An alternative elastase-mediated degradation of fibrinogen and fibrin observed in a patient with herpes simplex encephalitis and pneumonia

A 74-year-old female developed pneumonia following herpes simplex encephalitis. Her white blood cell counts reached 28,400/microliters, about 90% of which consisted of granulocytes. The polymorphonuclear (PMN) elastase/alpha 1-antitrypsin complex levels increased and reached the maximum of 5,019 ng/ml, indicating the release of a large amount of elastase derived from the granulocytes. The mechanism of PMN elastase release was most likely to be granulocyte destruction associated with phagocytosis. The cleavage of fibrinogen and fibrin by PMN elastase, independent of plasmin, was indicated by the presence of the fragments in immunoprecipitated plasma from the patient corresponding to elastase-induced FDP D and DD fragments and the absence of fragments corresponding to plasmin-induced FDP D and DD fragments on SDS-PAGE. These findings suggested that the large amount of PMN elastase released from the excessive numbers of granulocytes in this patient with herpes simplex encephalitis and pneumonia, induced the cleavage of fibrinogen and fibrin without the participation of plasmin.

[A case of atlanto-axial rotatory fixation associated with Jefferson's fracture]

The authors present a case of atlanto-axial rotatory fixation associated with Jefferson's fracture. A 52-year-old man was admitted to our hospital complaining of severe neck pain and torticollis after a traffic accident. Cervical x-ray films showed fracture of the atlas. CT scans demonstrated traumatic subarachnoid hemorrhage and atlanto-axial rotatory fixation. The patient was managed with skull traction and reposition was achieved. Although he was maintained in a halo device for 4 months, rotary fixation recurred. He underwent posterior fusion between the atlas and axis. We review the literature and discuss the diagnostic problems and methods of treatment for atlanto-axial rotatory fixation.

Minute hepatocellular carcinoma originating in the caudate lobe with a long-term surviving of 9 years 6 months after surgical resection: a case report

An extremely rare case of minute hepatocellular carcinoma originating in the caudate lobe who was resected and surviving for 9 years 6 months is presented. A 52 year-old male patient was diagnosed as having a minute hepatocellular carcinoma originating in the caudate lobe by lipiodol computed tomography and celiac angiography. Although the caudate lobectomy was successfully performed, refractory ascites developed for 4 months after surgical procedure. After remission of ascites, the patient is well and surviving for 9 years 6 months without recurrence of hepatocellular carcinoma. This case suggests that early detection and treatment of hepatocellular carcinoma can lead to a long-term survival even when the caudate lobe of the liver is involved.

Bone loss of the radius in rheumatoid arthritis. Comparison between 34 patients and 40 controls

We measured bone mineral density (BMD) in the radius by dual energy X-ray absorptiometry in 34 patients with rheumatoid arthritis (RA) and in 40 healthy controls. The BMD in RA patients in their fifties and sixties, but not in their forties and seventies, was significantly lower than that in the control subjects. The decrease in total radial BMD correlated with grip strength, RA activity and RA stage. The decrease in distal radial BMD correlated with RA activity, but not with grip strength. The levels of serum parathyroid hormone, alkaline phosphatase, and urinary hydroxyproline/creatinine were significantly higher in the patients. From these findings, we suggest that the bone loss in RA patients is affected by severity of inflammation, disuse, postmenopausal osteoporosis and secondary hyperparathyroidism.

Marked elevation of plasma carcinoembryonic antigen and stomach carcinoma

BACKGROUND

This study was undertaken to clarify the relationship between marked elevation of plasma carcinoembryonic antigen (CEA) and signet ring cell carcinoma of the stomach.

METHODS

To elucidate the contributing factor of extreme elevation of plasma CEA value, the histologic and biochemical records for 310 cases of stomach carcinoma, including 202 advanced and 108 early, collected between 1980 to 1994 from the San-in Rosai Hospital and Tottori University Hospital were studied. Immunohistochemical localization of CEA in the stomach was performed using a peroxidase antiperoxidase (PAP) staining technique.

RESULTS

Among 310 cases of gastric carcinoma, 44 (14%) had abnormal plasma CEA values. The positivity rates of early and advanced gastric carcinoma were 3.7% (4/18) and 19% (40/202), respectively. Concerning advanced gastric carcinoma, 20 cases had more than 51 ng/mL, and 20 cases had between 5 ng/mL and 50 ng/mL. Four cases with plasma CEA values of more than 1,000 ng/mL had histological signet ring cell carcinoma (one case), and poorly differentiated adenocarcinoma with signet ring cell carcinoma (2 cases). Three cases of signet ring cell carcinoma or poorly differentiated adenocarcinoma of the stomach were massive local infiltration rather than hepatic metastasis. Among 40 cases with elevated plasma CEA, a multivariate regression analysis showed that only one variable (lymph node metastasis) was an independent factor (P < 0.05). Significantly higher rates of peritoneal metastasis (P < 0.0001) and lymph node metastasis (P < 0.05) were observed in patients with marked elevations of plasma CEA than in patients with moderate elevations of plasma CEA. No correlation was obtained between plasma CEA value and several biochemical tests.

CONCLUSIONS

Marked elevation of plasma CEA may be found in the absence of liver metastasis from signet ring or poorly differentiated gastric carcinoma. Patients with marked elevations of CEA also had lymphatic and peritoneal dissemination.

Malignant fibrous histiocytoma of the lateral wall of the orbit

A 58-year-old male presented with malignant fibrous histiocytoma originating from the lateral wall of the orbit, manifesting as left exophthalmos and diplopia on left lateral gaze. Magnetic resonance (MR) imaging demonstrated the tumor extending into the left orbit and under the temporalis muscle. The tumor was isointense with muscle on T1-weighted MR images and was surrounded by a low-intensity rim, which was proved to be the capsule after histological examination. The tumor was completely removed after detaching the lateral orbital rim and zygomatic arch using the dismasking flap method. He underwent one course of CYVADIC chemotherapy and has demonstrated no recurrence for 1 year and 6 months postoperatively.

Hepatocellular carcinoma exhibiting a concentric structure of different histologic grades: evaluation by chondroitin sulfate iron colloid-enhanced MR imaging

A patient with hepatocellular carcinoma exhibiting a concentric structure of different histologic grades was examined with chondroitin sulfate iron colloid (CSIC)-enhanced MR imaging. After CSIC injection, the advanced component was enhanced in comparison with the surrounding liver, and the well-differentiated component was not enhanced. CSIC-enhanced MR imaging was helpful in evaluating histologic grade on the basis of reticuloendothelial function.

Inflammatory pseudotumors of the spleen: CT and MRI findings

OBJECTIVE

Our goal was to elucidate the CT and MRI findings of inflammatory pseudotumors of the spleen.

METHODS

The CT and MRI findings of three patients with inflammatory pseudotumors of the spleen were reviewed and compared with the pathologic findings.

RESULTS

On the early phase of CT, the masses were hypodense to the normal spleen, and on the delayed phase, they demonstrated delayed enhancement. On T1-weighted MR images, the masses were isointense to the normal spleen, and on T2-weighted images, the masses had heterogeneous low signal intensities. After administration of Gd-DTPA, the masses showed delayed enhancement.

CONCLUSION

Inflammatory pseudotumors of the spleen were characterized by low signal intensity on T2-weighted MR images and delayed enhancement after contrast material administration on CT and MRI. The fibrous stroma may contribute to these unusual findings.

Further studies of HLA-DR antigens on colonic epithelium in ulcerative colitis

The aim of this study was to determine whether HLA-DR antigens are expressed on colonic epithelium in macroscopically involved areas in all cases of ulcerative colitis and whether the expression precedes inflammation (colitis). Thirty-four cases of active ulcerative colitis were studied including two cases in which island-like lesions were observed proximally apart from the main lesion, and three cases in which distal colitis became entire colitis in 8 months or less. Detection of HLA-DR antigens on colonic epithelium was performed with the immunoperoxidase method using anti-HLA-DR monoclonal antibodies. HLA-DR antigens were expressed on colonic epithelium in macroscopically involved areas in all 34 cases. In the macroscopically normal areas, the antigens were modestly expressed in six of 16 specimens (cases) in the presence of microscopic inflammation. The antigens were expressed on colonic epithelium in island-like lesions, but not in the intervening mucosa between the proximal island-like lesions and the distal main lesion. HLA-DR antigens were not expressed on colonic epithelium in the proximal non-inflamed mucosa where colitis later developed. These results lead to the conclusion that HLA-DR antigen expression does not precede, but is associated with the inflammation.

Intrahepatic cholangiocarcinoma with a long-term survival of 12 years after surgical resection: report of a case and review of the literature

The prognosis of primary liver cancer, especially cholangiocarcinoma, is extremely poor. A long term, 12 years survivor of intrahepatic cholangiocarcinoma arising in a local dilatation of the intrahepatic bile duct is presented. A 40-year-old male patient was presented with recurrent upper abdominal pain, fever, and jaundice. Computed tomography revealed a localized duct dilatation, and ultrasound clearly demonstrated a tumor mass arising within the bile duct. At surgery in March, 1982, the tumor mass was resected and histologically confirmed as a well differentiated papillary adenocarcinoma arising. In March, 1994, the patient is alive and cancer-free, 12 years after surgical resection. To our knowledge, there has been no report on a patient surviving more than 10 years after initial treatment. This case suggests that a localized cystic dilatation of the intrahepatic-bile duct on imaging modalities may harbor a bile duct carcinoma, and this in turn may contribute to early diagnosis of carcinomas and improved long term survival.

Long-term decrease in serum N-terminal propeptide of type III procollagen in patients with chronic hepatitis C treated with interferon alfa

To evaluate the effect of interferon alfa (IFN-alpha) on the hepatic extracellular matrix, we investigated the changes in serum N-terminal propeptide of type III procollagen during and after 4 months of INF-alpha treatment in 178 treated and 45 nontreated patients with chronic hepatitis C. Serum pretreatment levels in nonresponders were significantly higher than those in long-term and short-term responders, but those levels were not different in the latter two groups. Serum propeptide levels decreased significantly during and after IFN-alpha therapy in the treated patients, although those levels were unchanged in the nontreated patients. This decrease was sustained for 12 months after IFN-alpha was completed not only in long-but also in short-term responders and nonresponders. Serum propeptide levels decreased in those with elevated pretreatment levels, but not in those with normal initial levels, whereas serum transaminase levels decreased similarly in both groups. The changes in serum propeptide levels during and after treatment were more closely correlated with the initial levels compared with those in serum transaminase levels. These results suggested that IFN-alpha treatment induces the long-term suppression of active fibrogenesis in chronic hepatitis C independent of antiviral and anti-necroinflammatory effects, thus preventing progression to cirrhosis.

Simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid

We report a case of simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid in the same thyroid gland. Immunoreactivity of calcitonin, carcinoembryonic antigen, neuron specific enolase and thyroglobulin made a sharp distinction between both neoplasms of the thyroid. It appears reasonable to consider that simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid in this case does not have embryological or genetical significance.

Effects of bathing in hot water on portal hemodynamics in healthy subjects and in patients with compensated liver cirrhosis

Bathing in hot water induces vasodilatation of the peripheral vessels and alteration of blood distribution. Using a Doppler flowmeter, we evaluated the effect of bathing in hot water on portal hemodynamics. Eight controls and 8 patients with compensated liver cirrhosis remained immersed in hot water at 42 degrees C for 5 minutes. Portal flow significantly decreased from 811 +/- 141 (ml/min) at the baseline to 530 +/- 98 in the controls and from 855 +/- 308 to 642 +/- 208 in cirrhotics immediately after bathing. This decrease (25%) in cirrhotics was significantly less than that (35%) in controls because vessel diameter did not decrease as rapidly as it did in controls. Portal flow after 30 minutes returned to the baseline values in controls but remained low in cirrhotics. These findings suggest that cirrhotics have a lower hemodynamic response to bathing in hot water compared with that in controls.

Asymptomatic extrahepatic portal obstruction without portal hypertensive findings detected in ultrasonic mass screening

BACKGROUND/AIMS

We report three adult cases of extrahepatic portal obstruction (EHPO) detected by ultrasonic (US) mass screening.

MATERIAL AND METHODS

All these cases were asymptomatic with no abnormalities on hematological or biochemical tests. Only indocynanine green clearance test revealed a slight abnormality. By imaging modalities, the portal trunk could not be visualized and cavernous transformation could be visualized.

RESULTS

There were no findings of portal hypertension, such as splenomegaly, esophageal varices and hepatofugal collaterals, in any of these cases.

CONCLUSIONS

As many EHPOs without symptoms can be detected on US mass survey, US is considered to be the best modality for screening for this disease.

Fibro-osseous pseudotumor of the digits arising in the subungual region: a rare benign lesion simulating extraskeletal osteosarcoma

A rare case of subungual fibro-osseous pseudotumor of the digits in a 59 year old woman is reported. A painful polypoid mass with ulcerative changes was noted in the subungual portion of the right first toe. Macroscopically, the tumor arose chiefly in the subcutaneous region and was unrelated to the underlying bone tissue. Histologically, the lesion contained fibroblast-like tumor cells producing an extensive osteoid substance in a granulation-like background. Although it was necessary to distinguish the lesion from extraskeletal osteosarcoma, the tumor cells lacked prominent atypical features. It is considered that pathologists and clinicians should add fibro-osseous pseudotumor of the digits to the differential diagnosis of subungual tumor.

Regional Proteus syndrome: report of an autopsy case

An uncommon autopsy case involving Proteus syndrome with multiple hamartomatous lesions in a 52 year old woman is reported. At birth, hemihypertrophy was noted on the right side of the face. Leiomyoma of the urinary bladder was extirpated at 37 years of age. She died of sepsis due to a brain abscess. At autopsy, diffuse asymmetrical lipomatosis was noted on the right side of the face, scalp, lip, oral mucosa, tongue and on the left side of the cerebellar peduncle. Multiple meningiomas, cavernous hemangiomas and osseous hypertrophy overlapped in the intracranial regions. The present case is considered as a regional type of Proteus syndrome displaying a somatic mosaicism.

[Secondary porphyrinuria]

The condition that the porphyrins are excreted into the urine due to impairment of bile excretion, is called as secondary porphyrinuria. The main porphyrin is coproporphyrin, there fore the condition is called as secondary coproporphyrinuria. Secondary porphyrinuria is associated with various disorders, such as hepatobiliary diseases, hereditary hyperbilirubinemia, intoxications, blood and metabolic diseases, but the etiology of secondary porphyrinuria is unclear. Coproporphyrin is divided into two isomers, one is coproporphyrin-I type and the other is coproporphyrin-III type. In normal human urine, coproporphyrin-III type is predominant, and the ratio of coproporphyrin-I to total coproporphyrin is 10-50% (% as isomer I), while in urines of hepatobiliary diseases, the ratio is 40-60%. In Dubin-Johnson syndrome, the ratio is 80-100%. Coproporphyrinuria in hepatocellular carcinoma and alcoholic liver disease may be different from that in hepatobiliary diseases, often associated with uroporphyrinuria as well as coproporphyrinuria. Coproporphyrinuria arising in blood and metabolic diseases must be taken into account of associated liver diseases.

Physiological differences of soluble and insoluble dietary fibre fractions of brown algae and mushrooms in pepsin activity in vitro and protein digestibility

Soluble and insoluble dietary fibre fractions were separated from Konbu, Wakame and Hijiki seaweeds and Shiitake, Hiratake and Yanagimatsutake mushrooms, respectively, and the effects of the fractions on pepsin activity in vitro and of those from Wakame on apparent protein digestibility in vivo were studied. Addition of each dietary fibre fraction inhibited pepsin activity in vitro in all the dietary fibre fractions tested, particularly the inhibition by soluble dietary fibre fractions being significantly greater, by 62-99%, than that by insoluble dietary fibre fractions, by 22-36% (P< 0.01 in each food). This suggests that soluble dietary fibres in algae and mushrooms are likely to play a different physiological role from insoluble dietary fibres. Measurement of viscosity of each soluble dietary fibre fraction resulted in the correlation of viscosity with the inhibition of pepsin activity by the soluble fraction. Young adult rats given a normal protein diet containing 5% of the soluble dietary fibre fraction derived from the Wakame seaweed showed a greater decrease in apparent protein digestibility by 9.4% than those given the diet containing 5% of the insoluble one (P< 0.01). This may have resulted in the significantly lower body weight gain of the former rats than that of the latter rats.

[Treatment of the porphyrias]

There are seven porphyrias which are caused by defective functions of the enzymes in the haem biosynthesis. The clinical classification of porphyrias are divided into three types which are neuroporphyria, neurocutaneous porphyria and cutaneous porphyria. For acute porphyric attack of neuroporphyria and neurocutaneous porphyria, the treatments of choice are administration of glucose and/or hematin, haem arginate and tinprotoporphyrin. Porphyria cutanea tarda in cutaneous porphyria is controlled by removal of iron by phrebotomies or low-dose chloriquine. A novel approach of intravenous administration of interferon may be useful to control the associated case of chronic hepatitis type C. Skin symptoms in erythropoietic protoporphyria can be alleviated with beta carotene. Hepatic failure due to protoporphyria may need a liver transplantation. Cimetidine, a H2-receptor antagonist, may be useful in the treatment of acute porphyric attack and in remission stage in neuroporphyrias, neurocutaneous porphyrias and cutaneous porphyrias such as porphyria cutanea tarda and protoporphyria.

Clinical evaluation of a monoclonal antibody to serum KM01 for the diagnosis of hepatocellular carcinoma

In order to evaluate a monoclonal antibody KM01 which was developed in mice immunized against a human colon carcinoma cell line, serum levels of KM01 and other tumor markers were studied in patients with both hepatocellular carcinoma and liver cirrhosis and in patients with liver cirrhosis alone. The KM01 levels in the sera of 50 patients with hepatocellular carcinoma plus liver cirrhosis and 50 patients with liver cirrhosis were measured using an enzyme immunoassay method and compared with various tumor markers including alpha-fetoprotein (AFP), DUPAN-2, and protein induced vitamin K absence or antagonist-II (PIVKA-II). The mean serum level (+/- S.D.) and sensitivity of KM01 in patients with hepatocellular carcinoma plus liver cirrhosis were 734 (+/- 716) units/ml and 64%, respectively, and they were significantly higher than those of liver cirrhosis patients (P < 0.001). Three out of 9 cases showing negative serum AFP levels had positive serum KM01 levels. Although the sensitivity of serum KM01 level for hepatocellular carcinoma was inferior to serum AFP and plasma PIVKA-II values, the sensitivity of a combination assay of serum KM01 or AFP was increased to 88%. Clinical data of the patients with markedly elevated serum KM01 levels (more than 1000 units/ml) were compared with patients with moderately elevated levels (530-1000 units/ml); serum bilirubin and alkaline-phosphatase were statistically higher in the former group (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Lipoadenofibroma of the uterine corpus. Report of a new variant of adenofibroma (benign müllerian mixed tumor)

This report documents an uncommon case of uterine adenofibroma with a fatty component, for which the term lipoadenofibroma is proposed. Abdominal computed tomography and echography revealed a cystic submucosal lesion in the uterine corpus of a 67-year-old woman. Microscopically, the tumor was composed of benign epithelial cells of a proliferative-endometrial type and nonepithelial stromal cells. The latter mesenchymal elements contained scattered foci of mature adipose cells. The present case is considered to be a new variant of adenofibroma (benign müllerian mixed tumor) of the uterine corpus.

Isolation and characterization of a cytotoxic metabolite of Talaromyces bacillosporus

A cytotoxic metabolite, talarotoxin, was isolated from a fungus, Talaromyces bacillosporus IFO 8397, cultured on rice. The structure of the toxin was elucidated and found to contain a pyrrolizidinedione connected with a trans delta 1-octalin through a conjugated triene.

[A case of external supravesical hernia--repair with laparoscopic surgery]

We report a case of external supravesical hernia. A 39-year-old Japanese male with history of bilateral herniorrhaphy visited our hospital with complaint of uncomfortable thumb-tip-sized subcutaneous mass cephalad and lateral to the pubic bone. Hernia port was observed laparoscopically in the right supravesical fossa, establishing the diagnosis of right external supravesical hernia. The patient received laparoscopic herniorrhaphy with fixing of polypropylene mesh on the preperitoneal layer and he was discharged on the third postoperative day. This patient seems the first case of external supravesical hernia ever receiving herniorraphy based on laparoscopic findings from inside the abdominal cavity.

Malignant peripheral nerve sheath tumor with prominent intracytoplasmic vacuolation: report of a case

A case of malignant peripheral nerve sheath tumor with uncommon features is reported. A mass was noted in the left thigh of a 16 year old man. Histologically, most areas of the tumor exhibited the typical appearance of malignant peripheral nerve sheath tumor, but some tumor cells had rounded nuclei and cytoplasm, resembling an epithelioid pattern. It was noted that some rounded tumor cells showed prominent intracytoplasmic vacuolation. Immunohistochemically, almost all of the tumor cells, including the rounded and vacuolated ones, were positive for S-100 protein and vimentin. Electron microscopic study revealed well-developed cytoplasmic processes, intracytoplasmic intermediate-sized filaments, basement lamina formation and extracellular long-spacing collagens. These findings were compatible with those of Schwann cell differentiation. Moreover, ultrastructurally, the vacuolated spaces contained a few granular materials and were derived from the dilatation of the rough endoplasmic reticulum. It is speculated that intracytoplasmic vacuolation in malignant peripheral nerve sheath tumor would be caused by degeneration of the tumor cells.

Erythropoietic protoporphyria with severe cholestasis

A 74-year-old woman with erythropoietic protoporphyria (EPP) with hepatic dysfunction is reported. She had been photosensitive for two years prior to admission. Physical examination revealed hepatosplenomegaly and erosions on her face. Moderate increases in serum bilirubin and biliary tract enzymes were noted. Histology of the biopsied liver revealed moderate fibrosis and dilatation of bile canaliculi containing orange pigment. Marked increases in protoporphyrin in erythrocytes and feces were noted. The patient died of hepatic failure a year and a half after admission with maximum serum bilirubin of 34 mg/dl. This patient seems to be the oldest among reported EPP cases with liver dysfunction.

Aspergillus arvii spec. nov., a new animal pathogen?

Aspergillus arvii sp. nov. Aho, Horie, Nishimura & Miyaji isolated from liver lesions of a dairy cow in Finland, is suggested to represent a new species. It differs from the other members of the Aspergillus fumigatus group by its stable brown colony colour, the ornamentation of its conidia as well as the shape of the vesicles and length of conidiophores.

Induction of HLA-DR antigen expression on human colonic epithelium by tumor necrosis factor-alpha and interferon-gamma

BACKGROUND

We investigated the effects of tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) on HLA-DR expression on human normal colonic epithelium, using an organ culture technique.

METHODS

Biopsy specimens from normal colonic mucosa were cultured for 24 h with various concentrations of TNF-alpha and/or IFN-gamma. Epithelial HLA-DR antigens were identified by an indirect immunoperoxidase staining method.

RESULTS

No expression of epithelial HLA-DR antigens was observed in specimens cultured with medium alone. Concentrations of 10(3) U/ml or higher of TNF-alpha and 10(2) U/ml or higher of IFN-gamma induced expression of HLA-DR antigens in a dose-dependent manner. Expression of HLA-DR was increased in specimens cultured with both TNF-alpha and IFN-gamma compared with those cultured with either cytokine alone.

CONCLUSIONS

Our findings suggest that both TNF-alpha and IFN-gamma play important roles in regulating the expression of HLA-DR on colonic epithelium in patients with inflammatory bowel disease.

Roles of myosin light-chain kinase in platelet shape change and aggregation

We examined the roles of myosin light-chain kinase in platelet responses to ADP using wortmannin, which almost completely inhibited myosin light-chain kinase at 3-6 microM. This concentration of wortmannin did not affect ADP-induced changes in the shape of the platelets, but it markedly inhibited aggregation in platelet-rich plasma and washed platelets. ML-9, another inhibitor of myosin light chain kinase, elicited similar effects on the platelet responses to wortmannin. Electron microscopic studies showed that there was no wortmannin effect on the ADP-induced spheration of discoid platelets, pseudopod formation, or granule centralization. Wortmannin at concentrations which prevented myosin light-chain kinase also inhibited platelet aggregation induced by ADP in the presence of U46619, an analogue of thromboxane A2, which is a prerequisite for ADP-induced irreversible aggregation. Although wortmannin partially inhibited protein kinase C, the protein kinase C inhibitor Ro-31-7549 (5 microM) prevented neither ADP- or ADP/U46619-induced changes in the shape of the platelets nor aggregation. These results suggest that myosin light-chain kinase activation is a prerequisite for ADP-induced platelet aggregation, but not for changes in their shape.

Crystalloid granuloma of the parotid gland: a case report

A case of an uncommon granulomatous lesion of the parotid gland is presented. A tumorous lesion was pointed out in the upper left neck region of a 63 year old Japanese female and then extirpated. Histologically, the tumor arose in the parotid gland and showed a chronic granulomatous lesion with lymphocytes and histiocytic cells, including the multinucleated foreign body type. In addition, numerous so-called crystalloids were deposited throughout the lesion. The crystalloids were partially positive on von Kossa's stain and nonbirefringent under polarized light. To the authors' knowledge, this is the second reported case of crystalloid granuloma of the parotid gland since the first one was described by Takeda in 1991.

Diagnostic usefulness of MR imaging for pedunculated hepatocellular carcinoma

Pedunculated hepatocellular carcinoma (HC) is an uncommon tumor of the liver. We present the case of a 56-year-old man with pedunculated HC arising from the lower surface of the liver. We recommend sagittal magnetic resonance imaging, which offers a superior choice of scanning planes, in the diagnosis of pedunculated HC.

Prostaglandin F2 alpha enhances tyrosine phosphorylation and DNA synthesis through phospholipase C-coupled receptor via Ca(2+)-dependent intracellular pathway in NIH-3T3 cells

Previously, we characterized the prostaglandin (PG) F2 alpha receptor linked to phospholipase C activation and DNA synthesis in NIH-3T3 cells (Nakao, A., Watanabe, T., Taniguchi, S., Nakamura, M., Honda, Z-I., Shimizu, T., and Kurokawa, K. (1993) J. Cell. Physiol. 155, 257-264). To elucidate intracellular events evoked via this receptor, we examined changes caused by PGF2 alpha stimulation in the phosphotyrosine composition of cellular proteins. The addition of PGF2 alpha to cells in quiescent culture rapidly increased the levels of phosphotyrosine in cellular proteins with Mr values of 70,000 (pp70), 85,000 (pp85), 92,000 (pp92), 100,000 (pp100), and 125,000 (pp125); the latter was immunologically identified as p125 focal adhesion kinase. The PGF2 alpha-induced changes in the level of intracellular Ca2+ ([Ca2+]i) elevation, formation of inositol phosphates, and [3H]thymidine incorporation followed a similar dose dependence as PGF2 alpha-induced tyrosine phosphorylation. This tyrosine phosphorylation was independent of extracellular Ca2+, while a [Ca2+]i chelator, 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (50 microM), completely inhibited the PGF2 alpha-induced elevation of [Ca2+]i, tyrosine phosphorylation, and [3H]thymidine incorporation. Ionomycin (0.1 microM), which induced [Ca2+]i elevation without formation of inositol phosphates, mimicked the PGF2 alpha-induced tyrosine phosphorylation. 12-O-Tetradecanoylphorbol-13-acetate (TPA) also induced [3H]thymidine incorporation in a dose-dependent manner but had no significant effect on tyrosine phosphorylation. The PGF2 alpha-induced tyrosine phosphorylation could be observed even in the cells pretreated with TPA (5 microM, 24 h). PGF2 alpha exhibited an additive effect on TPA-induced [3H]thymidine incorporation but had no effect on the 32P-phosphorylation of a known 80-kDa protein kinase (PK) C substrate. Both staurosporine and H-7 inhibited the PGF2 alpha-induced increase in [3H]thymidine incorporation and tyrosine phosphorylation in a similar dose-dependent manner whether or not cells were pretreated with TPA (5 microM, 24 h). However, W-7 and KN-62 had no effect on these cellular responses even at the concentration for the almost complete inhibition of Ca2+/calmodulin-dependent PKs (20 microM). These results, taken together, indicate that PGF2 alpha receptor-mediated tyrosine phosphorylation is evoked by a [Ca2+]i-dependent mechanism that is sensitive to staurosporine and H-7 but which is independent of PKC or Ca2+/calmodulin PKs. Finally, the data suggest that this PGF2 alpha-induced signaling pathway is linked to the proliferation of cells.

[Clinical significance of serum and urinary neopterins after transcatheter arterial embolization for hepatocellular carcinoma]

To elucidate the immunological effects of transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC), serum and urinary neopterins were measured using the radioimmunoassay in patients with HCC before and after TAE (n = 11), and compared with one shot arterial injection (AI)(n = 8). At the third day after TAE, serum and urinary neopterin levels were maximally elevated up to 164% and 158% from their respective baselines (p < 0.01). By contrast, these levels were unaffected after AI. In considering the changes of natural killer cell activity, C-reactive protein, transaminase and alpha-fetoprotein, these results suggest that the determination of neopterin levels after TAE may be not only valuable to assess the necrotic effect of TAE, but also be useful for evaluating cellular immunity after TAE.

Protein kinase C-dependent and -independent mechanisms of dense granule exocytosis by human platelets

We examined the mechanisms of ATP release by human platelets using Ro-31-7549, a specific inhibitor of protein kinase C. Ro-31-7549 almost completely inhibited TPA-induced platelet aggregation and ATP release at 5-10 microM in washed platelets and in platelet-rich plasma. However, it suppressed thrombin- and U46619-induced ATP release by only 48% and 21%, respectively, and had little effect on aggregation in washed platelet suspensions containing serum or in platelet-rich plasma. The addition of GRGDS to prevent aggregation inhibited this residual thrombin-induced release by 53% and the residual U46619 release by 100% in the presence of Ro-31-7549. In washed platelet suspensions free of serum or plasma, Ro-31-7549 almost completely inhibited the ATP release and partially suppressed the aggregation induced by these agonists. These results suggested that there are protein kinase C-dependent and -independent mechanisms for ATP release by human platelets and that activation of the latter mechanism may depend on aggregation and plasma factors.

Dural arteriovenous fistulae involving the transverse-sigmoid sinus and foramen magnum

The authors present a rare case of dural arteriovenous fistulae (AVFs) involving both the transverse-sigmoid sinus and the foramen magnum, which was treated successfully with multi-staged endovascular procedures. The transverse-sigmoid sinus, which was thrombosed proximally and distally, was occluded by transarterial embolization followed by intraoperative embolization of the sinus using platinum coils. The dural AVF involving the foramen magnum was occluded via a transvenous approach.

Altered lipoprotein metabolism in transgenic mice expressing low levels of a human receptor-binding-defective apolipoprotein E variant

Transgenic mouse lines were produced that expressed low levels of a receptor-binding-defective variant of human apolipoprotein (apo) E, apoE(Arg112, Cys142). In transgenic mice, the human apoE was produced only by the kidney, whereas endogenous mouse apoE was produced mainly by the liver. The plasma concentration of the transgenic protein was about half that of endogenous apoE. The expression of transgenic apoE did not affect total plasma cholesterol and triglyceride levels, but the distribution of the human variant differed from that of endogenous apoE in the intermediate size and density range, where the transgenic protein accumulated selectively. Immunoblots of agarose gels of lipoprotein fractions showed that the transgenic protein occurred primarily on large alpha-migrating particles (HDL1). This phenomenon was not observed in transgenic mice expressing normal human apoE-3, which distributed like endogenous apoE, suggesting that the defective apoE variant perturbed HDL1 metabolism. In mice fed a high-fat, high-cholesterol diet, the transgenic apoE associated primarily with the apoB-containing lipoproteins. A significantly higher increase in very low density lipoprotein cholesterol was observed in fat-fed transgenics compared to fat-fed nontransgenic mice, suggesting a metabolic perturbation of apoB-containing lipoproteins. Thus, the receptor-binding-defective variant, apoE(Arg112, Cys142), expressed at low levels by the kidney, alters lipoprotein metabolism in transgenic mice, presumably by interfering with apoE-mediated removal of the lipoproteins from circulation.

Combination therapy with transcatheter arterial embolization and percutaneous ethanol injection for advanced hepatocellular carcinoma

The effectiveness of transcatheter arterial embolization (TAE) combined with percutaneous ethanol injection (PEI) was investigated in 18 patients with advanced hepatocellular carcinoma (HCC), and compared with 18 patients with HCC treated by TAE therapy alone. In both groups, patients had multiple lesions or a single lesion larger than 3 cm. The pretreatment characteristics of the patients in the two groups showed that serum bilirubin in the TAE-PEI group was significantly higher than that in the TAE-only group, but that the patients in the two groups were comparable in all other respects. The cumulative survival rate of the TAE-PEI group estimated by the Kaplan-Meier method was 100% for 10 months, 82% for 20 months, 53% for 30 months and 18% for 40 months, whereas that of the TAE-only group was 75% for 10 months, 50% for 20 months, 30% for 30 months and 30% for 40 months. The survival rate in the TAE-PEI group was significantly higher than that in the TAE group. Moreover, the survival rate of patients whose main tumor was 4 cm or larger, was significantly higher in the TAE-PEI group than that in the TAE-only group. The average survival period of these patients in the TAE-PEI group was five times as long as that in the TAE-only group. The survival rate of Child's B and C patients in the TAE-PEI group was significantly higher than that in the TAE-only group.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of gamma-glutamyl transpeptidase mRNA after depletion of glutathione in rat liver

Gamma-glutamyl transpeptidase (gamma-GT) is the enzyme in the gamma-glutamyl cycle which mediates the first step of glutathione degradation. Recently, it has been reported that diethyl maleate, a glutathione-depleting agent, enhanced hepatic gamma-GT activity. In this study, we examined how gamma-GT mRNA was expressed after the depletion of glutathione by using the RT-PCR method and in situ hybridization technique with digoxigenin-labeled oligonucleotide probe. We could detect hepatic gamma-GT mRNA in the epithelial cell of bile duct and the cytoplasm of hepatocytes in the periportal area, even in control rats. Furthermore, we found that the expression of gamma-GT mRNA was expanded to hepatocytes of a whole lobule 12 hr after depletion of glutathione by diethyl maleate, followed by the return to the pretreatment condition under which gamma-GT mRNA appears to be controlled in correlation with hepatic glutathione levels. These results suggest that the depletion of glutathione may induce hepatic gamma-GT activity through an increased synthesis of its mRNA.

Expression of HLA-DR antigens on colonic epithelium around lymph follicles. An anomalous expression in Crohn's disease

The relationship between the lymph follicle and expression of HLA-DR antigens on the colonic epithelium was investigated. Colonic specimens containing lymph follicles were examined immunohistochemically for HLA-DR expression. Thirty-six biopsy specimens (29 from macroscopically uninvolved areas and seven from aphthoid lesions) were obtained from 10 patients with Crohn's disease, and another 43 specimens were obtained from 33 patients with various intestinal diseases (non-Crohn's disease). HLA-DR antigens were expressed on the epithelium around the lymph follicle in both groups. However, the rate of expression (31/36) in Crohn's disease was significantly higher than that (5/43) in non-Crohn's diseases (P < 0.001). In addition, the extent and intensity of expression were broader and stronger in Crohn's disease than in non-Crohn's disease. This study is the first demonstration of anomalous HLA-DR expression on the epithelium around the lymph follicle in Crohn's disease.

Bu ji (hozai) for treatment of postoperative gastric cancer patients

We proposed that postgastrectomy cancer patients with organ deficit were xu zheng, or of deficient constitution, and administered bu ji or supplementary regimen to them. With alleviation of the symptoms, our diagnosis seemed correct from the traditional medicine perspective. Interleukin 2 reactivity, natural killer activity, nutritional index and bone mineral indices also improved. Such results suggest that our diagnosis was also correct according to Western medical theory. In addition, nutrition seemed to have positive relationship with NK activity and bone mineral content. Therefore, administration of bu ji seemed useful to improve the quality of life of postoperative cancer patients.

TM-1 cells from an established human malignant glioma cell line produce PDGF, TGF-alpha, and TGF-beta which cooperatively play a stimulatory role for an autocrine growth promotion

We have previously established a human malignant glioma cell line, TM-1. TM-1 cells could proliferate in the serum-free medium. In the present study, immunochemical analysis demonstrated that platelet-derived growth factor (PDGF), transforming growth factor (TGF)-alpha, and TGF-beta are present in the serum-free medium conditioned by growing TM-1 cells. While the cells appeared to possess a single type of binding sites for epidermal growth factor (EGF) with properties comparable to those determined for other tumor cells, the conditioned medium did not contain EGF.PDGF, TGF-alpha, and EGF added exogenously to serum-free media stimulated thymidine incorporation into DNA of TM-1 cells. In addition, antibodies specific for PDGF and TGF-alpha suppressed this activity. These results indicate autocrine and stimulatory roles of PDGF and TGF-alpha for the proliferation of TM-1 cells. As observed for other tumor cells, TGF-beta by itself weakly suppressed thymidine incorporation by TM-1 cells. However, TGF-beta employed in combination with TGF-alpha or EGF appeared to stimulate thymidine incorporation, suggesting that a cooperative action of TGF-beta with different growth factors may be involved in the stimulatory growth regulation at least for TM-1 cells.

Ca2+ entry pathways activated by the tumor promoter thapsigargin in human platelets

Thapsigargin-activated Ca2+ entry into platelets was examined in the presence of S-145, a thromboxane A2 receptor antagonist, to inhibit indirect effects by endogenously formed prostaglandin H2/thromboxane A2. With external Ca2+ present, 0.2 microM thapsigargin caused a prompt increase in intracellular Ca2+ concentration ([Ca2+]i) followed by a gradual increase. Pretreatment with 6 microM wortmannin, a specific inhibitor of myosin light chain kinase, partly inhibited the increase in [Ca2+]i. In Ca(2+)-free EGTA buffer, thapsigargin induced a smaller increase in [Ca2+]i, and subsequent addition of Ca2+ to the buffer caused a further prompt increase in [Ca2+]i, demonstrating external Ca2+ entry. Wortmannin only partly inhibited this entry of external Ca2+. The wortmannin-insensitive Ca2+ entry pathway remained open for more than 6 min in Ca(2+)-free buffer. On the other hand, when receptor agonists such as thrombin and U46619 were substituted for thapsigargin, activation of the wortmannin-insensitive Ca2+ entry was transient (Hashimoto et al., J. Biol. Chem (1992) 267, 17078-17081). In the presence of S-145 and wortmannin, thapsigargin stimulated phosphorylation of neither the 20-kDa myosin light chain nor the 47-kDa protein, a substrate of protein kinase C. These results suggest that thapsigargin induces external Ca2+ entry by two mechanisms: (1) a mechanism involving myosin light chain kinase; (2) a mechanism, not activated by receptor agonists, that is independent of the major protein kinases of platelets.