Serum alpha-subunit levels in patients with pituitary adenomas

OBJECTIVE

We investigated preoperative and postoperative serum alpha-subunit levels and the alpha-subunit response to TRH in patients with various types of pituitary tumour and correlated the data with histological findings in order to clarify the significance of alpha-subunit measurement in pituitary adenomas.

PATIENTS

We examined 59 patients with pituitary tumours (22 with GH cell adenomas, 30 with clinically nonfunctioning adenomas and seven with other tumours) treated at Toranomon Hospital between 1996 and 1998.

RESULTS

The basal alpha-subunit level was supranormal in six out of 22 (27%) patients with a GH cell adenoma and in nine out of 30 (30%) patients with a nonfunctioning adenoma. A paradoxical alpha-subunit response to TRH was found in seven out of 22 (32%) patients with a GH cell adenoma. These seven patients also showed a paradoxical GH response to TRH administration. In addition, paradoxical response to TRH was found in eight out of 30 (27%) patients with a clinically nonfunctioning adenoma. In contrast, patients with other types of pituitary tumour showed neither a supranormal alpha-subunit level nor a paradoxical response to TRH. The supranormal alpha-subunit level and the abnormal response to TRH were normalized in both GH cell adenoma and nonfunctioning adenoma patients after successful surgery. Immunohistochemical studies showed alpha-subunit positive cells in 51% of GH cell adenomas or nonfunctioning adenomas and there was a good concordance with the serum alpha-subunit levels in both GH cell adenoma and nonfunctioning adenoma patients.

CONCLUSIONS

These findings suggest that supranormal serum alpha-subunit levels are mainly due to hypersecretion by the tumour itself, while the paradoxical alpha-subunit response to TRH is an associated phenomenon in patients with a GH cell adenoma or nonfunctioning adenoma. The alpha-subunit level and the response to TRH may be useful indicators for assessing the operative outcome, especially in nonfunctioning adenoma patients who have no other definite endocrine markers.

[Bone metabolism and angiogenesis]

Bone metabolism is regulated not only by the nutrition supplied by vessel but also by the signals from the cells in vascular tissues. Identification of such signaling molecules has been the major issue in the field of research on the relationship between bone and vasculatures. This review touches on the recent findings on the expression and functions of such signaling molecules including VEGF, MMP and non-collagenous bone matrix proteins.

[An immunopathological study of autoimmune keratitis in nude mice with embryonic rat thymus grafts]

PURPOSE

The purpose of the present study was to examine the keratitis detected in these mice after the xenogeneic thymus gland transplantation.

METHODS

The thymus glands were collected from F 344 rat embryos and transplanted under the renal capsules of BALB/c nude mice (rat TG nude mice). Histological and immunohistological examinations and a transfer experiment of keratitis was also conducted.

RESULTS

The histological image was characterized by the infiltration of mononuclear cells and neutrophils and the marked angiogenesis. The autoantibodies reacting specifically to corneal epithelial cells and corneal stroma were recognized in the blood. The deposits of immunoglobulins and complements were simultaneously observed in the corneal stroma and around the basement membrane. Corneal lesions of rat TG nude mice were therefore successfully transferred into naive nude mice by host splenic CD 4 positive cells.

CONCLUSION

The present study demonstrated that autoimmunity was involved in the development of keratitis in rat TG nude mice and that these mice were the first animal models to develop autoimmune keratitis spontaneously.

[Clinical features of epidemic nosocomial keratoconjunctivitis in 41 patients]

PURPOSE

To evaluate the clinical features of nosocomial epidemic keratoconjunctivitis (EKC) occurring in the ophthalmology ward of Tokyo Medical University Hospital.

MATERIALS AND METHODS

We studied the symptoms and clinical course of 41 patients who had EKC caused by nosocomial infections in our hospital. We attempted to detect adenovirus antigen and viral DNA from conjunctival swabs and also to isolate the virus.

RESULTS

The clinical symptoms of EKC, including postoperative cases, were not severe. In some cases, patients' complaints, for example, increase of lacrimation or appearance of a foreign body sensation, were contributory to diagnosis. Among the 41 patients, 31 out of 34 (91.2%) EKC patients who had undergone ophthalmic surgery had EKC in the operated eye. In cases receiving bilateral operations, EKC occurred first in the initially operated eye. The sensitivity of Adeno-check was 76.9%. Adenovirus type 19 was isolated from conjunctival swabs in 26 cases.

CONCLUSIONS

The early diagnosis of EKC is extremely important to prevent the spread of nosocomial infections. Careful observation of operated eyes and close attention to patient complaints may aid in the early detection of EKC.

New diagnostic approach for ocular tuberculosis by ELISA using the cord factor as antigen

BACKGROUND/AIMS

Diagnosis of ocular tuberculosis is difficult, particularly the retinal vasculitis type, because most cases occur without concurrent active pulmonary tuberculosis. Recently, it has been reported that detection of antibodies against purified cord factor (trehalose-6,6'-dimycolate, TDM), the best studied, most antigenic, and most abundant cell wall component of tubercule bacilli, is very useful for rapid serodiagnosis of pulmonary tuberculosis. In this study, an attempt was made to evaluate whether the detection of anticord factor antibody is also useful for diagnosis of ocular tuberculosis and the necessity of antituberculous therapy for tuberculous retinochoroiditis was discussed.

METHODS

Cases consisted of 15 patients with uveitis and retinal vasculitis, nine patients with presumed ocular tuberculosis, three patients with sarcoidosis, and three patients with Behçet's disease. IgG antibodies against purified cord factor prepared from Mycobacterium tuberculosis H37Rv were detected by enzyme linked immunosorbent assay.

RESULTS

All cases of clinically presumed ocular tuberculosis were positive, whereas all of the cases of sarcoidosis or Behçet's disease were negative for anticord factor antibodies. When the anticord factor antibody titres were compared on the basis of the presence or absence of previous antituberculosis chemotherapy, the mean anticord factor antibody titre of the untreated group showed a tendency to be higher than in the treated group, but not significantly (p=0.07).

CONCLUSIONS

The detection of anticord factor antibody may be useful to support the diagnosis of ocular tuberculosis. Additionally, a positive result for anticord factor antibody may indicate that tubercule bacilli are present in some organ(s) of the patient even in the absence of active systemic disease.

Typing of Herpes Simplex Virus in Patients with Uveitis

Aim: To examine the type of herpes simplex virus (HSV) in cases with uveitis.Materials and Methods: Intraocular fluid specimens obtained from 3 cases with herpetic iridocyclitis and 6 cases with acute retinal necrosis (ARN) were examined by polymerase chain reaction (PCR). HSV typing was performed by the restriction patterns of the PCR products. Serum samples obtained from these cases and 33 cases with uveitis were examined by neutralization test (NT) for the availability of the typing of HSV.Results: The restriction patterns of the PCR products amplified from 3 specimens of iridocyclitis revealed HSV type 1 DNA. HSV type 2 DNA was identified in 5 of 6 cases of ARN and HSV type 1 DNA was found in only one case. The results of serum NT titers correlated with the typing of the amplicons.Conclusions: In the cases studied, HSV type 1 was the dominant etiological agent in herpetic iridocyclitis, while HSV type 2 plated a similar role in HSV-associated ARN. The examination of the serum NT may be helpful for the identification of the etiological types of HSV in patients with uveitis.

Negative regulation of BMP/Smad signaling by Tob in osteoblasts

Bone morphogenetic protein (BMP) controls osteoblast proliferation and differentiation through Smad proteins. Here we show that Tob, a member of the emerging family of antiproliferative proteins, is a negative regulator of BMP/Smad signaling in osteoblasts. Mice carrying a targeted deletion of the tob gene have a greater bone mass resulting from increased numbers of osteoblasts. Orthotopic bone formation in response to BMP2 is elevated in tob-deficient mice. Overproduction of Tob represses BMP2-induced, Smad-mediated transcriptional activation. Finally, Tob associates with receptor-regulated Smads (Smad1, 5, and 8) and colocalizes with these Smads in the nuclear bodies upon BMP2 stimulation. The results indicate that Tob negatively regulates osteoblast proliferation and differentiation by suppressing the activity of the receptor-regulated Smad proteins.

Chronic inhibition of nitric oxide synthesis in rats increases aortic superoxide anion production via the action of angiotensin II

OBJECTIVE

Chronic inhibition of nitric oxide (NO) synthesis by Nomega-nitro-L-arginine methyl ester (L-NAME) increases vascular tissue angiotensin II activity and oxidative stress in animals by incompletely understood mechanisms. In a rat model, we investigated the role of local angiotensin II activity in the pathogenesis of increased oxidative stress.

DESIGN

We studied the aortas of control rats and others receiving L-NAME or L-NAME plus an angiotensin II type 1 receptor antagonist (CS-866).

RESULTS

Administration of L-NAME for 7 days significantly increased superoxide anion (O2-) and both immunoreactivity and electrophoretically demonstrable activity of redox-sensitive transcription factors (NF-kappaB and AP-1). Treatment with the angiotensin II type 1 receptor antagonist prevented all of the above changes. The observed effects of the type 1 receptor antagonist was independent of the L-NAME-induced arterial hypertension.

CONCLUSIONS

These findings suggest that chronic inhibition of NO synthesis may increase vascular oxidative stress and oxidative stress-sensitive signals via the action of angiotensin II mediated via type 1 receptors.

Gastric amyloidosis with massive bleeding requiring emergency surgery

We report a 66-year-old woman who had massive bleeding from a gastric ulcer complicating primary systemic amyloidosis, in whom emergency surgery proved lifesaving. Physical examination revealed anemia and macroglossia. Gastroscopy was performed, and an extensive, irregular, hemorrhagic ulcer was found in the gastric body. Biopsy resulted in a diagnosis of amyloidosis. On the 11th hospital day the patient went into shock as a result of a massive hemorrhage. Emergency surgery was performed, but the extent of the submucosal lesion in the stomach could not be identified, and total gastrectomy was unavoidable. Histological examination of the surgical specimen and biopsy tissue collected from other organs revealed amyloid deposition extending from the submucosa to the muscularis propria of the stomach. There was also deposition of large amounts of amyloid around the small blood vessels in the liver and under the mucosa of the small intestine. The amyloid was AA-antibody-negative and resistant to treatment with K2MO4, and a diagnosis of AL-type systemic amyloidosis was made. The patient's general condition recovered after the operation, but on the 103rd hospital day, she experienced sudden onset of arrhythmia and died. Patients with amyloidosis in whom gastrointestinal surgery is performed are rare; only 41 cases, including our own, have been reported in the Japanese literature since 1972.

Reconstruction and limb salvage using a free vascularised fibular graft for periacetabular malignant bone tumours

We treated four patients with periacetabular malignant tumours by pelvic reconstruction with a free vascularised fibular graft after resection of the tumour. The mean follow-up period was 32 months (9 to 39). The diagnosis was chondrosarcoma in three patients and osteosarcoma in one. In two patients total resection of the hemipelvis was required and in the other two less, but still massive, resection was undertaken. All were treated with an immediate free vascularised fibular graft which included arthrodesis of the hip and reconstruction of the pelvic ring. One patient died. The other three have remained free from recurrence. Solid union of the graft was achieved between four and 14 months after surgery. Shortening of the involved limbs was less than 2 cm. The patients had no pain and were independent walkers without external support. Emotional acceptance was satisfactory. Our results suggest that reconstruction with the use of a free vascularised graft is an alternative to other types of reconstructive procedure after resection of periacetabular tumours.

Reconstruction and limb salvage using a free vascularised fibular graft for periacetabular malignant bone tumours

We treated four patients with periacetabular malignant tumours by pelvic reconstruction with a free vascularised fibular graft after resection of the tumour. The mean follow-up period was 32 months (9 to 39). The diagnosis was chondrosarcoma in three patients and osteosarcoma in one. In two patients total resection of the hemipelvis was required and in the other two less, but still massive, resection was undertaken. All were treated with an immediate free vascularised fibular graft which included arthrodesis of the hip and reconstruction of the pelvic ring.

One patient died. The other three have remained free from recurrence. Solid union of the graft was achieved between four and 14 months after surgery. Shortening of the involved limbs was less than 2 cm. The patients had no pain and were independent walkers without external support. Emotional acceptance was satisfactory.

Our results suggest that reconstruction with the use of a free vascularised graft is an alternative to other types of reconstructive procedure after resection of periacetabular tumours.

Restoration of hearing with an auditory brainstem implant in a patient with neurofibromatosis type 2--case report

A 25-year-old male with neurofibromatosis type 2 had hearing restored with an auditory brainstem implant (ABI) after removal of an acoustic schwannoma. The ABI allows the patient to discern many different environment sounds and is a significant adjunct to lip-reading, enabling conversation with people who have clear pronunciation without the necessity for writing.

The characteristics of static visual fields in children with psychogenic visual disturbances

PURPOSE

It is well-known that patients with psychogenic visual disturbances (PVD) exhibit characteristic kinetic visual fields. Even when the kinetic fields are normalized, the static fields of PVD children frequently remain abnormal. To verify this finding, we performed static perimetry on those children whose kinetic fields were initially normal or which normalized during the follow-up period, and compared the results with those of children with psychosomatic disorders (PSD) and normal children.

METHODS

We examined 9 PVD children (17 eyes), 16 PSD children (32 eyes), and 16 normal children (16 eyes). Program 30-2 or 24-2 of the Humphrey Field Analyzer was used in the examinations on all subjects.

RESULTS

The average mean deviation (MD) of the PVD group was significantly lower than that of the other groups (P <. 01). False negative errors and short-term fluctuations were significantly higher in the PVD group than in the other groups (P <. 05).

CONCLUSION

Although PVD and PSD children possess a similar underlying psychological dysfunction, their performances in visual field testing proved to be quite different. In the PVD group, even when kinetic fields were normal, functional visual field loss in the static fields was common and had characteristic response properties.

Interaction between inflammatory cells and heparin-surface-modified intraocular lens

PURPOSE

To investigate the interaction and adherence of inflammatory cells to a heparin-surface-modified intraocular lens (HSM IOL).

SETTING

Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo, Japan.

METHODS

Splenic mononuclear leukocytes from rats with experimental autoimmune uveitis were cultured with the optic of an HSM IOL for 96 hours. The number of adherent cells on the HSM IOL surface was measured with and without the addition of interphotoreceptor retinoid-binding protein and concanavalin A (ConA) to the culture medium. The adherent cells were observed under a light microscope or a scanning electron microscope.

RESULTS

Interphotoreceptor retinoid-binding protein and ConA increased the number of adherent cells on the HSM IOL relative to the control. Adherent cells on the HSM IOL were small and round, considered to be mainly lymphocytes.

CONCLUSION

Activated lymphocytes tended to adhere to the surface of the HSM IOL.

Pigmented villonodular synovitis secondary to laceration of the perforating branch of the peroneal artery

A case of peroneal artery injury subsequently developed into a lesion resembling an extra-articular tenosynovial giant cell tumor, which is a type of pigmented villonodular synovitis (PVNS). This case supports the hypothesis that accident trauma, such as a vascular injury, can be the etiology of PVNS.

Conserved T cell receptor complementarity-determining region 3 of ocular T cells in mice with experimental autoimmune uveoretinitis

PURPOSE

To characterize T cells infiltrating into the ocular tissues of mice with experimental autoimmune uveoretinitis (EAU) immunized with interphotoreceptor retinoid-binding protein (IRBP).

METHODS

The T cell receptor (TCR) repertoire on T cells obtained from ocular lesions of EAU mice was analyzed by reverse transcriptase-polymerase chain reaction. The clonotype of the T cells was examined by the single-strand conformation polymorphism (SSCP) method, followed by sequence analysis of the TCR beta-chain complementarity-determining region 3 (CDR3).

RESULTS

The repertoire of the TCR BV gene in T cells from inflamed lesions was heterogeneous. SSCP analysis showed accumulation of multiple T cells specifically in ocular tissues of EAU mice, suggesting that these cells were expanded by an antigen-driven stimulation. Junctional sequence analysis demonstrated the presence of highly conserved amino acid sequence motifs (AGTGG, AGD) in CDR3 of BV2-positive T cells.

CONCLUSIONS

Our findings suggest that T cells infiltrating into ocular lesions of EAU mice recognize restricted T cell epitopes of IRBP, resulting in autoimmune uveoretinitis.

Clonally accumulating T cells in the anterior chamber of Behçet disease

PURPOSE

To clarify the nature of infiltrating T cells into the anterior chamber of a patient with Behçet disease.

METHODS

Aqueous humor was obtained from a patient with ocular Behçet disease by paracentesis. RNA isolated from the cells in aqueous humor was reverse transcribed into complementary DNA. Complementary DNA encoding the variable (V) diversity (D) joining (J) (junctional) region of T-cell receptor beta chain V domain (TCR BV) chain was amplified by T-cell receptor BV family polymerase chain reaction.

RESULTS

Polymerase chain reaction Southern blot analysis showed that T-cell receptor BV3, BV5, and BV7 were dominantly expressed on ocular T cells of this patient. In addition, DNA sequencing revealed that monoclonal or oligoclonal T-cell accumulation was found in T-cell receptor BV3(+), BV5(+), and BV7(+) T cells.

CONCLUSION

These findings suggest that some T cells infiltrating into the anterior chamber of a patient with ocular Behçet disease expand by antigen-driven stimulation, indicating the pivotal role of T cells in the pathogenesis of ocular Behçet disease.

[Typing of herpes simplex virus in patients with uveitis]

AIM

To examine the type of herpes simplex virus (HSV) in cases with uveitis.

MATERIALS AND METHODS

Intraocular fluid specimens obtained from 3 cases with herpetic iridocyclitis and 6 cases with acute retinal necrosis (ARN) were examined by polymerase chain reaction (PCR). HSV typing was performed by the restriction patterns of the PCR products. Serum samples obtained from these cases and 33 cases with uveitis were examined by neutralization test (NT) for the availability of the typing of HSV.

RESULTS

The restriction patterns of the PCR products amplified from 3 specimens of iridocyclitis revealed HSV type 1 DNA. HSV type 2 DNA was identified in 5 of 6 cases of ARN and HSV type 1 DNA was found in only one case. The results of serum NT titers correlated with the typing of the amplicons.

CONCLUSIONS

In the cases studied, HSV type 1 was the dominant etiological agent in herpetic iridocyclitis, while HSV type 2 played a similar role in HSV-associated ARN. The examination of the serum NT may be helpful for the identification of the etiological types of HSV in patients with uveitis.

Latissimus dorsi musculocutaneous free flap transplantation to salvage below-elbow amputation in an emergency operation: a case report

We used a free latissimus dorsi musculocutaneous flap (LD m-c flap) to cover a large skin defect at the stump of a forearm in an emergency operation. The patient we discuss is a 52-year-old man. Amputation at the distal one third of the left forearm occurred after catching his hand and wrist in a machine. The amputated left hand was severely damaged and there were wide skin defects. The function of the elbow joint was well preserved. Both the radius and ulna were cut 7 cm distal from the elbow joint. A 20 x 8 cm square of LD m-c flap was transplanted, to the stump of the forearm. The flap survived without incident. The range of motion of the elbow joint was from 20 degrees to 85 degrees. The prosthesis was well fitted to the stump, and the patient returned to his workshop 9 months after injury.

In vivo intravascular laser photodynamic therapy in rabbit atherosclerotic lesions using a lateral direction fiber

BACKGROUND AND OBJECTIVE

This study was performed to evaluate the possibility of inducing regression of atherosclerotic foci by photodynamic therapy (PDT) using hematoporphyrin derivative (HpD).

STUDY DESIGN/MATERIALS AND METHODS

Atherosclerotic rabbits were divided into four groups: A (n = 6) and C (n = 6) were given 5 mg/kg of HpD intravenously; Groups B (n = 4) and D (n = 4) were not. Twenty-four hours after HpD administration, the aortae of groups A and B were exposed to 200 mw output argon dye laser beam at 630 nm for 10 minutes; groups C and D were exposed to 400 mw for 5 minutes. Three rabbits from groups A and C and two rabbits from groups B and D were sacrificed immediately after laser photoradiation, being named groups A 0, C 0 and groups B 0, D 0, respectively. Groups A 7, C 7, and Groups B 7, D 7 were sacrificed 7 days after the photoradiation.

RESULTS

In groups A 7 and C 7, most intimal cells and endothelial cells had become necrotic and disappeared, and a loss of intima was observed. No such changes were found in groups B 7, D 7.

CONCLUSION

The above data suggest that PDT caused effective regression of the atherosclerotic lesions.

Resection arthrodesis of the knee with a vascularised fibular graft

We present the results in 12 patients of arthrodesis of the knee using a vascularised fibular graft after resection of a malignant bone tumour. At a mean follow-up of 95 months (60 to 178) all patients were free from disease although 11 had had at least one complication, with stress fracture of the graft in five patients, nonunion in two and deep infection requiring above-knee amputation in one.

Despite the high rate of complications, satisfactory results can be obtained using this technique. Careful preoperative counselling is required.