Plasma levels of the monocyte chemotactic and activating factor/monocyte chemoattractant protein-1 are elevated in patients with acute myocardial infarction

Cardiac inflammatory responses appear to play a pivotal role in scar formation after acute myocardial infarction. Monocyte chemotactic and activating factor (MCAF) monocyte chemoattractant protein-1 (MCP-1) is a cytokine with chemotactic activity for mononuclear phagocytes, but also for NK cells, T cells, mast cells, and basophils. To investigate the possible involvement of MCAF/MCP-1 in the pathogenesis, its course was studied in patients with acute myocardial infarction. Twenty-three consecutive patients with acute myocardial infarction and 18 patients with angina pectoris were studied. Cytokines were measured by enzyme-linked immunosorbent assay. Plasma levels of interleukin IL-1alpha, IL-1beta, and IL-2 were below the detection limit of our method. IL-6 and interferon-gamma were detected in 17.4%, and tumor necrosis factor-alpha in 13.0% of patients with acute myocardial infarction, but the frequency was not statistically significantly different from that in angina pectoris. The plasma level of MCAF/MCP-1 in myocardial infarction tended to increase at 3 h after the onset of chest pain (133 +/- 19 pg/ml, P= 0.06) and was significantly elevated at 9 h (143 +/- 20 pg/ml) when compared with that in angina pectoris (87 +/- 6 pg/ml, P<0.05). The MCAF/MCP-1 level remained increased during the 24-hours observation period (P<0.01), and maximum level (168 +/- 13 pg/ml) was seen at 24 hour. The level of MCAF/ MCP-1 correlated significantly with the plasma level of another chemokine, IL-8, at 12 h after the onset of chest pain (r=0.51, P<0.05), suggesting that common stimuli mediate the release of both cytokines in myocardial infarction. The identification of MCAF/MCP-1 as an inflammatory mediator in acute myocardial infarction suggests that mononuclear phagocytes may play an important role in the early stage of the disease.

Effects of catholytes on the mobilization of proteins after capillary isoelectric focusing

Purified proteins and human plasma proteins were separated by capillary isoelectric focusing and detected by cathodic mobilization, e.g. by replacing the cathodic sodium hydroxide solution by solutions containing another anion. The effect of catholyte anions on the resolution of mobilized proteins was examined. Compared with the chloride or phosphate anion, organic anions having small dissociation constants improved protein resolution, especially in the range of acidic proteins. Among the catholytes examined, acetic acid gave the best resolution for purified proteins and human plasma proteins. Measurement of the changes of electric current during the mobilization process indicated that organic anions with low mobility move slowly towards the anode and retard changes of pH gradient in the capillary. Isoelectric focusing, cathodic mobilization, and direct pH measurement in polyacrylamide gel columns (1.3 mm internal diameter and 38 mm long) also revealed these effects of low mobility anions. In order to visualize the behavior of human plasma proteins in the mobilization step, micro two-dimensional polyacrylamide gel electrophoresis was employed. The results indicated that the proteins migrate towards the cathode, preserving their relative positions attained during the isoelectric focusing step.

[Retroperitoneal malignant Schwannoma in the pelvis: a case report]

We report a case of malignant Schwannoma in the retroperitoneal space and discuss the clinical features briefly. A 77-year-old male visited our hospital in August, 1994 with the chief complaint of bloody stool. Digital rectal examination disclosed a large, elastic and soft mass in the prostatic region, presented identically by ultrasonography and computed tomography. Histological examination of the mass by transperineal biopsy revealed benign cellular Schwannoma. The patient underwent radical prostatectomy including the tumor because the tumor and the prostate could not be separated. Histological examination of this specimen also revealed benign Schwannoma with normal prostatic tissue. However, 2 months after the operation an abdominal CT scan revealed multiple metastasis in the liver, which was later diagnosed as malignant Schwannoma histologically. He is still alive with hepatic metastasis 15 months postoperatively.

Carinal resection and reconstruction for recurrent lung cancer

A patient with a recurrent tumor in the trachea adjacent to the right main bronchus was treated by surgical resection 19 months after undergoing surgery for the primary cancer. The patient had previously undergone right upper lobectomy for T1N0M0 stage I squamous cell carcinoma. A carinal resection was performed which included 4 rings of the trachea, 2 rings of the right main bronchus, and 1 ring of the left main bronchus. Reconstruction consisted of an end-to-end anastomosis of the trachea and left main bronchus, and an end-to-side anastomosis of the right and left main bronchi. The postoperative course was uneventful, and at present the patient is healthy 12 months following reoperation.

Thoracoscopic approach to the diagnosis and treatment of diaphragmatic disorders

Thoracoscopy was used in the diagnosis and treatment of three patients with diaphragmatic disorders, including traumatic injury of the diaphragm, partial eventration of the diaphragm, and catamenial pneumothorax (endometriosis of the diaphragm). An excellent view of the diaphragm was obtained by using thoracoscopy. The diaphragmatic injury was repaired primarily, the eventration plicated, and the focal endometriosis resected. Recovery was rapid and uneventful in all three patients. Thoracoscopic surgery, although relatively new, may be an acceptable alternative to the conventional operative management of diaphragmatic disorders and may actually reduce the morbidity and mortality associated with thoracotomy.

[Combined treatment with resection, intraoperative hypotonic and post-operative systemic chemotherapy using cis-platinum for a mediastinal yolk sac tumor: a case report]

Generally yolk sac tumor in the mediastinum is a rare and highly malignant neoplasm. We report a case of yolk sac tumor, which was treated with resection, and then intraoperative hypotonic and postoperative systemic chemotherapy. A 33-year-old man was diagnosed as a mediastinal tumor with chest X-ray and chest CT findings. At operation he had mediastinal tumor which invaded to the part of the right upper lobe and pericardium, disseminated on the right diaphragm. A large tumor was removed with partial pericardiectomy and wedge resection of the right upper lobe. After resection hypotonic chemotherapy with cis-platinum was performed. This tumor had endodermal sinus structure, Schiller-Duval body, and eosinophilic hyaline globolus which were histological characteristics of yolk sac tumor, and the value of serum alpha-fetoprotein (AFP) was high. After operation with this diagnosis systemic chemotherapy consisted of cis-platinum, etoposide were performed. Patient was discharged uneventfully 8 months later.

10 MV x-ray zero-area phantom scatter correction factors (Sp) obtained using three extrapolation methods

Three sets of 10 MV x-ray zero-area phantom scatter correction factors (Sp) have been obtained using three methods. The three methods are all based on the Bjärngard-Petti extrapolation principle. The three sets of data assume lateral CPE (charged particle equilibrium) for the primary absorbed dose. Using the most reliable set of data, a set of 10 MV x-ray SMRs (scatter-maximum ratios) is produced and parameterized. With respect to the zero-area Sp correction factor at a depth of 2.5 cm, the parameterized expression gives Sp (0; 2.5) = 0.931 and a Rice-Chin Monte Carlo simulation gives Sp (0; 2.5) = 0.927. The former is only 0.4% larger than the latter.

Two types of phantom scatter correction factors (Sp) for high-energy photons

Two types of phantom scatter correction factors (Sp) are introduced for high-energy photons. One is the traditional Sp correction factor. It is produced using the primary absorbed dose under lateral CPE (charged particle equilibrium). It usually takes a non-zero value at zero-area field. The other is produced using the actual primary absorbed dose, which fails in lateral CPE when the field is small. It takes a value of zero at zero-area field. The two types of Sp correction factors can be connected with the laterally spread primary absorbed dose (LSD).

[Indications and techniques for surgical treatment of pulmonary emphysema]

We compared two surgical treatments for pulmonary emphysema: unilateral thoracoscopic surgery and bilateral volume reduction (pneumectomy). There were no significant complications with either technique. Symptoms were relieved and pulmonary function improved with both. Post-operative pain was more severe and postoperative blood loss was greater after pneumectomy, but the improvement in pulmonary function was also greater. Possible advantages of bilateral thoracoscopic surgery over pneumectomy should be studied.

[Dynamic stent useful for trachocarinal stenosis due to lung cancer]

In this study, a new tracheobronchial stent was used for treating a patient with tracheocarinal stenosis due to lung cancer. The patient was 41 year-old male with lung mass in the right upper lobe and metastatic mediastinal lymph node which caused tracheocarinal stenosis. The stent was introduced under general anesthesia with a jet ventilator. The respiratory condition of the patient could be controlled fairly well, and the ventilation tube didn't interfere with the stenting. The stent was a tracheobronchial silicone stent provided with a flexible posterior membrane and tracheal cartilage-shaped steel struts. Coughing is less difficult than other stents owing to better design. This patient has been able to cough up sputum from the day of the operation and there has been no need for bronchoscopic examination for removal of secretions.

Thoracoscopic diagnosis of Goodpasture's syndrome

Goodpasture's syndrome is a rare glomerulonephritis that is associated with or preceded by hemoptysis. An 11-year-old boy who demonstrated hematuria and hemosputum was successfully and definitely diagnosed as having Goodpasture's syndrome by thoracoscopic resection, although most cases generally require an open thoracotomy. The patient's postoperative course was uneventful. Thoracoscopy appears to be a safe and effective modality for the diagnosis of Goodpasture's syndrome.

Nodular lymphoid hyperplasia in the lung

We describe an immunocompetent adult patient presenting with cough and hemoptysis who was found to have a pulmonary mass localized to the right upper lobe. Lobectomy was performed and pathological examination revealed nodular lymphoid hyperplasia (pseudolymphoma) of the bronchus-associated lymphoid tissue.

Inotropic agents differentially inhibit the induction of nitric oxide synthase by endotoxin in cultured macrophages

We investigated the effects of inotropic agents with phosphodiesterase III inhibitory properties, amrinone, pimobendan and vesnarinone, and cell permeable cyclic nucleotide analogue, 8-bromo adenosine 3'5'-cyclic monophosphate (8 Br-cAMP) on the induction of nitric oxide synthase (NOS) by lipopolysaccharide in J774A.1 macrophages in vitro. Although all three inotropic agents inhibited nitrite accumulation, the degree of inhibition was different, with pimobendan being the most potent inhibitor and amrinone the least. Vesnarinone inhibited nitrite formation biphasically. 8 Br-cAMP increased nitrite production at high concentrations, suggesting that the inhibitory effects of inotropic agents could not be explained by an increase in cAMP. Although differential inhibition of inducible NOS by inotropic agents may explain the different effects of these drugs in patients with heart failure, further study is necessary to reach this conclusion.

A new method of the electrolyte-free long-term preservation of human sperm at 4 degrees C

OBJECTIVES

To develop a new method for the long-term preservation of human sperm.

SETTING

Andrology laboratory of our hospital.

PATIENTS

Thirty-one normal and 19 asthenozoospermic semen samples obtained from patients attending our infertility clinic. The average sperm motility was 70.2% and 36.0% in the normal and asthenozoospermic groups, respectively.

INTERVENTIONS

Ejaculated sperm were centrifuged and washed using the electrolyte-free Percoll gradient and then were preserved at 4 degrees C.

MAIN OUTCOME MEASURES

The motility of the preserved sperm was analyzed using computer-assisted semen analyzer after the addition of Ham's modified F-10 (GIBCO, Grand Island, NY).

RESULTS

In the normal group, motility rate after the addition of Ham's F-10 for 1, 2, and 4 weeks of preservation was 65.4%, 40.4%, and 5.5%, respectively. In the asthenozoospermic group, motility rate after 1 and 2 weeks of preservation was 31.3% and 18.1%, respectively. Preservation solutions containing sodium or potassium decreased motility after preservation. Restoration of preserved sperm was not achieved by incubation alone; however, reinitiation was induced by incubation together with Ham's F-10.

CONCLUSIONS

Human sperm in the electrolyte-free solution survived for a long period of time at 4 degrees C and reinitiation of sperm motility after preservation required the addition of Ham's F-10.

The role of potassium ion and extracellular alkalization in reinitiation of human spermatozoa preserved in electrolyte-free solution at 4 degrees C

OBJECTIVE

To elucidate reinitiation factors in human spermatozoa preserved in the electrolyte-free solution at 4 degrees C.

SETTING

Andrology laboratory of our hospital.

PATIENTS

Semen samples were obtained from patients attending our infertility clinic.

INTERVENTIONS

Ejaculated sperm were centrifuged and washed using the electrolyte-free Percoll gradient and then were preserved for 1 week at 4 degrees C.

MAIN OUTCOME MEASURES

The motility of preserved sperm was incubated and analyzed after the addition of electrolyte solutions.

RESULTS

The motility rate was 9.6% when the preserved sperm were incubated directly. The motility increased to 35.1% after alkalization (pH 7.8) and further increased to 40.7% when 0.1 mM KCl was added. The motility decreased to 1.4% in a weak acidic solution (pH 6.8), however, the addition of a > or = 10 mM concentration of NaCl or > or = 0.1 mM concentration of KCl increased in motility. The motility rate in 40 mM NaCl and 40 mM KCl (pH 6.8) was 19.8% and 31.5%, respectively. The restoration of motility by NaCl was inhibited by 1 mM amiloride. The motility also rose to 54.1% and 32.3% in 0.04% NH3 and 80 mM NH4Cl solution, respectively.

CONCLUSIONS

The reinitiation of preserved spermatozoa was induced by potassium ion and extracellular alkalization.

Increased circulating hepatocyte growth factor in the early stage of acute myocardial infarction

We measured serum hepatocyte growth factor (HGF) in patients with acute myocardial infarction, angina pectoris, and other heart diseases. In patients with acute myocardial infarction, blood was collected at the time of admission. Serum HGF was elevated within 3 hours in 8 of 10 patients (80%) with acute myocardial infarction after onset of chest pain (9.4 +/- 3.2 ng/mL, mean +/- SEM, values in normal subjects <0.39 ng/mL). Mean value of serum HGF was 11.0 +/-2.6 ng.mL (n=11) in patients who admitted to the hospital between 6 and 9 hours and 13.1 +/- 5.7 ng.mL between 12 and 24 hours after onset. Elevated HGF levels were significantly more frequent than those of creatine kinase within 3 hours, and elevated levels correlated well with those of serum creatine kinase at 6-9 hours after onset of acute myocardial infarction. No increase in serum HGF value was found in patients with angina pectoris or other heart diseases. Thus, measurement of HGF is a sensitive method for early diagnosis of acute myocardial infarction.

[A case of asymptomatic extra-adrenal pheochromocytoma]

A 46-year-old female first presented to our clinic with a chief complaint of an abdominal mass. A computerized tomographic (CT) scan revealed a 6 cm retroperitoneal mass below the left kidney. Preoperative hormonal examinations showed elevation of catecholamines and vanillymandelic acid (VMA) in her 24-hour urine, although she had no hypertension. Therefore, the tumor was uneventfully removed and histologically diagnosed as pheochromocytoma. It is difficult to preoperatively diagnose normotensive extra-adrenal pheochromocytoma without any considerations of the possibilities. However, it may be hazardous to treat pheochromocytoma surgically without any preparations. In the present case, we emphasized the importance of preoperative accurate diagnosis of extra-adrenal pheochromocytoma and discussed briefly the clinical features in the literature.

10 MV x-ray SMRs obtained using zero-area S(p) correction factors derived by means of the Bjärngard-Petti method

Based on the Khan concept, a new set of 10 MV x-ray scatter-maximum ratios (SMRs) has been produced. THese new SMRs reflect no electron contamination and are parametrized. A method has been developed for determining the minimum field size with lateral CPE (charged particle equilibrium) at the field centre. It is found that for 10 MV x-rays the minimum square field with lateral CPE at large depths on the central axis in water is 3.5 x 3.5 cm2. The zero-area phantom scatter correction factor (S(p)) is derived using the Bjärngard-Petti method. It is found that the effect of electron contamination is to reduce the zero-area Sp correction factor.

[Thoracoscopic surgery versus axillary thoracotomy for spontaneous pneumothorax]

From October 1974 through March 1995, 453 patients with spontaneous pneumothorax admited to our institution and 416 patients underwent an operation. Among them, except bilateral pneumothorax, 204 patients under sixty years of age underwent an axillary incision (Group Ax) and 80 patients underwent a thoracoscopic surgery (Group Ts). In Group Ax, 178 male and 26 female, median age was 26.6 years old and in Group Ts, 68 male and 12 female, median age was 24.6 years old. The median operating time was significantly shorter for patients in Group Ts than for those in Group Ax (73.2 versus 111.3 minutes; p < 0.05). The median intraoperative blood loss was significantly less in Group Ts than in Group Ax (5.4 versus 65.6 g; p < 0.01). There was no significant difference in the duration of intercostal drain placement between the two groups (2.1 versus 2.7 days) but the median postoperative hospital stay was significantly shorter in Group Ts than in Group Ax (8.0 versus 12.5 days; p < 0.01). 58.9% of the patients needed postoperative analgesia in Group Ts, while 82.3% of the patients in Group Ax, and it was significantly less in Group Ts. The rate of recurrent pneumothorax was more in Group Ts (5.0% versus 2.9%), because of fail to notice the bulla under the thoracoscopy. Recently we observe the thoracic cavity using electric bronchoscope in order that we may not miss the bulla, and we take laser treatment for bullous emphysema with much effect.

A fetal intestinal-type alkaline phosphatase produced in Caco-2 cells

Enzymic, immunological and lectin-binding properties of alkaline phosphatase (AP) produced in Caco-2 cells, a human colon carcinoma cell line, were investigated. The enzyme was very similar to fetal intestinal (meconium) AP in the enzymic and immunological properties, but different from fetal intestinal AP in lectin-binding properties; expression of the galactose moiety was altered in AP of Caco-2 cells, compared to that of fetal intestinal AP. These results indicate that AP of Caco-2 cells can be used in place of fetal intestinal AP when the enzymic properties of an AP of unknown origin are investigated, but cannot be used instead of fetal intestinal AP in the structural study of AP.

The induction of cytotoxicity by a bispecific antibody against CEA positive cell line, in vitro

A mouse anti-human carcinoembryonic antigen (CEA) x anti-human CD3 bispecific antibody, AB5C10*UCHT1, was developed. This antibody-heteroconjugate was chemically prepared by cross-linking the AB5C10 monoclonal antibody reactive with human CEA with the monoclonal antibody, UCHT1, which binds to CD3 on human T-lymphocytes. The AB5C10*UCHT1 recognized both CEA expressed on the KATOIII cell line and CD3 expressed on T-lymphocytes, as determined using flowcytometry. Next, AB5C10*UCHT1-mediated cytolysis was analyzed by 51Cr-release assay. When 51Cr-labeled target KATOIII cells were incubated for 6 h with effector cells that had been pretreated with AB5C10*UCHT1 for 60 min at 4 degrees C, the percentage specific lysis was significantly increased compared to that of untreated effector cells. Using peripheral blood mononuclear cells (PBMC) and lymphokine-activated killer (LAK) cells pretreated with AB5C10*UCHT1 for effector cells, the percentage specific lysis was determined to be 16.3% and 57.4% at effector: target (E:T) ratios of 100:1 and 12.5:1, respectively. On the other hand, the percentage specific lysis of untreated PBMC and LAK cells determined to be 3.0% and 35.8% at E:T ratios of 100:1 and 12.5:1, respectively. The minimum effective dose of AB5C10*UCHT1 required for antibody-mediated cytotoxicity was 0.1 mu g/ml. The results of this study suggest that AB5C10*UCHT1 could be useful for augmenting the cytotoxicity of CD3-positive T-cells against CEA-positive target cells in vitro.

[Comparison of clinical effects between granisetron alone and combination of granisetron and methylprednisolone against the nausea and vomiting induced by CDDP chemotherapy--comparative study by the cross-over trial. University of Tsukuba Antiemetics Study Group]

A cross-over clinical trial was carried out to compare the antiemetic effect and safety between granisetron alone (40 micrograms/kg) and the combination of granisetron and methylprednisolone (MP: 10 mg/kg) in urological cancer patients treated with cisplatin. Forty-eight courses were given with granisetron alone and 47 courses with both granisetron and MP. The antiemetic effect of nausea and vomiting was evaluated in the acute emetic phase. during the 24 hours following the CDDP administration, and in the delayed emetic phase, 2 to 7 days after the administration. Combination therapy of granisetron and MP demonstrated a greater antiemetic effect during the 72 hours following the CDDP administration than by granisetron alone. But there was no significant difference in antiemetic effect between combination therapy and granisetron alone after the 3rd day. Combination therapy also demonstrated more efficacy in complete antiemetic effect, with no emesis and less than moderate nausea, than by granisetron alone. Both treatments showed no side effects and were safe.

Enzyme-linked immunosorbent assay (ELISA) for Aleuria aurantia lectin-reactive serum cholinesterase to differentiate liver cirrhosis and chronic hepatitis

We have established an enzyme-linked immunosorbent assay (ELISA) for total serum cholinesterase (ChE) using 2 new monoclonal antibodies (mAbs) to ChE (E.C.3.1.1.8). The ELISA results correlated very well with the results of a serum ChE activity assay, which has been widely used for differentiating patients with liver diseases, such as hepatocellular carcinoma, liver cirrhosis and chronic hepatitis, from normal individuals. We next established an ELISA for Aleuria aurantia lectin (AAL)-reactive serum ChE using one of the anti-ChE mAbs and AAL, which specifically recognizes L-fucose alpha 1-->2, L-fucose alpha 1-->3, and L-fucose alpha 1-->6 structures. The ratio of AAL-reactive ChE to total ChE in sera determined by the two ELISA procedures was increased in patients with hepatocellular carcinoma and liver cirrhosis compared with patients with chronic hepatitis and normal individuals. We then applied the ELISA for AAL-reactive ChE directly to 10-fold-diluted serum samples, and by using a cut-off value of the mean + 2S.D. for normal individuals, we could effectively differentiate liver cirrhosis from chronic hepatitis. This single ELISA for AAL-reactive ChE could be a useful aid in clinical diagnosis.

Crystal structure of Streptomyces erythraeus trypsin at 1.9 A resolution

A trypsin-like serine protease from Streptomyces erythraeus (abbreviated as SET) has been crystallized at pH 7, which is within its active pH range. The crystal structure of SET has been solved by molecular replacement using the atomic model of Streptomyces griseus trypsin (SGT), which is 37% homologous with SET, and refined to the crystallographic R factor of 0.199 for 15,878 reflections with Fo/sigma(F) > 3 between 7 and 1.9 A resolution. The final model of SET contains 1,619 protein atoms and 97 water molecules. No Ca2+ ion is present in SET apparently because (i) the two carboxylate groups from two Glu residues, which bind a Ca2+ ion in bovine trypsin (BT) or SGT, have disappeared; and (ii) a guanidino group from an Arg residue is unfavorably present in the potential binding region. There is an unusual type II beta-turn in which the third residue is Asp instead of Gly. This Asp residue is the only non-Gly residue significantly outside the allowed regions in the Ramachandran map. The three-dimensional structure of SET is essentially the same as those of other trypsins of mammalian origin. The 211 C alpha atoms of SET exhibit an r.m.s. deviation of 1.16 A with equivalent atoms of BT, and the 208 equivalent C alpha atoms between SET and SGT exhibit an r.m.s. deviation of 1.09 A. The large deviations in C alpha positions between SET and BT or between SET and SGT are mainly observed in the first domain. The conformations of the side-chains of the catalytic triad are mutually similar to each other in these three proteases. Each of the chi 1 torsion angles of the three residues is distributed within +/- 5 degrees from each corresponding mean value. The hydrogen bond distances related to the side-chains in the triad coincide fairly well, though the relative disposition of the side-chains differs by 0.1-0.6 A among SET, BT, and SGT. The hydrogen bond network concerned with Ser(195), Asp(189), and water molecules in the substrate binding pocket differs from that in BT or SGT.

[Chronic recurrent polyneuropathy in a patient with autoimmune hemolytic anemia associated with antibodies to gangliosides GM1, GA1, and GD1b]

We report a case of chronic recurrent polyneuropathy with warm-type autoimmune hemolytic anemia (AIHA) associated with antibodies to gangliosides GM1, GA1 and GD1b. There have been few reports of AIHA associated with polyneuropathy. A 39-year-old man was admitted in May 1991 because of severe hemolytic anemia. Direct Coombs' test was positive of IgG1 and complement type. The treatment was started with prednisolone, the hematological abnormalities disappeared after 6 months, but thereafter, he developed muscle weakness of all limbs and AIHA within 7 weeks. On neurological examination, he was unable to arise from a chair and could not stand, had muscle atrophy and numbness of the distal part of all limbs and areflexia. Cerebrospinal fluid was acellular and protein content was 117 mg/dl. Electrodiagnostic studies showed mild slowing of nerve conduction velocities associated with severe decrease in amplitudes of compound muscle action potential and multifocal conduction block. A sural nerve biopsy specimen showed moderate loss of small myelinated fibers, but not of unmyleinated fibers. AIHA was substantially improved by methylprednisolone (1,000 mg/day) for 3 days, but neurological symptoms remained unchanged. A month later, he was given 2 courses of intravenous gammaglobulin infusion (0.4 g/kg/day) for 5 days. He was able to walk after the second course. In May 1992, the mild motor-sensory polyneuropathy recurred and gammaglobulin infusion was effective for neurological symptoms. We detected the high level of anti-GM1 antibody titer in the patient's serum by ELISA, the level of the antibody titers correlated with neurological manifestation. A thin-layer chromatography with immunostaining showed the presence of anti-GM1, GA1 and GD1b antibodies in his serum. We grouped the reported cases of AIHA into cold and warm types, according to its hemolytic temperature, and characterized the neurological manifestations in each type. We also discussed the pathogenic role of anti-gangliosides antibodies in this case.

A new approach for bronchoplastic procedures in the treatment of bronchial carcinoid tumors

Usually patients with typical carcinoid tumors originating in a segmental bronchus undergo segmentectomy with or without a bronchoplastic procedure. We have performed only sleeve resection of the bronchus for a bronchial carcinoid tumor located in the left basal bronchus thus preserving the lung tissue. This was made possible by transecting and reanastomosing the pulmonary artery.

Postoperative chylothorax following partial resection of mediastinal lymphangioma: report of a case

We report herein the rare case of a 20-year-old man in whom a mediastinal lymphangioma was incidentally detected by a chest roentgenogram taken during a routine health examination. Both computed tomography and magnetic resonance imaging confirmed a mass measuring 3 x 7 cm in diameter in the left anterior mediastinum. A thoracoscopic exploration was done, which confirmed a diagnosis of mediastinal lymphangioma, and 3 days later a sternotomy was performed. However, the tumor could not be completely extirpated due to partial invasion. Following the thoracoscopic procedure, a chylous discharge developed which was difficult to treat conservatively and he continued to drain 700-1,000 ml of chyle daily 2 weeks following the tumor extirpation. Therefore, a right thoracotomy with ligation of the thoracic duct was performed which resolved the chylothorax. The patient remains well without any regrowth of the regional tumor 9 months after his operation.

Thoracoscopic resection of a localized visceropleural mesothelioma

Herein we present a case report of a 46-year-old man with a localized visceropleural mesothelioma detected incidentally during a health examination. The patient underwent a thoracoscopic resection, and his postoperative course was uneventful. A thoracoscopic resection of peripheral localized nodules can be easily performed using thoracoscopic techniques, and this method should not be considered inferior to thoracotomy in terms of curability.

Quantitative analysis of stromal fat content of human parathyroid glands associated with thyroid diseases using computer image analysis

The stromal fat content in the parathyroid glands and its significance are still controversial. Several methods have also been introduced to evaluate the content in the literature. In an attempt to better understand the significance of stromal fat content, a computer image analyzing system was applied and 62 glands were investigated using routinely processed tissue. Our study revealed that the average stromal fat content was 34.8 +/- 18.7% which was lower than that of other studies. The stromal fat content was correlated with the age, grade of obesity, area of the gland and serum parathormone level; however, no consistent patterns were obtained with other clinical parameters. These results indicate that the change of stromal fat content may be related to the general condition of the patient similar to the change of fat in other organs. However, the decrease of the content may indicate the early change of parathormone secretory activity even if the serum examination shows no evidence of hyperfunction of the glands.

Anatomic comparison of the ipsilateral and the contralateral testis in intravaginal torsion

Sixteen cases of intravaginal testicular torsion were studied to compare the intrascrotal anatomy with that of the contralateral testis and to determine possible anatomic predisposition to testicular torsion. The anatomy of the contralateral testis was not always similar to that of the ipsilateral testis, and four of the contralateral testes were judged to be without risk of torsion.

Study of liver function in infants with atopic dermatitis using the 13C-methacetin breath test

Serum glutamic-oxaloacetic transaminase (GOT) levels were determined in 214 infants (133 males and 81 females) with atopic dermatitis during their first visit to the Department of Allergy, National Children's Hospital, Tokyo, Japan. Compared with the normal hospital range, their levels were found to be significantly higher, a tendency which was more conspicuous in lower age groups. We carried out a 13C-methacetin breath test (MBT), administering the stable-isotope-labeled compound to 11 children with higher serum GOT values and 5 within the normal range to investigate hepatic metabolism of methacetin in infants with atopic dermatitis. 13C-methacetin was given orally, and the 13CO2 level in the breath was determined immediately before and after administration, by mass spectrometry. Compared to the normal controls, the atopic infants demonstrated significantly lower 13CO2 peak excretion and delayed peak time. The clearance rate of 13CO2 was also decreased. These results suggest some relationship between atopic dermatitis and liver function in infants.

[Extracorporeal shock wave lithotripsy for urinary calculi in an ileal reservoir following reconstruction of the urinary bladder]

A new method for reconstruction of the urinary bladder was introduced by Taguchi in 1977. It consisted of two components; making of pseudo-urethra and the reconstruction of urinary reservoir in the pelvis. The latter was made of the ileum and the peritoneum with temporary use of Japanese paper. This operative method was applied to a 28-year-old female patient when she had cystectomy and bilateral ureterostomy. Thereafter she had has no trouble for 13 years. However, her recent rentogenogram showed urinary tract calculi in the reservoir. Endoscopic treatment was not indicated because of the deformed reservoir and the inflexible pseudourethra. Thus, extracorporeal shock wave lithotripsy (ESWL) was applied to the case with successful results. We herrin reported the case and discussed the usefulness of ESWL for urinali calculi in the ileal reservoir.

[A case of middle ureteral tumor treated by end-to-end anastomosis following resection of 6.7 cm segment]

A 71-year-old male with a right ureteral tumor in the midportion and contracted kidney of the opposite side, due to complete vesicoureteral reflux, underwent end-to-end anastomosis after partial ureterectomy 6.7 cm in length. Our experience in this case led us to conclude that end-to-end anastomosis of the upper or mid-portion of the ureter was possible for the maximal 7.0 cm length of the ureteral loss, when the kidney could be fixed downward as much as possible.

[Effect of caffeine and pentoxifylline on human sperm motility after one week storage at 3 degrees C]

The effect of caffeine (C) and pentoxifylline (P) on the sperm motility was examined after a 3 degrees C storage in a TEST yolk buffer for one week. Thus stored 24 semen samples from infertile patients were incubated with or without C or P at 37 degrees C. The motility was analysed for up to 240 minutes. The poststorage addition of C (1 mM) and P (1 mM) significantly increased the serum motility rate (p < 0.01). The stimulant effect of C and P was rather transient lasting no more than 2 hours. The prestorage addition of C and P in a preservant TEST yolk buffer was less effective than the poststorage administration. According to the time-related profiles of the sperm motility, 24 cases were divided into three groups. In group A (11 cases), the sperm motility rate increased from 30 to 90 minutes even without C or P. This group was responder of C and P. In group B (8 cases), the motility rate increased only in response to C and P and, in group C (5 cases), no such responses were observed. The prestorage semen qualities in terms of the sperm concentration, the motility rate, the velocity, the linearity, and the amplitude of the lateral head displacement were compared in these three groups. There was a significant difference between these 3 groups (p < 0.05) on the parameters in terms of the sperm concentration, motility rate and velocity. It was suggested that these prestorage parameters predict the sperm activity in response to C and P after a one week 3 degrees C storage.

A method of obtaining the Awall correction factor of an ionization chamber in a 60Co gamma-ray beam using tissue-air ratio data

A method is reported that evaluates the wall correction factor (Awall)water of an ionization chamber using measured data. The method needs a revised type of tissue-air ratio (TARcav) that should be measured with the ionization chamber. An experimental study has been carried out for 60Co gamma-rays using zero-area TARcav data extrapolated from non-zero-area TARcav data using the extrapolation method developed by Bjärngard and Petti. Using this technique, it is found that the value of (Awall)water for an ionization chamber has a deviation of -0.1% to -0.4% as compared with the Monte Carlo results. An experimental study has also been carried out using a published set of 60Co traditional tissue-air ratio (TAR) data assuming TARcav = TAR.

Increased reactive oxygen species formation in semen of patients with spinal cord injury

OBJECTIVES

To evaluate reactive oxygen species production of semen samples and Percoll-washed spermatozoa from men with spinal cord injuries and to determine if there is a relationship between this reactive oxygen species production and sperm motility.

PARTICIPANTS

Semen samples from healthy volunteers and infertile patients were collected by masturbation.

INTERVENTIONS

Semen samples from men with a spinal cord injury were obtained by electroejaculation or by masturbation after treatment with physostigmine.

MAIN OUTCOME MEASUREMENTS

Motility was measured using the CellSoft computer-assisted analysis system (Cryo Resources Ltd., Montgomery, NY). Luminol-amplified chemiluminescence was used to measure reactive oxygen species production.

RESULTS

Semen samples and Percoll-washed spermatozoa from men with a spinal cord injury produced reactive oxygen species at much higher frequency and levels than equivalent preparations from infertile men or healthy volunteers. There was an inverse relationship between the percentage of motility and reactive oxygen species production in Percoll-washed spermatozoa from men with a spinal cord injury.

CONCLUSION

Semen samples and Percoll-washed spermatozoa from men with spinal cord injury produce high levels of reactive oxygen species that may be related to the low sperm motility and infertility observed in these men.

Distribution of neuropeptide-containing nerve fibers in the synovium and adjacent bone of the rat knee joint

OBJECTIVE

The innervation of normal rat synovium and adjacent bone, especially the communicatory nerve fibers between them, were investigated.

METHODS

Nerve fibers were visualized using immunohistochemistry. Antisera to substance P(SP) and antisera to calcitonin gene-related peptide (CGRP) were employed to identify sensory nerves, while antisera to neuropeptide Y (NPY) were used to identify sympathetic nerves.

RESULTS

In the synovium, SP-positive nerve fibers were found in the lining cell layer, with some fibers branching toward the joint space. In the sublining layer of the synovium, SP-positive and CGRP-positive fibers were observed mainly near the blood vessels. NPY-positive fibers were predominantly seen as a network around the blood vessels in the sublining layer. A large number of SP-positive and CGRP-positive fibers were seen near the attachment of the meniscus to the synovium. Toluidine blue positive mast cells were detected in close proximity to all three types of fibers, especially near the blood vessels. In bones forming the knee joint, nerve fibers immunoreactive to SP, CGRP and NPY were present in the bone marrow and some of these fibers communicated with the synovium through the synovium-bone junction located in the bare area.

CONCLUSION

The role of nerves, especially the role of the communicatory nerves between the synovium and the bone marrow, should be considered in the pathophysiolosy of erosive arthritis.

Clinicopathological study on upper urinary tract tumors and associated bladder tumors

We reviewed 82 patients with 83 upper urinary tract tumors and investigated those who had associated bladder tumors. Of these patients, 7 (9%) had previous bladder tumors, 14 (17%) had concurrent bladder tumors, and 18 (22%) subsequently developed bladder tumors. As 1 patient subsequently developed a bladder and a upper urinary tract tumor at different times, 38 patients (46%) had associated bladder tumors. The time interval between the occurrence of a previous bladder tumor and the subsequent upper urinary tract tumor was 11 to 144 months (mean: 41 months), while that between an upper urinary tract tumor and the subsequent bladder tumor was 3-31 months (mean: 12 months). Most of the previous bladder tumors were papillary, multiple, and noninvasive (pT1 or less). Multiple upper urinary tract tumors were associated with a high incidence of concurrent bladder tumors, while high-grade (G2, G3) or invasive (pT2 or more) upper urinary tract tumors were associated with a high incidence of concurrent and subsequent bladder tumors. Patients with concurrent bladder tumors had a worse prognosis than those with previous or subsequent bladder tumors due to the increased incidence of high-stage tumors at either the upper tract or bladder site. Our findings suggest that tumor cell implantation is a possible mechanism for the recurrence of bladder tumors and upper urinary tract tumors.

Tracheal anastomosis using a metallic stapler. An experimental study

Experimental use of a metallic stapler in tracheoplastic surgery is described. In contrast to monofilament sutures, the technique permits nontraumatizing tracheal repair and may therefore be advantageous in clinical treatment for lesions of the cervical and the intrathoracic trachea.

Lansoprazole reverses Helicobacter pylori-inhibited gastric epithelial cell growth

Helicobacter pylori is associated with retarded healing and recurrence of peptic ulcer. Acid inhibitory agents, including proton pump inhibitors (PPIs), accelerate healing of peptic ulceration. Because epithelial cell proliferation is important for ulcer healing, we studied the effects of H. pylori and lansoprazole, a novel PPI, on gastric epithelial cell growth in vitro. Cell viability was significantly decreased when they incubated with 10(8) CFU/ml H. pylori. Nevertheless, all doses tested, from 10(6) to 10(8) CFU/ml H. pylori inhibited cell growth in a dose-dependent fashion. Co-incubation with AG-2000, an acid-converted derivative of lansoprazole, reversed H. pylori-inhibited cell growth. These results indicate that the antiulcer action of lansoprazole may involve a reversible effect on H. pylori-inhibited cell growth in addition to its well-established acid inhibitory action on parietal cells.

[Pulmonary hamartoma: atypical cases and current concept of management]

Twenty seven cases of surgically excised pulmonary hamartomas were reviewed. Patient's ages varied from twenty eight year-old to seventy seven year-old with an average of fifty three year-old. Of twenty seven cases, seventeen cases were man, seventeen cases has mass on right lung, and twenty six cases has solitary mass. While twenty five cases were asymptomatic, one case had cough, and the other cases had a history of hemoptysis (Case 3). Medical treatment for pulmonary tuberculosis had been continued unless the confirmed diagnosis on two cases. On one case followed as tuberculosis for twelve years, size of tumor shadow grew to two times bigger on chest X-ray films (Case 1). One of 27 cases showed multiple mass (Case 2). Histopathologically, twenty six cases were chondromatous hamartoma, and one case was non-chondromatous hamartoma. Pulmonary hamartoma is a benign tumor, and majority of cases are asymptomatic and not growing. On cases with presumed pulmonary hamartoma, less invasive thoracoscopic surgery seemed valuable for both therapeutic and diagnostic purpose to avoid continuous non-rational treatment and mental pressure of patient by prolonged follow up with unconfirmed diagnosis since complete differentiation from malignant neoplasm should not satisfactory on many cases.

[Clinical study on torsion of appendix in intrascrotal organ]

We reviewed 12 cases of torsion of appendix in the intrascrotal organ treated surgically and discussed its clinical features. An accurate diagnosis could be made in 5 of the 12 patients before operation because they had a palpable localized tender nodule at the affected area, but not in the other 7 patients because their whole scrotal contents had become swollen with time. The histological study on 6 patients with testicular swelling revealed their spermatogenesis intact. Therefore, we believe that torsion of the appendix in the intrascrotal organ has little influence on future fertility, and thus, correct preoperative diagnosis may diminish the necessity for surgical treatment.

Etretinate-induced heterotopic bone formation about the hip joint. A case report including ultrastructural study

Despite considerable documentation for retinoid-induced hyperostosis, sufficient knowledge regarding its management and histologic features is not available. In a 26-year-old man with etretinate-induced heterotopic bone formation about the hip joint, the use of etidronate disodium was unsuccessful. Surgical excision of the heterotopic bone dramatically improved restricted motion of the hip joint without initiating significant postoperative heterotopic ossification. Ultrastructural study showed abundant myofibroblasts in the fibrous tissue close to the heterotopic bone. Their role in local biologic events should be determined.

Astrovirus as a cause of gastroenteritis in Japan

We used an enzyme immunoassay (EIA) to screen for astrovirus in stool specimens from outbreaks and sporadic cases of gastroenteritis collected between 1982 and 1992 in six prefectural public health institutes in Japan. Three outbreaks of gastroenteritis involving schoolchildren and adults were confirmed to be attributable to astrovirus. Astrovirus was detected in 6 to 10% of the specimens from patients with sporadic gastroenteritis from whom no other bacterial or viral agent had been identified. Among the sporadic cases, astrovirus was most frequently detected in infants less than 1 year of age, and the incidence peaked in March and April. Using specimens from recent outbreaks, we found that the EIA was more sensitive than electron microscopy (EM) for the detection of astrovirus, and many EM-negative specimens were positive by EIA. However, some stool specimens previously found to have astrovirus-like particles by EM were negative by EIA, perhaps because of inadequate storage conditions, such as long-term storage and repeated freezings and thawings. Our results indicate that astrovirus is more commonly associated with childhood gastroenteritis than has been previously appreciated and suggest that further studies to examine the epidemiology and disease burden of this virus are needed.

Serum gastrin levels following administration of omeprazole alone or in combination with pirenzepine

Serum gastrin levels in 44 peptic ulcer patients (26 gastric ulcer patients and 18 duodenal ulcer patients) were determined after they had been treated with omeprazole (OPZ) (20 mg/day) alone or in combination with pirenzepine (PZP) (100 mg/day). Serum gastrin levels were measured before, as well as 2, 4, and 6 weeks after administration, and the changes were compared. The levels were significantly elevated (twofold) at 2 weeks of treatment in both the OPZ and OPZ plus PZP groups. In patients taking OPZ alone, the levels rose up to 6 weeks, while in those taking OPZ plus PZP the levels decreased at 4 and 6 weeks. At 4 weeks, serum gastrin levels in the OPZ plus PZP group were lower (although not significantly) than those in patients taking OPZ alone. In gastric ulcer patients, serum gastrin levels in the OPZ group were significantly elevated, while in the OPZ plus PZP group, these levels were only slightly, but not significantly elevated. There was no significant difference between the two gastric ulcer groups at any time. In duodenal ulcer patients, serum gastrin levels increased significantly at 2 weeks of treatment in both groups. At 4 weeks and thereafter, the serum gastrin levels remained significantly high in patients taking OPZ alone, while they decreased at both 4 and 6 weeks in patients taking OPZ plus PZP. Thus, serum gastrin levels in duodenal ulcer patients were markedly decreased by the addition of PZP.(ABSTRACT TRUNCATED AT 250 WORDS)