A space-occupying lesion in the liver due to Capillaria infection

A space-occupying lesion 3.5 by 2.0 cm in size caused by Capillaria infection was revealed ultrasonographically in segment 6 (S6) of the liver of a 32-year-old woman from Okinawa, Japan, who was hospitalized with a complaint of pain in the right upper quadrant. Laboratory examination showed leukocytosis of 10,400/mm3 with 22% eosinophils and slight impairment of liver function. The tumor was removed surgically and found to be a necrotic granuloma with eosinophilic infiltration formed around a degenerated nematode. The causative agent was presumed to be Capillaria hepatica based on the morphology of the bacillary bands and stichosome observed in the sectioned worm and in the fragments of worm recovered by dissecting the tumor tissue that was embedded in paraffin.

Suppressive role of endogenous endothelial monocyte chemoattractant protein-1 on monocyte transendothelial migration in vitro

Monocyte chemoattractant protein-1 (MCP-1, or monocyte chemotactic and activating factor) is thought to play an important role in monocyte infiltration into tissue, but little is known about its effect on monocyte-endothelium interaction. We examined the effect of MCP-1 produced by cytokine-activated endothelial cells (ECs) on monocyte-endothelium adhesion and subsequent transendothelial migration by using a double-chamber vessel model. Unstimulated ECs showed no MCP-1 expression, but exposure to interleukin-1 beta (IL-1 beta, 25 U/mL) induced marked MCP-1 mRNA expression and protein synthesis. When placed in the lower compartment, recombinant human (rh) MCP-1 (100 ng/mL) produced a 1.9-fold and a 2.7-fold increase in adhesion and migration, respectively, compared with a corresponding 51% and 59% decrease when placed in the upper compartment. Migration of monocytes was dependent on a gradient of rh-MCP-1 from the apical to basilar side of the EC layer. Furthermore, a forward gradient of MCP-1 induced adherent cells to increase their subsequent migration, whereas a reverse gradient induced the cells to detach and completely inhibited their subsequent migration. Pretreatment with IL-1 beta for 4 and 24 hours produced a 20% and 63% increase in monocyte migration, respectively. In the presence of anti-MCP-1 antibody, the increase was further enhanced by 52% and 152%, respectively. These results suggest that endogenous endothelial MCP-1, when secreted by IL-1-stimulated ECs, suppresses monocyte migration in the presence of MCP-1 on the basilar side of the EC layer.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of amplified Mycobacterium Tuberculosis Direct Test (MTD), Amplicor Mycobacteria kit (Amplicor) and PCR method for detection Mycobacterium tuberculosis in clinical specimens]

Accuracy amplified Mycobacterium Tuberculosis Direct Test (MTD), Amplicor Mycobacteria kit (Amplicor) and PCR method routinely used in the University of Tokyo Hospital (J. Clin. Microbiol. 31: 446-450 1991) were evaluated and compared with the same samples. The detection limits of MTD, Amplicor and PCR method (University of Tokyo) were 0.01-0.1 CFU/tube, 0.625 CFU/tube and 0.2 CFU/tube respectively, which were almost the same. These were shown to be at least as sensitive as the conventional culture techniques. The Tokyo Univ. method using radioisotope, takes up to 3 days, on the other hand 2 kits take 4-5 hours. These kits become useful tools for the early and rapid detection of M. tuberculosis in uncultured clinical specimens. But the risk of laboratory contamination and false-positive results remain. These must be further improved.

Morphology of the nerve terminals of laryngeal muscles in the Japanese monkey (Macaca fuscata)

Laryngeal muscles, namely, the cricothyroid (CT), lateral crico-arytenoid (LCA), thyrio-arytenoid (TA), posterior crio-arytenoid (PCA), interarytenoid (IA) muscles, of Japanese monkeys (body weight, 4.4-8.3 kg; 3-10 years old, male) were examined histologically and by light and scanning electron microscopy. The diameter of muscle fibres with nerve terminals in the CT of the Japanese monkey was larger than that of other laryngeal muscles. However, the areas of nerve terminals varied among laryngeal muscles. The mean diameters of nerve terminals of the CT and PCA were large and basically resembled those of other laryngeal muscles. They contribute mainly to maintenance of phonation which the adductor muscles contribute mainly to postural adjustments of the cartilage. The differences in features of nerve terminals of each muscle suggest the CT and PCA may contribute mainly to the frequency or pitch of voice and intensity of the voice during vocalization and to respiration.

Expression of leukocyte chemotactic cytokines in myocardial tissue

Cytotoxic action of leukocytes may be involved in the pathogenesis of inflammatory heart muscle disorders. We investigated the expression of rat leukocyte chemotactic cytokines--cytokine induced neutrophil chemoattractant (CINC) and JE--in cultured neonatal rat cardiac myocytes; CINC belongs to the interleukin 8 (IL-8) family and JE is a homologue of human monocyte chemoattractant protein 1 (MCP-1). In Northern blot analysis, CINC and JE transcripts were not clearly observed in unstimulated rat cardiac myocytes. However, their expression was clearly observed after exposure to tumour necrosis factor-alpha (TNF-alpha; 100 U/ml) for 2-6 h. We then evaluated IL-8 and MCP-1 mRNA expression in human endomyocardial biopsy specimens from seven patients with idiopathic dilated cardiomyopathy by polymerase chain reaction analysis. Both IL-8 and MCP-1 mRNA transcripts were recognized in all patients studied. These results show for the first time that leukocyte chemotactic cytokines, IL-8 and MCP-1, are expressed in myocardial tissue, which might contribute to the pathogenesis of inflammatory heart muscle disorders.

Genetic determinants of plasma factor VII activity in the Japanese

We investigated the frequency of the factor VII Gln353 (FVII Gln353) allele in Japan, where coronary artery disease is much less common and factor VII coagulant activity (FVIIc) is lower than in Western countries. Japanese males (n = 144) aged 40-59 years living in 2 different districts were studied, and the FVIIc and activated factor VII (FVIIa) levels were measured with human (FVIIa Hum) and bovine soluble tissue factor (FVIIa Bov). The frequency of the FVII Gln353 allele in the 2 districts was 0.026 and 0.052 (combined: 0.034), which was about one third of that in a European population. Thus, the lower FVIIc level in Japanese is not due to the effect of FVII Gln353 allele. Ten individuals with the Gln353 allele showed a 39% decrease of FVIIa Hum levels and a 29% decrease of the FVIIa Bov level compared with 134 individuals homozygous for the FVII Arg353 allele. These decreases of FVIIa were greater than the decrease of FVIIc (17%), suggesting that FVII Gln353 may be difficult to activate in vivo. The marked decrease of FVIIa levels in individuals with the FVII Gln353 allele suggests that they are genetically protected against cardiovascular disease irrespective of ethnic background, by virtue of their decreased FVIIa level.

[Coronary artery bypass grafting in a patient with a single coronary artery]

Coronary artery bypass grafting in a patient with a single coronary artery is reported. A 61-year-old male who had chest pain and palpitation was transferred to our hospital. His ECG showed ischemic change, and CPK rose to a high level. Emergency coronary angiography revealed a type L II A (Lipton's criteria) single coronary artery and atherosclerotic stenosis on three major branches. He underwent CABG of LAD using LITA, #3 and #14 using saphenous vein grafts. Post operative angiography confirmed patent grafts, and the patient was free from symptoms.

[An outbreak of acute pulmonary histoplasmosis among travelers to a bat-inhabited cave in Brazil]

Histoplasmosis is known to be endemic in various parts of the world, especially in North and Latin America. In Japan, Histoplasma capsulatum has rarely been isolated from the natural environment. To date, only seven cases of histoplasmosis have been reported in Japan including some that were contracted in foreign countries. Herein, we report the occurrence of acute histoplasmosis among Japanese travelers who were exposed to bat guano in a cave near Manaus, Brazil. A group of 8 Japanese travelers entered a cave for a total of 2 hours in March, 1993. All the visitors had been healthy and had no history of abnormal chest roentgenograms. From 10 to 20 days after the exposure, 7 (87.5%) of the 8 individuals developed abnormal symptoms including fever, malaise, loss of appetite, myalgia, arthralgia, chest pain and dry cough. Five (62.5%) had nodular infiltrative shadows with or without hilar lymphadenopathy in the chest roentgenograms. Eight (100%) of the individuals showed serologic evidence of histoplasmosis. Despite the small number of subjects, this high rate of infection may be related to the fact that the subjects stayed in an enclosed area where air exchange was minimal, at the end of a deep cave infested with numerous bats. The cave involved has never been documented as being endemic for histoplasmosis. The threat of H. capsulatum infection in bat-inhabited caves should be emphasized to travelers and also to physicians.

Aneurysmal dilatation of the pulmonary trunk with mild pulmonic stenosis

We present the unusual case of a 72-year-old woman whose chest X-ray showed an abnormal left hilar shadow. A pulmonary angiogram revealed an aneurysm in the pulmonary artery with a diameter of 55 mm that extended from the main pulmonary trunk to its bifurcation. Mild pulmonic stenosis with a systolic pressure gradient of 18 mmHg across the pulmonic valve was recognized. Mild dilatation of the ascending aorta was also present. The pressure gradient across the pulmonic valve was lower than is typical for an aneurysmal dilatation, suggesting that this patient represented a case of idiopathic pulmonary artery dilatation. We suspected the presence of a congenital structural alteration common to the pulmonary artery and the ascending aorta.

Monocyte chemoattractant protein 1 inhibits growth of rat vascular smooth muscle cells

The early atherosclerotic lesion is characterized by the migration of inflammatory cells, including monocytes, which may serve as a source of cytokines such as monocyte chemoattractant protein 1 (MCP-1), a homologue of mouse JE. We investigated the effect of MCP-1 on the growth of vascular smooth muscle cells (VSMC) isolated from rat aortae. In Northern blot analysis, MCP-1/JE transcripts were not observed in unstimulated VSMC, but its expression was clearly observed by exposure to lipopolysaccharide (1 micrograms/ml) for 6 h. Human recombinant MCP-1 inhibited the uptake of [3H]thymidine by VSMC cultured in 0.5% fetal bovine serum (FBS) containing Dulbecco's modified Eagle's medium (DMEM) in a dose-dependent manner. The inhibitory effect of MCP-1 on the growth of VSMC was also confirmed by a change in cell counts. The antiproliferative effect of MCP-1 was significantly blocked in the presence of an anti-MCP-1 antibody. MCP-1-induced inhibition of [3H]thymidine uptake was not affected in the presence of indomethacin (1 micrograms/ml) or NG-monomethyl-L-arginine (0.1 mM), and MCP-1 showed no effect on 6-ketoprostaglandin F1 alpha, guanosine 3',5'-cyclic monophosphate, and adenosine 3',5'-cyclic monophosphate syntheses in VSMC. These results indicate that MCP-1 inhibits the proliferation of VSMC in vitro and that its effect is independent of prostaglandin or nitric oxide generation.

Three-dimensional structure of the perimysium in sternocleidomastoid muscle

The morphology of the sternocleidomastoid muscle (SCM) of human fetuses, ranged from 12 to 32 weeks gestation, was investigated by a light microscopy and a scanning electron microscopy. The collagenous fibers of the perimysium of the SCM formed complex structures from 24 weeks gestation by contrast to fibers of the endomysium of the SCM. The cross-sectional area (CSA) of the bundle of muscle fibers and the CSA of the individual muscle fibers of the SCM increased during development from 12 to 32 weeks gestation, in a process linked to the development of the perimysium. Therefore the perimysium affects and controls to the muscle fiber of the developed SCM and acts to resisting stretch forces in the movements. The changes in the arrangement and development of the collagenous fibers in the perimysium may be correlated to with these of the muscle fibers.

Successful treatment of Pneumocystis carinii Pneumonia in mice with benanomicin A (ME1451)

Benanomicin A (BNM-A) has antimycotic activities via binding to mannan in the cell walls of fungi. Anti-Pneumocystis carinii activity of the agent was examined in the P. carinii-infected BALB/c nu/nu female mouse model because P. carinii also possesses mannan in the membranes. The infected mice were treated with intraperitoneal injections of six doses of BNM-A (1, 2.5, 5, 10, 30, and 100 mg/kg of body weight), 4 mg of pentamidine isethionate per kg, 100 mg of sulfamethoxazole per kg combined with 20 mg of trimethoprim per kg (co-trimoxazole), or saline for 21 days. Each dosage group consisted of 10 mice. During treatment, five mice in the control group (saline) died, whereas 8 to 10 mice in all treatment groups survived. Almost the same efficacies were obtained for the groups treated with 5 mg or more and 10 mg or more of BNM-A per kg regarding the weight and number, respectively, of cysts found in the lungs as were obtained for the groups treated with pentamidine isethionate and co-trimoxazole. Overall, a dose of 10 mg of BNM-A per kg was effective against P. carinii pneumonia infection in the mice. Thus, BNM-A is a good candidate for a novel treatment for P. carinii pneumonia as a compound with a new mechanism of action against P. carinii.

Radioimmunoassay method for the determination of 22-oxacalcitriol, a novel analog of 1 alpha,25-dihydroxyvitamin D3 having valuable clinical potency, in rat and human plasma

22-Oxacalcitriol is a synthetic analog of 1 alpha,25-dihydroxyvitamin D3, which is expected to be a novel agent for the treatment of patients with secondary hyperparathyroidism, psoriasis, and/or breast cancer. A sensitive and practical RIA for 22-oxacalcitriol in rat and human plasma has been developed. A rabbit antiserum raised against 22-oxacalcitriol 3-hemiglutarate conjugated with bovine serum albumin was used in combination with a tritium-labeled 22-oxacalcitriol having high specific radioactivity. A plasma sample was extracted with ethyl ether and the extract was successively purified with Bond Elut C18 and a normal-phase HPLC prior to the RIA to remove interfering substances. Accuracy of the RIA was assessed by various studies including serial dilution and recovery tests. Intra- and inter-assay coefficients of variation were lower than 10%, and the quantification limit was low enough for practical use (33 pg/ml plasma). The present RIA will be useful for the pharmacokinetic studies of 22-oxacalcitriol in both preclinical and clinical stages.

CT of lymphoepithelial cysts of the pancreas

OBJECTIVE

To clarify imaging and clinicopathologic features of lymphoepithelial cysts (LEC), a benign lesion of the pancreas.

MATERIALS AND METHODS

Two male patients with LECs that were found incidentally and proven surgically were reviewed.

RESULTS

Sonography revealed a hypoechoic mass in both cases, one of which had septation and an intracystic isoechoic component within it. The mass was shown as low attenuation on unenhanced CT, and the intracystic solid component was not enhanced by dynamic CT or computed tomographic arteriography. One lesion had calcifications around the mass. Magnetic resonance imaging showed hyper- in hypointensity on T1-weighted imaging and hypo- in hyper- on T2-weighted imaging in one case. Both lesions were located on the surface of the head of the pancreas, and the main pancreatic ducts appeared normal on endoscopic retrograde pancreatography. Both patients were asymptomatic.

CONCLUSION

These imaging and clinical findings suggest LEC, which should be considered when one encounters cystic lesions of the pancreas.

Ouabain enhances nitric oxide synthesis in rat vascular smooth muscle cells induced by interleukin-1 beta

Incubation of cultured rat vascular smooth muscle cells with interleukin-1 beta caused a significant increase in the production of nitrite, a stable metabolite of nitric oxide (NO), in time- and dose-dependent manners. Addition of ouabain to the culture further enhanced interleukin-1 beta-induced nitrite production. Similarly, interleukin-1 beta produced a significant increase in the cellular level of guanosine 3',5'-cyclic monophosphate, and the increase was significantly enhanced by coincubation with ouabain. The calcium ionophore ionomycin also significantly enhanced interleukin-1 beta-induced nitrite generation. These findings indicate that ouabain enhances NO synthesis in vascular smooth muscle cells induced by interleukin-1 beta, presumably through an increase in intracellular calcium ion concentrations.

Cloning and functional expression of human endothelin-converting enzyme cDNA

Endothelin (ET) is a 21-residue potent vasoconstrictive peptide produced by vascular endothelial cells and formed from its precursor, big endothelin (big ET), by endothelin-converting enzyme (ECE). This paper describes the cloning and functional expression of a cDNA encoding a human ECE from human umbilical vein endothelial cells (HUVEC). Human ECE consists of 758 amino acid residues and has high homology to rat and bovine ECE. Immunoblot analysis using a monoclonal antibody risen against rat lung ECE showed the presence of immunoreactive protein in membrane fraction prepared from both HUVEC and COS-1 cells transfected with human ECE cDNA. Both COS-1 cells expressing human ECE and its membrane fraction converted big ET-1 most efficiently among big ETs.

Measurement of human immunodeficiency virus type 1 p24 in serum by an ultrasensitive enzyme immunoassay, the two-site immune complex transfer enzyme immunoassay

Human immunodeficiency virus type 1 (HIV-1) p24 antigen was measured by an ultrasensitive enzyme immunoassay (two-site immune complex transfer enzyme immunoassay). The antigen was reacted simultaneously with 2,4-dinitrophenyl-biotinyl-bovine serum albumin-anti-recombinant p24 (rp24) Fab' conjugate and anti-rp24 Fab'-beta-D-galactosidase conjugate. The complex that was formed, comprising the three components, was transferred from polystyrene beads coated with affinity-purified (anti-2,4-dinitrophenyl group) immunoglobulin G (IgG) to polystyrene beads coated with streptavidin. The detection limit of rp24 was 2.4 fg (0.1 amol) per assay or 0.24 pg/ml with as little as 10 microliters of serum. When sera were treated at low pH, p24 was detected in 34 (68%) of 50 serum samples from asymptomatic carriers, in 25 (86%) of 29 serum samples from patients with advanced HIV-1 infection, and in none of 117 serum samples from HIV-1-seronegative individuals. Levels of p24 in serum were inversely correlated to those of anti-HIV-1 p24 IgG, and the recovery of rp24 added to serum decreased to zero with increasing levels of anti-HIV-1 p24 IgG in serum. This sensitive method may be used as a powerful tool for investigating the disease.

Separation and characterization of 25-hydroxyvitamin D3 3-sulfate in human plasma by high-performance liquid chromatography

The separation and characterization of 25-hydroxyvitamin D3 3-sulfate in human plasma are carried out by high-performance liquid chromatography. The vitamin D sulfate fraction is obtained from a plasma specimen (three volunteers) by the combined use of a Sep-Pak C18 cartridge, for solid-phase extraction, and a lipophilic gel (piperidinohydroxypropyl Sephadex LH-20), for ion-exchange chromatography. 25-Hydroxyvitamin D3 3-sulfate is identified in the examined three specimens in two ways: its chromatographic behavior and that of its fluorescent labeled derivative using 4-[4-(6-methoxy-2-benzoxazolyl)phenyl]-1,2,4-triazoline-3,5- dione; and data obtained from the solvolysis reaction.

[A case of leiomyosarcoma as a mediastinal tumor excised by bilateral thoracotomy]

Leiomyosarcoma as a mediastinal tumor is so rare that no more than 6 and 12 cases have so far been reported in and out Japan, respectively. The patient was 74-year-old male. While treated at the outpatient clinic of our university hospital for low back pain, he was referred to our department because of a shadow of the mediastinum on chest roentgenogram. A fist-sized tumor was found located in the posterior mediastinum behind the heart. Since it was difficult to make a preoperative definitive diagnosis, it was excised by bilateral thoracotomy. Histologically, it was compatible with sarcoma and a definitive diagnosis of leiomyosarcoma was made based on electron microscopic findings.

Expression of P450 17 alpha-hydroxylase and P450aromatase genes in isolated granulosa, theca interna, and theca externa layers of chicken ovarian follicles during follicular growth

Concentrations of estradiol (E), testosterone (T), and progesterone (P) and levels of the 1.9-kb and 4.0-kb mRNA encoding P450 17 alpha-hydroxylase (P450 17 alpha) and P450aromatase (P450arom), respectively, were measured in the isolated granulosa, theca interna, and theca externa of the largest preovulatory (F1-F4) follicles of the chicken 20 h and 3 h before expected ovulation of F1. In the granulosa layer, E and T concentrations remained low throughout this period of follicular growth, whereas P concentrations were high 3 h before ovulation in F2 and F1 follicles. E levels were highest in the theca interna and externa of the smallest (F4) follicle, decreasing progressively with follicular growth. T content of theca interna and granulosa was greater in less mature F4-F2 follicles than in the most mature (F1) follicle, whereas theca externa contained little T. P was quantifiable in significant amounts only in granulosa tissue, peaking in F2 and F1 follicles at 3 h before ovulation, at which time plasma levels of steroids also rose significantly. P450 17 alpha was expressed mainly in theca interna, whereas the P450arom mRNA levels found in theca externa reflected the pattern of E in this compartment. Expression of these two genes was very low in granulosa tissue, remaining unchanged during follicular growth. These results indicate that E and T synthesis in the chicken ovary is regulated, at least in part, at mRNA levels of P450 17 alpha and P450arom in the theca interna and theca externa layers during follicular growth.

[Lymphatics of the thoracic surface of the diaphragm especially located around the inferior surface of the pericardial sac]

The lymphatics on the thoracic surface of the diaphragm, especially lying around the lateral and posterior sides of the base of the cardiac sac, were examined in 68 adult Japanese cadavers macroscopically (37 males and 24 females, aged 45-92 years, no clinical evidences of neoplasms). In this observation, a vein which drained into the terminal portion of the inferior vena cava was observed. The lymph nodes in this region were located along the vein frequently (80.9%). The vein passed through the esophageal hiatus, or penetrated the diaphragm and finally communicated with veins around the esophagogastric junction. However, lymphatic vessels were not observed passing through the phrenico-esophageal membrane and/or the diaphragm. The collecting vessels, which originated from the lymphatics, drained into the esophageal lymphatics, and it drained into the thoracic duct via the esophageal lymphatics. In pleural effusion cases, lymphatic nets were clearly observed on the thoracic surface of the diaphragm immediately under the parietal pleura. The lymphatic nets did not communicate with the diaphragmatic lymphatics around the base of the cardiac sac. Moreover, large collecting vessel from the lymphatic nets passed through the muscular crus of the diaphragm near the medial arcuate ligament and traveled inferior to merge at the original portion of the thoracic duct at the level of the renal vessels. From these observations, the lymphatics on the posterior part of the thoracic surface of the diaphragm communicated with several regional lymphatics independently. This morphological lymphatic traveling suggests that the route differs in cases of pleural effusion or cancer metastasis.