[A morphological study to elucidate the differences in visceral pleura in young and old mice]

The pleura is not only a mechanical envelope for the lung but also represents a crossroad for the exchange of cells and fluids. We studied ultrastructural differences in the visceral pleura of male mice in a young age group (aged 1 day, 1 week (wk), 2 wks) and an old age group (10 months (mos), 16 mos, 18 mos, 28 mos, and 30 mos), by both scanning and transmission electron microscopy. Surface microvilli (SMV) of mesothelial cells appeared to be sparse at day 1, then gradually increased in density and reached a plateau at approximately 10 mos. The length of the SMV changed in parallel with density which was confirmed by a morphometric study. After 28 mos, the SMV was partially loose, with an irregular and thin appearance. The morphological properties of pleural connective tissues, including collagen, elastin, and fibroblasts, changed in morphology with the changes in mesothelial cells; the elastic layer beneath mesothelial cells formed at 2wks and was maintained until 28 mos; collagen bundles increased in volume density throughout life, whereas cellular components including mesothelial cells, fibroblasts, and alveolar epithelial cells became atrophic with aging. From these observations, we concluded that although SMV do not have any known functions in the pleura, they change with age in a manner that likely corresponds to the changes in pleural connective tissue as well as structural changes in lung parenchyma.

[Outcome of repeated pulmonary aspiration in frail elderly. The Project Team for Aspiration Pneumonia]

Aspiration pneumonia is a major cause of death among frail elderly patients. Pulmonary aspiration is commonly reported in association with episodes of pneumonia, but the clinical significance and outcome in patients with recurrent pulmonary aspiration remain uncertain. We studied outcomes retrospectively in elderly patinents with recurrent aspiration. A total of 38 patients (M25, F13: mean age 81.4 yr) who were recognized to have undergone repeated aspiration were enrolled. Of them, 89.5% had suffered cerebrovascular disorder or other neurological disorders as the major underlying disease, and 63.2% showed moderate or severe cognitive impairment. Activities of daily living (ADL) were low and 97.4% were bedridden. At the time of enrollment, 79% had aspiration pneumonia or aspiration bronchitis. The mean number of admissions during the observation period was 2.3, and 60.9% of admissions were due to pneumonia. Of the patients obsered, 84.2% died during the observation period: the median survival time was 736 days. Major causes of death were pneumonia, respiratory failure, and asphyxia (65.6%). Percutaneous endoscopic gastrostomy (PEG) was carried out in 16 patients and these patients survived longer than patients who did not undergo PEG, although 75% of the PEG group died of pneumonia. We conclude that: 1) repeated pulmonary aspiration mostly occurrs with underlying diseases of cerebrovascular disorders, dementia, and deterioration of ADL, and 2) although the prognosis following repeated pulmonary aspiration was poor. PEG contributed to a longer survival, but did not prevent pneumonia.

Epidermal proliferation of the skin in metallothionein-null mice

Metallothionein (MT) is a low-molecular weight metal-binding protein. Although the physiologic function of MT is not fully known, it is present in various species and various organs including the skin. MT is strongly stained in hyperplastic epidermal tissues in normal skin and in hyperplastic skin lesions, and increased expression of mRNA of the MT gene has been demonstrated in skin stimulated by proliferative agents, suggesting that MT is involved in the proliferation of epidermal keratinocytes. To improve our understanding of the role of MT in epidermal hyperplasia, mice with null mutations in their MT-1 and MT-2 genes were used in this study. We compared the epidermal hyperplasia in MT-null mice and in normal C57BL/6 J mice after treatments with cholera toxin, 12-0-tetradecanoylphorbol-13-acetate, and ultraviolet B irradiation, which stimulate epidermal proliferation. Immunostaining of MT was not detected in the skin of MT-null mice, and these mice developed significantly less epidermal hyperplasia than the normal mice after exposure to each stimulator. We determined the metal contents of skin samples by the proton-induced x-ray emission method. The zinc content of the skin of the MT-null mice was lower than that of the control mice before stimulation. After stimulation of epidermal hyperplasia, MT-null and normal mice showed significantly reduced levels of zinc. These findings indicate that cellular MT is involved in the proliferative process of the epidermis induced by cholera toxin, 12-0-tetradecanoylphorbol-13-acetate, and ultraviolet B light through its regulatory action on the metal metabolism required for cell growth.

Prevention of diabetes in non-obese diabetic (NOD) mice by short-term and high-dose IGF-I treatment

This report describes the results of IGF-I treatment in a NOD mouse colony with a high incidence of overt diabetes. The animals were treated with IGF-I 17.9 nmol/day at 28-41 days of age and 35.9 nmol/day at 42-69 days of age and observed up to 280 days of age. Three of 12 (25%) IGF-I-treated animals developed diabetes compared with 8 of 11 (73%) controls (P < 0.05). The severity of insulitis at the conclusion of the follow-up was less pronounced in non-diabetic treated animals than in non-diabetic controls. These data support previous findings that IGF-I treatment protects the pancreatic beta-cells from destruction by diabetic autoimmunity in NOD mice.

Increased urinary excretion of pyridinoline and deoxypyridinoline in a girl with congenital contractural arachnodactyly

Congenital contractural arachnodactyly (CCA) is caused by mutations in the gene for fibrillin 2 glycoprotein, a component of connective tissue. The causes of osteodystrophy or osteodysplasia in CCA are unknown. We report bone metabolism in a 28 month-old girl with CCA. Serum alkaline phosphatase and osteocalcin levels were 650 IU/l and 22 ng/ml at 1.5 months old (control: 530+/-65, 16.5+/-4.3), and 580 IU/l and 21 ng/ml at 28 months old (control: 465+/-58, 15.0+/-3.5), i.e. in upper-normal levels. The urinary pyridinoline and deoxypyridinoline levels were 1176 and 194 micromol/mol creatinine at 1.5 months old (control: 329+/-76, 63+/-12), and 407 and 111 micromol/mol cr at 28 months old (control: 231+/-49, 50+/-11), apparently higher than the control values. These findings may indicate that abnormal fibrillin may impair bone metabolism and cause the osteodystrophy or osteodysplasia in CCA.

Antibody-dependent enhancement of feline infectious peritonitis virus infection in feline alveolar macrophages and human monocyte cell line U937 by serum of cats experimentally or naturally infected with feline coronavirus

Infection of the type II feline infectious peritonitis virus (FIPV) strain 79-1146 to primary feline alveolar macrophages and human monocyte cell line U937 was enhanced by the sera of cats experimentally infected with the 79-1146 strain, but not those of cats infected with KU-2 or UCD-1 strain of type I FIPV. The experiments using sera of cats with feline infectious peritonitis (FIP) and of cats naturally infected with feline coronavirus (FCoV) revealed that infection of the FIPV 79-1146 strain to the U937 cells was enhanced only by the sera of cats infected with type II FIPV or feline enteric coronavirus. The samples positive for antibody-dependent enhancement (ADE) activity had high neutralizing antibody titers against the FIPV 79-1146 strain and the samples negative for ADE activity had low neutralizing antibody titers. These findings support the previous results where a monoclonal antibody with neutralizing activity had high ADE activity, suggesting that there was a close relationship between the neutralization and enhancement sites. And then it is also suggested that ADE of infection is likely to be induced by re-infection with the same serotype of virus in type II FIPV infection. Furthermore, U937 cells are considered useful and can be substituted for the feline macrophages for determining ADE of FIPV-infection.

[Recent advance in alveolar formation]

Recent technological advance in both molecular biology and morphology contributes to develop a research of alveolar formation in pre- and postnatal period. Retinoid, which has been known more than 2,000 compounds, has a key role for newly alveolar synthesis through various metabolic pathways related Hox gene, vitamin A laden fibroblast and collagen-elastin network. It has been shown that retinoid is a possible therapeutic regimen not only diffuse lung injury, such as bronchopulmonary dysplasia, but also a hopeful new-drug for newly alveolar synthesis in severe emphysema.

Differences in virus receptor for type I and type II feline infectious peritonitis virus

Feline infectious peritonitis viruses (FIPVs) are classified into type I and type II serogroups. Here, we report that feline aminopeptidase N (APN), a cell-surface metalloprotease on the intestinal, lung and kidney epithelial cells, is a receptor for type II FIPV but not for type I FIPV. A monoclonal antibody (MAb) R-G-4, which blocks infection of Felis catus whole fetus (fcwf-4) cells by type II FIPV, was obtained by immunizing mice with fcwf-4 cells which are highly susceptible to FIPV. This MAb also blocked infection of fcwf-4 cells by type II feline enteric coronavirus (FECV), canine coronavirus (CCV), and transmissible gastroenteritis virus (TGEV). On the other hand, it did not block infection by type I FIPVs. MAb R-G-4 recognized a polypeptide of relative molecular mass 120-130 kDa in feline intestinal brush-border membrane (BBM) proteins. The polypeptide possessed aminopeptidase activity, and the first 15 N-terminal amino acid sequence was identical to that of the feline APN. Feline intestinal BBM proteins and the polypeptide reacted with MAb R-G-4 (feline APN) inhibited the infectivity of type II FIPV, type II FECV, CCV and TGEV to fcwf-4 cells, but did not inhibit the infectivity of type I FIPVs.

Partial adenine phosphoribosyltransferase deficiency detected by ureterolithiasis

A 30-year-old woman was admitted to our hospital because of recurrent ureterolithiasis. She was suspected of having adenine phosphoribosyltransferase (APRT) deficiency based on the presence of 2,8-dihydroxyadenine (DHA) crystals in her urinary sediment, infrared spectrophotometric analysis of the excreted stone, and then the definitive diagnosis by gene analysis. A pedigree study indicated only a slight possibility of this disease in the family. From these results, we consider that urinary sediment and stone analysis should be used for screening while gene analysis should be employed for definitive diagnosis of APRT deficiency, so that the complications of this condition can be prevented.

The effect of GABAergic system activity on hyperthermia-induced seizures in rats

Developing rats were given GABA antagonists and agonist before electrical seizure discharges were induced by heating the brain of a rat with infra-red rays. The thresholds for the GABA antagonist groups were significantly lower than that for the control, and the threshold for the GABA agonist group was significantly higher than that for the control. These results support the hypothesis that reduced GABAergic system activity underlies febrile seizures.

Effects of cigarette smoking on the serum concentration of lung surfactant protein A (SP-A)

We have tested the hypothesis that serum surfactant protein A (SP-A) production may be affected by cigarette smoke exposure, and that alterations in serum levels may reflect smoking habits. A total of 52 subjects were divided into the following two groups: active smokers (Group A; n = 23); and nonsmokers (Group B; n = 29). The assessment of smoking habit was determined by self-report, carbon monoxide concentration in expired air, and cotinine concentration in urine. Serum SP-A was compared in both groups and was found to be higher in Group A (active smokers) (p < 0.002). We conclude that surfactant protein A levels are increased in the serum of smokers. However, it was found that this is not a sensitive discriminating factor to separate smokers from nonsmokers.

Transient late neonatal hypocalcemia with high serum parathyroid hormone

We report two patients with transient late neonatal hypocalcemia. Serum examination showed low calcium (Ca), high phosphorus, high parathyroid hormone (PTH), normal 25-hydroxyvitamin D and low or normal 1,25-dihydroxyvitamin D (1,25(OH)2vitD) levels. PTH infusion test revealed normal cyclic AMP production. In these patients, 1,25(OH)2vitD production by PTH, or Ca mobilization from bone and Ca absorption from intestine by PTH and 1,25(OH)2vitD might have been disturbed transiently due to developmental immaturities. This is a new type of transient late neonatal hypocalcemia with high serum PTH levels.

Cross-relaxation times of normal and biochemically induced osteoarthritic rabbit knee cartilages

We measured the spin-lattice relaxation times (T1) of water protons and intermolecular cross-relaxation times (T(IS)) from irradiated protein protons (f2-irradiation at 1.95 or -4.00 ppm) of rabbit normal and monoiodoacetate-induced degenerated knee articular cartilages to observed water protons. The mean values of T1 (T1) for control and degenerated rabbit knee cartilages were 1.87+/-0.15 (mean+/-SD, n=29) and 1.82+/-0.13 s (n=34), respectively. The mean values of water content (W(H2O)) for control and degenerated rabbit knee cartilages were 82.9+/-2.09 (n=26) and 83.1+/-2.57% (n=28), respectively. These values were not statistically different from each other. However, the mean values of T(IS) (T(IS)) for normal knee articular cartilage were significantly different from those for degenerated cartilage: (normal), T(IS) (f2=1.95 ppm)=2.46+/-0.62 s (n=28), T(IS) (f2=-4.00 ppm)=4.25+/-1.26 s (n=26); (degenerated), T(IS) (f2=1.95 ppm)=1.99+/-0.76s (n=34), T(IS) (f2=-4.00 ppm)=3.33+/-0.76 s (n=31). Obtained results may be attributed to the reported switchover from type II to type I collagen syntheses in osteoarthritic cartilage, resulting in broad collagen fibers. This specificity of cross-relaxation effect may prove useful in the noninvasive and pathophysiological evaluation of cartilage tissues in vivo.

[Anesthetic management for a patient with pure autonomic failure]

Pure autonomic failure is characterized by orthostatic hypotension, sweating disorder, urinary incontinence, and syncope. A 64 year-old man with pure autonomia failure was scheduled for suprapubic prostatectomy. We monitoring direct arterial pressure and inserted pulmonary artery catheter prior to the induction of anesthesia. General anesthesia was induced with diazepam 10 mg, fentanyl 0.3 mg, and vecuronium 8 mg for tracheal intubation. Anesthesia was maintained with sevoflurane (0.2-1.5%), 60% nitrous oxide in oxygen supplemented with intermittent epidural anesthesia. During anesthesia, blood loss was immediately replaced with banked blood because autonomic failure could not compensate hypovolemia well. Epidural anesthesia in this patient was considered to cause less hypotension than in patients with normal autonomic function. Therefore, we think epidural anesthesia is a useful anesthesia method for patients with pure autonomic failure. The emergence from anesthesia was smooth and no complications were seen during the perioperative period.

[Self-management of bronchial asthma and emergency admissions due to acute asthma attacks in the elderly]

We hypothesized that an intensive personal educational program would reduce the number of hospital admissions due to acute exacerbations of chronic airflow obstruction in elderly patients. The educational program was designed to improve self-management of asthma in these patients. We compared the number of patients admitted for treatment of acute asthma attacks at Tokyo Metropolitan Geriatric Hospital from April 1987 through March 1989 (before the program began) with the number admitted from April 1991 through March 1993 (after the program began). Fewer patients were admitted in the latter period than in the former. During the latter period, fewer patients were admitted due to mild or moderate asthma attacks, but there was no such difference in the number admitted due to near-fatal attacks.

[Two cases of papillary adenocarcinoma of the thyroid gland associated with chylothorax]

Case 1. An 85-year-old woman had a papillary adenocarcinoma of the thyroid gland and a pleural effusion. The pleural effusion appeared to be a chylous exudate and it did not re-accumulate after thoracenthesis. Thoracic imaging indicated that the chylothorax was caused by direct invasion of the thoracic duct by the thyroid carcinoma. Case 2. A 53-year-old woman had a 20-year history of recurrent chylothorax. She died due to sepsis one year after the third admission for dyspnea and chylothorax. The autopsy findings included papillary adenocarcinoma of the thyroid gland with metastasis to the left supraclavicular lymph nodes. The thoracic duct was inflamed, fibrotic, and completely obstructed. Invasion by the carcinoma may have compressed and destroyed the thoracic duct, and caused chylothorax. Recurrent inflammatory granulation caused total obstruction of the thoracic duct. Reports of chylothorax associated with carcinoma of the thyroid gland are rare.

Clinical study of epilepsy with severe febrile seizures and seizures induced by hot water bath

We followed five cases with severe febrile seizures (FS) with early onset and seizures induced by hot water bath, indicating severe myoclonic epilepsy in infancy (SME) or the peripheral form of SME. These cases, however, had far better clinical courses than that of SME or the peripheral form of SME. These cases were characterized by: (a) severe FS with early onset and seizures induced by hot water bath; (b) a lack of myoclonic seizures; (c) no psychomotor deterioration; (d) no underlying disorders or signs of brain insult on neurologic and laboratory examination; (e) relatively successful seizure control; (f) none of the severe EEG abnormalities seen in SME and the peripheral form of SME; and (g) a positive family history of convulsive disorders.

[Malignant tumors in a Japanese geriatric hospital]

We studied the cases of 909 patients with malignant tumors (497 men and 412 women) who were admitted to Tokyo Metropolitan Geriatric Hospital from April 1994 to July 1995. The mean age was 78.6 years (range: 60 to 103 years). The most common tumors were gastric cancer, colo-rectal cancer, and lung cancer. However, the most common tumors in those who died (n = 263) were gastric cancer, lung cancer, and liver cancer. In 425, abnormalities were found during routine health checks or incidental laboratory examinations, while the patients were asymptomatic. On the first admission, 23.4% were found distant metastases. The rate of complications with other diseases was 82.3%. About one third (31.2%) were informed of their situation, and 18.5% had not received any treatment for their malignancies. In 63%, performance status at the time of discharge was the same as that measured on admission or better.

[Relationship of atopic dermatitis to residential environment. A study of the comparison between diagnosis by medical examination and assessment by questionnaire]

Diagnosis of atopic dermatitis (AD) according to criterion of the Japanese Dermatology Society by medical examination and a questionnaire survey concerning the living environment and presence of allergic diseases were performed on 1725 elementary school children living in Hirosaki-city and its suburbs in Aomiri Prefecture. In addition a scratch test for mite antigen was conducted 523 of the children and a patch test on 240. No difference was found between the rate of children diagnosed as having AD during the medical examination which was 12.9%, and the rate of children who responded as presently having AD in the questionnaire which was 12.8%. However the rate of concordance between those diagnosed to have AD by medical examination and the group that responded as having AD in the questionnaire was about 50%. For AD in children diagnosed by medical examination, a residential environment of the houses that there were moldy and leaking appeared to be a risk factor. Risk factors of children with AD from the questionnaire survey appeared to be houses built within 20 years. Clearly there were differences in conclusions regarding risk factor between the medical examination and the questionnaire. In terms of increasing reliability, a medical examination would be preferred. From the results of allergic tests, the children who lived in houses built within 20 years had a high response to the patch test. These results suggest that houses that are moldy and leaking, or built within 20 years may be considered to be risk factors for outbreak of AD.