Malignant pleural mesothelioma presenting as achalasia

A 65-year-old man with an occupational history of asbestos exposure developed dysphagia and vomiting. Clinical examinations at onset revealed a dilated esophagus with smooth narrowing at the gastroesophageal junction and no apparent tumor in and around the esophagus. Achalasia was suspected. Dysphagia progressed gradually and examinations performed three months after the onset disclosed a tumor in the pleural and the peritoneal cavities. At laparotomy, the tumor extended from the pleural cavity into the peritoneal cavity. Histological examination of the biopsied specimen demonstrated malignant mesothelioma. We report the first case of malignant pleural mesothelioma presenting as achalasia.

Biological effects of diesel exhaust particles (DEP) on isolated cardiac muscle of guinea pigs

Diesel engine-powered vehicles emit some 30 to 100 times more particles than do gasoline engine cars. We previously reported that diesel exhaust particles (DEP) could produce superoxide anions in an in vitro study. Furthermore, mice instilled intratracheally with DEP showed high mortality at low doses. The cause of death was lung edema with damage to the lung endothelial cells. In order to elucidate the mechanism of the onset of mortality induced by DEP, we examined the direct action of DEP on the isolated atrium of guinea pigs. A light-duty (2740cc), four cylinder diesel engine was used. The DEP were collected on fiberglass filter. DEP caused a negative inotropic action that was followed by the cardiac arrest of the isolated left atrium. These actions were not inhibited by propranolol, atropine, verapamil, diltiazem, diphenhydramine, indomethacin, superoxide dismutase or catalase. The precise mechanism of cardiac arrest is unknown. However, these results suggest that cardiac toxicity induced by DEP might be involved in lung edema.

Stable expression of the neuronal BI (class A) calcium channel in baby hamster kidney cells

Plasmids containing the BI (alpha 1) cDNA with the dihydrofolate reductase (DHFR) gene, skeletal muscle alpha 2-subunit cDNA with the neo marker gene, and beta-subunit cDNA were co-transfected into baby hamster kidney (BHK) cells. BHK cells lack endogenous calcium channel activity. Twenty percent of the methotrexate (MTX) and G418 resistant clones were found to express calcium channel activity using the patch-clamp technique. A single clone, BHKBI147, demonstrated stable electrophysiological characteristics over 20 passages. Ca2+ currents of the BI channel in BHKBI147 cells were largely blocked by a specific P-type blocker, omega-AgaIVA, with an IC50 of 150 nM. Unlike the BI channel, Ca2+ currents of cardiac L-type channels expressed in BHK cells were completely blocked by the L-type antagonist, nifedipine, with an IC50 of 56 nM.

Emergency cardiopulmonary bypass support in patients with cardiac arrest caused by myocardial infarction

Emergency percutaneous cardiopulmonary bypass support (PCPS) was instituted in 3 patients with acute myocardial infarction in cardiac arrest refractory to conventional resuscitation measures. All had severe double or triple vessel disease. Percutaneous transluminal coronary angioplasty (PTCA) was performed in 1 patient and PTCA and directional coronary atherectomy (DCA) were performed in the other 2 patients on combined intraaortic balloon pumping (IABP) and PCPS. Flow rates of 2 to 5 L/min were achieved, with restoration of mean arterial pressure to more than 60 mm Hg during PCPS. The status of all patients was improved hemodynamically with PCPS. One patient died of hemorrhage during PCPS. DCA was successfully performed in the other 2 patients, and PCPS and IABP was discontinued. Time on PCPS ranged from 10 h to 8 days. Time on IABP ranged from 10 days to 2 weeks. These 2 patients died of pneumonia or multiorgan failure after 1.5 months. In conclusion, emergency PCPS is a powerful resuscitative tool that may stabilize the condition of patients in cardiac arrest to allow for definitive intervention.

Rheumatoid-susceptible alleles of HLA-DRB1 are genetically recessive to non-susceptible alleles in the progression of bone destruction in the wrists and fingers of patients with RA

OBJECTIVE

To assess the relationship between HLA-DRB1 genotypes and the progression of bone destruction in Japanese patients with RA.

METHODS

The HLA-DRB1 alleles were determined by polymerase chain reaction and allele specific oligonucleotide probe techniques in 160 Japanese patients with RA. HLA-DR 0101, 0401, 0404, 0405, 1001 and 1402 were regarded as susceptible alleles of RA according to previous reports. Patients were classified into three groups (S/S, S/N and N/N group), based on the possession of two, one or no susceptible factor. The grading of radio-graphic changes in the wrists and fingers were evaluated by Larsen's criteria. The radiographic grades were first compared with the results of genotyping in the 160 cross sectional cases. A retrospective study was then conducted on a subgroup consisting of 57 cases taken from the 160 cases used for the cross sectional study.

RESULTS

In the scatter diagram of the 160 cross sectional cases expressing the relationship between the stage of bone destruction and duration of RA, the regression line and the 95% confidence intervals separated the S/S group from the S/N and N/N groups in the early phase of development of bone destruction. In the retrospective study on the 57 cases the median years taken to development to stage V in the wrists after the onset of symptoms were 13.1 in the patients in the S/S group, 22.7 in the S/N group and 23.0 in the N/N group. The difference observed between the S/S and S/N group, and between the S/S and N/N group were statistically significant (p < 0.01), but that between the S/N and N/N groups was not. Thus the bone destruction in the wrists and fingers progressed more rapidly in the S/S group than in the S/N and N/N groups; and the rheumatoid susceptible alleles of HLA-DRB1 can be considered to be genetically recessive to the non-susceptible alleles in the progression of bone destructions in the wrists and fingers.

CONCLUSION

Genotyping of HLA-DRB1 can be a useful prognostic marker in the early phase of RA.

Steroidal constituents from the roots and stems of Aclepias fruticosa

Steroidal constituents from the roots and stems of Asclepias fruticosa L. were investigated separately. From the roots, twelve pregnane pentaosides and uzarigenin beta-sophoroside were isolated together with three known coroglaucigenin and corotoxigenin glycosides. Pregnane glycosides were composed of ikemagenin or kidjolanin as an aglycone, and D-digitoxose, D-cymarose, D-oleandrose and terminal D-glucose as component sugars. Among the constituents from the stems, cardenolides show a similar pattern to those from leaves. 17 alpha-Hydroxycalactin and 17 alpha-hydroxyafroside were newly obtained along with known doubly linked and normally linked glycosides. Two pregnane glycosides and uzarigenin beta-sophoroside obtained from the roots were also isolated.

Early changes in volume and non-enhanced volume of acoustic neurinoma after stereotactic gamma-radiosurgery

The effectiveness of stereotactic gamma-radiosurgery for treating acoustic neurinoma was evaluated by measuring the volumes of the tumor, non-enhanced tumor, and cerebellar edema in 13 patients with acoustic neurinoma who were followed up for 9 to 15 months (median 12.7 mos) after treatment. The tumor volume and non-enhanced volume tended to reach a maximum after 6 months, and cerebellar edema volume after 9 months, then decreased gradually thereafter. Hearing loss tended to increase gradually, but involvement of the facial nerve was transient.

The high prevalence of the diabetic patients with a mutation in the mitochondrial gene in Japan

Recently, an A to G transition at position 3243 in transfer ribonucleic acidLeu(UUR) [the 3243 base-pair (bp) mutation] originally found in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes has been identified in patients with diabetes and deafness. To determine the prevalence of the diabetic patients with this mutation in Japan, we screened 550 randomly selected cohorts of diabetic patients without prior information about clinical features such as type of diabetes, family history of diabetes, age of onset, and mode of therapy. We have identified 5 patients with this mutation, suggesting that approximately 0.9% of diabetic patients have the 3243 bp mutation. However, there were no subjects with this mutation in 250 controls with normal glucose tolerance. The percentage of mutant DNA in whole mitochondrial DNA did not correlate to the degree of symptoms. We conclude that the 3243 bp mutation in the mitochondrial gene plays an important part as a cause of diabetes in Japan.

Impaired intracellular transport contributes to partial thyroxine-binding globulin deficiency in a Japanese family

We have previously reported a Japanese family manifesting partial TBG deficiency (TBG-PDJ). This variant was characterized by a decreased level of serum TBG concentration, heat lability, and normal isoelectric focussing pattern, but the affinity to iodothyronine is unknown. The TBG-PDJ gene possesses a single nucleotide substitution replacing the normal Pro363(CCT) with Leu(CTT); however, the precise mechanism that results in the reduction of the TBG concentration in the serum of the subjects harboring this mutation remains unknown. This was investigated in the current communication by expressing the complementary DNAs of TBG-PDJ and the common type TBG (TBG-C) in COS-1 cells. Pulse-chase experiments revealed impaired secretion of TBG-PDJ. TBG-C secretion into the medium was evident during 60 min of the pulse period and was almost completed by 12 h. On the other hand, TBG-PDJ was secreted slowly and continued to accumulate between 12-24 h of the chase period. The molecular mass of TBG-PDJ in the cell lysate was identical to that of TBG-C when estimated by gel electrophoresis (54 kilodaltons). The content of TBG-PDJ in the cell lysate decreased less rapidly than that of TBG-C, indicating that impaired TBG-PDJ secretion accounts for the partial TBG deficiency. Oligosaccharide units of intracellular TBG-C were resistant to endoglycosidase-H, but half of those of TBG-PDJ were sensitive to the enzyme digestion, suggesting partial retention of TBG-PDJ within the rough endoplasmic reticulum. Northern blot analysis revealed abundant messenger ribonucleic acid for the glucose-regulated protein-78, the level of which was 3.54-fold greater in the cells transfected with TBG-PDJ than in nontransfected COS-1 cells, whereas that in TBG-C-transfected cells was same as that in the nontransfected cells. Increased expression of glucose-regulated protein-78 together with the sensitivity to endoglycosidase-H suggests impairment of intracellular processing of TBG-PDJ. Our results indicate that the impaired intracellular transport of the TBG-PDJ molecule is the main cause of the reduced concentration of immunoreactive TBG in the serum of subjects harboring this TBG variant.

Another approach for aortic valve replacement through left thoracotomy

We report a 54-year-old man with a history of esophagectomy and retrosternal esophagogastric anastomosis for esophageal cancer through right thoracotomy in whom cardiac failure developed due to aortic regurgitation. He underwent aortic valve replacement through a left thoracotomy with division of two great arteries and their strong traction toward the surgeon by stay sutures. He has been well for 3 years postoperatively in New York Heart Association class I.

Chronic eosinophilic pneumonia progressing to lung fibrosis

A 65 year old Japanese man was hospitalized with fever. Opacities distributed mainly in the subpleural regions were found on chest computed tomographic scan (CT), and these promptly cleared with corticosteroid therapy. Four years later, he presented with severe eosinophilia. Both chest X-ray and high resolution CT scan showed ground-glass opacities and honeycombing, suggesting lung fibrosis. A lung biopsy demonstrated intra-alveolar eosinophil infiltration, interstitial thickening with eosinophil infiltration, and a widely-distributed desquamative interstitial pneumonia-like reaction. With corticosteroid therapy, the ground-glass opacities decreased with a corresponding clinical improvement, although lung honeycombing and blood eosinophilia remained. In this case, circulating intercellular adhesion molecule-1 and circulating and bronchoalveolar lavage fluid eosinophil granule proteins were felt to be more effective markers for evaluating disease activity than the blood eosinophil number.

Effect of acute experimental pulmonary arterial occlusion on the deposition and clearance of technetium-99m-DTPA radioaerosols

Canine models of autologous PE and balloon occlusion of the pulmonary vasculature were used to evaluate radioaerosol deposition and to quantify radioaerosol clearance in the immediate postembolic period.

METHODS

A total of 28 animals were anesthetized, intubated and studied (central balloon occlusion = 4, peripheral balloon occlusion = 7, autologous PE = 5, various control groups = 12). A gamma camera computer system was used to monitor the distribution and clearance rate of inhaled DTPA radioaerosol. The perfusion defect distribution was determined after the radioaerosol study using 99mTc-MAA.

RESULTS

A new radioaerosol deposition defect was seen in 3 of 16 animals in a zone of acute vascular occlusion by a balloon (n = 2) or PE (n = 1). In addition, radioaerosol clearance rates were altered substantially. Peripheral vascular occlusion and PE caused radioaerosol clearance rates to accelerate significantly (control clearance half-time = 33.6 +/- 4.6 min, post-balloon occlusion = 19.0 +/- 8.3 min, post-PE = 12.4 +/_ 3.7 min, both p < 0.05). In only one case did these clearance rate changes create a visible abnormality in the aerosol images.

CONCLUSIONS

The pulmonary deposition patterns and clearance rates of 99mTc-DTPA radioaerosol can be altered by acute vascular occlusion or PE. These findings should be considered when interpreting radioaerosol images in patients with suspected PE.

Anti-ulcer effects of lactic acid bacteria and their cell wall polysaccharides

The anti-ulcer effects of bifidobacteria, lactobacilli and streptococci were examined using the acetic acid-induced gastric ulcer and ethanol-induced erosion models in rats. Bifidobacterium breve YIT4014 and 4043, and Bifidobacterium bifidum YIT4007 were administered orally, and anti-ulcer effects were confirmed for not only these organisms but also their polysaccharide fractions (PSFs). The major component of these anti-ulcer polysaccharides was rhamnose. In particular, polysaccharides in which the rhamnose content exceeded 60% were more effective in healing gastric ulcers. After administration of the PSF from B. bifidum YIT4007, the levels of epidermal growth factor and basic fibroblast growth factor increased in gastric tissues. Similar results were observed for the culture supernatant of gastric epithelial cells cultured with PSF. Furthermore, the production of 6-ketoprostaglandin F1 alpha by macrophages was also enhanced by PSF. These results indicated that these bacteria and their polysaccharides induced host repair and protective systems in the gastric ulcer model.

[A case of rupture of the ascending aorta owing to prosthetic graft dilation following replacement of the descending aorta]

A 55-year-old male was diagnosed as acute type A aortic dissection caused by retrograde propagation from a tear in the descending aorta. A replacement of the descending aorta was performed with a prosthetic graft (VASCUTEK). Sixteen days after the operation, the patient required an emergency operation due to a rupture in the ascending aorta. Transesophageal echo and contrast enhanced CT indicated the point of entry to be at the proximal anastomotic portion of the prosthetic graft and the prosthetic graft (30 mm in diameter) to be dilated to 45 mm. Intimal tear at anastomotic portion owing to graft dilation was suspected as the main factor causing rupture of the ascending aorta.

Suppression of interleukin 8 production by progesterone in rabbit uterine cervix

Uterine cervical fibroblasts prepared from rabbits at 23 days of gestation were found to produce spontaneously the neutrophil chemotactic factor/interleukin 8 (IL-8). When the cells were treated with recombinant human interleukin 1 alpha and 1 beta (rhIL-1 alpha and -1 beta), both cytokines similarly enhanced the production of IL-8 in a dose-dependent manner. Recombinant tumour necrosis factor alpha also enhanced its production to a lesser extent, but interleukin 6 failed to modulate the production. Physiological concentrations of progesterone suppressed both the spontaneous and IL-1-mediated production of IL-8 in parallel with the decrease in the steady-state levels of its mRNA. These suppressive actions of progesterone were offset by co-treatment of cells with a progesterone antagonist, mifepristone (RU486). In conclusion, basal and IL-1-induced IL-8 production in rabbit uterine cervical fibroblasts is down-regulated by progesterone at the transcriptional level. These results obtained in vitro and our previous observations indicating that progesterone modulates the extra-cellular matrix breakdown via the suppression of production of matrix metalloproteinases and the augmentation of production matrix metalloproteinases and the augmentation of production of their specific inhibitors (TIMP-1) [Sato, Ito, Mori, Yamashita, Hayakawa and Nagase (1991) Biochem. J. 275, 645-650] may explain the mechanisms of the maintenance of pregnancy until parturition and the acceleration of uterine cervical ripening and dilatation at term.

Presence of a capsule in Erysipelothrix rhusiopathiae and its relationship to virulence for mice

Three avirulent insertional mutants of Erysipelothrix rhusiopathiae were obtained by the technique of transposon mutagenesis with the self-conjugative transposon Tn916. The interactions between murine polymorphonuclear leukocytes and parent and mutant strains were studied in vitro. In the presence of normal serum, the virulent parent strain was resistant to phagocytosis, whereas the avirulent mutant strains were efficiently phagocytosed. In the presence of immune serum, the parent and the mutant strains were both efficiently phagocytosed. Electron microscopic examination of the parent strain demonstrated the presence of a structure resembling a capsule which was absent on the mutant strains, suggesting that a capsule may be involved in virulence. This was confirmed in studies in which an avirulent mutant strain reverted to virulence following acquisition of a capsule when the transposon was lost by spontaneous excision. These results strongly suggest that virulence of E. rhusiopathiae is associated, at least in part, with resistance to phagocytosis by polymorphonuclear leukocytes and that this antiphagocytic ability of the bacterium results from its possession of a capsule.

Evaluation of hypothermic heart preservation with University of Wisconsin solution in heterotopically and orthotopically transplanted canine hearts

In simple cold storage of the heart, 4 hours has been proved to be a clinically safe ischemic time. The University of Wisconsin solution has been reported to extend cold ischemic time in preservation of the liver, kidney, and pancreas. The purpose of this study is to clarify the safe cold ischemic time in heart preservation with University of Wisconsin solution experimentally in heterotopically and orthotopically transplanted canine hearts. In heterotopic heart transplantation, 120 minutes after reperfusion, maximum slope of the left ventricular end-systolic pressure-volume relationship was recovered to 94% +/- 13% in the 4-hour simple cold preservation group with GIK solution and 104% +/- 11% in the 8-hour simple cold preservation group with University of Wisconsin solution but was not recovered in the 8-hour simple cold preservation with GIK solution and 16-hour simple cold preservation with University of Wisconsin solution groups. One hundred twenty minutes after reperfusion, myocardial tissue blood flow measured by laser Doppler flowmeter was recovered to 90% +/- 19% after 4 hours with simple cold preservation with GIK solution and 98% +/- 9% after 8 hours with simple cold preservation with University of Wisconsin solution but was not recovered after 8 hours with simple cold preservation with GIK solution and 16 hours with simple cold preservation with University of Wisconsin solution.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of a heterodimeric (placental-intestinal) hybrid alkaline phosphatase in KB cells

A hybrid heterodimeric alkaline phosphatase expressed in KB cells, consisting of placental and intestinal (fetal) subunits, was purified by use of two different immunoaffinity columns using the monoclonal antibodies 2HIMS-1 and HPMS-1. The closely related subunits were found to yield a dimeric active enzyme glycosylated as the mature heterodimeric forms. This enzyme displays intermediate properties to the placental and intestinal (fetal) isozymes with regard to heat stability, inhibition patterns with amino acids and amino acid derivatives, as well as reactivity with monoclonal antibodies specific for human alkaline phosphatase isozymes. Peptide fragments obtained from the hybrid enzyme after cyanogen bromide cleavage belong to either the placental or intestinal (meconial) isozyme as evaluated by SDS polyacrylamid gel electrophoresis, and the N-terminal amino acid sequences, corresponding to the placental and intestinal subunits, can be identified in the peptide fragments. By N-glycanase digestion or tunicamycin treatment, the molecular mass of the subunits was reduced to 62 kDa compared to 69 kDa for the native ones. The results confirm that some cell lines can synthesize hybrid alkaline phosphatases.

Promoting and synergistic effects of chrysazin on 1,2-dimethylhydrazine-induced carcinogenesis in male ICR/CD-1 mice

The modifying effects of chrysazin on 1,2-dimethylhydrazine (DMH)-induced colon and liver carcinogenesis were examined in male ICR/CD-1 mice. Starting at 6 weeks of age, mice were divided into four groups, two of which were treated with s.c. injections of DMH (20 mg/kg body wt) once a week for 12 weeks. A week after the final injection of DMH, one group was kept on the basal diet throughout the study (group I), and the other group was fed the diet containing chrysazin (mixed in basal diet at 0.2% concentration) alone for 42 weeks (group II). The other two groups were injected with normal saline and given the diet containing 0.2% chrysazin for 42 weeks (group III), or the basal diet during the experiment (group IV). The incidence and multiplicity of colon tumors of group II were significantly greater than those of group I (P < 0.05, P < 0.01). The incidence and multiplicity of the hepatocellular neoplasms of group II were larger than those of group I (P < 0.002, P < 0.02 respectively). In group III, colon tumors were not found, though a few liver neoplasms and severe inflammatory lesions of the colon were observed. The activity of ornithine decarboxylase of the colonic mucosa in mice exposed to chrysazin was stronger than that of animals without chrysazin. The results suggest that the promoting effect of chrysazin is probably related to an increase of cell proliferation in the target organ. A synergistic effect of DMH with chrysazin was also observed in liver tumorigenesis.