Angiotensin I-converting enzyme insertion/deletion polymorphism: potential significance in nephrology

Angiotensin I-converting enzyme (ACE) plays a pivotal role in cardiovascular homeostasis and by activating angiotensin I into angiotensin II and inactivating bradykinin. These two peptides play antagonistic roles on the cardiovascular system by regulating vascular tone and vascular smooth muscle cell proliferation. Identification of the ACE gene as a genetic marker for various forms of cardiovascular disease is a recent result of the progress made in molecular biology and genetics. The insertion/deletion (ID) polymorphism of the ACE gene defined by the presence or absence of the 287 base pair Alu sequence situated in intron 16 has been investigated as a possible genetic marker for a variety of cardiovascular disease including myocardial infarction, essential hypertension, cardiomyopathy, and diabetic vascular complications. This paper reviews prior reports and briefly describes our recent study on the association of the ACE I/D polymorphism and antiproteinuric effect of ACE inhibitors in patients with proteinuria.

[Favorable prognosis in a case of recurrent cerebral infarctions caused by chronic disseminated intravascular coagulation due to ovarian carcinoma]

We report a 53-year-old woman who developed a cerebral infarction in the left middle cerebral artery area. Although she did not have a hemorrhagic tendency, the results of her examination showed a chronic disseminated intravascular coagulation (DIC) and a left ovarian carcinoma. Gabexate mesilate (FOY) and nafamostat mesilate (FUT) were not effective for her DIC. One month after admission, she had another cerebral infarction in the right posterior cerebral artery area. She was treated by heparin sodium and her chronic DIC improved. Then, she was operated on for ovarian carcinoma; the histologic finding was clear cell adenocarcinoma. No recurrence of DIC nor cerebral infarction was observed postoperatively. Patients with cerebral infarctions caused by chronic DIC due to ovarian carcinoma have been reported in the literature, but few patients had a favorable prognosis such as the present case. Heparin therapy appears to be the treatment of choice for chronic DIC rather than FOY or FUT, if there is no hemorrhagic tendency. When a patient with DIC develops cerebral infarction, one should always investigate for possible malignant tumors.

Effects of serotonin on the release of thyrotropin-releasing hormone from the rat retina in vitro

Effects of serotonin on the release of thyrotropin-releasing hormone (TRH) from the rat retina were studied in vitro. The retina was incubated in medium 199 (pH 7.4) with 1.0 mg/ml of bacitracin and 100 micrograms/ml of ascorbic acid (medium) for 20 min. The amount of TRH release into the medium was measured by radioimmunoassay. The TRH release from the rat retina was inhibited significantly in a dose-related manner with the addition of serotonin and enhanced with cyproheptadine. The inhibitory effect of serotonin on TRH release from the retina was blocked with the addition of cyproheptadine. The elution profile of methanol extract of the rat retina was identical to that of synthetic TRH. The findings suggest that the serotonergic system inhibits TRH release from the rat retina in vitro.

Oral and maxillofacial radiology teaching file on the World Wide Web

An oral and maxillofacial radiology teaching file on the World Wide Web was created effective June 15, 1995. The file contains 106 cases (279 images) of 94 diseases in the oral and maxillofacial region.

Texture analysis of sonographic features of the parotid gland in Sjögren's syndrome

OBJECTIVE

The purpose of this study was to develop a method for quantitative analysis of the sonographic features of parotid glands as a noninvasive tool for the diagnosis of Sjögren's syndrome.

SUBJECTS AND METHODS

Sonographic texture analyses were performed on the parotid glands of 44 patients with Sjögren's syndrome, 83 healthy volunteers, and 17 patients with chronic parotitis, using a fast Fourier transform program.

RESULTS

Texture analysis of sonographic studies of the parotid gland using a Fourier transform showed that the sum of the normalized radial power spectrum in the low-spatial-frequency region (S value) of the parotid gland was significantly higher (p < .0001) in the patients with definite Sjögren's syndrome [6.70 +/- 2.13 (x10(5))] than in the 72 age-matched normal volunteers [3.25 +/- 1.08 (x10(5))]. However, patients with probable Sjögren's syndrome showed S values [3.92 +/- 1.88 (x10(5))] similar to those of the controls. On the other hand, SDs of the echo levels in the parotid gland showed significantly greater (p < .0001) values in patients with definite (4.63 1.07) and probable (4.53 1.47) Sjögren's syndrome than in the normal controls (3.30 0.76). Discriminant analysis showed that a combination of these two distinctive values increased diagnostic accuracy to 96.9%. Furthermore, S values and SDs correlated well with the qualitative grading of sonographic features and with the gradings of sialography.

CONCLUSION

The system we describe for texture analysis of sonographic images is useful in the diagnosis of Sjögren's syndrome.

Genetic basis of left ventricular remodeling after myocardial infarction

The purpose of the present study was to assess whether the insertion (I)/deletion (D) polymorphism of the angiotensin converting enzyme (ACE) gene, and the polymorphism of angiotensinogen (AGT) gene with threonine (T) instead of methionine (M) at amino acid 235 in exon 2 (M235T) were associated with left ventricular dilatation after myocardial infarction. In 103 patients with myocardial infarction, the left ventricular (LV) end-diastolic volume index (EDVI) and the end-systolic volume index (ESVI) were assessed by echocardiography at two time points, namely at 7 +/- 4 days and at 3.9 +/- 1.3 months (mean +/- S.D.) after the infarction. The increases in the LVEDVI and LVESVI on the second echocardiogram were significantly higher in subjects with the DD and ID genotypes than in patients with the II genotype (P < 0.05 and P < 0.005, respectively). Multiple regression analysis revealed that the LVESVI at the first echocardiographic examination and the ACE I/D genotype were significant predictors of the LVEDVI and LVESVI at the second echocardiographic examination. However, the AGT M235T genotype was eliminated. In conclusion, the DD and ID genotypes of the ACE gene were significantly associated with the progression of the LVEDVI and LVESVI after myocardial infarction. The presence of the deletion allele of the ACE gene may be a risk factor of congestive heart failure after a myocardial infarction.

A low-affinity vasopressin V2-receptor gene in a kindred with X-linked nephrogenic diabetes insipidus

In this study, a mutation in vasopressin Type 2 receptor (V2R) in a patient with hereditary nephrogenic diabetes insipidus (NDI) has been identified and characterized. The sequencing of the V2R gene from the patient revealed that there was a missense mutation (TAT to TGT) resulting in the substitution of 205Tyr for Cys in the putative third extracellular domain. The expression analysis in COS cells showed that the binding affinity of the mutant receptor (KD = 19.8 nM) for arginine vasopressin was much lower than that of the wild-type receptor (KD = 1.8 nM) so that intracellular cAMP production stimulated by arginine vasopressin was impaired in cells with the mutant V2R. From these results, it was concluded that the single amino-acid substitution of V2R is responsible for this familial disease.

[Clinical features of anterior inferior cerebellar artery territory infarcts--a study of ten patients]

Clinical features of the anterior inferior cerebellar artery (AICA) territory infarcts were investigated in ten patients, ranging in age from 38 to 76 years. In all patients, there were MR images of infarction located in the area supplied by the AICA. The lesion was on the left side in 6 patients and right side in 4. The lesion of brain stem including the middle cerebellar peduncle was found in 7 patients and that extended to the cerebellum was in 3 patients. The main ipsilateral neurological signs were the VII and VIII cranial nerves palsy and cerebellar ataxia. The V and VI cranial nerves palsy. Horner's syndrome, and dysphagia were also present. The main contralateral sign was superficial sensory disturbance, but no hemiplegia. The underlying pathology included chiefly hyperlipidemia, hypertension, and diabetes mellitus. Cerebral angiography was performed in 8 patients, most of which was observed severe arteriosclerosis suggesting poor hemodynamics in the vertebral and basilar arteries. The prognosis was relatively good, but the VII, VIII, and V cranial nerves palsy and contralateral superficial sensory disturbance remained as the sequelae. As mentioned above, there were various neurological findings and MR images in AICA territory infarcts. Especially there were some patients whose lesion extended to the upper medulla and neurological findings were similar to the Wallenberg syndrome. It is important that one investigates not only axial slices but also coronal slices of MR image to estimate the extension of AICA territory infarct.

[A case of erythroleukemia found after multiple cerebral hemorrhage]

A 61-year-old man without hypertension was admitted for unconsciousness. Brain CT showed multiple cerebral hemorrhage of the left frontal lobe and right occipital lobe. The hemoglobin was 7.0 g/dl, the platelet count 7,000, the white-cell count 7,600 with erythroblasts, and the fibrinogen 327 mg/dl. No disseminated intravascular coagulation was found. Bone marrow examination demonstrated 69.2% erythroblasts including abnormal types of nucleus, 12.8% myeloblasts, 12.8% neutrophils, 0.8% monocytes, 4% lymphocytes, and 0.4% reticulocytes. Chromosomal examination showed 7 of 20 bone marrow cells were variously abnormal. A diagnosis of erythroleukemia with major karyotype aberrations (MAKA) was made. The patient died 5 days after admission. Histologically, cerebral hemorrhagic lesions showed complete necrosis, but neither invasion of leukemic cells nor amyloid angiopathy. We suspected that the cause of cerebral hemorrhage was severe loss of platelets. This is a rare case of erythroleukemia found after multiple cerebral hemorrhage. As a cause of cerebral hemorrhage in an old man without hypertension, one should consider not only cerebral amyloid angiopathy but also leukemia.

Association of angiotensin I-converting enzyme gene polymorphism with susceptibility to antiproteinuric effect of angiotensin I-converting enzyme inhibitors in patients with proteinuria

The antiproteinuric effect of angiotensin I-converting enzyme (ACE) inhibitors in patients with renal diseases of various origins has been well recognized. However, individual responses regarding the degree of decrease in urinary protein excretion appear to vary considerably. The mechanism underlying this variable response to ACE inhibitors has not been clarified yet. A possible role of ACE gene insertion/deletion (I/D) polymorphism in the responsiveness to antiproteinuric effect of ACE inhibitors is examined. Thirty-six patients with proteinuria (23 men and 13 woman; mean age, 47 +/- 13 yr) were studied. These patients were classified into two groups on the basis of the percent decrease in their urinary protein excretion: the effective group, those with a decrease in proteinuria (18 patients, -64 +/- 19%) and the noneffective group (18 patients, +13 +/- 40%). A 287-base pair (bp) I/D polymorphism in the ACE gene was examined by polymerase chain reaction. The allelic frequencies of the ACE gene were I/D = 0.53/0.47 in the effective group and I/D = 0.81/0.19 in the noneffective group. The difference in the allelic frequencies between the two groups was significant (chi 2 = 6.25, P = 0.0114 < 0.05). Furthermore, the difference in the responsiveness of proteinuria to ACE inhibition between genotype II versus genotype ID + DD was statistically significant (chi 2 = 4.05, P = 0.0442 < 0.05). There was no significant difference between the two groups with regard to initial urinary protein level, blood pressure, renal function, and daily sodium intake. The genetic susceptibility to the antihypertensive effect of ACE inhibitors was also studied, but no significant relation was observed. This study suggests the association of ACE gene I/D polymorphism with the antiproteinuric efficacy of ACE inhibitors in patients with proteinuria.

Sudden hemorrhage of the breast caused by breast cancer without skin invasion: report of a case

A rare case of sudden hemorrhage caused by breast cancer is herein presented. A 65-year-old woman was admitted to our hospital because of bleeding from her left breast. On physical examination, a continuous hemorrhage accompanied by an open cavity formation was observed in her left breast. She had no history of breast trauma. Her bleeding profile studies and liver function were both normal. In addition, no anticoagulation medication had been administered. The histological findings of the cavity wall indicated invasive ductal carcinoma without skin invasion. After carrying out chemotherapy, a standard radical mastectomy was performed.

Untreated Graves' disease patients without clinical ophthalmopathy demonstrate a high frequency of extraocular muscle (EOM) enlargement by magnetic resonance

12 of 17, a significant frequency (71%), of untreated Graves' disease patients with no clinical ophthalmopathy showed extraocular muscle (EOM) enlargement by Magnetic Resonance Imaging (MRI). Enlargement was bilateral in 41% and unilateral in 29% in these patients. Apparent enlargements of EOM were also detected, by MRI, in all of 11 Graves' disease patients with clinical ophthalmopathy, bilateral in 73% and unilateral in 27% of patients in this group. Both group showed the inferior rectus muscle as the most frequently involved (56% and 77% respectively). In 16 patients without autoimmune thyroid disorders or ophthalmopathy who served as normal controls, only 2 of these patients (12%) demonstrated mild EOM enlargement. The severity and patterns of EOM enlargement revealed no correlation with abnormalities in serum thyroid function tests or serum thyroidal autoantibodies. In conclusion, a high frequency of Graves' disease patients without clinical eye signs or symptoms harbor EOM abnormalities, as demonstrated by MRI. This suggests that present clinical examination methods are insufficient to diagnose varying degrees of ophthalmopathy in patients with autoimmune thyroid disorders who do not initially present with clinical ophthalmopathy.

Temperature-sensitive mutation of DNA polymerase alpha induces growth-suppressive phenotypes involving retinoblastoma protein and cyclin D1

Temperature-sensitive (ts) cell cycle mutant mouse cell, tsFT20, is deficient in DNA polymerase alpha activity to initiate DNA replication at replicon origins. Here, we analyzed phenotypes concerning growth control genes in the arrested tsFT20 cells. Analysis of cyclins showed that expression levels of cyclin D1, which is essential for G1/S transition, remarkably decreased in the mutant cells after temperature up-shift. Further we examined phosphorylation states of retinoblastoma protein (pRB) in the cells. Though the tsFT20 cells arrested in G1/S-S phase at nonpermissive temperature (Eki et al., (1990) J. Biol. Chem. 265 26-33), a large proportion of pRB was found as an underphosphorylated growth-suppressive form in the arrested cells. In revertant cell lines of tsFT20, pRB was not underphosphorylated even at nonpermissive temperature. The pRB underphosphorylation occurred later than the decrease of mRNA levels of cyclin D1, thus the underphosphorylation may be caused by the decrease in amount of cyclin D1 protein. These results indicated that the mutational inactivation of DNA polymerase alpha evokes phenotypes in which the inhibitory machinery of G1/S transition has been turned on.

Assignment of the 49-kDa (PRIM1) and 58-kDa (PRIM2A and PRIM2B) subunit genes of the human DNA primase to chromosome bands 1q44 and 6p11.1-p12

DNA primase is an essential replication protein that catalyzes the synthesis of oligoribonucleotide primers. DNA primase, consisting of two subunits (p49 and p58), plays a key role in both the initiation of DNA replication and the synthesis of Okazaki fragments for lagging strand synthesis. We mapped the locations of human chromosomes of the genes coding for both subunits [p49 (PRIM1) and p58 (PRIM2)] by PCR amplification using DNAs of a panel of somatic hybrids, to chromosomes 1 and 6, respectively. The PRIM1 gene was mapped to 1q44, and two PRIM2 loci (PRIM2A and PRIM2B) were detected at 6p11.1-p12 by fluorescence in situ hybridization using several genomic DNA probes.

Neoadjuvant chemotherapy with etoposide, leucovorin, 5-fluorouracil and cisplatin for advanced esophageal squamous cell carcinoma

Eighteen patients with invasive periadventitial tissue (T4) or distant lymph node metastatic (M1,LYM) squamous cell carcinoma were entered into a pilot study of neoadjuvant chemotherapy with etoposide (50 mg/m2/day, days 1-5), leucovorin (30 mg/body/day, days 2-5), 5-fluorouracil (5-FU; 400 mg/m2/day, days 2-5) and cisplatin (100 mg/m2/day, day 1) (ELFP). The overall response rate was 56%. The response rates in the T4 tumor and M1,LYM patients were 56 and 50%, respectively. Radical esophagectomies were performed on six of 17 patients who had completely recovered from the chemotherapy, a resectability of 35%. Histologically, the primary tumor was moderately to slightly effective, and the lymph nodes markedly to moderately effective. Histologic responses in the lymph nodes were different from those in the primary tumors and in each node. There were four chemo-surgically related deaths. Median survival times in responding and non-responding patients were nine and three months, respectively. In conclusion, neoadjuvant chemotherapy with ELFP appears to be effective against esophageal squamous cell cancer with periadventitial tissue invasion or distant lymph node metastasis. Chemo-surgically related deaths were however, 22%, showing neoadjuvant chemotherapy to necessitate extremely careful attention to the medical and surgical management of patients.

Automated measurement of urinary iodine with use of ultraviolet irradiation

We have modified an automated measurement system of urinary iodine (UI) and established a sensitive UI assay system by using ultraviolet (UV) digestion. The automated system is sensitive enough to detect concentrations of UI &lt; 0.78 mumol/L (&lt; 10 micrograms/dL) in a small volume of urine (500 microL). Sample throughput is &gt; 30/h, including a water washing. The within-assay imprecision (CV) was &lt; or = 10% in the UI range of 0.10-3.00 mumol/L; the between-assay CV was usually &lt; or = 15% in the same range. Analytical recovery of iodine added to urine samples was consistently &gt; 90%. The theoretical values were recovered when UV irradiation was used but not in its absence. High (supraphysiological) doses of thiocyanate or ascorbic acid, which are major interfering substances to the ceric-arsenious acid reaction, did not interfere with this system. The correlation between UI determined by this method and by the acid digestion method was linear (r = 0.994). For samples containing iodine at &lt; 1.00 mumol/L, the correlation between values by both methods was still significant (r = 0.937). UI in an iodine-deficient area in Ukraine, measured by this system, ranged from 0.06 to 1.83 mumol/L (median 0.44 mumol/L, n = 95), significantly lower than in Japan (range 0.23-50.70 mumol/L, median 4.70 mumol/L, n = 84) and consistent with mild iodine deficiency. This modified automated assay system, therefore, is useful and applicable for screening UI in inhabitants of iodine-deficient areas.

Automated measurement of urinary iodine with use of ultraviolet irradiation

We have modified an automated measurement system of urinary iodine (UI) and established a sensitive UI assay system by using ultraviolet (UV) digestion. The automated system is sensitive enough to detect concentrations of UI < 0.78 mumol/L (< 10 micrograms/dL) in a small volume of urine (500 microL). Sample throughput is > 30/h, including a water washing. The within-assay imprecision (CV) was < or = 10% in the UI range of 0.10-3.00 mumol/L; the between-assay CV was usually < or = 15% in the same range. Analytical recovery of iodine added to urine samples was consistently > 90%. The theoretical values were recovered when UV irradiation was used but not in its absence. High (supraphysiological) doses of thiocyanate or ascorbic acid, which are major interfering substances to the ceric-arsenious acid reaction, did not interfere with this system. The correlation between UI determined by this method and by the acid digestion method was linear (r = 0.994). For samples containing iodine at < 1.00 mumol/L, the correlation between values by both methods was still significant (r = 0.937). UI in an iodine-deficient area in Ukraine, measured by this system, ranged from 0.06 to 1.83 mumol/L (median 0.44 mumol/L, n = 95), significantly lower than in Japan (range 0.23-50.70 mumol/L, median 4.70 mumol/L, n = 84) and consistent with mild iodine deficiency. This modified automated assay system, therefore, is useful and applicable for screening UI in inhabitants of iodine-deficient areas.

[Cerebellar infarction in the territory of the superior cerebellar artery, presenting a predominant cerebellar symptom--with special reference to its pathophysiology]

Clinical features of cerebellar infarction in the territory of the superior cerebellar artery (SCA) were investigated in six male patients, ranging in age from 50 to 69 years. In all patients, there were MR images of infarction located in the area supplied by the SCA. The lesion was on the left-side in 2, right-side in 3 and bilateral (recurrent) in 1 patient. The onset of disease occurred with nausea, vomiting and floating sensation, with no overt brain stem signs other than symptoms of unilateral cerebellar ataxia and dysarthria. Five of the 6 patients had heart disease and cerebral angiography without definite evidence of SCA occlusion, strongly suggesting occlusion of the artery at its periphery due to cardiogenic embolism. A comparison of these 6 patients with those reported previously in Japan suggests that patients with SCA occlusion may be divided into two distinct subgroups: one manifesting diffuse brain stem signs in addition to cerebellar signs, and the other showing cerebellar signs as the only neurologic manifestation. In the former group, comprising the vast majority of patients, SCA occlusion occurred at the origin of the vessel due to a thrombus under a state of hypertension, diabetes mellitus or malignancy, producing signs of brain stem involvement, such as dissociating sensory disturbance and Horner's sign. While in the latter group, which included these 6 patients, paucity of brain stem signs, absence of definite cerebral angiographic evidence of SCA occlusion, and the presence of heart disease were distinguishing clinical features. Cardiogenic cerebral embolism was probably the underlying pathology in many of the cases and the functional prognosis was favorable.

Genetic basis of the silent phenotype of serum butyrylcholinesterase in three compound heterozygotes

Three Japanese patients showed very low butyrylcholinesterase activity in their sera and appeared to be homozygous for silent genes for butyrylcholinesterase. From DNA analysis, all three patients were compound heterozygotes: GGA(Gly) to CGA(Arg) at codon 365 (G365R) and TTC(Phe) to TCC(Ser) at codon 418 (F418S) in patient 1, G365R and CGT(Arg) to TGT(Cys) at codon 515 (R515C) in patient 2 and ACT(Thr) to CCT(Pro) at codon 250 (T250P) and AGA(Arg) to TGA(Stop) at codon 465 (R465X) in patient 3. The K-variant, GCA(Ala) to ACA(Thr) at codon 539, was also found in patients 1 and 2. Simple identification methods for all the mutations were developed and applied to family analysis and control individuals. The mutant alleles (with silent gene and K-variant) were segregated as predicted by theory in pedigrees of patients 1 and 2. Four of the mutations, F418S, R515C, T250P and R465X, were initially discovered in Japan and genetic heterogeneity among the human population for the butyrylcholinesterase gene was suggested.

[A male case of primary Sjögren's syndrome with interstitial pneumonitis and interstitial tubulo-nephritis in the absence of dry eye and dry mouth: parotid gland MRI is a useful diagnostic method for Sjögren's syndrome]

Here we report a case of primary Sjögren's syndrome with hilar lymphadenopathy, interstitial pneumonitis and interstitial tubulo-nephritis. A 60-year old man was admitted to our hospital in May 1993 because of general fatigue and fever. He was noted to have hypergammaglobulinemia and had positive antibodies to nuclear antigens since 1990 in the absence of clinical manifestations. Since 9 months before admission, he presented with general fatigue, low grade fever and uveitis. On admission, chest X-ray and CT scan showed bilateral hilar lymphadenopathy and interstitial pneumonitis. The negative results for both serum angiotensin converting enzyme and histological findings of the cervical lymph node and the lung excluded the diagnosis of sarcoidosis. Serological examination exhibited marked elevation of polyclonal IgG level and anti-nuclear antibody, but neither anti-SS-A (Ro) nor anti-SS-B (La) antibody was detected. He did not have symptoms of xerophthalmia and xerostomia. Keratoconjunctivitis sicca was diagnosed by positive Schirmer's and rose bengal tests. His labial gland biopsy demonstrated severe mononuclear cell infiltration around the ducts. MRI findings of the parotid glands revealed heterogeneous and dotted high signal intensity similar to those in fat tissues in the T1- and T2-weighted images. These findings depicted that bilateral parotid gland was extensively destructed and was replaced by lipid tissue. Renal biopsy showed interstitial tubulo-nephritis. On the basis of the above findings, he was diagnosed to have primary Sjögren's syndrome and uveitis. Therefore, MR image of the parotid gland is considered to be a noninvasive and useful method for diagnosis of Sjögren's syndrome.

Synovial chondromatosis of the temporomandibular joint

A case of synovial chondromatosis of the temporomandibular joint in a 48-year-old woman is presented. Computed tomography and magnetic resonance imaging contributed to a clear understanding of the extent of the lesion and were helpful in both surgical treatment planning and follow-up.

Recurrent Cushing's disease associated with nephrotic syndrome

A case of recurrent Cushing's disease with nephrotic syndrome due to membranoproliferative glomerulonephritis (MPGN) is presented. Functional pituitary adenoma recurred 6 years after transsphenoidal pituitary adenomectomy. Due to infiltration into the surrounding tissues, transcranial surgery was performed. However, this failed to induce a remission and thus gamma knife therapy was applied. Histopathological evaluation revealed that the glomerular lesions had progressed to a rather advanced stage of MPGN. Although this association could be coincidental, the recurrence of pituitary macroadenoma might be induced by the cessation of steroid treatment for the nephrotic syndrome.

[Hemodynamic TIA associated with severe anemia--a case report]

A 62-year-old man developed recurrent TIAs presenting as mild unconsciousness, dysarthria and weakness of the right upper extremity lasting for 15 to 20 minutes. He was found to have severe iron deficiency anemia (hemoglobin: 5.5-5.9g/dl; hematocrit: 18.4-19.5%) which insidiously developed through the chronic bleeding from the gastric ulcer. He had slight hypertension (184/86mmHg), but no orthostatic hypotension. DSA and MR angiography showed severe stenosis at the origin of the bilateral internal carotid arteries and of the left vertebral artery. There was also hypoplasia of the right vertebral artery. Blood circulation detected by 123I-IMP-SPECT was markedly decreased in the whole brain and in the right hemisphere of the cerebellum. TIA was, however, completely disappeared following to the recovery of anemia. The present case suggested that the presence of severe anemia accelerated the occurrence of hemodynamic TIA (regional cerebral anemic hypoxia), which is probably the consequence of the reduced oxygen-transporting capacity of the blood.

137Cs concentration among children in areas contaminated with radioactive fallout from the Chernobyl accident: Mogilev and Gomel oblasts, Belarus

The level of radiation exposure in children in Belarus caused by the Chernobyl accident was investigated on the basis of whole body 137Cs count. The subjects were 10,062 children (4,762 boys and 5,300 girls) in Mogilev and Gomel, Belarus, who received Chernobyl Sasakawa Health and Medical Cooperation Project health examinations from May 1991 to December 1992 and who were 5-16 y old at the time of examination. The median whole body 137Cs count per body weight varied from 21-48 Bq kg-1 and from 28-126 Bq kg-1 in Mogilev oblast and Gomel oblast, respectively. (The "oblast" is the largest administrative district constituting the country. Belarus consists of 6 oblasts). Corresponding annual effective dose equivalents were all less than the public dose limit of 1 mSv y-1, but the observed levels in the children were considerably higher than the average level of 2.3 Bq kg-1 reported in the past for the former Soviet Union.

Thyroid diseases among atomic bomb survivors in Nagasaki

OBJECTIVE

To elucidate the current thyroid disease status for the Nagasaki Adult Health Study cohort of the Radiation Effects Research Foundation.

DESIGN

Survey study.

SETTING

Nagasaki, Japan.

PARTICIPANTS

Cohort members of the Nagasaki Adult Health Study who received biennial health examinations from October 1984 to April 1987 (n = 2856). A total of 2587 subjects remained after exclusion of persons exposed in Hiroshima or in utero and those who were not in Nagasaki at the time of the bombing. Thyroid radiation dose by the dosimetry system established in 1986 was available for 1978 of the 2587 subjects.

MAIN OUTCOME MEASURES

Thyroid diseases were diagnosed using uniform procedures including ultrasonic scanning. The relationship of the prevalence of each thyroid disease with thyroid radiation dose, sex, and age was analyzed using logistic models.

RESULTS

A significant dose-response relationship was observed for solid nodules, which include cancer, adenoma, adenomatous goiter, and nodules without histological diagnosis, and for antibody-positive spontaneous hypothyroidism (autoimmune hypothyroidism) but not for other diseases. The prevalence of solid nodules showed a monotonic dose-response relationship, yet that of autoimmune hypothyroidism displayed a concave dose-response relationship reaching a maximum (+/- SE) level of 0.7 +/- 0.2 Sv.

CONCLUSIONS

The present study confirmed the results of previous studies by showing a significant increase in solid nodules with dose to the thyroid and demonstrated for the first time a significant increase in autoimmune disease among atomic bomb survivors. A concave dose-response relationship indicates the necessity for further studies on the effects of relatively low doses of radiation on thyroid disease.

Successful preoperative preparation for thyroidectomy in Graves' disease using lithium alone: report of two cases

To elucidate the effect of lithium carbonate in the preoperative preparation of patients with Graves' disease, it was given without any other antithyroid medication to two patients as an alternative to thionamide, which had caused adverse effects. The initial dose of lithium carbonate was 600 mg/day, and the final doses were 1200 and 900 mg/day, while the periods of administration were 67 and 27 days, respectively. The highest serum concentrations of lithium during the administration period were 0.83 and 0.43 mEq/l, respectively. This preoperative preparation lowered serum thyroid hormone levels and clinical improvement. A subtotal thyroidectomy was performed uneventfully in both patients, after which the serum lithium levels decreased rapidly and the thyroid hormone levels increased only slightly for a few days. No adverse effects of lithium carbonate were observed. Thus, we conclude that the administration of lithium carbonate alone is an effective and safe method for the preoperative management of Graves' disease when conventional antithyroid drugs show adverse effects.

Personal computer-based small PACS for radiotherapy--analog image filing system for radiotherapy

The purpose of this study is to evaluate the usefulness of a personal computer-based small PACS using analog video images. The analog video recorder, personal computer, and display monitor constitute our system. An analog video recorder is composed of a laser disk recorder for still images and a video cassette recorder for moving images. The acquired video images are managed by a personal computer and database software. The serial communication ports of the personal computer and a video recorder are connected with the reverse cable, and the video recorder is controlled by the personal computer using our program. This system enables filing of multi-modality images including moving images and is used for following up and treatment planning of the patients who received radiotherapy.

Identification of a point mutation in the cDNA of the catalytic subunit of DNA polymerase alpha from a temperature-sensitive mouse FM3A cell line

DNA polymerase alpha is a key enzyme in eukaryotic chromosomal DNA replication. tsFT20 is a temperature-sensitive mutant cell line derived from mouse mammary carcinoma FM3A cells, and the cells contain heat-labile DNA polymerase alpha and are arrested at the S phase at the nonpermissive temperature. We isolated cDNA of the catalytic subunit of DNA polymerase alpha from tsFT20 cells. DNA sequence analysis revealed that the cDNA from tsFT20 has a single mutation, a cytosine to thymine substitution that changes amino acid 1180 from serine to phenylalanine. We have also shown that tsFT20 cells could be rescued by transfection with the wild-type cDNA. These results demonstrate that the point mutation in the gene of DNA polymerase alpha causes the temperature-sensitive phenotype of tsFT20 cells and provide additional evidence that DNA polymerase alpha is essential for chromosomal replication in mammalian cells. We also detected mutation sites in one spontaneous and six N-methyl-N'-nitro-N-nitrosoguanidine-induced growth revertants of tsFT20 cells by single strand conformation polymorphism analyses and direct sequencing. All revertant cell lines had a second point mutation adjacent to the first mutation site in tsFT20 cells.

[Advanced breast cancer with remarkable response to the combination therapy of mitoxantrone (MIT) and medroxyprogesteron acetate (MPA) after failure of anthracycline therapy: a case report]

A 67-year-old advanced breast cancer patient with multiple bone metastases showed a remarkable response to the combination therapy of mitoxantrone (MIT) and medroxyprogesteron acetate (MPA) after failure of anthracycline therapy. Eight course of CTF (cyclophosphamide, THP-adriamycin, 5-fluorouracil) and subsequent 4'-epi-adriamycin were performed for locally advanced breast cancer and multiple bone metastases, but the ulcerated breast cancer enlarged. Then the combination therapy of MIT (10 mg/day) and MPA (1,200 mg/day) was carried out. Seven months after treatment, the ulcerated breast cancer disappeared completely and the serum levels of CA 15-3, TPA and CEA decreased within the normal range. These results suggest that combination therapy with mitoxantrone may well be effective against the anthracycline-resistant breast cancer.

Peripheral blood T cell subsets as a prognostic factor in gastric cancer

The present study was carried out to find out whether or not peripheral blood T cell subsets predict the prognosis of a gastric cancer patient preoperatively. In this retrospective study, we used preoperative T cell subset data from 34 patients with advanced gastric cancer who had been treated by resection. T cell subsets were measured by single color flow cytometry before surgery. Multivariate analysis, using the Cox proportional hazard model, was adjusted to the CD3 cell count, disease stage, the CD16 cell count and the CD4/CD8 ratio, and suggested CD3 cell count (chi 2 = 4.95, P = 0.026) and disease stage (chi 2 = 9.32, P = 0.002) to be statistically the most independent prognostic factors. Using the hazard ratio, the relative risks of the worst versus the best prognosis were 24.3 for the CD3 cell count and 10 for disease stage. For patients with more than 1483 CD3 positive cells, a longer than average survival time can be expected. The prospective hazard ratio (lambda (t)/lambda 0(t)) of an arbitrary gastric cancer patient can be calculated using the following expression: log(e) (lambda (t)/lambda 0(t)) = -0.00127 (CD3 cell count-1483) +2.31186 (Stage-0.606), where Stage III is assigned a value of 0 and Stage IV a value of 1. The survival curve of an arbitrary gastric cancer patient can also be predicted.

Interferon-gamma inhibition of human thyrotropin receptor gene expression

To evaluate the role of interferon-gamma (IFN gamma) on human thyroid-specific gene expression, the effect of IFN gamma on TSH- and cAMP-induced TSH receptor gene expression was studied using cultured thyroid cells obtained from normal thyroid glands and those from patients with Graves' disease. Incubation of Graves' thyroid cells with 1.0 U/L bovine TSH or 1.0 mM 8-bromo-cAMP resulted in a 2-fold increase in TSH receptor mRNA expression, which was markedly inhibited in the presence of IFN gamma in a dose- and time-dependent manner. This inhibitory effect was completely neutralized by monoclonal antibody against IFN gamma. IFN alpha and -beta had no influence on TSH- and cAMP-stimulated TSH receptor mRNA expression. Paranodular normal thyroid cells showed the same results as those obtained using Graves' thyroid cells. Scatchard analysis of the [125I]TSH binding study showed that IFN gamma inhibited the number of TSH receptors up-regulated by TSH on the cell surface at the low affinity binding site (4.1 vs. 8.2 x 10(5)/cell). These results indicate that IFN gamma suppresses TSH- and cAMP stimulated human TSH receptor gene expression, resulting in a decrease in the number of TSH receptors. In conclusion, IFN gamma interacts via an intermediate pathway of TSH signal transduction and attenuates TSH receptor synthesis in normal and Graves' thyroid cells.

Esophageal ulceration following high-dose-rate intraluminal brachytherapy for esophageal cancer

Prophylaxis of esophageal ulceration was studied in 78 esophageal carcinoma patients after high-dose-rate intraluminal brachytherapy. Before the standard treatment regimen of radiotherapy was established, 15/17 patients developed ulcers. This decreased to 19/38 with the standard treatment regimen, and to 9/23 when antiulcer therapy was added (p < 0.01).

Effects of phorbol ester on protein kinase C activity and effects of depletion of its activity on thyrotrophin, forskolin and 8'-bromoadenosine 3',5'-cyclic monophosphate-induced [3H]thymidine incorporation in rat FRTL-5 cells

Protein kinase C (PKC) activity was measured in rat FRTL-5 cells cultured in medium containing insulin and transferrin (2H medium), in cells treated with phorbol 12,13-dibutyrate (PDBu), an activator of PKC, and in cells treated with 4 alpha-12,13-phorbol didecanoate (4 alpha-PDD), an inactive phorbol ester, in order to study the translocation and down-regulation of its activity. Provided the PDBu induced translocation and down-regulation of PKC activity, we used the down-regulated cells to study the roles played by PKC in DNA synthesis induced by stimuli which increase cyclic AMP (cAMP) and a cAMP analogue. Cytosolic preparations obtained from cells cultured in 2H media were fractionated on a DEAE-cellulose column, and fractions were assayed for PKC activity. PKC activity was eluted at concentrations between 0.06 and 0.15 mol NaCl/l with a peak at 0.1 mol/l. Exposure of cells to PDBu (100 ng/ml) resulted in 53% loss of initial PKC activity in the cytosolic fraction in concert with reciprocal augmentation of PKC activity in the particulate fraction that peaked at 321% of the initial level at 15 min of exposure. When cells were stimulated with 100 ng PDBu/ml for 15 min, three- and 1.9-fold greater PKC activity appeared in the particular and total cellular (cytosol plus particulate) fractions respectively than was the case for stimulation with 10 ng PDBu/ml. The total cellular PKC activity transiently increased at 15 min to 137% and subsequently decreased to 74, 40 and 25% of the initial level at 1, 12 and 24 h respectively. However, translocation of PKC activity to the particulate fraction was not observed in cells treated for 15 min with either 10 or 100 ng 4 alpha-PDD/ml and total cellular PKC activity was modestly reduced, to 97% of the initial level in cells exposed to 4 alpha-PDD (100 ng/ml) for 24 h. [3H]Thymidine incorporation was measured in cells whose PKC activity was stimulated by TSH, forskolin or 8-bromoadenosine cAMP simultaneously with PDBu (100 ng/ml), and also in cells whose PKC activity had been down-regulated by pretreatment with PDBu prior to the addition of each stimulant. The [3H]thymidine incorporation induced by each of the stimulants was inhibited in cells whose PKC activity was subjected to simultaneous stimulation, but was enhanced in cells whose PKC activity had previously been depleted. This potentiating effect of PDBu pretreatment on subsequent TSH-induced [3H]thymidine incorporation was not observed in cells exposed to PDBu for less than 12 h, but was observed in cells exposed for 24 h or longer.(ABSTRACT TRUNCATED AT 400 WORDS)

Long-term follow-up studies on iodine-131 treatment of hyperthyroid Graves' disease based on the measurement of thyroid volume by ultrasonography

In the present series of studies, the long-term (four year) effect of 80 Gy of 131I treatment was evaluated in patients with hyperthyroid Graves' disease whose thyroid volumes have been accurately estimated with a high resolution ultrasound scanner. One year after 131I treatment, 23.1% (3 out of 13 patients) remained hyperthyroid, 69.2% (9 out of 13) became euthyroid, and 7.7% (1 out of 13) were in a hypothyroid state. Since three patients in a hyperthyroid state one year after treatment were subsequently treated with either antithyroid drugs or additional 131I treatment, the remaining ten patients (9 euthyroid and 1 hypothyroid patients) have been followed up for three more years. Two patients developed a hypothyroid state three years after treatment and one patient four years after treatment. Overall, 60% (6 out of 10 patients) were in a euthyroid state and 40% (4 out of 10) in a hypothyroid state, four years after 80 Gy 131I treatment. There was no significant difference between eu- and hypothyroid groups in the sex ratio, age, radiation dose, therapeutic dose, thyroid gland volume, 24-hr 131I uptake, the effective half-life of 131I in the thyroid or the duration of hyperthyroidism. In our preliminary studies, the incidence of late hypothyroidism in our 131I treatment is similar to those previously reported. These suggest that uncertain factor(s), such as inhomogeneity of iodine distribution in the thyroid, unequal sensitivity of the thyroid cells to the radiation, and/or persistent destructive effects of the autoimmune process may influence the long-term effect of 131I treatment of Graves' disease.

Molecular cloning of the cDNAs for the four subunits of mouse DNA polymerase alpha-primase complex and their gene expression during cell proliferation and the cell cycle

The DNA polymerase alpha-primase complex purified from mouse FM3A cells is composed of four polypeptides with molecular masses of 180, 68, 54, and 46 kDa. The largest subunit has DNA polymerase activity, the two smallest subunits have DNA primase activity, and the function of the 68-kDa subunit is unknown. We have isolated the cDNAs of the four subunits by low stringency hybridization and reverse transcription polymerase chain reaction and determined their nucleotide sequences. The predicted amino acid sequence of the 180-kDa subunit shows 88, 38, 34, and 32% identity to those of the catalytic subunits of human, Drosophila melanogaster, Schizosaccharomyces pombe, and Saccharomyces cerevisiae DNA polymerase alpha, respectively, and contains seven regions whose orders and sequences are highly conserved among viral and other eukaryotic DNA polymerases. The deduced amino acid sequence of the 68-kDa subunit shows 25% identity to that of the 73-kDa subunit of D. melanogaster DNA polymerase alpha-primase, shows no significant sequence similarity to any other protein in the data bases, but contains a potential phosphorylation site(s) for cdc2 kinase. The amino acid sequence of the 54-kDa subunit shows 32% identity to that of the large subunit of S. cerevisiae DNA primase. During activation of quiescent Swiss mouse 3T3 cells to proliferate, the levels of mRNA of the four subunits of the DNA polymerase alpha-primase complex increased before DNA synthesis. In growing mouse FM3A cells, the transcripts of the four subunits are present throughout the cell cycle and increase slightly prior to the S phase.

Characterization of serum alpha 1-acid glycoprotein in fetal and newborn calves during development

Serum alpha 1-acid glycoprotein (alpha 1-AG) in bovine fetuses and newborn calves was characterized. Serum alpha 1-AG concentration increased during fetal development and neonatal stages. Mean +/- SD serum alpha 1-AG concentration reached a peak of 1,368 +/- 207 micrograms/ml immediately after birth, but thereafter gradually decreased to 249 +/- 100 micrograms/ml, similar to the normal adult bovine range. By use of isoelectric focusing of thin-layer gels, we detected 7 microheterogeneity bands ranging from pI 3.2 to 3.8 in adult bovine serum. Twelve bands ranging from pI 2.6 to 3.8 were found in 9-month fetuses and in neonates. The 5 most-acidic bands, which are absent in adult serum, ranged between pI 2.6 and 3.1 and decreased with maturation as band patterns assumed adult characteristics. By crossed affinity electrophoresis, alpha 1-AG of adult bovine serum was separated into 4 peaks according to its differential affinity to concanavalin A (conA). Seventy-five percent of the alpha 1-AG concentration was represented by peak 3 (P-3) and peak 4 (P-4), which had moderate or strong binding to conA. In contrast, fetal sera contained only peak 1 (P-1), which did not have conA-binding affinity. In neonatal sera, 4 peaks were recognized, of which P-1 comprised 70% of the total alpha 1-AG. Thereafter, with aging, percentage of P-3 and P-4 increased as band composition approached the normally expected adult pattern.

The influence of age and health status on the serum alpha 1-acid glycoprotein level of conventional and specific pathogen-free pigs

Serum alpha-1-acid glycoprotein (alpha 1AG) was measured in 212 Landrace White pigs between birth and finishing age. The alpha 1AG level of healthy pigs five to ten months of age was 338 +/- 79 micrograms/mL, and the upper normal limit in mature swine has been established as 500 micrograms/mL. In both specific pathogen-free (SPF) and conventional pigs, the alpha 1AG level within one day of birth was 14,263 +/- 2,393 micrograms/mL, 40 times the normal adult value, but rapidly decreased to 699 +/- 186 micrograms/mL by four weeks of age. In conventional pigs, alpha 1AG began to increase after four weeks, averaged 1,428 micrograms/mL by eight weeks, but gradually decreased to adult levels by 20 weeks of age. In comparison, alpha 1AG of SPF pigs was only 800 micrograms/mL at eight weeks and decreased more rapidly to normal by 16 weeks of age. The conventional pigs had a high incidence of clinical pneumonia and specific antibodies to Actinobacillus pleuropneumoniae and Mycoplasma hyopneumoniae at the age of eight weeks. As the clinical pneumonia disappeared, serum alpha 1AG level also gradually declined. In contrast, SPF pigs had little clinical illness, low alpha 1AG, and little serological evidence of microbial infection. Conventional pigs with nonrespiratory infections, encephalitis, or with hernias had increased alpha 1AG. While the very high alpha 1AG level of the neonatal pig may be due to genetic influences, increases later in life are likely in response to stimuli from its external environment. Monitoring of serum alpha 1AG in several herds aided in the recognition of disease processes and may have potential use in swine herd health management.

Evidence of thyroid volume increase in normal subjects receiving excess iodide

A prospective study was conducted on 10 normal male volunteers to investigate the effect of the administration of excess iodide on thyroid volume. After 1 week of dietary iodide restriction, all subjects were given daily oral doses (27 mg daily total iodine dose) of licorice lecithin-bound iodine tablets for 4 weeks. Thyroid function studies, total serum iodine concentration, and urinary iodine excretion were monitored. Thyroid volume was measured by high resolution echoscanner before treatment, on the day of the last treatment, and 1 month after the treatment. There was a significant rise in serum TSH levels, with a small decline in serum free T4 concentration during iodide administration; the values remained within the normal range except for two subjects. Serum thyroglobulin levels were increased in parallel with serum TSH levels, which became higher than normal after 1 week of treatment. The volume of the thyroid gland became significantly enlarged after 28 days of iodide intake. When iodide was discontinued, thyroid volume and function returned to baseline levels within 1 month for all subjects. This is the first documentated objective evidence that the compensatory rise in serum TSH in response to iodide administration elicits reversible thyroid hypertrophy in normal subjects.

Modulation of pituitary insulin-like growth factor-I bindings in rats bearing somatomammotrophic tumors

To clarify the hormonal regulation of pituitary insulin-like growth factor-I (IGF-I) bindings, we examined the continuous effect of growth hormone (GH) on [125I] IGF-I binding sites, using rats bearing transplantable GH-secreting rat pituitary tumor cells. A total of 24 female Wistar-Furth rats (4-week old) was divided into four groups (n = 6). The first group rats were control (C). The second group rats were injected subcutaneously with 3 x 10(6) GH3 pituitary tumor cells (GH). The third group rats were thyroidectomized (Tx) and the fourth were dual-treated (GHTx). The brain, pituitary gland, liver, and kidney were immediately subjected to quantitative receptor autoradiography after a 4-week treatment period. Using kinetic experiments, GH rats had higher Bmax values of specific [125I] IGF-I binding sites in the anterior pituitary gland and Tx rats had lower Bmax values than control rats. Two-way analysis of variance among the 4 groups was examined. The effects of both GH and Tx treatment on [125I] IGF-I binding Bmax were observed only in the anterior pituitary gland and not in the other tissues examined. There were no differences in the Kd values of the binding sites. These data indicate that continuous GH excess selectively up-regulates the number of pituitary IGF-I binding sites in vivo, and that this may play a role in feedback regulation of the GH-IGF-I axis.

Overexpression of the intact thyrotropin receptor in a human thyroid carcinoma cell line

Although thyrotropin is known to regulate thyroid cell differentiation and proliferation, human thyroid carcinoma cells are relatively insensitive or resistant to TSH stimulation. The expression levels of TSH receptor are significantly lower in carcinoma tissues than in normal tissues. Furthermore, in vitro human thyroid cell growth is not regulated by TSH itself. We, therefore, isolated neomycin-resistant stable human thyroid carcinoma cell (WRO cell) transfectants overexpressing intact human TSH receptor to evaluate the functional role of TSH receptor on carcinoma cells. Southern blot analysis confirmed incorporation and amplification of human TSH receptor complementary DNA sequences into genomic DNA. Northern gel analysis and reverse transcriptase-polymerase chain reaction analysis revealed the presence of specific TSH receptor messenger RNA (4.0 kilobases), and the specific binding and the affinity of [125I]TSH on stably transfected WRO cells were demonstrated compared to wild type. Nevertheless, impaired cAMP production to transfectants by TSH was observed. cAMP production was confirmed after stimulation of both wild type and transfectants by forskolin, cholera toxin, and isoproterenol. In contrast, TSH could affect the cytoplasmic calcium mobilization immediately after the addition of TSH to WRO transfectants. These results suggest that the impairment of TSH action on human thyroid carcinoma cells is not due to a major structural abnormality of the TSH receptor, reduction in the receptor number, or receptor affinity, but much more likely due to a TSH receptor-guanyl nucleotide-binding protein coupling defect.