Blood pressure at health screening as a predictor of coronary heart disease in Kyoto

AIM

Most epidemiologic studies that have evaluated coronary risk factors have measured either mortality or morbidity of coronary artery disease (CAD) as endpoints. However, earlier detection and elimination of coronary risk factors are crucial. We therefore performed Master's double (i.e. 1.5 min x 2 = 3 min) two-step exercise electrocardiograph (ECG) test in apparently healthy asymptomatic subjects (men, n = 2274; women, n = 959) to elucidate the risk factors for early-stage CAD or silent myocardial ischemia.

METHODS

We examined the possible association of blood pressure at health screening and other suspected risk factors with exercise ECG test performance. The ischemic ECG response was determined by (1) > or = 0.5 mm horizontal or sagging S-T segment depression, (2) > or = 2.0 mm J-shaped S-T segment depression, or (3) T inversion in post-exercise ECG.

RESULTS

We found that 4.7% of men and 10.6% of women exhibited ischemic responses. Among males, the ischemic responders to the exercise ECG test had higher systolic and diastolic blood pressure. In addition, the male ischemic responders were older, had a higher obesity index, higher serum cholesterol, triglyceride, low-density lipoprotein (LDL)-cholesterol, protein, glucose, and uric acid levels, and a lower serum potassium level than normal responders. In contrast, the female ischemic responders to the exercise ECG test had higher systolic pressure, and higher serum cholesterol, LDL-cholesterol, and protein levels than normal responders. Mean blood pressure was correlated positively with most of the other coronary risk factors, and mild hypertensives and hypertensives had abnormal lipid, glucose, and uric acid levels in both sexes. A comparison of risk factors by age group revealed that only younger and middle-aged ischemic responders had higher blood pressure, serum cholesterol, and glucose levels than normal responders of both sexes, and that in older subjects all the differences between normal and ischemic responders became insignificant.

CONCLUSIONS

Elevated blood pressure at health screening, together with abnormal lipid and glucose metabolism, might be risk factors predicting early-stage or silent CAD. The elimination of these risk factors in younger men and women seems to be important.

Sialolithiasis in children: report of four cases

Sialolithiasis in children is rare. Four cases of sialolithiasis in the submandibular gland occurring in children < or = 10 years old are reported. True and distal oblique occlusal radiographs were found to be useful for detection of the sialolith. A review of the literature on sialolithiasis in children is presented.

[A case of mucinous adenocarcinoma of the prostate]

We experienced a case of mucin producing prostate carcinoma, which occurred 46-year-old male patient. Serum tumor markers of prostate carcinoma were all in normal levels, and physical findings were similar to those of benign prostate hypertrophy. Histopathological study showed poorly differentiated mucinous adenocarcinoma occupying more than 30% of specimen. In literatures there seemed two types of mucin producing prostate carcinoma, the one is different from usual prostate carcinoma as our case and the other is a subtype of usual one, and so it was suggested that we must respect to this point on diagnosis and therapy of it.

Effects of gamma-linolenic and eicosapentaenoic acids on blood pressure in SHR

1. The present study was performed to determine whether chronic treatments with gamma linolenic acid (n-6, GLA) or eicosapentaenoic acid (n-3, EPA) would alter serum and red blood cell (RBC) unsaturated fatty acid composition, and to determine whether these treatments would affect blood pressure (BP), serum lipid metabolism and the development of atherosclerosis in spontaneously hypertensive rats (SHR). 2. To compare the effects on atherosclerosis, some SHR were denuded of aortic endothelium so that the development of atherosclerosis would be accelerated. Olive oil (control), GLA or EPA (low dose: 5 mg/day per rat, high dose: 50 mg/day per kg, respectively) was administered intraperitoneally for 6 weeks in SHR. 3. GLA treatments increased GLA and its metabolite, dihomo-GLA, levels in serum but not in RBC, while EPA treatments increased EPA level both in serum and in RBC. 4. The BP of control SHR was further elevated. EPA significantly reduced this elevation of systolic, mean and diastolic pressure within the first week and thereafter, whereas GLA did not affect BP elevation. Neither heart rate or bodyweight gain was affected by these treatments. 5. Serum total cholesterol (TC), triglyceride (TG), and glucose (G) levels and the development of atherosclerosis were unaffected by either GLA or EPA treatment. 6. In summary, chronic EPA but not GLA treatment slightly reduced BP elevation in SHR. Although chronic GLA or EPA treatment increased the respective serum level, these treatments unaltered serum TC, TG and G levels, and could not prevent the development of aortic atherosclerosis in SHR.

Role of nitric oxide in impaired coronary circulation and improvement by angiotensin II receptor antagonist in spontaneously hypertensive rats

1. To determine whether coronary flow regulation by nitric oxide (NO) is impaired in the hypertensive heart (HTH), coronary perfusion was measured in isolated rat hearts using NO synthesis inhibitor L-NG-monomethyl arginine (L-NMMA) in Wistar-Kyoto (WKY) rat and spontaneously hypertensive rat (SHR) with and without chronic Nomega-nitro-L-arginine-methylester (L-NAME) treatment. Moreover, the effect of angiotensin II receptor antagonist (AT1 receptor antagonist) (TCV-116) on the impaired coronary circulation in HTH was examined. 2. Coronary flow (CF) was decreased in HTH accompanied with cardiac hypertrophy. The decreased response of CF to L-NMMA infusion was diminished in HTH. It is suggested that NO production was reduced in coronary vasculature in HTH. 3. In chronic L-NAME treated SHR, blood pressure and cardiac hypertrophy were accelerated. Although coronary flow resistance (CFR) was increased, the increased response of CFR to L-NMMA infusion was not altered. 4. The AT1 antagonist improved total minimal coronary flow resistance (MCFR) restoring CFR response in SHR, although it did not recover CFR response in chronic L-NAME treated SHR. 5. Taken together the findings suggest that NO production was exhausted in the coronary artery even in the developing stage of hypertension and this exhaustion could contribute to the impairment of coronary circulation of HTH.

Hypothalamic and medullary GABAA and GABAB-ergic systems differently regulate sympathetic and cardiovascular systems

1. To determine whether hypothalamic and medullary GABA (gamma-aminobutyric acid)B stimulation would affect the sympathetic and cardiovascular activities, and to determine whether these effects would be altered in hypertension, baclofen (a GABAB agonist) was injected into a hypothalamic pressor area (ventromedial hypothalamus, VMH), a depressor area (anterior hypothalamus, AH), or a nucleus tractus solitarius (NTS) in normotensive and spontaneously hypertensive rats (SHR). 2. Intracerebroventricular (ICV) injections of a GABAA agonist (muscimol, 1 mu g) decreased blood pressure (BP) and heart rate (HR). ICV injections of baclofen (2 mu g) elicited biphasic depressor and pressor effects, and these effects were abolished by a pretreatment with saclofen (GABAB antagonist, 100 mu g, icv). 3. Muscimol (400 ng) and baclofen (800 ng) injected into VMH decreased sympathetic nerve activity (SNA), BP and HR to almost similar levels, while saclofen injected into VMH increased HR without affecting BP levels. 4. The same dose of baclofen injected into AH increased BP, but muscimol (AH) did not alter BP. 5. Both muscimol and baclofen injected into NTS increased BP, but its magnitude was larger in baclofen injections. 6. Depressor and sympatho-inhibitory effects of baclofen (VMH) in SHR were larger than those in normotensive Wistar-Kyoto (WKY) rats, while pressor responses elicited by baclofen (AH) did not differ between SHR and WKY. 7. In summary, GABA reduces SNA, BP and HR through both GABAA and GABAB receptors in VMH. In addition, the GABAB system acts on AH and NTS to further regulate the cardiovascular activities. In SHR, GABAB-ergic dysfunction in VMH but not in AH might contribute to the development of hypertension.

Role of baroreflex and central alpha2-adrenergic receptor systems in the diurnal variation of blood pressure and heart rate in normotensive and hypertensive rats

1. To elucidate whether baroreflex could contribute to manifest the diurnal blood pressure variations (DBPV) in normotension and hypertension, DBPV were recorded continuously via a femoral artery in awake normotensive (NT) rats and spontaneously hypertensive rats (SHR) with and without sinoaortic denervation (SAD). To determine the role of central alpha2-adrenergic receptor system in DBPV in hypertension, guanabentz (0.5-1.0 mu g/kg per min) was infused in SHR. 2. There were no differences in mean arterial pressure (MAP) variability (SD) of MAP of 24 h (MAP -- SD/MAP) and SD of 24 h heart rate (HR -- SD/HR) between SHR and NT. SAD did not elevate MAP and HR in both SHR and NT. 3. However, in SAD rats, MAP -- SD/MAP was significantly greater than those in sham-operated rats in both SHR and NT, while MAP -- SD/MAP and HR -- SD/HR did not show any difference between the two groups even after SAD. On the other hand, SAD did not augment HR -- SD/HR in either strain. 4. During guanabentz infusion, MAP was significantly lowered in sham-operated and SAD -- SHR. Moreover, MAP -- SD/MAP was significantly reduced in sham-operated, but it was not in SAD -- SHR. 5. These findings suggest that baroreflex could suppress tonically the diurnal change of blood pressure in NT and SHR. The regulation of diurnal blood pressure by baroreflex via a central alpha-adrenergic receptor system may be altered in SHR.

Moloney murine leukemia virus infection accelerates lymphomagenesis in E mu-bcl-2 transgenic mice

E mu-bcl-2 transgenic mice bearing the bcl-2 proto-oncogene linked to the immunoglobulin enhancer (E mu) sporadically develop B or T cell lymphomas after a long latent period. To identify genes that play important roles in development of lymphoid malignancies, proviral insertional mutagenesis with Moloney murine leukemia virus (MMuLV) was carried out in two lines of transgenic mice expressing the bcl-2 gene primarily in B or T cells. MMuLV infection of non-transgenic mice induced primarily mature T cell lymphomas. By contrast, infection of newborn E mu-blc-2 mice with the virus accelerated lymphomagenesis, and nearly all of the mice eventually succumbed to clonal pre-B, B, or mainly immature T cell lymphoma, indicating the active contribution of the bcl-2 gene in lymphomagenesis. Southern blot analysis of tumor DNA from MMuLV-infected transgenic mice revealed a proviral insertion at the c-myc gene in 26% (9/35) of tumors, at the pim-1 gene in 6% (2/35) and at the pim-2 (recently renamed tic-1) gene in 23% (8/35). Some tumors carried two activated oncogenes. No insertion was detected at the bmi-1 gene. These data suggest the usefulness of this transgenic system for analysis of lymphomagenesis involving the activated bcl-2 gene.

[Use of semirigid ureteroscopes for treatment of ureteral calculi]

BACKGROUND

The objective of this study is to evaluate the efficacy of ureteroscopic lithotripsy as the treatment of ureteral stones in the recent era by comparing the result using a semirigid ureteroscope with the result using a conventional ureteroscope.

METHODS

Between 1991 and 1994, 136 patients with ureteral calculi underwent transurethral ureteroscopic lithotripsy in our hospital. From July 1991 to March 1993, 14F rigid ureteroscope with the rod lens system was used for 82 patients (group 1), whereas from April 1993 to July 1994 either a 9.5F or 7F semirigid fiberoptic ureteroscope was used for 54 patients (group 2). Insertion of ureteroscopes was performed under continuous irrigation of saline without mechanical dilation of the ureteral orifice in both groups.

RESULTS

The rates of complete removal of stone at the first trial were 56.1% in group 1 and 72.2% in group 2 with the overall complete removal rate of 62.5%. The complete removal rates of stones in the upper, middle and lower ureters were 18.2%, 54.8% and 72.4% in group 1 and 14.3%, 72.7% and 88.0% in group 2, respectively. The major reasons for unsuccessful treatments was upward migration of stones during the procedure. As intraoperative complications, ureteral disruption occurred in 1 case in group 1, and ureteral perforation in 5 patients in group 1 (6.1%) and 2 in group 2 (3.8%). Acute bacterial infection with prolonged fever was observed in 3 patients in group 1 and in none in group 2.

CONCLUSION

From these results, the new semirigid ureteroscope with fiberoptic imaging bundles made the transurethral lithotripsy a safer and more efficient procedure for the treatment of ureteral calculi especially those in the lower ureters.

[A case of abdominal desmoid causing urinary tract obstruction]

A 62-year-old male patient presented with a complaint of the lower abdominal distention. Ultrasonography demonstrated bilateral hydronephroses and a huge heterogeneous mass in the pelvic cavity. Excretory urogram showed left-non visualized kidney and right-hydronephrosis. CT showed a heterogenous mass, situating 25 cm in diameter, adjacent to the left side of the bladder. Tumor resection was carried out on May 17th of 1994. Histopathological diagnosis of the surgical specimen was abdominal desmoid with HE stain.

DNA ploidy pattern and cell cycle stage of tumor cells in soft-tissue sarcomas: clinical implications

Staining and counting of argyrophilic nucleolar organizer region (AgNOR), segments of DNA with ribosomal genes, is useful for estimation of the proliferative activity in soft tissue sarcoma (STS). The precise role of AgNOR in STS, however, is still uncertain. In the present study, ploidy pattern and stage of cell cycle were analyzed in 151 cases of STS in the extremities and trunk, and their correlation with AgNOR and utility as independent prognostic factors were estimated. For this, microspectrophotometric and flow-cytometric analyses were done on paraffin-embedded material from 84 and 111 cases, respectively. Fifty-five percent cases showed an aneuploid pattern with a less favorable prognosis. The range of the DNA index and percentage of cells in S + G2M phase were 0.89-2.04 (mean +/- SD, 1.23 +/- 0.32) and 5.4-83.7% (mean +/- SD, 32.95 +/- 17.92), respectively. Tumors having less than 40% cells in the S + G2M phase showed a favorable prognosis compared to those over 40%. Both the ploidy pattern and stage of the cell cycle showed a good correlation with the AgNOR count: a high frequency of cases having aneuploidy and S + G2M phase in the AgNOR high count group. These findings provide a theoretical base for explaining the utility of AgNOR for the estimation of proliferative activity. In multivariate analysis, only AgNOR counts were a prognostic factor among histologic factors reflecting proliferative activity of tumors. The DNA ploidy pattern and the stage of the cell cycle was proved not to be an independent factor for prognosis.

Young borderline hypertensives are hyperreactive to mental arithmetic stress: spectral analysis of R-R intervals

To investigate whether sympathetic tone and its reactivity to stress are increased in borderline hypertension, we compared pressor and autonomic nervous responses to mental arithmetic stress in male borderline hypertensives (BH) and normotensive volunteers (NT). Three age groups, 30, 40 and 50-year-old groups, which included 30 to 39, 40 to 49 and 50 to 59-year-old subjects, were studied. Fractional LF (%LF), fractional HF (%HF) and L/H, obtained from the power spectrum of R-R intervals, were used as indices of autonomic nervous function. Baseline autonomic nervous indices did not differ between NT and BH of any age group. Blood pressure rose higher during mental arithmetic stress in 50 than in 30-year-old NT but not in comparable age groups of BH. Pressor responses were augmented in BH compared to NT only in the 30-year-old group. However, the differences were not significant when pressor responses were expressed as percent increases in blood pressure. Both %L and L/H increased during arithmetic stress. The increase in %L did not differ between NT and BH but that in L/H (% delta L/H) was larger in 50 than in 30-year-old NT. % delta L/H was larger in BH than in NT only in the 30-year-old group. These findings suggest that both pressor and autonomic nervous responses to metal arithmetic stress were altered by aging and augmented in BH compared to NT in the 30-year-old group.

[Experience in seven cases of laparoscopic adrenalectomy]

We have experienced 7 cases of laparoscopic adrenalectomy for adrenal tumors during the past two years since our department opened in July, 1992. In four cases, the tumors were clinically diagnosed preoperatively as primary aldosteronism and in the other three cases as endocrine-inactive tumors. Four tumors were found on the left adrenal and three on the right. Five tumors were successfully resected with laparoscopic surgery, but in the other two cases it was immediately followed by open surgery because of an uncontrollable hemorrhage. Laparoscopically unresected tumors existed, one on the right and the other on the left adrenal. The average operation time for laparoscopic adrenalectomy was twice as much as that of open adrenalectomy previously performed. However, the operation time has been recently shortened to be less than 200 minutes. Hemorrhage during the operation was rather less in laparoscopic surgeries if they were successfully done. Postoperative recovery was found to be much faster and the hospital stay was shortened by more than 10 days in patients operated with a laparoscope. These findings indicate that laparoscopic adrenalectomy is a minimally invasive operation that can increase the QOL's of the patient. Although we consider that this operation may propagate as a method for adrenalectomy in future, it must be performed with a careful backup system in the case of an emergency.

Accumulation of gamma/delta T cells in human dysgerminoma and seminoma: roles in autologous tumor killing and granuloma formation

The precise biological function of a subset of T cells bearing gamma/delta T cell receptor (TCR) remains poorly understood. The present study demonstrated the presence of gamma/delta T cells in tumor-infiltrating lymphocytes (TIL) and peripheral blood lymphocytes (PBL) of human patients with dysgerminoma and seminoma when determined by flow cytometry and in situ immunohistochemical staining. TIL contained a high percentage of gamma/delta T cells, ranging from 17.3 to 35.1%. gamma/delta T cells often accumulated within the granulomatous inflammation of tumor tissues. The majority of gamma/delta T cells were V gamma 9/V delta 2+ cells. Freshly isolated PBL, TIL and purified gamma/delta T cells showed autologous tumor killing (ATK) activity, which could be inhibited by monoclonal antibodies (mAb) against V delta 2. Furthermore, two gamma/delta T cell clones established from TIL showed cytotoxicity against autologous and allogeneic dysgerminoma, while they had low or no lytic effects on other cell types including carcinomas of ovary and tumor cell lines such as K562, Daudi and Molt-4. Lysis of autologous tumor cells by the clone was inhibited completely by anti-V delta 2 mAb and partially by mAb against CD3, LFA-1 alpha and ICAM-1 molecules, while it was resistant to anti-CD8, anti-HLA-ABC and anti-HLA-DR mAb. Supernatants produced by gamma/delta T cell clones induced adhesion, aggregation and increased DNA synthesis of monocytes and some characteristics of activated macrophages or epithelioid cells. Tumor necrosis factor (TNF)-alpha, granulocyte-macrophage colony stimulating factor (GM-CSF) and interferon (IFN)-gamma were detected in the supernatants of gamma/delta T cell clone. These results suggest that gamma/delta T cells accumulating in dysgerminoma and seminoma exhibit ATK activity through V gamma 9/delta 2 TCR and these gamma/delta T cells also play a role in the formation of granulomatous inflammation, which is associated with human dysgerminoma and seminoma.

Activation of natural killer cells by the mAb YTA-1 that recognizes leukocyte function-associated antigen-1

The mAb YTA-1, which brightly stains CD3-CD16+ large granular lymphocytes (LGL)/natural killer (NK) cells and CD8+ T cells by immunofluorescence, is specific for leukocyte function-associated antigen (LFA)-1. Some mAbs recognizing the LFA-1 alpha chain (CD11a) or LFA-1 beta chain (CD18) inhibited the binding of YTA-1 to peripheral blood mononuclear cells. YTA-1 mAb could be chemically cross-linked to 170 and 96 kDa molecules, whose molecular weights correspond to those of LFA-1 alpha and beta respectively. YTA-1 bound to COS-7 cells co-transfected with CD11a and CD18 cDNAs, but not to untransfected cells. Reactivities of YTA-1 to K562 cells transfected with LFA-1 alpha and beta (CD11a/CD18) cDNAs and to CHO cells transfected with Mac-1 (CD11b/CD18) or p150, 95 (CD11c/CD18) cDNAs strongly suggest that YTA-1 recognizes either LFA-1 alpha or an epitope formed by a combination of LFA-1 alpha and beta. Treatment of fresh CD3-CD16+ LGL with YTA-1 augmented cytolytic activity and induced proliferation. F(ab')2 fragments of YTA-1 augmented NK cytotoxicity, indicating that the NK activating signal was transmitted through LFA-1 without involvement of Fc gamma receptor III. In contrast, the other mAbs against LFA-1 could not activate NK cells. These results collectively indicate that YTA-1 recognizes a unique epitope of LFA-1, which is involved in activation of fresh NK cells.

Monohexosylceramides of larval and adult forms of the tapeworm, Spirometra erinacei

The occurrence of glycosphingolipids with unique carbohydrate structures in different species of cestode, Platyhelminth, which had been shown previously, prompted us to study the molecular species of the monohexosylceramides (cerebrosides) in the pseudophyllidean cestode, Spirometra erinacei. The purpose of the study was to obtain a basis for future investigations of the physiological role of glycolipids in parasitism. Cerebrosides were isolated from S. erinacei at two growth stages, i.e., from the larval form (plerocercoid) and from the adult tapeworms (intestinal form). The cerebrosides were separated into four subfractions by silica gel column chromatography, and their constituents were analyzed by gas-liquid chromatography, gas chromatography/mass spectrometry, and high-performance liquid chromatography/mass spectrometry. The hexoses of the cerebrosides consisted primarily of galactose in both growth stages, while only a small amount of glucose was detected. The ceramides were composed of sphinganine (d18:0) and phytosphingosine (t18:0) as sphingoid bases, and of nonhydroxy fatty acids ranging from C16 to C30 and hydroxy stearic acid (18h:0). The cerebrosides of adult tapeworms contained more 18h:0 than those of plerocercoids. The combination of hexoses and ceramides in the cerebroside molecules was slightly different in the two growth stages: the glucocerebrosides of plerocercoids contained only d18:0-nonhydroxy fatty acids in their ceramide moieties, whereas those of adult tapeworms contained varying ceramide moieties. Our data indicate that the molecular species of glycolipids present were essentially homeostatic throughout growth in spite of the entirely different environmental conditions, although there were slight differences in the hexose distribution in the two growth stages.

Suppression of pulmonary metastasis by angiogenesis inhibitor TNP-470 in murine osteosarcoma

We treated a murine osteosarcoma cell line, LM8, which preferentially metastasizes to the lungs, with a new angiogenesis inhibitor, TNP-470, to evaluate the efficacy of this compound in the suppression of pulmonary metastasis of osteosarcoma. In an in vivo experiment, tumor cells were inoculated i.v. into C3H mice, and TNP-470 or vehicle alone (control group) was administered s.c. every day for 3 weeks. In the TNP-470-treated groups, both the number of pulmonary metastatic nodules and the lung wet weight were significantly reduced in a dose-dependent manner. Similarly, vascular density in the metastatic tumors estimated by immunohistochemical staining with anti-von-Willebrand factor antibody as an endothelial marker were significantly reduced. No severe side-effects were found. In an in vitro experiment, viable tumor cells were counted after 3 days' treatment with TNP-470. The 50% inhibitory concentration was 0.6 ng/ml for LM8, which was more sensitive than other tumor cells previously reported. Our results show that TNP-470 suppresses the pulmonary metastasis of LM8 and suggest that both its anti-angiogenic activity and cytostatic activity towards LM8 are responsible for the antitumor effect.

Angiosarcoma in Japan. A review of 99 cases

BACKGROUND

Angiosarcoma is rare, and information about its clinical features are limited. Therefore, a large scale study of angiosarcoma was performed in Japan.

METHODS

Through a nationwide Japanese study, 99 cases of angiosarcoma were collected and their clinicopathologic findings were summarized relative to predisposing risk factors.

RESULTS

The patient age at diagnosis was 3-92 years, (mean, 62 years), with a two to one male to female ratio. The head and face were the most common primary site (29 cases); other sites were liver (17); trunk (13): pleural cavity (6), chest wall (2), abdominal wall (2), buttock (2), inguinal region (1); heart (12); and extremities (7). The proven predisposing risk factors included chronic pyothorax for angiosarcoma in the pleural cavity (six), thorotrast in the liver (five), radiotherapy to the abdominal wall and buttock (four), and chronic limb edema of the forearm (one). Irrespective of primary sites, the majority of cases had metastases to lung in 72 cases, bone in 42, liver in 36, regional lymph nodes in 30, and adrenal gland in 24. The 2-year survival rate was 17%.

CONCLUSIONS

This study describes a different etiology in the development of angiosarcoma in patients from Japan compared with that of patients from Western countries, though the frequency of angiosarcoma among all soft-tissue sarcomas was similar in both areas. In Japan, chronic pyothorax, radiotherapy, and thorotrast proved to be distinctive causative factors of angiosarcoma.

Stimulation of NK-like YT cells via leukocyte function-associated antigen (LFA)-1. Possible involvement of LFA-1-associated tyrosine kinase in signal transduction after recognition of NK target cells

The YTA-1 anti-LFA-1 alpha mAb activates protein tyrosine kinase (PTK), augments NK cytotoxicity, and induces proliferation of fresh CD3- large granular lymphocytes. We demonstrate here that LFA-1 is physically associated in the YT human NK-like cell line cells with a PTK(s) that is distinct from Src family PTKs such as Lck, Fyn, or Lyn. In vitro kinase assays revealed similar association of protein kinase activity with LFA-1 in normal CD3- large granular lymphocytes. Tyrosine phosphorylation of the proteins associated with LFA-1 drastically increased in YT cells after stimulation with NK-sensitive K562 cells but not with NK-resistant P815 cells. Furthermore, pretreatment of YT cells with TS1/22 anti-LFA-1 alpha and TS1/18 anti-LFA-1 beta mAbs abrogated not only the cytotoxicity against K562 cells but also an increase in tyrosine phosphorylation of LFA-1-associated molecules induced by K562 stimulation. These results provide biochemical evidence that the PTK(s) associated with LFA-1 is involved in the signal transduction that follows the recognition of NK target cells.

Stimulation of NK-like YT cells via leukocyte function-associated antigen (LFA)-1. Possible involvement of LFA-1-associated tyrosine kinase in signal transduction after recognition of NK target cells

The YTA-1 anti-LFA-1 alpha mAb activates protein tyrosine kinase (PTK), augments NK cytotoxicity, and induces proliferation of fresh CD3- large granular lymphocytes. We demonstrate here that LFA-1 is physically associated in the YT human NK-like cell line cells with a PTK(s) that is distinct from Src family PTKs such as Lck, Fyn, or Lyn. In vitro kinase assays revealed similar association of protein kinase activity with LFA-1 in normal CD3- large granular lymphocytes. Tyrosine phosphorylation of the proteins associated with LFA-1 drastically increased in YT cells after stimulation with NK-sensitive K562 cells but not with NK-resistant P815 cells. Furthermore, pretreatment of YT cells with TS1/22 anti-LFA-1 alpha and TS1/18 anti-LFA-1 beta mAbs abrogated not only the cytotoxicity against K562 cells but also an increase in tyrosine phosphorylation of LFA-1-associated molecules induced by K562 stimulation. These results provide biochemical evidence that the PTK(s) associated with LFA-1 is involved in the signal transduction that follows the recognition of NK target cells.

Inhibition of proliferation and induction of apoptosis by abrogation of heat-shock protein (HSP) 70 expression in tumor cells

Tumor cells often express elevated levels of heat-shock protein (HSP) 70. The present study was designed to investigate the role of HSP70 in the proliferation and survival of tumor cells in the human system. When Molt-4 and other tumor cells were treated in vitro with HSP70 antisense oligomer, they displayed propidium-iodide-stained condensed nuclei (intact or fragmented). A ladder-like pattern of DNA fragments was observed with HSP70 antisense-oligomer-treated tumor cells in agrose gel electrophoresis, which was consistent with internucleosomal DNA fragmentation. Flow cytometry analysis revealed the hypodiploid DNA peak of propidium-iodide-stained nuclei in the antisense-oligomer-treated cells. The apoptosis induced by HSP antisense oligomer was dose- and time-dependent. The antisense oligomer induced apoptosis mainly in tumor cells at G1 and S phase, resulting in an inhibition of cell proliferation. HSP70 antisense oligomer caused DNA-sequence-specific inhibition of HSP70 expression, which preceded apparent apoptosis. These results indicate that HSP70 antisense treatment inhibits the expression of HSP70, which in turn inhibits cell proliferation and induces apoptosis in tumor cells and suggest that HSP70 is required for tumor cells to proliferate and survive under normal condition.

Keloid formation after surgery for release of polysyndactyly of the feet in a child

Keloid formation on the hands and the feet is very rare but should always be anticipated as a possible complication after surgery. Failure to recognise the potential for keloid may result in a severe deformity that is functionally and cosmetically undesirable. We report severe keloid formation after simple release of polysyndactyly of the feet of a 2-year-old child.

Transvaginal ultrasonographic morphology in polycystic ovarian syndrome

To assess the morphological findings based on transvaginal ultrasound, the ovarian volume and the number and size of small follicles were studied in 47 patients with polycystic ovarian syndrome (PCOS) diagnosed clinically. Thirty normal volunteers served as controls. The mean ovarian volume (10.3 ml) and number of follicles (10.6) in patients with PCOS were significantly higher than those of controls. An ovarian volume > 6.2 ml and follicles > 10 with a diameter of 2-8 mm were the most prominent features in the ovaries of patients with PCOS and 94% of 47 patients with PCOS had at least one of these ultrasonic findings. However, marked asymmetry of the two ovaries was seen in about 50% of patients with PCOS and a considerable overlap existed between controls and patients with PCOS in the ovarian volume and in the number of follicles. Three (6%) patients with normal ovarian volume and normal number of follicles were observed. Therefore, it is difficult to clearly distinguish a patient with PCOS from a normal woman only by transvaginal ultrasonic criteria using the ovarian volume and/or the number of follicles, although these criteria could be clinically useful for the screening of PCOS.

Angiosarcoma developing from chronic pyothorax

In our previous study, we suggested that long-standing pleural inflammation might be an etiological factor for development of pleural soft-tissue sarcomas, especially malignant fibrous histiocytoma and angiosarcoma (AS). To study the etiological importance of chronic pyothorax for development of pleural AS, a nationwide study of AS in Japan was carried out. Histological and clinical findings in 99 collected cases with AS were reviewed. Six (6%) of the 99 cases were chronic pyothorax-associated AS. Another three cases of pyothorax-associated AS previously reported by us were also included. They were eight males and one female from 45 to 74 yr of age (median 65 yr). All patients had a 15- to 40- (mean 30) yr history of chronic tuberculous pyothorax. Histologically, the tumors contained irregular, occasionally dilated vascular channels, which were invested by tumor cells with an epithelioid appearance. From the statistical data reported previously, annual incidence of AS is probably 0.01 to 0.02 per 100,000 population. Meanwhile, there was an incidence rate of pyothorax-associated AS among chronic pyothorax patients of 0.036 per 100 patients. Thus, the frequency rate of pyothorax-associated AS is supposedly over 3600-fold higher than that in normal population. The present study shows that chronic tuberculous pyothorax is one of the causes of AS development.

Relationship between ultrasonography and histopathological changes in polycystic ovarian syndrome

We investigated retrospectively the relationship between the ultrasonographic appearance of the ovaries and histopathological findings in patients with polycystic ovarian syndrome (PCOS) and compared these histopathological findings with endocrine concentrations. A total of 20 patients with PCOS were studied. Each patient had a history of infertility, menstrual disturbance and > 10 small cysts in each ovary that were detected by transvaginal ultrasound. Ovarian ultrasound appearance was classified as a general cystic pattern (GCP) or peripheral cystic pattern (PCP). Histological examination of specimens from patients undergoing ovarian wedge resection by laparotomy were compared with ultrasonographic images. In 15 of the 16 ovaries with GCP, the histopathological findings were consistent with the ultrasonographic images. In all 24 ovaries with PCP, the histopathological and ultrasonographic images were consistent. The mean ovarian capsular thickness was significantly higher in the GCP than the PCP. Androstenedione was significantly higher in the GCP than the PCP, whereas the ratio of luteinizing hormone to follicle-stimulating hormone was significantly higher in the PCP than the GCP. Therefore, our results suggested that GCP and PCP correspond to histopathological differences. Histological GCP and PCP appear to differ endocrinologically.

Bioabsorbable osteosynthetic implants of ultra high strength poly-L-lactide. A clinical study

We have developed reasonably strong but bioabsorbable osteosynthetic screws, pins and nails made of ultra high strength poly-L-lactide (PLLA) and evaluated their use in 143 patients. The PLLA implants have the highest strength among those reported to date. They lose about 10% of their initial strength within 8 weeks, about 40% within 4 weeks and nearly 100% within 20 weeks in vivo. The patients were aged from 9 to 78 years, and the follow up was from 2 to 6 years. The implants were used for fixation of bone grafts in 84 patients, peri- and intra-articular fractures in 49, after osteotomy in 8, and in 2 others. Bony union was not achieved in only one case. In the early stages of the study, breakage of screws occurred in 12 cases (8%), mostly because of an inappropriate size of tap; these problems have not occurred after improvement of the tapping system. There were no cases with abnormal blood tests, infection or foreign body reaction.

The hypoosmotic swelling test

In the present study, the effect of the concentration of the hypoosmotic solution, incubation time and duration from sperm collection to incubation on the hypoosmotic swelling (HOS) test were evaluated. Sperm were obtained from 20 fertile donors. The most stable sperm tail swelling was obtained at 150 mOsm. Incubation for 30 minutes was sufficient for the evaluation of overall swelling but not for the evaluation of b- and g-type sperm swelling. This suggests that incubation for one hour is necessary to obtain stable results. Incubation for more than one hour did not affect the percentage or type of sperm swelling. The time from sperm collection to incubation did not affect the HOS test. The HOS test is practical and not affected by the duration of incubation or time from sperm collection to incubation.

[Studies on the inhibitory action of leminoprazole against rabbit gastric H+,K(+)-ATPase]

Inhibitory action of leminoprazole ((+/-)-2-[[2-(isobutylmethylamino)benzyl]sulfinyl]-1H-benzimidazol e, NC-1300-O-3, LEM) against the H+,K(+)-ATPase activity in rabbit gastric vesicles was investigated. LEM inhibited the H+,K(+)-ATPase activity in leaky vesicles in a concentration- and time-dependent manner. When preincubated with gastric vesicles (20 micrograms protein/ml) for 30 min at 37 degrees C in medium (pH 6.1 or 7.4), the IC50 values were 5.3 microM and 19 microM, respectively. The inhibitory action of LEM was not competitive with respect to K+ and was not reversed by dilution, suggesting that the inhibitory action is irreversible. Inhibition of the enzyme activity by LEM was not found when beta-mercaptoethanol (0.1 mM) was premixed with enzyme before addition of LEM, and it was partially recovered by addition of beta-mercaptoethanol or dithiothreitol (50 mM) after LEM treatment. These results suggest that LEM reacts with essential SH groups of H+,K(+)-ATPase and inactivates the enzyme by forming a covalent disulfide bond. The inhibitory activity of LEM was more potent at pH 6.1 than at pH 7.4, and the rate of the reaction of LEM with GSH was enhanced by lowering the pH of the medium. The inhibition of proton transport by LEM (30 microM) was found after the intact vesicles were fully acidified. LEM also strongly inhibited the valinomycin-stimulated H+,K(+)-ATPase activity. Therefore, it is considered that LEM inhibits H+,K(+)-ATPase activity by an unknown activated reaction under the acidic condition. Alternatively, the possibility was also suggested that an acidic condition is not always necessary for the inhibition of H+,K(+)-ATPase activity by LEM, since LEM, at higher concentration, inhibited the initial rate of acidification and inhibited nigericin-stimulated H+,K(+)-ATPase activity in intact vesicles.

Induction of apoptosis by quercetin: involvement of heat shock protein

Quercetin, a widely distributed bioflavonoid, inhibits the growth of tumor cells. The present study was designed to investigate the possible involvement of apoptosis and heat shock protein in the antitumor activity of quercetin. Treatment with quercetin of K562, Molt-4, Raji, and MCAS tumor cell lines resulted in morphological changes, including propidium iodide-stained condensed nuclei (intact or fragmented), condensation of nuclear chromatin, and nuclear fragmentation. Agarose gel electrophoresis of quercetin-treated tumor cells demonstrated a typical ladder-like pattern of DNA fragments. In addition, the hypodiploid DNA peak of propidium iodide-stained nuclei was revealed by flow cytometry. Quercetin induced apoptosis in cells at G1 and S in a dose- and time-dependent manner. The apoptosis-inducing activity of quercetin was enhanced by cycloheximide and actinomycin D. A nuclease inhibitor, aurintricarboxylic acid, inhibited quercetin-induced apoptosis, whereas deprivation of intracellular calcium by EGTA had no effect. 12-O-Tetradecanoylphorbol-13-acetate and H-7 did not affect the induction of apoptosis by quercetin. The synthesis of HSP70 was inhibited by quercetin when determined by immunocytochemistry, Western blot analysis, and Northern blot analysis. Quercetin-treated tumor cells were not induced to show aggregation of HSP70 in the nuclei and nucleolus in response to heat shock, resulting in apoptosis. By contrast, when tumor cells were first exposed to heat shock, no apoptosis was induced by quercetin. In addition, pretreatment of tumor cells with HSP70 antisense oligomer that specifically inhibited the synthesis of HSP70 enhanced the subsequent induction of apoptosis by quercetin. These results suggest that quercetin displays antitumor activity by triggering apoptosis and that HSP70 may affect quercetin-induced apoptosis.

Treatment of virus-induced myocardial injury with a novel immunomodulating agent, vesnarinone. Suppression of natural killer cell activity and tumor necrosis factor-alpha production

Controversy still exists concerning the therapy for viral myocarditis which manifests a wide variety of clinical symptoms. Vesnarinone, a quinolinone derivative that was developed as a positive inotropic agent with complex actions, including phosphodiesterase inhibition and cation channel modification, has recently been confirmed to improve the prognosis of patients with chronic heart failure. However, the precise mechanism of this beneficial effect is not yet clearly understood. In this study, using a murine model of acute viral myocarditis resulting from encephalomyocarditis virus infection, survival and myocardial damage were markedly improved by treatment with vesnarinone. In contrast, survival was not improved by treatment with amrinone, a phosphodiesterase inhibitor. Although vesnarinone did not inhibit viral replication or protect myocytes from viral direct cell injury, it did inhibit the increase in natural killer cell activity after viral infection. On the other hand, amrinone failed to inhibit natural killer cell activity. Both vesnarinone and amrinone suppressed the production of tumor necrosis factor-alpha. Therefore, we postulate that vesnarinone exerted its beneficial effects through an inhibition of natural killer cell activity, and that it serves as an immunomodulator providing new therapeutic possibilities for the treatment of viral myocarditis and/or immunological disorders.

Molecular basis for subtypic differences of the "a" subunit of coagulation factor XIII with description of the genesis of the subtypes

The "a" subunit of human coagulation factor XIII (F13A) exhibits genetic polymorphism defined by four common alleles, F13A*1A, *1B, *2A, and *2B. We have previously suggested on the basis of the isoelectric focusing patterns of the four allele products that point mutations at two separate sites and one intragenic crossing over might be involved in the genes of F13A polymorphism. Here, we report nucleotide substitutions associated with F13A polymorphism. A C/T transition of the second nucleotide of codon 564 in exon 12 is responsible for the difference between F13A*1A and *1B and that between F13A*2A and *2B, and a set of two base changes in codons 650 and 651 in exon 14 leads to the differences between F13A*1A and *2A and those between F13A*1B and *2B. The four combinations of the point mutations at the two exons thus correspond to the four alleles, two of which were generated by the point mutations from ancestral monomorphic gene. The results suggest strongly that intragenic crossing over must be involved in the genesis of the fourth allele. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods discriminating these base changes in exons 12 and 14 are also presented.

[Effect of a new antiulcer drug, leminoprazole, on the gastric mucosal H+,K(+)-ATPase activity in rats]

The inhibitory action of leminoprazole on the activity of rat gastric mucosal H+,K(+)-ATPase was investigated in vitro and ex vivo. Leminoprazole and omeprazole concentration-dependently inhibited the H+,K(+)-ATPase activity, and their IC50 values were 31 microM and 24 microM, respectively, at pH7.4. Leminoprazole dose-dependently inhibited the H+,K(+)-ATPase activity at 3 and 6 hr after the administration at 10-100 mg/kg, p.o. Leminoprazole (60 mg/kg, p.o.) inhibited the H+,K(+)-ATPase activity persistently, and the duration of its inhibitory action was much longer than that of omeprazole (30 mg/kg, p.o.). In pylorus-ligated rats, good correlations between the respective inhibitory rates against gastric acid output and H+,K(+)-ATPase activity was found after the administration of leminoprazole. These results suggest that leminoprazole inhibits the gastric acid secretion by its ability to inhibit the H+,K(+)-ATPase activity in rats; its inhibitory activity was comparable to that of omeprazole. In addition, leminoprazole (100 mg/kg) inhibited the H+,K(+)-ATPase activity even when administered intragastrically after pylorus-ligation, suggesting that this drug can inhibit H+,K(+)-ATPase activity directly from the gastric lumen. Moreover, leminoprazole (100 mg/kg, p.o.) when administered repeatedly for 2 or 4 weeks inhibited the H+,K(+)-ATPase activity to the same degree as the single administration.

Effects of NC-1300-O-3 on gastric mucus secretion and prostaglandin release in rats

We investigated the effect of NC-1300-O-3 on gastric mucus secretion and prostaglandin release into the gastric lumen in rats. NC-1300-O-3 following single or repeated administration for up to 4 weeks significantly increased the hexose content in the gastric lumen at 10 to 100 mg/kg, p.o. Omeprazole and cimetidine at doses that strongly inhibited gastric acid secretion had no effect on the hexose content following single or repeated administration for 8 days. When administered repeatedly for 8 days, NC-1300-O-3, omeprazole and cimetidine significantly decreased the hexosamine content in gastric surface mucosa, but significantly increased gastric mucus secretion was observed at the same time only with NC-1300-O-3, indicating that this agent has a profile of action on gastric mucus metabolism different from those of omeprazole and cimetidine. NC-1300-O-3 at 10 and 30 mg/kg, p.o. and omeprazole at 30 mg/kg, p.o. increased the release of prostaglandins into the gastric lumen, and this was markedly inhibited by pretreatment with indomethacin, suggesting that these agents may enhance prostaglandin biosynthesis in the gastric mucosa. From these results, it seems that the enhancement of NC-1300-O-3 on gastric mucus secretion and prostaglandin biosynthesis in the gastric mucosa contribute to the antiulcer effect of NC-1300-O-3.

Limitations of panoramic radiography in the detection of bone defects in the posterior wall of the maxillary sinus: an experimental study

Some lesions in the maxillary sinus may be adequately detected by panoramic radiography. The present study was designed to evaluate the ability of panoramic radiography in detecting experimental bony defects in the posterior wall of the maxillary sinus by comparison with Waters' projection and CT. Bony defects in the mediosuperior and medioinferior regions of the posterior wall were readily detected by panoramic radiography, but those in the laterosuperior or centre were not. It is concluded that there are limitations to the detection of bony defects in the posterior wall of the maxillary sinus by panoramic radiography alone. It is recommended that this technique should not be used for the detection of small osteolytic lesions in the maxillary sinus.

A staging system for soft-tissue sarcoma and its evaluation in relation to treatment

In order to define the significant factors for a staging system of soft-tissue sarcomas (STS), histologic and clinical findings in 190 adult patients with localized STS in the extremities and trunk were reviewed. The male-to-female ratio was 1.21. The histologic grading of tumors was defined according to the criteria recently proposed by us: tumors were low-grade in 65 cases, intermediate-grade in 57 cases and high-grade in 68 cases. The initial surgical procedure was as follows: intracapsular excision in 9 cases, marginal excision in 104 and wide local excision in 77, including 15 amputations. The mode of treatment was surgery alone (101 patients), surgery and chemotherapy (58), surgery and radiotherapy (22) and surgery and combined chemo- and radiotherapy (9). Univariate analysis revealed histologic grade, sex, tumor size and tumor depth to be significant prognostic factors. Multivariate analysis revealed histologic grade to be the only independent factor for prognosis. Significant clinical factors in each histologic grade were then evaluated. In the low-grade group, local recurrence significantly affected prognosis. Most of the patients with local recurrence had had marginal resection as the initial surgical procedure. No clinical factors affecting prognosis in the intermediate-grade group could be determined. In the high-grade group, patients with wide local excision and adjuvant chemotherapy had a better prognosis than those with marginal excision with or without adjuvant chemotherapy and wide local excision without chemotherapy (p = 0.09). In conclusion, histologic grade was the only significant factor for the staging of STS. On the basis of our staging system, different modalities of treatment for each grade of STS might be indicated; adequate surgery is essential for the prevention of local recurrence, which resulted in reduced mortality in patients with low-grade STS. For high-grade STS, the prevention of distant metastasis by combined extensive surgery and adjuvant chemotherapy may make long-term survival possible.

Transvaginal ultrasonic assessment of the response to clomiphene citrate in polycystic ovarian syndrome

OBJECTIVE

To study the relationship between some ovarian morphological findings based on transvaginal ultrasound (US) and the clomiphene citrate (CC) responsiveness in patients with polycystic ovarian syndrome (PCOS).

DESIGN

A comparative study of ovarian US features between the CC responders and the CC nonresponders.

SETTING

Infertility and Endocrine Clinic, Department of Obstetrics Gynecology, Shimane Medical University Hospital, Izumo, Japan.

PATIENTS

Forty-seven infertile patients with PCOS and 30 healthy volunteers.

INTERVENTIONS

A dose of 50 to 200 mg/d CC was given for ovulation induction in patients with PCOS.

MAIN OUTCOME MEASURES

Ovarian volume and number of follicles; serum LH, FSH, T, delta 4 androstenedione, and DHEAS.

RESULTS

The mean ovarian volume (11.9 mL) and the number of small follicles (13.0) were significantly larger in the CC nonresponders compared with those of the CC responders (7.9 mL and 7.0, respectively). Only 47% of the CC responders and 79% of the CC nonresponders had bilaterally enlarged ovaries (> 6.2 mL). Considerable overlap existed between the different groups. However, 96% of the CC nonresponders had a significantly increased number of follicles (> or = 10 follicles) in each ovary compared with that (16%) of the CC responders. Furthermore, with the combination of these parameters, none of the CC nonresponders had bilaterally normal ovaries, and 96% of patients with PCOS with bilaterally abnormal ovaries were CC nonresponsive.

CONCLUSIONS

Small multiple follicles (> or = 10) and enlarged ovarian volume (> 6.2 mL) were the most prominent transvaginal US features of ovaries in patients with PCOS with CC nonresponsiveness. These US features could be clinically useful for distinguishing clearly a CC nonresponder from a CC responder.

Clinical significance of autologous tumor killing (ATK) activity and its induction therapy in human cancer

The activity of blood lymphocytes to kill autologous freshly isolated tumor cells tested at the time of surgery predicts a favorable clinical course in patients who have primary localized solid tumor and receive curative operation. The strong correlation of autologous tumor killing (ATK) activity with disease-free interval and total survival indicates that ATK activity is a meaningful prognostic indicator and provides evidence for immunological control of tumor growth and metastasis. Although there is no direct evidence that ATK lymphocytes play a critical role in regression of tumor and prevention of tumor regrowth, the lack of ATK activity in patients who relapsed and died may not result from other factors related to their poor performance status, immune functions and tumor characteristics. Clinical trials with ATK induction therapy resulted in an improvement of the clinical outcome in patients who naturally have no such potential. The data indicate that the presence of both natural and induced ATK activity is strongly associated with long-term survival. In addition, adoptive transfer of BRM-induced ATK effector cells resulted in prolongation of survival time even in patients with documented metastatic tumors. Thus, considerable emphasis should be placed on a strategy that induces ATK activity in vivo. Such an approach may provide a new focus for cancer immunotherapy.

Cytoprotective effect of NC-1300-O-3 against gastric lesions induced by necrotizing agents in rats

The cytoprotective effect of NC-1300-O-3 and its mechanism of action were investigated. NC-1300-O-3 at doses of 3 and 10 mg/kg, p.o. significantly prevented the formation of gastric lesions by HCl.ethanol in rats, and its efficacy was not influenced by repeated administration for up to 4 weeks. The interaction between NC-1300-O-3 and necrotizing agents in the stomach, which is considered to be related to the development of cytoprotection, was not observed. A preventive effect of NC-1300-O-3 against gastric lesions was observed at the same dose even when gastric secretion was completely inhibited by pretreatment with omeprazole. This suggests that the cytoprotective effect of NC-1300-O-3 is an action on the gastric mucosa independent of its antisecretory effect. The cytoprotective effect of NC-1300-O-3 was not affected by pretreatment with indomethacin but was partly decreased by N-ethylmaleimide pretreatment, suggesting the participation of endogenous sulfhydryl compounds in the action of NC-1300-O-3. This compound dose-dependently increased the hexosamine content in the gastric lumen in rats at a dose range of 3-30 mg/kg, p.o. and slightly inhibited a reduction in surface mucus and mucosal hexosamine content caused by necrotizing agents. Moreover, NC-1300-O-3 at doses of 10 and 30 mg/kg, p.o. significantly inhibited the increased gastric vascular permeability caused by alcohol treatment; and at 30 mg/kg, p.o., it inhibited the reduction in potential difference caused by aspirin in rats. These actions were suggested to contribute to the cytoprotective effect of NC-1300-O-3.

Association of blood pressure variability with induction of atherosclerosis in cholesterol-fed rats

The influence of increased lability of blood pressure on the development of aortic atherosclerosis was examined. Because sinoaortic denervation (SAD) produced increased lability of blood pressure without blood pressure elevation, the development of atheromatous plaque was examined in SAD rats. These rats were fed a high-cholesterol diet and were denuded of endothelium so that development of atherosclerosis was accelerated. Five groups of male Wistar rats were used: A) controls, B) high-cholesterol diet (HC), C) HC+denudation (DN), D) HC+DN+renal artery clipping (2K1C), and E) HC+DN+sinoaortic denervation (SAD). Denudation was accomplished by scraping the aortic lumen with a balloon catheter, and hypertension was induced by clipping the left renal artery. After recording blood pressure and heart rate for 6 weeks, the rats were killed, blood samples were collected, and thoracic aortas were removed for pathologic examination. All the groups of rats fed a high-cholesterol diet developed marked hypercholesterolemia and hypotriglyceridemia. High-cholesterol diet alone could not induce aortic atherosclerosis, whereas aorta of HC+DN rats showed slight intimal thickening with smooth muscle cell proliferation. On the other hand, aorta of HC+DN + 2K1C rats showed marked atheromatous plaque with prominent cellular proliferation, and aorta of SAD rats also showed mild to moderate atheromatous plaque. Accordingly, we concluded that increased variability in circadian blood pressure per se, as well as hypertension, could induce aortic atherosclerosis in the hypercholesterolemic and endothelium-denuded rats.

Usefulness of argyrophilic nucleolar organizer staining for predicting prognosis of patients with recurrent soft tissue sarcoma

Local recurrence of tumor is a common phenomenon in soft tissue sarcoma (STS) and may be accompanied by an increase in malignant potential. In the present study, an increase of proliferative activity in recurrent tumors compared to primary tumors was observed using a silver stain for nucleolar organizer regions (AgNOR), and its implication for predicting prognosis is assessed. 44 patients with STS showing local tumor recurrence were selected. Local recurrence was defined as new tumor growth more than 2 months after the initial surgery in the same region where the primary tumor occurred. All patients received surgery, followed in 11 patients by adjuvant radiotherapy and/or chemotherapy. The histologic subtype was malignant fibrous histiocytoma in 22 cases, synovial sarcoma in 5, leiomyosarcoma in 4, liposarcoma in 3, malignant schwannoma in 3, and others in 7. The interval between initial surgery and local recurrence ranged from 2 to 72 months. No patients changed from one histological subtype to another. Histological changes included an increase in mitosis, cellularity, and sclerosis in 43.2, 31.8, and 27.3%, respectively. The AgNOR count (mean +/- SD) in recurrent tumors (7.22 +/- 2.59) was significantly higher than that in primary tumors (5.58 +/- 2.28; p < 0.0057), clearly showing a tendency for an increase in proliferative activity during recurrence. The 5-year survival rate of patients with a marked increase (> 4) in AgNOR count (16.7%) was worse than with minor to moderate increases (60.0%; p < 0.02). Marked AgNOR increase was more frequently observed in the tumors located in the head and neck and retroperitoneum (40%) than in other sites (9%). Irrespective of the primary site of tumors, a marked AgNOR increase resulted in an unfavorable prognosis. Multivariate analysis of change in histologic factors including AgNOR, cellularity, mitotic counts, pleomorphism, myxoid change, necrosis, sclerosis, and tumor size showed that increase of AgNOR counts was significant (p < 0.05). The present findings suggest that AgNOR counts can be used as a prognostic factor in recurrent STS.

[A case of immature teratoma and yolk sac tumor of the testis associated with pulmonary metastases of 2 distinct histological types]

A 24-year-old man presented with right scrotal swelling and was diagnosed as having a testicular cancer. A high inguinal orchiectomy was carried out. Histological examination revealed immature teratoma and yolk sac tumor of the testis. Eight months later, 2 separate metastatic lesions appeared in the lungs, both of which were removed by operation after a course of combination chemotherapy with Etoposide and Cisplatin. The histology showed one to be composed of immature teratoma, and the another of yolk sac tumor.

Tetraplegic wheelchair basketball

Tetraplegic wheelchair basketball was started in the Kanagawa Rehabilitation Center (KRC) as a recreational sport for tetraplegics in 1980. In this game, there are two goals on each side, thus we call it 'twin basketball'. One goal is of ordinary height and the other is low. Three ways of shooting and two ways of dribbling are allowed according to the player's level of tetraplegia and technical skill. The first official game was held in 1983. Since then, the game has been taken up in several areas of Japan. The first All Japan championship game was held in 1987, ten teams including 98 tetraplegics attending. Five years later, in the sixth championship game, 18 teams including 171 tetraplegics attended. As official physicians, we have examined the physical condition and technical skills of all players since 1987. All players are classified, and assigned points from 1 to 4.5. The total number of points of five players in one team are limited to 11.