An acquired bullous dermatosis due to an autoimmune reaction against uncein

A 59-year-old male showed acquired, mechanically induced, scarring blisters on the fingers, toes, scalp and abdomen, as well as in the oral cavity. Ultrastructural and immunohistochemical examination of the bullae revealed junctional epidermal-dermal separation and IgG deposits in the lamina lucida of the basement membrane zone (BMZ), where the reactivity of the 19-DEJ-1 monoclonal antibody was decreased. Anti-BMZ autoantibodies detected in his serum were reactive to the lower lamina lucida region of normal human skin. SDS-PAGE of affinity purified antigens from human keratinocytes with IgG from the patient's serum revealed three polypeptide bands at 165, 135 and 100 kDa, in reduced condition. The indirect immunofluorescence test of his serum was negative on skin cryosections from patients with lethal junctional epidermolysis bullosa. Pretreatment of normal human skin sections with the patient's serum, blocked the binding of 19-DEJ-1 monoclonal antibody but not that of the GB3 monoclonal antibody. This case is considered to be an acquired autoimmune bullous dermatosis due to an autoantibody reaction against uncein (19-DEJ-1 antigen), a component of anchoring filaments.

50-mile walking race suppresses neutrophil bactericidal function by inducing increases in cortisol and ketone bodies

To examine the effect of intensive aerobic exercise on the interaction between endocrine and immune systems, we studied in ten normal healthy male subjects the effect of a 50-mile walking race on blood concentration of hormones (insulin, GH, ACTH, cortisol, adrenaline, noradrenaline, and dopamine), ketone bodies, specific immunological functions (IgG, IgM, and PHA/Con A-induced lymphocyte blastformation test), and nonspecific immune (CH50, and neutrophil bactericidal functions). Neutrophil bactericidal activity was measured as chemiluminescences amplified by luciferin analog (CLA-DCL) and luminol (L-DCL). The race increased cortisol and ketone bodies, and decreased insulin, CLA-DCL, and L-DCL (all parameters; P < 0.01). However, other parameters were not significantly changed. There were significant negative correlations between changes of ketone bodies/cortisol and CLA/L-DCL (P < 0.05), however there was no significant correlations between changes of insulin and CLA/L-DCL. These data indicate that extensive aerobic exercise causes impaired neutrophil bactericidal function, probably due to the induced increases in both cortisol and ketone bodies. This impaired neutrophil function may cause the susceptibility to infection after an extensive exercise.

Surgical treatment of children with medically intractable epilepsy--outcome of various surgical procedures

Outcome after temporal lobe resection, extratemporal resection, and corpus callosotomy was studied in 33 children aged 15 years or less with medically intractable epilepsy. Seizure-free control was achieved in 67% (6/9) of pediatric patients versus 67% (60/90) of adult patients receiving temporal lobe resection and in 33% (4/12) of pediatric patients versus 25% (7/28) of adult patients receiving extratemporal resection. Among patients suffering from drop attacks and generalized convulsive seizures, 42% (5/12) of pediatric patients versus 25% (6/24) of adult patients receiving corpus callosotomy became seizure-free. The most prominent histological diagnoses in temporal lobe resections were three cases of mesial temporal sclerosis, four of ganglioglioma, and two of neuronal migration disorders. Neuronal migration disorders were the main histology in extratemporal resections. Four of five patients with behavioral problems treated by corpus callosotomy exhibited improved hyperactivity and/or attention deficits. There was no surgical morbidity or mortality. The outcome of pediatric patients was at least as favorable as that of adult patients, and improvement of behavioral disturbances could be expected after surgery. Surgical treatment is an effective and safe procedure for children with medically intractable epilepsy.

Histology of fetal eyes with oculocutaneous albinism

The diagnosis of tyrosinase-negative oculocutaneous albinism (OCA) was made in a 19-week-old fetus by skin biopsy. Because the parents had an 11-year-old son with tyrosinase-negative OCA, they requested that the fetus be aborted at the 20th week of gestation. A histological analysis of the eyes was performed. Throughout the retina, the ganglion cell layer was separated from the inner neuroblastic layer by the inner plexiform layer. However, the number of ganglion cells was decreased and the nerve fiber layer was immature. Bipolar and horizontal cells had begun to segregate into the inner nuclear layer. Rods and cones were identifiable in the posterior, but not peripheral, retina. Cones were more numerous in the center of the retina, and no rod-free area was identifiable. In addition, the ciliary body (epithelial folds, blood vessels in the mesodermal connective tissue core, and ciliary muscle) was less developed than in a normal fetus. Melanosomes in the retinal pigment epithelium only contained filaments without melanization and were therefore classified as stage I or II melanosomes. However, the ciliary epithelium also contained some stage III melanosomes with melanin adherent to the filaments.

Lifestyle determinants for social activity levels among the Japanese elderly

We conducted a self-administered questionnaire survey to a total of 5239 elderly persons in four areas in Japan in 1993, which inquired about past lifestyles and present social activities. Based on the survey data, we first developed social activity measures, and then examined associations of the present total social activity measure with past lifestyles and physical conditions. The lifestyles significantly associated with high social activity after 65 years of age were 'high educational attainment'; having been 'healthy', 'plump', 'physically active' and 'having had hobbies' at about 50 years of age; and having 'frequent intake of many kinds of foods' during 30-50 years of age. Intake during 30-50 years of age of Japanese-style foods (rice, soybean paste soup, bean curd, pickles), noodles, beans, plant roots and potatoes was not significantly linked with the social activity levels at old age in either males or females. The same was true for smoking and drinking habits at about 50 years of age. Our findings essentially suggest the importance of a positive attitude at middle age to maintain and promote health status and improve lifestyles in order to attain high social activity at old age.

Rehearsal strategies, test expectancy, and memory monitoring in free recall

Three experiments were carried out to determine (a) the effectiveness of associative rehearsal and rote repetition for long-term recall with and without expectation of a later recall test, and (b) the subjects' ability to assess their own future recall performance. The overall results showed that a test expectancy effect was not obtained when a voluntary selection in strategies was prohibited, but was found for subjects not instructed in the use of any particular strategy. It is also shown that the subjects could predict correctly that the items studied with associative rehearsal would be recalled more successfully at the final test than when they were studied with rote repetition. A superiority of associative rehearsal for prediction was not found when the subjects used only one type of rehearsal, but was found when they were not given the immediate test. The results suggest that the expectancy effect can be explained in terms of subjects' intentional shifts of strategies based on their metacognitive assessment of such strategies.

Determination of the 8-methyl ether of xanthurenic acid in human serum by high-performance liquid chromatography with fluorescence detection

We developed a simple and sensitive assay for the 8-methyl ether of xanthurenic acid in serum by high-performance liquid chromatography with fluorescence detection (excitation at 340 nm, emission at 450 nm). The compound under study in serum samples was extracted with Sep-Pak C18 cartridge and the extract was applied to an octadecylsilane-bonded column (Nucleosil 5C18, 150 x 4 mm I.D.). The mobile phase used was a mixture of 0.05 M sodium acetate buffer (pH 6.0), containing 5 mM sodium 1-octanesulfonate and 0.1 mM Na2EDTA, and acetonitrile (93:7, v/v). The 8-methyl ether of xanthurenic acid from serum samples was sufficiently separated to be clearly distinguishable. The quantification limit was 2 x 10(-14) mol, which was sensitive enough to detect 8-methyl ether of xanthurenic acid in serum from normal subjects. The method was applied to samples from patients with deficiency in tryptophan metabolism, xanthurenic acid/3-hydroxy kynurenineuria and showed a striking elevation in serum 8-methyl ether of xanthurenic acid.

Further association study on dopamine D2 receptor variant S311C in schizophrenia and affective disorders

The dopamine D2 receptor gene is a candidate gene for schizophrenia because the potency of certain neuroleptics correlates with their affinity for this receptor. Case-control studies in 291 schizophrenics, 78 patients with affective disorders, and 579 controls on an association of a molecular variant of S311C of the dopamine D2 receptor with psychiatric disorders were conducted. The frequency of individuals with S311C was significantly higher in schizophrenics with the absence of negative symptoms (17.1%, P < 0.00001), but similar in schizophrenics with the presence of negative symptoms (5.7%, P = 0.46) when compared with the controls (4.1%). The frequency of S311C was significantly higher in familial schizophrenics from one local area but not in those from other areas. It was significant that S311C was frequently present in patients with mood-incongruent psychotic affective disorders (33.3%, P < 0.0001), but not in those with other affective disorders. These data suggest that S311C might be one of the genetic factors for symptomatic dimensions of delusions and hallucinations and might be involved in underlying clinical heterogeneity in schizophrenia and affective disorders.

Pemphigus: from immunofluorescence to molecular biology

Since the discovery of autoantibodies in patients with pemphigus, pemphigus has been intensively studied by dermatologists and cutaneous or cellular biologists by means of various techniques including immunofluorescence, immunoelectron microscopy, immunoprecipitation, immunoblotting, and molecular biology. In this article, up-dated topics on pemphigus obtained by each individual technique are reviewed. In the course of immunofluorescence studies on unusual cases of blistering diseases, a new entity characterized by immunoglobulin A (IgA)-type autoantibodies directed against keratinocyte cell surfaces has been discovered. Immunoelectron microscopy using low temperature post-embedding gold labeling enabled us to quantitate binding sites of pemphigus autoantibodies within desmosomes at different levels of epidermis. Immunoprecipitation and immunoblot analyses allowed us to characterize antigen complexes in paraneoplastic pemphigus. Finally, approaches using molecular biology not only have given us a fundamental insight that pemphigus autoantigen is a cadherin-type cell adhesion molecule both in pemphigus vulgaris and pemphigus foliaceus, but also provided tools to develop novel diagnostic and therapeutic strategies.

[A case with perineuritis]

We reported a 62-year-old woman with perineuritis. She suffered from dysesthesia in the right radial wrist. One month later, dysesthesia in the left radial wrist occurred. Four months later, dysesthesia developed in both soles of the foot. On a neurologic examination, hypalgesia, hypesthesia, dysesthesia and areflexia were disclosed. Sensory disturbance was a distal dominant distribution. Serum anti-Borrelia burgdorferi antibody was not detected. Cerebrospinal fluid examination revealed normal protein content and cell numbers. Motor nerve conduction velocities were normal, but the sensory nerve conduction velocity of median nerve, ulnar nerve and sural nerve could not be elicited. Sural nerve biopsy revealed marked thickening of perineurium and infiltration of mononuclear cells in and around the perineurium. The infiltration of mononuclear cells was also observed around middle-sized epineurial artery and arterioles. Treatment with daily 40 mg of prednisolone only relieved the dysesthsia. After treatment with daily 60 mg of prednisolone the sensory disturbance was gradually improved. Sensory nerve potential could be evolved seven months later.

Radical surgery for advanced gallbladder carcinoma

Forty-four patients with advanced gallbladder carcinoma (18 with stage pT3 and 26 with stage pT4 of the Union Internacional Contra la Cancrum classification) were aggressively managed by extended heptatic resection in 33 patients, bile duct resection in 28, pancreaticoduodenectomy in seven, gastrointestinal resection in eleven and portal vein resection and reconstruction in seven. Adjacent organ involvement was classified as follows: type I, hepatic involvement with or without gastrointestinal invasion (Ia, Ib); type II, bile duct involvement with or without gastrointestinal invasion (IIa, IIb); type III, hepatic and bile duct involvement with or without gastrointestinal invasion (IIIa, IIIb); type IV, gastrointestinal involvement without hepatic or bile duct invasion. Fourteen of 15 patients with type I tumours had a curative resection compared with seven of 26 with type III lesions (P < 0.0001). The surgical mortality rate was two of 15 patients with type I tumours, seven of 26 with type III tumours and nine of 44 for the whole group. The long-term survival rate after curative resection was four and two of 23 at 3 and 5 years respectively, significantly better than two and none of 21 at 1 and 2 years after non-curative resection (P < 0.01). The survival rate after curative resection for patients with type I tumours was four and two of 14 at 3 and 5 years respectively, significantly better than for other types (P < 0.05). This classification of advanced gallbladder carcinoma according to involvement of adjacent organs might be helpful in planning surgery for this condition; in particular, type I tumours should be treated by a radical surgical procedure to achieve a favourable outcome.

Noninvasive evaluation of malignancy of brain tumors with proton MR spectroscopy

PURPOSE

To test clinical proton MR spectroscopy as a noninvasive method for predicting tumor malignancy.

METHODS

Water-suppressed single-voxel point resolved spectroscopy in the frontal white matter of 17 healthy volunteers and 25 patients with brain tumors yielded spectra with peaks of N-acetyl aspartate (NAA), choline-containing compounds (Cho), creatine/phosphocreatine (Cre), and lactate. These peak intensities were semiquantitated as a ratio to that of the external reference. The validity of the semiquantitation was first evaluated through phantom and volunteer experiments.

RESULTS

The variation in measurements of the designated region in the volunteers was less than 10%. Normal ranges of NAA/reference, Cho/reference, and Cre/reference were 3.59 +/- 0.68, 1.96 +/- 0.66, and 1.53 +/- 0.64 (mean +/- SD), respectively. In 17 gliomas, the Cho/reference value in high-grade gliomas was significantly higher than in low-grade gliomas. Levels of NAA/reference were also significantly different in low-grade and high-grade malignancy. In eight meningiomas (four newly diagnosed and four recurrent), the level of Cho/reference was significantly higher in recurrent meningiomas than in normal white matter or in newly diagnosed meningiomas.

CONCLUSIONS

Higher grades of brain tumors in this study were associated with higher Cho/reference and lower NAA/reference values. These results suggest that clinical proton MR spectroscopy may help predict tumor malignancy.

97-kDa linear IgA bullous dermatosis (LAD) antigen localizes to the lamina lucida of the epidermal basement membrane

Linear IgA bullous dermatosis (LAD) is an autoimmune blistering disease in which IgA autoantibodies develop against the epidermal basement membrane zone. Target antigens of the circulating autoantibodies are thought to be heterogeneous, and their ultrastructural localization has not been fully elucidated. Previous studies with immunoblotting have demonstrated that the 97-kDa autoantigen is detected most frequently in patients' sera and is thought to be a major LAD antigen. Although a recent report suggests that the 97-kDa antigen localized to the hemidesmosomal plaques and the adjacent lamina lucida, discrepancies still exist among previous immunoelectron microscopic findings. To identify the precise localization of the 97-kDa LAD antigen, we used two different low-temperature immunoelectron microscopic techniques. For immunolabeling, we selected five LAD sera that had a high titer of autoantibodies against the 97-kDa LAD antigen. A post-embedding method with cryofixation and freeze substitution failed to immunolabel the 97-kDa LAD antigen. Cryoultramicrotomy with immunoelectron microscopy succeeded in preserving the antigenicity of the 97-kDa LAD antigen. In all cases, the majority of labeling occurred in the lamina lucida beneath the hemidesmosomes. No specific labeling was observed in the hemidesmosomal attachment plaques or the lamina densa or sublamina densa region, including anchoring fibrils. These results indicate that the 97-kDa LAD antigen is a component of the lamina lucida.

Treatment for inpatients with anorexia nervosa: comparison of liquid formula with regular meals for improvement from emaciation

A new refeeding program using only liquid formula was given to six anorexic inpatients (LF group) at the initial stage of hospitalization. These patients were compared with six other inpatients who received regular meals (RM group). The LF group did not develop a phobia of gaining weight, while the RM group showed a vicious cycle of gastrointestinal discomforts leading to fat phobia and stagnation in weight gain. By comparison, the LF group had fewer gastrointestinal symptoms, which resulted in the disruption of this cycle and seemed to help motivate these patients to obtain a steady gain in bodyweight.

Validation of recalled food intake in the past in a Japanese population

To evaluate the validity of the recall method in estimating food intake in the distant past, we assessed past and current food intakes by mailed food questionnaires among 80 residents in Gifu, Japan who had answered the same questionnaire 9 years ago. We compared rank correlations and differences between recalled food intake scores and past ones with those between current food intake scores and past ones. We observed higher scores of recalled intake for meat, potatoes and alcohol, and a lower score of recalled intake for cereals than the scores of past intake. We observed increase in food intake scores of soyabean products, dairy products and potatoes and decrease in that of cereals intakes from past to current. The rank correlation coefficients between the recalled and past food intake scores (r = 0.24-0.89) were greater than those between the current and past ones (r = 0.10-0.70) for every food item except for dairy products. After stratification by sex, age and degree of change in body mass index (BMI), the greater correlation between the recalled and past food intake scores remained. These findings suggest that the recall method is more preferable than the current data to estimate food intake in the distant past in Japan.

Isolation and amino acid sequence of a molt-inhibiting hormone from the American crayfish, Procambarus clarkii

A molt-inhibiting hormone (Prc-MIH) was isolated from the sinus glands of the American crayfish, Procambarus clarkii, and its amino acid sequence was determined. It comprised 75 amino acid residues and had an amidated carboxyl terminus. The amino acid sequence was much more similar to MIH of the shore crab (Cam-MIH) than to MIH of the American lobster (Hoa-MIH).

A novel subepidermal blistering disease with autoantibodies to a 200-kDa antigen of the basement membrane zone

Several components of the basement membrane zone (BMZ) have been identified as antigenic targets in autoimmune bullous diseases. We report a novel disease with autoantibodies to a BMZ antigen that is different from the targets described so far. The patient suffering from this disorder showed tense bullae and severe mucous membrane involvement rapidly responding to oral tetracyclines and colchicine. Histopathologic findings resembled those of dermatitis herpetiformis. Direct immunofluorescence microscopy showed linear deposits of IgG and C3 at the BMZ. By indirect immunofluorescence studies on split human skin, using both 1 M NaCl and suction blistering for dermal-epidermal separation, IgG antibodies localized exclusively to the dermal side of the split. The antibodies were mainly of the IgG4 sub-class. By Western blot analysis of epidermal and dermal extracts, the patient's serum unequivocally reacted with a dermal antigen of 200 kDa. It did not recognize bullous pemphigoid antigens (the autoantigen of epidermolysis bullosa acquisita), purified preparations of laminin-1 and laminin-5, or the recently described 105-kDa BMZ antigen. By immunoblotting of concentrated conditioned SCC-25 medium, the patient's antibodies reacted with a band of 200 kDa and several bands of lower molecular weight. No reactivity was seen with extracts of cultured human fibroblasts. By indirect immunogold electron microscopy, immunoreactants localized to the lower lamina lucida. After clearance of skin lesions, both indirect immunofluorescence and Western blot analysis became negative. This patient suffers from a novel autoimmune bullous disease with autoantibodies to a 200-kDa antigen of the BMZ.

Evidence for involvement of Escherichia coli genes pmbA, csrA and a previously unrecognized gene tldD, in the control of DNA gyrase by letD (ccdB) of sex factor F

The letA (ccdA) and letD (ccdB) genes of the F plasmid, located just outside the sequence essential for replication, contribute to stable maintenance of the plasmid in Escherichia coli cells. The letD gene product acts to inhibit partitioning of chromosomal DNA and cell division by inhibiting DNA gyrase activity, whereas the letA gene product acts to reverse the inhibitory activity of the letD gene product. To identify the host factor(s) involved in this process, we analyzed the mutants that escaped letD expression and their suppressor, and found that the three E. coli genes tldD, tldE and zfiA participate in the process, in addition to the groE genes we reported previously. The tldD and tldE mutations made cells tolerant for letD expression, as did groES mutations, while the mutation in the zfiA gene made tldD, tldE and groES mutants LetD sensitive. We hypothesize that these gene products are factors that modulate activity of DNA gyrase along with the letD gene product; the zfiA gene product acts to inhibit interaction between the LetD protein and the A subunit of DNA gyrase, while the tldD, tldE and groE gene products act to suppress the inhibitory activity of the zfiA gene product. The tldD, tldE, and zfiA genes are located at 70.4, 96.0 and 58.2 minutes on the E. coli chromosome, respectively, and code for proteins with relative molecular masses of 51,000, 48,000 and 6800, respectively. tldD is a novel gene, but the tldE and zfiA genes proved to be the pmbA gene (production of Microcin B17) and the csrA gene (carbon storage regulator), respectively.

Clinical histopathological characteristics of basal cell carcinoma in Japanese patients

BACKGROUND

Basal cell carcinoma (BCC) does not commonly occur in the African and Asian races. Thus, there have been few reviews that have described the clinical overview of BCC among Japanese patients. There have been no large-scale analyses, including the histopathological features of BCC, except for the white race. We retrospectively examined 243 Japanese patients with BCC and analyzed the color of the tumors, the patient's age at which these tumors occurred, the site of the lesions, the histopathological patterns, and the incidence of recurrence and metastasis of the tumors; we compared these features with those in the other races statistically.

OBSERVATIONS

Clinically, approximately 75% of the tumors were pigmented and showed a so-called black pearly appearance. The male-female ratio was 0.97, and the average age of the patients was 59 years. Seventy-five percent of the tumors occurred on the head and neck. Fifty-four percent of the tumors showed a solid type of histopathological pattern. The incidence of recurrence and metastasis is extremely rare.

CONCLUSION

The high incidence of hyperpigmentation in the lesional skin of BCC is the most characteristic feature of BCCs in Japanese patients.

Prenatal diagnosis of inherited skin diseases

Significant advances in the prenatal diagnosis of hereditary skin disorders, including severe forms of epidermolysis bullosa (EB) and tyrosinase-negative oculocutaneous albinism (OCA1A), have been reviewed. Fetal skin biopsy during the second trimester of pregnancy has been utilized successfully for the prenatal diagnosis of EB and OCA1A. Recently, elucidation of the specific gene mutation in affected individuals allowed us to perform DNA-based prenatal diagnosis during the first trimester of pregnancy. Over the last 5 years, we have established several new strategies for prenatal diagnosis for EB and OCA1A at the Special Clinic for Inherited Skin Disorders at Keio University Hospital.

Metallothionein content increased in the liver of mice exposed to magnetic fields

Although recent studies have shown that various stress can induce metallothionein (MT) synthesis in animal tissues, the induction of MT synthesis by exposure to static magnetic fields (SMF) has not been reported. We measured MT levels in the liver, kidney and brain of mice exposed to SMF and also evaluated the effect of SMF exposure on the induction of hepatic MT by treatment with carbon tetrachloride (CCl4). The MT content in the liver was significantly increased by exposure to 4.7 T of SMF for 6, 24, or 48 h, whereas that in the kidney or brain was not changed compared to the control. The combination of CCl4 injection and SMF exposure induced elevation of the hepatic MT content exceeding that induced by either treatment alone. These results indicate that exposure to the strong SMF induces MT synthesis in the liver in mice and enhances the hepatic MT synthesis induced by CCl4 administration.