP increased in a short period showed progression of bone metastasis. A 3-month interval between bone scintigraphy procedure in stage D2 prostatic cancer patients is generally recommended. However, we think that in prostatic cancer patients follow-up bone scintigraphy at regular short intervals is unnecessary if there is no change in serum PAP levels, symptoms or physical condition. Bone scintigraphy should be performed when the tumor marker changes rapidly or when any physical symptom appears.