[Fetal genitourinary abnormalities associated with oligohydramnios]

After 16 weeks of gestation, amniotic fluid mainly consisted of fetal urine. Therefore, the association of oligohydramnios with fetal urinary tract abnormalities implies severe deterioration of renal function. The relationship of the kidney and amniotic fluid in pulmonary development has been investigated, and fetuses with oligohydramnios starting in the second trimester are considered to have uniformly fatal outcomes. We analysed underlying urological disorders, gestational age at presentation, and ultimate outcomes in 45 fetuses with severe oligohydramnios, and especially focused on clinical courses and prognosis of 7 surviving patients. Clinical and/or autopsy diagnosis included bilateral renal hypodysplasia in 20 patients, urethral atresia with/without prune belly deformity in 9, posterior urethral valve in 6, polycystic kidney disease in 4, hydrometrocolpos in 2, hereditary renal dysplasia in 2, and the others. The average gestational age at detection of severe oligohydramnios was about 30 weeks, ranging from 16 weeks in patient with urethral atresia. Urological disorders of 7 surviving patients consisted of 4 posterior urethral valves, one hydrometrocolpos, one hydronephrosis of the solitary kidney, and one bilateral megaureter. In these 7 patients severe oligohydramnios striated in the third trimester. Four patients required ventilator supports together with the administration of surfactant, but they were weaned in one to 4 days. There was no evidence of pulmonary hypoplasia on chest X-ray films. Urological emergency drainage was necessary in all patients on the day of delivery to 2 days postnatally. One patient with posterior urethral valve developed ESRF 6 months after birth. Two patients have a normal serum creatinine, but another 4 have slight elevation of SCr for their age.(ABSTRACT TRUNCATED AT 250 WORDS)

Involvement of a cytochrome P4502D subfamily in human liver microsomal bunitrolol 4-hydroxylation

The oxidative metabolism of bunitrolol, an adrenergic beta-receptor antagonist was examined in human liver microsomes fortified with an NADPH-generating system. The microsomal fractions (n = 11) showed bunitrolol 4-hydroxylase activities, which correlated well with CYP2D6 contents (correlation coefficient, r = 0.854), debrisoquine 4-hydroxylase (r = 0.953) and imipramine 2-hydroxylase (r = 0.976) activities. On the other hand, the bunitrolol 4-hydroxylase activity showed relatively poor correlations with CYP3A4 content (r = 0.552) and testosterone 6 beta-hydroxylase activity (r = 0.668). The bunitrolol 4-hydroxylase activity was significantly inhibited by quinidine, a selective inhibitor for CYP2D6. Polyclonal antibodies raised against rat liver microsomal cytochrome P450BTL, which is thought to belong to the CYP2D subfamily, effectively inhibited bunitrolol 4-hydroxylation. In contrast, polyclonal antibodies raised against human liver microsomal CYP3A4 did not show any inhibitory effect on the activity. These results suggest that CYP2D6 is involved in the bunitrolol 4-hydroxylase activity in human liver microsomes.

Carcinogenicity studies of oxolinic acid in rats and mice

A chronic feeding study was conducted to determine the carcinogenic potential of oxolinic acid, an antimicrobial agent, in rats and mice. Oxolinic acid was administered in the diet to Wistar rats (0, 30, 100, 300 or 1000 ppm; 50 rats/dose/sex) for 104 wk and to ICR mice (0, 50, 150 or 500 ppm; 50 mice/dose/sex) for 78 wk. Clinical signs, body weight, food consumption, autopsy findings and histopathological data were noted. Mortality was unaffected by oxolinic acid administration in neither species. In rats, body weight gain was suppressed in both sexes at 1000 ppm. Histopathological examinations conducted after autopsy at 104 wk revealed a slight increase in benign Leydig cell tumours of the testis at 1000 ppm, which did not appear until late in the lifetime of rats. No other treatment-related neoplastic lesions were observed in rats. Non-neoplastic lesions in males at 1000 ppm included Leydig cell hyperplasia and tubular atrophy of the testes. In mice, decreased body weight gain was observed in both sexes at 500 ppm, but no non-neoplastic or neoplastic lesions attributable to the treatment with oxolinic acid occurred in either sex. In conclusion, oxolinic acid induced benign Leydig cell tumours of the testis in rats at the highest dose level tested (1000 ppm). The no-effect level for tumour induction was confirmed to be 300 ppm (10.9 mg/kg/day) in rats. None was induced in mice.

[Analysis of the preceding R-R interval and the coupling interval on premature ventricular contractions]

Premature Ventricular Contractions (PVCs) are one of the common arrhythmias. Although the analysis of the preceding R-R interval and the coupling interval on the Holter electrocardiogram, the Lorenz plotting method, has been used to characterize mature of PVC, this analysis has typically been performed without regard to the morphological classification of the electrocardiogram waveforms. Therefore, we performed the Lorenz plotting after a PVC classification. We analyzed 45 cases with more than 1,000 PVCs per day. Twenty-six of the cases with PVCs had no organic heart disease (idiopathic PVC); nineteen of the cases with PVCs had organic heart disease (PVC with disease). Each R-R interval was analyzed after classification based on the morphology of each QRS wave of the PVC. The computer generated a two-dimensional plot of the relationship between the preceding R-R interval of PVC and the following coupling interval. The forms of PVCs were monoform in idiopathic PVC and were mostly multiform in PVC with disease. The patterns on Lorenz plotting in idiopathic PVC had a tendency to be uniform with small standard deviations. In contrast, multiform PVCs tended to be highly variable with large standard deviations. The value of SD was 32.1 +/- 12.0 msec in idiopathic PVC, and that of the slope "a" was 0.048 +/- 0.051 in PVC with disease. Using the SD values and the slope "a" values, we were able to classify idiopathic PVC vs. PVC with disease with a 95% sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of capillary hemangioma of the testis in a child]

Testicular tumors derived from connective tissue, blood vessels and musculature are uncommon and intratesticular tumors of vascular origin are extremely rare. A rare case of capillary hemangioma of the testis in a child is reported. An 11-year-old boy was admitted with the chief complaint of painless mass in the right scrotum. He was diagnosed with a right testicular tumor by physical examination and ultrasonography, preoperatively. Right high orchiectomy was done on December 10, 1990. The testis measured 2.5 x 2.3 x 1.5 cm. Pathologically, the tumor was diagnosed as a capillary hemangioma of the testis.

[Establishment of hyperbilirubinuria rat mutant--a new animal model for jaundice]

A new animal model for jaundice, a hyperbilirubinemic rat mutant (EHBR, Eizai hyperbilirubinuria rat), was established from Sprague-Dawley rats. Hyperbilirubinemia was inherited as an autosomal recessive trait. The gene manifesting jaundice was named "hyb". Homozygotes developed jaundice immediately after birth, and a high bilirubin concentration was detected in plasma and urine. The plasma bilirubin levels were high in the neonatal period, but they decreased from 6 to 10 weeks old. In male homozygotes, plasma bilirubin levels increased rapidly until about 40 weeks, and decreased thereafter. Female homozygotes showed slightly high plasma bilirubin levels until 56 weeks, then increased rapidly thereafter. At 72 weeks, the plasma bilirubin level of females was comparable to that of males. About 80 percent of the plasma bilirubin was conjugated. Plasma biochemistry demonstrated the increase of total cholesterol and total bile acid in the homozygotes. Histopathologically, the homozygote was characterized by brown pigment in the hepatocytes, and glomerular lesions with mesangial expansion. From these findings it was considered that EHBR might be a useful animal model for studying constitutional conjugated hyperbilirubinemia and bilirubin metabolism.

[Histological study of fetal hydronephrosis. Development background of prenatal treatment]

It is still unclear whether prenatal decompression of the dilated urinary tracts can preserve renal development and function. Following the previous report on the relationship between the nephrogenesis and the gestational weeks in normal fetuses, we studied the hydronephrotic kidneys to find the histological background of the fetal treatment. Of the fetuses autopsied in the Department of Pathology of our Institute from 1982 to 1992, 32 kidneys from 21 fetuses associated with dilatation of the upper urinary tracts irrespective of the presence of urethral obstruction on macroscopic inspections were reviewed. The underlying disorders causing hydronephrosis included urethral obstruction in 7, vesico-intestinal fissure in 3, hydrometrocolpos in 2 and double ureter in 1. The etiology of the hydronephrosis was not clarified in another 8. The position and configuration of the ureteral orifices were not described in the autopsy reports. Microscopic examination was done to define the radial glomerular count (RGC), presence or absence of the nephrogenic zone, cortical cysts and dysplastic elements, changes of the collecting tubules and interstitium. Of the kidneys 19 had cortical cysts of various sizes. In some kidneys, the normal cortex was mixed with pathological segments where there were subcapsular small cysts and tubular dilatation. Nephrogenic zone, which was observed in specimens of 33-weeks fetus with moderate hydronephrosis, was already missing by 28 weeks in severe hydronephrosis. Collecting tubules were dilated in 12 kidneys with mild to moderate hydronephrosis. Tubular atrophy and increase in the interstitium were seen in 12 kidneys, eleven of which were of the fetus over 30 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Migration and maturation of Langerhans cells in squamous metaplasia of the rat trachea induced by vitamin A deficiency

The migration and maturation of Langerhans cells (LCs) in rat tracheal squamous metaplasia due to vitamin A deficiency were investigated immunohistochemically and electron microscopically. In the early stage of metaplasia, i.e. basal cell hyperplasia, no LCs with Birbeck granules (BGs) could be found, but there were desmosome-free cells which had the morphological characteristic of immature LCs. They were clearly different from inflammatory cells such as macrophages and lymphocytes, and were, therefore, considered to be precursors of LCs. In the stage of stratification, small numbers of Ia- and protein kinase C type II (PKCII)-positive cells were recognized. Ultrastructurally they were immature LCs with ovoid nuclei, many free ribosomes and few dendrites. The cytoplasm was dark and a few BGs and atypical granules (AGs) could be seen in the Golgi area. In the early stage of cornification, LCs with partially intended nuclei, prominent nucleoli and well-developed Golgi complexes were found. There were many BGs and AGs and structures transitional between them in the Golgi areas. In epithelium showing mature squamous metaplasia, many Ia- and PKCII-positive dendritic cells could be seen. Most of these were typical mature LCs with lobulated nuclei, clear cytoplasm and prominent dendritic processes. The number of BGs and AGs were fewer than in the LCs found in the early stage of cornification, and these granules were distributed throughout the cytoplasm. In the final stage, where the basal cells had differentiated into a flatter epithelium, few LCs could be seen.(ABSTRACT TRUNCATED AT 250 WORDS)

[Histological study of the fetal kidneys. Development of the nephrons according to gestational weeks]

Despite recent advance of prenatal ultrasonography leading to an increase in the detection of various fetal urological abnormalities, a lot a unresolved problems exist surrounding their diagnosis and management. It is unclear whether an antenatal intervention helps to preserve the renal function, because little has been known about the nephrogenesis of the human fetal kidney associated with congenital obstruction. To find the normal development of the kidney, we studied the fetal kidneys in relation to the gestational weeks. Of all fetuses autopsied in the Department of Pathology of our Institute from 1982 to 1992, 87 kidneys from 60 fetuses which showed no abnormalities of the urinary tracts on macroscopic inspections were reviewed. Microscopic examination was done to define the radial glomerular count (RGC) and glomerular size according to gestational weeks. Nephrogenic zone was observed in all kidneys before 34 weeks of gestation, and disappeared in all kidneys after 37 weeks. The RGC increased steadily with gestational weeks, and gradually reached a plateau of around 12 counts at about 36 weeks. The RGC was not influenced by the intrauterine fetal growth. The glomeruli were arranged in the uniform fashion on the medullary ray with the smallest in the most superficial cortex and the largest in the juxtamedullary zone. The superficial glomeruli remained at the surprisingly same size up to birth. Juxtamedullary glomeruli showed no significant differences before birth, either. Based on the present studies to know the normal standard of renal development, pathological changes are possible to define. It was thought that an understanding of the morphological characteristics of fetal kidneys would give clues to elucidate pathogenesis of abnormal kidneys.

[Study on the cellular proliferation and endocrine activity of the parathyroid gland in hyperparathyroidism]

Flow cytometric DNA analysis was performed in 21 cases of primary hyperparathyroidism (19 adenomas in 19 cases and 5 glands with primary hyperplasia) and 24 glands with secondary hyperplasia. Tissue intact-PTH concentration was measured in another 41 glands with secondary hyperplasia. Glands with adenoma had a higher proliferative index than normal glands or glands with secondary hyperplasia. In the adenoma group, there was a negative correlation between proliferative index and age, an indicator of the tumorous nature of adenomas. Daily urinary calcium excretion in case of adenoma and tissue intact-PHT concentration in glands with secondary hyperplasia also showed correlations with proliferative index, which demonstrates a close relationship between cellular proliferation and endocrine activity. Gland weight and proliferative index had no significant correlation in both groups. Therefore, another mechanism besides cellular proliferation and endocrine activity, such as number of non-functional parathyroid cells, should be considered.

Involvement of CYP2D6 in oxidative metabolism of cinnarizine and flunarizine in human liver microsomes

Oxidative metabolism of cinnarizine (CZ) and its fluorine derivative flunarizine (FZ), both of which are selective calcium entry blockers, was examined in human liver microsomes. The ring-hydroxylations and the N-desalkylations constituted primary metabolic pathways in microsomal metabolism of CZ and FZ. Among these pathways, the ring-hydroxylase (p-hydroxylation) activities at the cinnamyl moiety of both drugs were highly correlated with debrisoquine 4-hydroxylase activity and CYP2D6 content. Quinidine, a selective inhibitor of CYP2D6, suppressed the ring-hydroxylase activities of CZ and FZ. These results suggest that CYP2D6 is involved in the ring-hydroxylation of the cinnamyl moiety of both CZ and FZ in human liver microsomes.

Effects of procymidone on reproductive organs and serum gonadotropins in male rats

To investigate the mechanism and toxicological significance of testicular interstitial cell tumors (ICT) observed in a long-term rat study with procymidone, N-(3,5-dichlorophenyl)-1,2-dimethylcyclopropane-1,2-dicarboximi de, male Sprague-Dawley rats were fed procymidone in diets for up to 6 months with a positive control group receiving a single subcutaneous injection of cadmium chloride. Examinations mainly for gonadal functions such as serum testosterone and luteinizing hormone (LH), reproductive organ weight and histopathology presented evidence of the indirect involvement of gonadotropins in the production of ICT in rats. A significant increase in both serum testosterone and LH was observed in the early stage at high dietary concentrations of procymidone without any lesion in gonadal systems in histopathology, whereas administration of cadmium chloride produced the expected substantial increase in serum LH and a concomitant decrease in serum testosterone with a marked damaging effect on gonadal systems. Increases in serum testosterone and LH levels in animals receiving procymidone were reversible. The no-effect level for procymidone on serum testosterone and LH was 300 ppm over six months of treatment. The possible mechanism of ICT production in rats by non-genotoxic procymidone, structurally similar to flutamide, a synthetic non-steroidal antiandrogen, is likely to be derived from its induction of a hypergonadotropism due to the competitive binding to the androgen receptor, preventing the normal effect of testosterone to control the circulating level of LH.

The affinity of procymidone to androgen receptor in rats and mice

To clarify the mechanism of gonadotropin imbalances and the differential response of rat and mouse testicular interstitial cells (Leydig cells) to procymidone, N-(3,5-dichlorophenyl)-1,2-dimethylcyclopropane-1,2-dicarboximi de, male Sprague-Dawley rats and ICR mice were fed procymidone in diet for 2 weeks at 0, 700, 2,000 and 6,000 ppm for rats, or 0, 1,000, 5,000 and 10,000 ppm for mice. Testosterone and luteinizing hormone (LH) levels in serum, testis or pituitary and the in vitro binding affinities of procymidone, flutamide and related compounds to the androgen receptor in prostate cytosol of rats and mice were examined. Hypergonadotropism in rats and mice was clearly observed in the same order two weeks after the initiation of treatment with procymidone. Increased levels of testosterone and LH in serum at 6,000 ppm and LH in pituitary at and above 700 ppm in rats were observed. In mice, testosterone levels in serum and testis elevated at 10,000 ppm. LH levels in serum and pituitary elevated significantly as well at around 5,000 to 10,000 ppm. In the competitive binding assay, procymidone showed a significant but lower binding affinity comparing to that of cyproterone acetate, the steroidal androgen receptor antagonist, for the androgen receptor in both rats and mice under the condition that unlabeled dihydrotestosterone (DHT) effectively inhibited the binding of [3H]-DHT to the androgen receptor in both species. The relative binding affinity (RBA) of procymidone was of the same order as that of flutamide, a synthetic non-steroidal antiandrogen structurally similar to procymidone. These results indicate that procymidone is an active antiandrogen and the androgen receptor antagonism is the likely mechanism of action.

Vesicoureteral reflux in infants under one year old. Follow-up study and consideration on development of renal scarring

In an attempt to clarify reflux nephropathy (RN), 67 infants aged under one year with vesicoureteral reflux (VUR) were retrospectively classified into two groups, non-surgical and surgical. They were evaluated on VUR grading, VUR spontaneous cessation rate, and incidence of scarring. As a whole, spontaneous cessation rate was 61 percent. The cessation rate was higher for infants with lower VUR grading. The average age at cessation was 2.5 years. Some patients showed no scarring at presentation despite severe VUR. However, most cases of renal scarrings at the time of presentation belonged to grade IV or V. Scarring advanced in 3 kidneys of the non-surgical group and in 13 kidneys of the surgical group. Of these 16 kidneys, 7 were rated as grade IV and 9 as grade V. An association between development of scarring and recurrent urinary tract infections was suggested.

Pituitary carcinoma of pars distalis as a common neoplasm in Fischer-344 rats

The incidence of invasive spontaneous pituitary carcinomas in Fischer-344 rats were studied. The pituitaries were examined histopathologically together with surrounding tissues including sphenoid bone. The incidence of carcinoma was higher than that previously reported in Fischer-344 rats. All the carcinomas observed in this study showed evidence of local invasion either ventrally into bone and bone marrow or laterally into peripheral nerves and blood vessels. No dorsal infiltration into the brain was recognized. Pituitary carcinoma with local invasion is a relatively common neoplasm when examined histopathologically together with the surrounding tissues.

Cerebral glucose metabolism and striatal 18F-dopa uptake by PET in cases of chorea with or without dementia

Cerebral glucose metabolism was studied by positron emission tomography with [18F]fluorodeoxyglucose in 12 patients with chorea due to different underlying diseases. The striatal 18F-dopa uptake was also studied with 6-L-[18F]fluorodopa in 6 of them. Five of them were diagnosed as Huntington's disease two were as 'sporadic progressive chorea and dementia' with characteristic symptoms and signs of Huntington's disease but no family histories, two were as choreoacanthocytosis, and two had hemichorea caused by suspected vascular lesions in the contralateral striatum revealed by MRI. Caudate and putaminal glucose metabolism decreased in chorea compared to the controls. Hemichorea showed decreased glucose metabolism only in the contralateral striatum. Moreover the glucose metabolism decreased in demented each 7 patients in the frontal, temporal and parietal cortices as well as in the striatum. The caudate and putaminal 18F-dopa uptake in patients with chorea showed no difference with that in the controls. The pathogenetic mechanism of chorea may involve decreased glucose metabolism and normal presynaptic dopaminergic activity in the striatum, and that of the demented state in chorea may also involve an additional decrease of the glucose metabolism in the frontal, temporal and parietal cortices.

[Indications for urinary drainage in neonates detected in utero]

The routine use of maternal ultrasonography has led to increasing discovery of fetal abnormalities of the urinary tract. It is well known that some of the fetal hydronephrosis improves spontaneously, and that there is non-obstructed type of hydronephrosis. However, some of the infants require the management in the neonatal periods because of the mass effect from the dilated urinary tract, urinary tract infection, or deterioration of the renal function. Herein we report on 103 cases with urinary tract abnormalities detected by the prenatal ultrasonography, and analysed the renal function in the early neonatal periods to determine the necessity of the emergency urinary drainage. 1. Renal function of the normal neonates (control) Seventy four infants without abnormalities of the urinary tract were studied on serum creatinine (SCr) and fractional excretion of sodium (FENa) during the first four weeks of life. The SCr of infants at birth to one day postnatally was almost the same with maternal SCr. In infants with a gestational age of 33-40 weeks it fell steadily and reached the value around 0.6 mg/dl at 1 week after birth. The fall of SCr was significantly slow in infants with a GA of 28-32 weeks. Similarly, the FENa was significantly higher in infants with a GA of 28-32 weeks than in infants with a GA of more than 33 weeks. Glomerulo-tubular balance was maintained as early as 1 week postnatally in the latter group. 2. Infants treated in the neonatal periods Urological management was done on 26 infants (23%) during the neonatal periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Hormonal disregulation mechanism in the rat thyroid tumor induced by diniconazole

To assess the toxicological significance of thyroidal tumor observed slightly in a long-term rat study with diniconazole, (E)-1-(2,4-dichlorophenyl)- 4,4-dimethyl-2-(1,2,4-triazol-1-yl)-1-penten-3-ol, a 3-month subacute feeding study was conducted in male Crj: CD (SD) rats by administering diniconazole in diet at concentrations of 0, 100, 1,000, or 2,000 ppm. Examinations mainly for thyroid functions were performed at Weeks 2, 4 and 13. Measurement of serum hormone levels revealed continuous decreases in serum thyroxine (T4) and free T4 levels at and above 1,000 ppm and increase in serum thyroid stimulating hormone (TSH) level at 2,000 ppm concurrently with liver weight and hepatic UDP-glucuronyltransferase (UDP-GT) increases at and above 1,000 ppm. No changes were observed in serum triiodothyronine (T3) and free T3 levels. Increase in thyroid uptake of 125I and organification of 125I in the thyroid at 2,000 ppm and thyroid follicular cell hyperplasia at and above 1,000 ppm were also observed. However, no compound-related changes were observed in autopsy and organ weight in the thyroid. Based on the above results, diniconazole induces increases in the hepatic UDP-GT activity and the thyroid hormone excretion from the liver. The increased excretion of thyroid hormones causes decrease in serum T4 and free T4 levels, triggering the feedback mechanism of the pituitary gland, promotion of TSH release from the pituitary gland and increase in serum TSH level. The increased serum TSH level probably leads to increased 125I uptake of thyroid and thyroid follicular cell hyperplasia. Thus, the thyroid tumorigenesis in rats treated with diniconazole is due to the secondary overstimulant effect on the thyroid by increased serum TSH level. The toxicological significance in humans is extremely low and it is unlikely that diniconazole would increase thyroid tumor in humans even if diniconazole were to alter normal thyroid hormone level in humans.

Studies on Langerhans cells in the tracheal squamous metaplasia of vitamin A deficient rats

LCs in the tracheal squamous metaplasia of vitamin A deficient rats were studied. The first appearance of LCs with Birbeck granules (BGs) was in the stage of stratification. The number of LCs increased along with the development of metaplasia, but decreased in number in the later stage, where basal cells also differentiate into flattened epithelium. In the area where only basal cells differentiated into flatter epithelium, without a cornified layer, LCs with BGs could also be found. These findings suggest that LCs which originate in bone marrow mature in squamous epithelium. The distribution and morphology of LCs are dependent on the state of keratinocytes, but not the presence of a cornified layer.

Positron emission tomographic (PET) studies in dementia

Positron emission tomographic (PET) studies of regional cerebral glucose metabolism were performed in patients with various types of dementia, patients with Parkinson's disease but without dementia, and healthy normal controls. Patients with Alzheimer-type dementia showed significant decreases in glucose metabolism in frontal, temporal, parietal, sensory-motor and striatal regions. Patients with Pick's disease revealed decreased glucose metabolism in frontal and temporal regions. Parkinsonian patients with dementia had significant reductions of glucose metabolism in frontal, temporal, parietal, occipital, sensory-motor and striatal regions. Patients with Huntington's disease revealed decreased glucose metabolism in frontal, parietal and striatal regions. Patients with Creutzfeldt-Jakob's disease showed marked decreases in glucose metabolism throughout all brain regions. On the other hand, patients with Parkinson's disease but without dementia exhibited no reductions of cerebral glucose metabolism. Cerebral glucose hypometabolism in these various types of dementia might reflect neuronal dysfunction and cell death.

Effects of erythropoietin on trace elements in patients with chronic renal failure undergoing hemodialysis

We examined the relationship between recombinant human erythropoietin (rHuEPO) therapy and serum levels of the trace elements aluminum, silicon, zinc, nickel, and manganese in 55 patients undergoing chronic hemodialysis (HD) in whom rHuEPO (for 12 weeks) was effective in reducing anemia, and in 55 patients undergoing HD without rHuEPO treatment. In the rHuEPO group, serum Al level was significantly decreased and Si level showed a tendency to decrease. Zn, Ni, and Mn levels, however, were significantly increased.

Effect of alpha-interferon on anti-alpha-fetoprotein-monoclonal-antibody targeting of hepatoma

We studied the potential of alpha-interferon (IFN-alpha) to enhance alpha-fetoprotein (AFP) and thus alter the localization of 125I-labeled antibody to the human hepatoma xenograft in athymic mice using monoclonal antibody (MAb) 19F12, which recognized AFP on the surface of human hepatoma cells. Treatment of the human hepatoma cell NuE with IFN-alpha increased the surface expression of AFP 2.4-fold in an IFN-dose-dependent manner. The IFN-alpha treatment substantially increased (2.7-fold) the localization of 125I-labeled 19F12 to NuE xenografts in athymic mice. The increase in localization of 125I-labeled 19F12 was dependent on the circulating plasma IFN levels. Our experimental results suggested that IFN-alpha could act as a potent modulator of the cellular antigen AFP, and be used to enhance the targeting of a conjugated MAb to hepatoma cell populations.

Comparison of Langerhans cells and interdigitating reticulum cells

Double immunostaining for OKT-6 and S-100 protein antibodies was carried out. However, it was impossible to stain using two antibodies at the same time, or using one antibody prior to another. We first stained using FITC labeled OKT-6 antibody, and secondary stained for S-100 protein by the ABC method, after taking photographs and removing OKT-6 reaction products. The exact same cells could be stained by both OKT-6 and S-100 protein antibodies. It has been elucidated that both OKT-6 and S-100 protein positive cells are LCs, and only S-100 protein positive, but OKT-6 negative cells are IDCs. LCs only exist in the superficial and hilar lymph nodes. However IDCs exist not only in these lymph nodes, but also in the mesenteric lymph nodes and spleens.

Serum vanadium levels in chronic hemodialysis patients

Serum vanadium, aluminum, silicon and beta 2-microglobulin levels as well as the red cell count, hemoglobin and systolic blood pressure were simultaneously measured in 80 chronic hemodialysis patients. The serum vanadium level was positively correlated with the serum levels of aluminum, silicon and beta 2-microglobulin as well as the systolic blood pressure, and was inversely correlated with the red cell count and hemoglobin. The mean serum vanadium level was 18.4 +/- 7.6 ng/ml before hemodialysis and decreased to 13.0 +/- 5.30 ng/ml at the completion of dialysis. The dialysate vanadium level increased from 0.4 +/- 0.2 (inflow) to 1.0 +/- 0.4 ng/ml (outflow). It was concluded that vanadium was transferred from blood to dialysate when purified water was used in the preparation of the dialysate.

Langerhans cells in the lymph node: mirror section and immunoelectron microscopic studies

Cells immunostained with antibodies against both OKT-6 and S-100 protein were observed only in superficial and hilar lymph nodes draining tissues with predominantly squamous epithelia. In contrast, in mesenteric lymph nodes and the spleen, only S-100 protein-positive, but OKT-6-negative cells were found. We suspect that the S-100 and OKT-6-positive cells might be Langerhans cells (LC) and the S-100-positive, OKT-6-negative cells, interdigitating reticulum cells (IDC). We further postulate that the LC in superficial and hilar lymph nodes might migrate from squamous epithelia, with which contact is required for the formation of Birbeck granules.

Regional cerebral glucose metabolism in patients with Parkinson's disease with or without dementia

By means of positron emission tomography, the cerebral glucose metabolism in 5 patients with Parkinson's disease with dementia was compared with that in 9 patients without dementia, and that in 5 normal volunteers. The metabolic rates for glucose were measured by placing one hundred regions of interest. In the demented patients, cerebral glucose metabolism was diffusely decreased compared with that of the non-demented patients and the normal controls. The most significant decrease in glucose metabolism was observed in the angular gyrus (49.7% of the normal controls). The glucose metabolism in the cingulate, pre- and postcentral, occipital and subcortical regions was relatively spared (62.1 to 85.5% of the normal controls). In the patients without dementia, the glucose metabolism in each region was not significantly different from that in the normal controls. These results suggest that diffuse glucose hypometabolism in the cerebral cortex may correlate with that of patients with Parkinson's disease with dementia.

[Management of multicystic dysplastic kidney detected in perinatal periods]

We analyzed 17 cases of multicystic dysplastic kidney (MCDK) to document the natural history of MCDK and its management. One patient was nephrectomied for respiratory failure associated with MCDK. Follow-up studies of 14 kidneys revealed that 5 kidneys (36%) did not change in size, 7 kidneys (50%) decreased in size. Two kidneys (14%) increased in size during the follow up periods and were nephrectomized. Hypertension and malignancy was not observed in our cases. Evaluations for the contralateral kidney and urinary tract system were performed in 15 patients and 5 (33%) revealed abnormalities--two patients with VUR, 1 with PUJ stenosis, 1 with ureteral stricture and 1 with ectopic ureterocele. In our hospital, the management for MCDK is conservative in most cases. Nephrectomy is indicated when there are complications resulting from the size of MCDK, or when the kidney continues to increase in size after the second year of life.

Effects of diethofencarb on thyroid function and hepatic UDP-glucuronyltransferase activity in rats

To examine the mechanism and toxicological significance of thyroidal tumor observed slightly in a long-term rat study with diethofencarb (isopropyl 3,4-diethoxycarbanilate), male Sprague-Dawley rats were fed diethofencarb in diets at concentrations of 0, 5,000 or 20,000 ppm for 3 months. Examinations mainly for thyroid functions including thyroid uptake of 125I, serum thyroid hormone and thyroid stimulating hormone (TSH) level, hepatic UDP-glucuronyltransferase (UDP-GT) activity and histopathological examination in thyroid were performed at week 13. Decreases of body weights and food consumptions were observed at and above 5,000 ppm. Under these conditions, decrease of serum free T4 and increase of serum TSH level were observed only at 20,000 ppm, concurrently with liver weight increase at and above 5,000 ppm and increase of hepatic UDP-GT activity at 20,000 ppm. However, no compound related effects were noted in thyroid weight, thyroid uptake of 125I and gross or histopathological examination in thyroid. These results indicate that the administration of diethofencarb leads to an increase in UDP-GT activity and acceleration of thyroid hormone excretion from the liver. The acceleration causes a decrease in serum free T4 level, triggering the feedback mechanism of the pituitary gland, promotion of TSH release and consequently an increase in serum TSH level. Thus, the slightly higher incidence of thyroid follicular cell tumors observed in the chronic and oncogenicity study with non-genotoxic diethofencarb is considered to be caused by these weak pituitary-thyroid hormonal imbalances. The toxicological significance in humans is extremely low according to the well established facts that the chronic TSH stimulating would not induce thyroid tumors in humans and humans may be less sensitive than rats in regard to the response to goitrogenic stimuli.

[A case of malignant rheumatoid arthritis with corticosteroid-reactive subacute myelopathy and multiple peripheral neuropathy]

We reported a 64-year-old man who had malignant rheumatoid arthritis (MRA) and developed subacute myelopathy and peripheral neuropathy. He had suffered from seropositive rheumatoid arthritis for 4 years, and developed weakness of four limbs, dysuria and constipation two months before the admission. Neurological examination revealed the diffuse muscle wasting and weakness in four limbs. Deep tendon reflexes were hyperactive in four limbs, but not in jaw jerk. Babinski sign was positive bilaterally. Deep sensation was decreased in four limbs and superficial sensation was decreased below the neck. Dysuria and constipation were noted, but anal and bulbocavernosus reflexes were present. On laboratory examination, RF and RAHA increased markedly. Serum complements decreased and immune complexes were positive. Nerve conduction study demonstrated multiple entrapment neuropathy in addition to mononeuritis multiplex. Histological examination of the biopsied sural nerve disclosed the obliterating endarteritis in the epineurium, and marked decrease in number of myelinated fibers. No compressive lesions were seen in the spinal canal by spine X-ray and MRI. Assuming that inflammatory process induced cervical myelopathy, corticosteroid therapy (predonisolone 60 mg/day) was administered and alleviated neurological symptoms, in accordance with the improvement of serological abnormalities. Therefore, an inflammatory process associated with MRA was supposed to damage the spinal cord as well as peripheral nerves in the present case.

A new rat mutant with chronic conjugated hyperbilirubinemia and renal glomerular lesions

A new mutant strain of inbred Sprague Dawley rats with autosomal recessive hyperbilirubinuria, were studied by biochemical, histologic, and ultrastructural methods. The plasma bilirubin concentration in the homozygote was significantly higher than that of the heterozygote, and about 80% of the bilirubin was conjugated. Plasma BSP and ICG clearance were both severely delayed in the homozygote. Plasma BSP elimination kinetics suggested that the pathophysiologic defect was not hepatic uptake or storage but rather in secretion into bile. Histopathology of the liver demonstrated brown pigment in the hepatocytes that appeared to be lipofuscin. The electron microscopic features of the hepatic pigment resembled those of the Dubin-Johnson syndrome. Homozygote histopathology also revealed glomerular lesions with mesangial expansion and proliferation in the kidneys. Immunohistologic studies disclosed mesangial granular deposition of IgG, IgA, and to a lesser degree, IgM and C3. These renal changes resembled those of IgA nephropathy. The spontaneous hyperbilirubinuric rat (EHBR) may be a useful animal model for studying constitutive conjugated hyperbilirubinemia, bilirubin metabolism, cholestasis, and glomerulonephropathy subsequent to hepatic dysfunction.

Clinical evaluation of nafamstat mesilate (FUT 175). A new anticoagulant for plasmapheresis

Nafamstat mesilate (FUT), a new anticoagulant with a short half-life of biologic activity, was used in six patients who had a history of bleeding (two from the eye, two nasally, and two orally) during plasmapheresis (PP) due to overdosage of heparin. FUT (1.2 mg/kg/hr) was injected into the arterial blood line during PP. Prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time (BT), and complete blood count (CBC) were measured before and after PP. Values of PT (17 +/- 1.4 sec) after treatment were nearly 1.5 times the levels of PT (12.5 +/- 0.8 sec) before treatment. Levels of APTT after PP (70.4 +/- 4.1 sec) were nearly double the values of APTT before PP (36.8 +/- 2.6 sec). There were no significant differences between red blood cell (RBC), hemoglobin (Hgb), or platelet counts before and after PP. No patient developed thrombosis, hemorrhage, or other side effect during PP. In conclusion, the optimal dosage of FUT was 1.2 mg/kg body weight/hr during PP. FUT is recommended as a useful anticoagulant during PP treatment of patients with an increased risk of bleeding.

Positron emission tomography (PET) in "pure akinesia"

Positron emission tomography (PET) studies on regional cerebral glucose metabolism and [18F]fluorodopa uptake were performed on 3 patients with "pure akinesia without rigidity and tremors", 3 progressive supranuclear palsy (PSP) patients, and 5 patients with Parkinson's disease. The "pure akinesia" and PSP patients showed a marked decrease in glucose metabolism in the frontal cortex and striatum, and a decreased uptake of [18F]fluorodopa in the striatum. While the Parkinson's disease patients had a decreased uptake of [18F]fluorodopa in the striatum but no abnormality in the glucose metabolism. Magnetic resonance imaging (MRI) showed atrophy of the pretectum and dorsal pons in "pure akinesia" and PSP patients, but there was no such abnormality in the Parkinson's disease patients. As described above, patients with "pure akinesia" and PSP patients revealed similar findings on PET and MRI studies, while Parkinson's disease patients showed substantially different results.

Striatal blood flow, glucose metabolism and 18F-dopa uptake: difference in Parkinson's disease and atypical parkinsonism

Striatal blood flow, glucose metabolism and 18F-Dopa uptake were studied with positron emission tomography (PET) in eight non-demented patients with idiopathic Parkinson's disease and eight with atypical Parkinsonism. Patients with atypical Parkinsonism had no specific cause for the Parkinsonian symptoms and were clinically different from Parkinson's disease with lack of resting tremor and a poor response to dopaminergic drugs. Decreased 18F-Dopa uptake in the putamen was observed in patients with Parkinson's disease and atypical Parkinsonism compared with normal controls. 18F-Dopa uptake in the head of the caudate was also significantly reduced in both conditions but relatively less in Parkinson's disease. Decreased blood flow and glucose metabolism in the striatum associated with a global cerebral decrease were also observed in patients with atypical Parkinsonism compared with controls, while they were preserved in patients with Parkinson's disease, indicating affected neurons not only in the striatum but also in the cerebrum in patients with atypical Parkinsonism compared with patients with Parkinson's disease. The differences in the caudate 18F-Dopa uptake, and blood flow and glucose metabolism in the cerebrum including the striatum between Parkinson's disease and atypical Parkinsonism assessed by PET may be due to the differences in the pathophysiological mechanism between Parkinson's disease and atypical Parkinsonism.

[A case of mixed connective tissue disease with subacute transverse myelopathy]

A rare case of mixed connective tissue disease (MCTD) with subacute transverse myelopathy and various neurological signs was reported. The patient, a 53 year-old woman, was admitted to our hospital with subacute progressive muscle weakness of left lower limb and sensory disturbance of bilateral lower extremities. At the age of 40, she suffered from sensory disturbance of her face, which improved in about three years. She had a high fever, Raynaud phenomenon, dyshydrosis on right side of her face at the age of 43. On the admission, physical examination revealed swollen fingers and telangiectasia of her face. Neurologically, she had transverse myelopathy at the level of Th6, bilateral trigeminal neuropathy, tonic, pupils, polyneuropathy and dyshydrosis. Laboratory examination showed positive antinuclear antibody, a high titer of antibody to RNase-sensitive components of extractable nuclear antigen, positive antinuclear RNP antibody and negative anti-Sm antibody. Her myelopathy improved with corticosteroid therapy, and ESR and the level of immunoglobulin were normalized. But, other neurological signs showed no improvement.

[Treatment of 300 patients with bladder cancer]

From September 1973 to September 1989, 300 patients with bladder cancer were treated at the Department of Urology, Hyogo College of Medicine. They were 231 males and 69 females with an average age of 65.3 years old. The overall 5-year survival rate (Kaplan-Meier's method) was 64.7%. The 5-year survival rates were not different between male patients and female patients, or between patients with single tumor and patients with multiple tumors. Patients with vesical irritation symptoms had more unfavorable prognosis than patients with painless hematuria. Size and configuration of the tumors also affected the prognosis. Histological diagnosis was transitional cell carcinoma in 291 patients, squamous cell carcinoma in 7 patients, adenocarcinoma in one patient and undifferentiated carcinoma in one patient. In patients with transitional cell carcinoma, the 5-year survival rates according to histological grades were 93.5% for G1, 77.8% for G2 and 31.6% for G3. The 5-year survival rate according to clinical stage was 94.4% for Ta, 79.7% for T1, 66.7% for Tis, 46.1% for T2, 38.5% for T3 and 26.6% for T4. Transurethral resection of bladder tumor (TUR-b.t.) was performed in 208 patients as an initial operation and the 5-year survival rate in these patients was 78.6%. The 5-year survival rates for total cystectomy (52 patients), partial cystectomy (6 patients) and simple tumor resection (4 patients) were 51.9%, 25.0% and 37.5%, respectively. These findings suggest that superficial tumors (Ta, T1) can be controlled with TUR-b.t. but infiltrating tumors (T2, T3, T4) should be treated more vigorously with multidisciplinary approaches.(ABSTRACT TRUNCATED AT 250 WORDS)

Vanadium transfer during haemodialysis

The authors examined transport of vanadium (V) in 100 chronic haemodialysis (HD) patients. Serum V levels were different at the inflow and the outflow site. Vanadium was transferred from blood to dialysate through the membrane. Serum V levels decreased in the course of haemodialysis.

Removal of silicon, aluminum and beta 2-microglobulin in chronic haemodialysis patients

One hundred outpatients on chronic haemodialysis with polymethylmethacrylate (PMMA) membrane dialyzer were randomly chosen. A control group of 100 likewise randomly chosen outpatients were treated with cuprophane membrane dialyzer. In both groups the treatments lasted for one year. Comparison of the test results revealed that Si, Al and beta 2-M.G levels could be reduced in patients on chronic HD with PMMA.

Trace Elements and Plasmapheresis

The relationship between serum aluminum (Al), zinc (Zn), copper (Cu), and iron (Fe) and plasmapheresis (PP) treatment was examined. Three patients with rheumatoid arthritis, six with myasthenia gravis, and 6 with multiple sclerosis were studied. Serum Al, Zn, Cu, and Fe were measured before and after PP. Plasma was separated by first filtration; a second filtration separated the plasma components. Three liters of plasma were treated in each PP session. With each PP treatment, total protein (TP) removed was 20 ± 5% and serum albumin removed was ± 6%. Serum Al rose significantly (p < 0.01 from 1.1 ± 0.2 μgl dl pre-PP to 2.8 ± 0.4 μg/dl post-PP. Serum Zn, Cu, and Fe decreased significantly (p < 0.01) from 86.2 ± 7.4 μg/dl, 126 ± 18 μg/dl, and 108 ± 14 μg/dl pre-PP to 58.4 ± 10.2 μg/dl, 104 ± 6 μg/dl, and 82 ± 16 μg/dI post-PP, respectively.

Two days after the end of the six-month PP treatment, serum Al levels rose significantly (p < 0.01), from 1.1 ± 0.2 μg/dl to 3.6 ± 0.8 μg/dl. However, serum TP, serum albumin, and serum Zn, Cu, and Fe did not change significantly.

It thus appears essential in PP treated patients, to remove Al from the blood to protect against aluminum intoxication

Trace elements and plasmapheresis

The relationship between serum aluminum (Al), zinc (Zn), copper (Cu), and iron (Fe) and plasmapheresis (PP) treatment was examined. Three patients with rheumatoid arthritis, six with myasthenia gravis, and 6 with multiple sclerosis were studied. Serum Al, Zn, Cu, and Fe were measured before and after PP. Plasma was separated by first filtration; a second filtration separated the plasma components. Three liters of plasma were treated in each PP session. With each PP treatment, total protein (TP) removed was 20 +/- 5% and serum albumin removed was +/- 6%. Serum Al rose significantly (p less than 0.01 from 1.1 +/- 0.2 micrograms/dl pre-PP to 2.8 +/- 0.4 micrograms/dl post-PP. Serum Zn, Cu, and Fe decreased significantly (p less than 0.01) from 86.2 +/- 7.4 micrograms/dl, 126 +/- 18 micrograms/dl, and 108 +/- 14 micrograms/dl pre-PP to 58.4 +/- 10.2 micrograms/dl, 104 +/- 6 micrograms/dl, and 82 +/- 16 micrograms/dl post-PP, respectively. Two days after the end of the six-month PP treatment, serum Al levels rose significantly (p less than 0.01), from 1.1 +/- 0.2 micrograms/dl to 3.6 +/- 0.8 micrograms/dl. However, serum TP, serum albumin, and serum Zn, Cu, and Fe did not change significantly. It thus appears essential in PP treated patients, to remove Al from the blood to protect against aluminum intoxication.

[Congenital lower urinary tract obstruction and enuresis in children]

We reviewed enuretic children among patients with congenital lower urinary tract obstructions experienced in the Department of Urology, Hyogo College of Medicine during 16 years from 1974 to 1989. Among 612 patients with congenital lower urinary tract obstructions, 139 (22.7%) had enuresis nocturna and/or diurna. The incidence of enuresis was 24.7% with posterior urethral valve (77 cases), 50.0% with anterior urethral valve (6 cases), 23.8% with congenital bulbar urethral stenosis in boys (303 cases) and 19.9% with congenital distal urethral stenosis in girls (226 cases). Diurnal enuresis was more common in enuresis associated with congenital lower urinary tract obstructions than in usual enuresis. In urodynamic examinations, more than half of enuretic children with congenital lower urinary obstructions showed hyperactive detrusor activity. Treatment of congenital lower urinary tract obstructions through operation resulted in cure or amelioration of enuresis in about 80% of the patients. Enuresis associated with lower urinary tract obstruction or neurogenic bladder is sometimes called complicated enuresis and it is an important role of a urologist to differentiate complicated enuresis from simple enuresis.

[A case of malakoplakia of the kidney and urinary bladder]

A case of malakoplakia which co-existed in the kidney and the urinary bladder is reported. The patient was a 51-year-old female who had been suffering from asymptomatic macroscopic hematuria. Cystoscopic examination revealed multiple yellow-red nodules in the posterior and lateral wall of the bladder. Transurethral punch biopsy of the mucosa was performed and histopathological examination of the specimens revealed the diagnosis of malakoplakia. The laboratory data at admission were within normal limits except for slightly accelerated erythrocyte sedimentation rate. The culture of urine was negative. The cytology of urine was interpreted as Papanicolaou class I. Intravenous pyelography demonstrated filling defect of the left upper renal calyx, which was confirmed by retrograde pyelography. Computerized tomography showed dilatation of the left upper calyx. An exploratory operation disclosed that the upper calyceal neck was obstructed by several small nodular lesion, which were very similar to the lesions in the bladder. Because intraoperative pathological diagnosis of the frozen section was malakoplakia, partial nephrectomy was performed. Histopathological examination of the kidney and the bladder showed typical Michaelis-Gutmann bodies in the granulomatous lesions. Follow-up examinations 4 months after operation revealed some residual lesions in the bladder which were treated with bethanechol, but no recurrence in the kidney.

Urinary crystal surface binding substances on calcium oxalate crystals

In order to study the effect of urinary crystal surface binding substances (CSBS), we extracted the naturally existing CSBS from urine from healthy individuals by conducting homogeneous crystallization of calcium oxalate. CSBS proved not to be promoters but rather strong inhibitors of calcium oxalate crystal growth and aggregation. It is suggested that CSBS exhibited their inhibitory effect by masking the growing sites and aggregating sites on the crystal surface. As for the characteristics of CSBS, we found around 10 peaks of molecular weight, and all of them contained both peptides and saccharides. The findings suggest that CSBS are composed of various kinds of glycoproteins and proteoglycans.

Safety, stability, and effectiveness of immunoadsorption under membrane plasmapheresis treatment for myasthenia gravis

Nine patients (five women and four men, average age 50.4 years) with refractory myasthenia gravis (MG) underwent thymectomy and were then treated with immunoadsorption under membrane plasmaphersis (IAP). Thymic histology showed hyperplasia in nine patients. An immunoadsorption column (ASAHI, Med, Co) was made with tryptophan. A Plasouto 1,000 (ASAHI, Med, Co) was used as the machine. The plasma separator was a first filter (ASAHI, Med, Co), and immunoadsorption columns were used for plasma perfusion. IAP treatment was performed three times weekly for a total of six times, after which IAP was done every 3 weeks. The removal rate of anti-Ach-R titer was 54 +/- 12%; IgG, IgA, and IgM levels improved in nine of nine patients after IAP treatment, and improvement of gait disturbances were seen in two of two. Muscle strength improved in all nine patients, whereas speech disturbances improved in two of three. Eye ptosis improved in nine of nine patients. Subjective improvement was reported by nine of nine patients, and none had severe side effects with IAP. In conclusion, IAP is a safe, stable, effective, and clinically useful treatment. for MG.

Silicon transfer during haemodialysis

Silicon transfers were examined during haemodialysis (HD) in 120 chronic HD patients who received 5-hour dialyses 3 times a week. Si levels were measured by flameless atomic absorption spectrophotometry. Ultrafiltrable Si levels approximately equalled dialysate Si levels. Serum Si levels before HD significantly increased in all patients and total protein values were also high. It is concluded that serum Si levels increasing with time during HD with cellulose acetate or cuprophan is due to haemoconcentration and liberation from the silicon rubber tube.