[A study of the relationship between diabetic neuropathy and diabetic retinopathy]

To evaluate the relationship between diabetic neuropathy and retinopathy, we examined autonomic nervous function, postural hypotension, nerve conduction velocity and coefficient of variation of R-R intervals. Forty-five non-insulin dependent diabetic cases were classified as no diabetic retinopathy (group A), simple diabetic retinopathy (group B) and proliferative diabetic retinopathy (group C). These groups did not differ in age or gender. The rate of postural hypotension (depression of systolic blood pressure over 30 mmHg) was 0% in group A, 7% in group Bs and 53% in group C. Nerve conduction velocity in both motor and sensory nerve was delayed over 20% in 0% of group A, 8% of group B, and 33% of group C. In CVR-R, 11% of group A and 7% of group B were decreased, and 44% (during rest) and 33% (during deep breathing) of group C was decreased. Between groups A and B there was no statistical difference. But group C had statistically significant difference from other groups, particularly in postural hypotension. Peripheral neuropathy might be closely related to diabetic retinopathy.

Erythema nodosum-like eruption in sarcoidosis

Two cases of sarcoidosis with tender, erythematous nodules on the legs are reported. The cutaneous lesions were clinically similar to those of erythema nodosum, but histologically showed non-caseating epithelioid granulomas. A review of 14 cases of this particular sarcoid eruption reported in Japan showed that 13 had ocular involvement as in our cases. In the light of the high frequency of ocular involvement, a skin biopsy should be considered in patients presenting with erythema nodosum-like eruptions situated on the legs.

Cadherins in cutaneous biology

The role of cadherins in cutaneous biology has focused mainly on the classical cadherins, E- and P-cadherin. In this review, roles for cadherins in skin morphogenesis, keratinocyte differentiation, and cancer metastasis are discussed. E-cadherin is expressed on the surfaces of whole epidermal layer cells, and P-cadherin is expressed only on the surfaces of basal cells. Ultrastructural studies have shown that E-cadherin is distributed on the cytoplasmic membranes of keratinocytes with a condensation in the intercellular space of the desmosomes. During human skin development, P-cadherin expression is spatiotemporally controlled and closely related to the segregation of basal layers as well as to the arrangement of epidermal cells into eccrine ducts. In human skin diseases, E-cadherin expression is markedly reduced on the acantholytic cells of tissues in pemphigus and also in Darier's disease. Keratinocytes cultured in high calcium produce a much more intense immunofluorescence of intercellular E- and P-cadherin than do cells grown in low calcium. Ultrastructural studies show that E-cadherin on the cytoplasmic membrane of the keratinocytes is shifted to desmosomes under physiological conditions and therein expresses an adhesion function is association with other desmosomal cadherins. Cell adhesion molecules are now considered to play significant roles in the cellular connections of cancers and metastatic cells. Reduced expression of E-cadherin on invasive neoplastic cells has been demonstrated for cancers of the stomach, liver, breast, and several other organs. This reduced expression of E-cadherin is observed in squamous cell carcinoma and Paget's disease. Soluble E-cadherins in sera are elevated in various skin diseases, including bullous pemphigoid, pemphigus vulgaris and psoriasis, but not in patients with burns. Markedly high levels in soluble E-cadherin are demonstrated in patients with metastatic cancers.

The epitope for anti-type VII collagen monoclonal antibody (LH7:2) locates at the central region of the N-terminal non-collagenous domain of type VII collagen

The monoclonal antibody LH7:2, which recognizes type VII collagen, is now used in the diagnosis and prenatal diagnosis of epidermolysis bullosa dystrophica. We constructed the expression vector which contains the cDNA fragment of type VII collagen. Western blot with LH7:2 was carried out with the resultant fusion proteins which overlap each other, and we found that reactivity is located in the central region of the N-terminal non-collagenous domain of type VII collagen, at a position 81 kDa upstream from the collagenous domain. This epitope mapping for LH7:2 may be useful in studying the role of type VII collagen in epidermolysis bullosa dystrophica.

Ultrastructural localization of E-cadherin cell adhesion molecule on the cytoplasmic membrane of keratinocytes in vivo and in vitro

We examined the ultrastructural localization of E (epithelial)-cadherin cell adhesion molecules by immunoperoxidase electron microscopy on the epithelium of mouse intestine, epidermis of human skin, and cultured human keratinocytes. The in vivo studies demonstrated that E-cadherin was present at the intermediate junction but not at the desmosome of the mouse intestinal single epithelium, and was found on the cytoplasmic membranes of keratinocytes with condensation in the intercellular space of the desmosomes, except for the basal surface of the basal cells. In vitro studies demonstrated that keratinocytes cultured in medium containing a low Ca2+ concentration (0.1 mM) lacked the tight connection through desmosomes, and that E-cadherin showed diffuse distribution and dot-like accumulation around the free surface of the cytoplasmic membrane. In culture medium containing a high concentration of Ca2+ (0.6 mM), keratinocytes formed desmosomal adhesion structures in which E-cadherin was accumulated. The free surface of the keratinocytes in this medium showed weaker distribution and a lesser amount of dot-like accumulation of E-cadherin than that in a low Ca2+ condition. These findings suggest that the distribution pattern of the E-cadherin cell adhesion molecules on the keratinocytes is different from that on the single epithelium of the intestine, and that E-cadherin on the cytoplasmic membrane of the keratinocytes shifts to the desmosomes under physiological conditions, participating in adhesion in association with other desmosomal cadherins.

Congenital myotonic dystrophy transmitted from an asymptomatic father with a DM-specific gene

We present the first report of paternal transmission of congenital myotonic dystrophy (DM). The patients had typical congenital DM and showed unstable CTG repeats on Southern blot analysis. The mother had no expansion of the DM gene, but the asymptomatic father had minimal expansion of the CTG repeats.

Effect of botulinum C3 exoenzyme on cell growth and cytoskeleton organization in transformed human epidermal cells in culture: a possible role for rho protein in epidermal cells

We examined the role of rho gene products (rho proteins) on cell growth and cytoskeleton organization in transformed human epidermal cells in culture (HSC-1), using recombinant botulinum C3 exoenzyme which specifically ADP-ribosylates rho proteins. Incubation of HSC-1 cell lysates with C3 exoenzyme revealed a single [32P]ADP-ribosylated protein with a molecular weight of 23,000. This protein was identified as rhoA protein by isoelectric focusing (pI 6.0). Addition of C3 exoenzyme to the culture medium of HSC-1 cells changed the shape of HSC-1 cells to a round form with beaded processes in a time- and dose-dependent manner. Moreover, C3 treatment reduced the cell growth rate; 72-h treatment with C3 exoenzyme at 1, 3, 10, 30 and 60 micrograms/ml culture medium resulted in 9.0 +/- 1.8%, 20 +/- 2.9%, 26 +/- 2.3%, 50 +/- 1.4% and 40 +/- 2.0% inhibition of the growth rate relative to controls, respectively. Under this condition, actin stress fibers were disassembled, as revealed using fluorescent-labeled phallacidin, whereas keratin intermediate filaments were not affected, visualized by immunofluorescence using anti-keratin antibody. These results suggest that rho proteins are closely related to cell growth and that these proteins regulate, at least in part, the assembly of actin stress fibers in transformed human epidermal cells.

[Clinical evaluation of controlled hypotensive anesthesia with MR7S1]

Efficacy, safety and the optimal dose of MR7S1, an injectable preparation of sodium nitroprusside, were studied in 37 patients (ASA class I and II) under nitrous oxide-oxygen-enflurane anesthesia. MR7S1 was administered by intravenous infusion. The dose of MR7S1 was increased gradually starting from 0.25 micrograms.kg-1.min-1 to the dose which could achieve the target value of systolic blood pressure (80-100 mmHg). Thereafter this dose level was maintained. During the period in which the dose was increased, the blood pressure was reduced in proportion to the rate of administration. With the rate of administration of 1.0 to 3.0 micrograms.kg-1.min-1, a significant decrease in systolic blood pressure (SBP) was observed compared with the pretreatment level of SBP. During the maintenance period, the SBP was maintained around 80 to 100 mmHg at a rate of administration of 0.25 to 3.5 micrograms.kg-1.min-1. Two out of 37 patients showed a slight decrease in PaO2, but these values returned to normal without any treatment. These findings suggest that MR7S1 is a useful agent to control blood pressure for the hypotensive anesthesia.

Postinflammatory bronchiectatic cavity observed by fibreoptic bronchoscopy

A 55 year old female, complaining of bloody sputum and fever, was referred to our institution. The chest roentgenogram on admission revealed a large thin-walled cavitary shadow in the right upper lobe. We could clearly observe the inner surface of the postinflammatory bronchiectatic cavity in the right B3 bronchus by fibreoptic bronchoscopy. This is the first case in which interesting bronchoscopic findings of a bronchiectatic cavity could be directly observed.

Construction of plasmids useful for production of the B subunit of cholera toxin from Vibrio cholerae or a heat-labile enterotoxin from enterotoxigenic Escherichia coli

A simple method to construct the plasmids producing the B subunit of porcine or human heatlabile enterotoxin or cholera toxin was developed, and the B subunits produced by the resulting plasmids were purified. The gene of LTp from pEWD 299 was ligated to pHSG 396 or pBluescript SK(+)-1 and the vector carrying one Xbal and EcoR1 site in the LTp-A gene was constructed. The Xbal-EcoR1 fragment of LTp-A gene was exchanged for the multicloning site of pHSG 396 containing Xbal, BamH1, Cla 1, Kpn1, Sac1 and EcoR1 sites. This plasmid (pTSU28) produced the LTp-B subunit. Moreover, the fragment of the LTp-B gene of pTSU 28 was exchanged by the EcoR1-HindIII fragment of LTh-B from E. coli H10407 strain (pTSU 35) or by the Cla 1-Hind III fragment of CT-B gene amplified by the PCR procedure with the chromosomal DNA of V. cholerae 86KT25 (pTSU 32). The DNA sequence of the CT-B subunit amplified by PCR procedure was compared and found identical to that cited in the literature [11]. After these plasmids were transformed into E. coli MV 1184 strain, the toxins produced by them were purified using a Bio-Gel A 5m affinity column for both LT-Bs and an immunobilized D-galactose affinity column for CT-B. Though both columns absorbed only the B subunit, the eluates contained a single protein corresponding to the B subunit, suggesting that each mutant produces only the B subunit.

Mutations in ras genes in cells cultured from mouse skin tumors induced by ultraviolet irradiation

Mutations in ras oncogenes were detected in cultured cells of mouse skin tumors induced by near-UV irradiation. DNA extracted from the UV-induced tumor cells was transfected to golden hamster embryo cells, and focus-forming ability was confirmed in 22 of 26 cell strains, 15 of which had the repetitive mouse sequence. Mouse ras genes were detected in 10 of these 22 cell strains. Point mutations in the ras genes were at Ha-ras codon 13 (GGC-->GTC in two strains, GGC-->AGC in one strain), Ki-ras codon 61 (CAA-->GAA in two strains), and N-ras codon 61 (CAA-->CAT in two strains, CAA-->AAA in two strains). In one tumor cell strain no base change was directed. Most mutations occurred at dipyrimidine sites. Pyrimidine dimers or pyrimidine(6-4)pyrimidone photoproducts are the likely cause of the skin cancers. The base change occurred preferentially at G.C base pairs, and transversions predominated.

Quantitative evaluations of male pattern baldness

Several methods for the evaluation of hair growth have been reported; however, none of the hitherto reported methods are satisfactory as unbiased double blind studies to evaluate the efficacy of hair growth agents. In the present paper, we describe quantitative evaluation methods for hair growth by measuring the anagen ratio and hair diameters in 56 Japanese subjects aged 23-56 for 3 years. The average anagen ratio decreased by 3.8% in 3 years. The average hair diameters showed a statistically significant decrease each year totalling 3.4 microns. Subjects were sorted according to their anagen ratio into 4 groups. Each group showed different distribution patterns of hair diameters. The higher anagen ratio group has a high frequency peak at thicker hair diameters and the lower anagen ratio group has a high frequency peak at thinner hair diameters. The number of thicker hairs decreased and the high frequency peak shifted to thinner hair diameters in 3 years. These methods are useful to evaluate both the progression of male pattern baldness and the effects of hair growth agents with double blind studies in an unbiased quantitative fashion.

Formation of 8-hydroxy-2'-deoxyguanosine in epidermis of hairless mice exposed to near-UV

Six-week-old male albino hairless mice (Hos: Hr-1) were exposed to a near-ultraviolet (UV) fluorescent sun lamp (33.5 kJ/m2/hr; wave length > 270 nm with a peak at 312.5 nm) to investigate the induction of oxidative DNA damage in epidermal cells. Significantly higher levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) were detected in a dose-dependent manner in epidermis of mice exposed to near-UV than in those of control animals. The ratio of 8-OHdG in near-UV-exposed/unexposed control was 2.08 +/- 0.19 after 168 kJ/m2 exposure, P < 0.01; 3.49 +/- 0.36 after 335 kJ/m2 exposure, P < 0.01 (means +/- SE). The levels of 8-OHdG decreased with time after near-UV exposure, suggesting the presence of removal and/or repair mechanisms. This is the first report that oxidative DNA base modification is induced in vivo in epidermal cells by near-UV exposure. Oxidative DNA base modification may be one of the causes of sunlight-induced skin carcinogenesis.

Two collagen-binding proteins, osteonectin and HSP47, are coordinately induced in transformed keratinocytes by heat and other stresses

pSE48 was one of six clones selected by differential colony hybridization as a cDNA coding for mRNA expressed in parietal endoderm-like F9 cells and not in primitive endoderm-like F9 cells. It was sequenced and identified as a segment of mouse osteonectin (SPARC) cDNA. We found osteonectin to be heat-inducible in some cells. Expression and secretion of osteonectin were then investigated using mouse (Pam 212) and human (HSC-1) keratinocyte cell lines. Both the mRNA levels and the secretion of osteonectin increased concurrently when Pam and HSC-1 cells cultured in low calcium medium were exposed to various stresses including heat shock and treatment with sodium arsenite or L-azetidine-2-carboxylic acid. Another collagen-binding stress protein, HSP47, was also found to be expressed, synthesized, and stress-inducible in the keratinocyte cell line. The degree of HSP47 induction by various stresses was not so prominent as that of HSP70 but greater than that of osteonectin. The time courses of osteonectin and HSP47 induction by heat shock were similar to each other and distinct from HSP70; they were slower and more persistent than HSP70. We identified a heat shock element-like sequence in the promoter region of the mouse and bovine osteonectin genes. This sequence might participate in the stress induction of osteonectin. Thus, osteonectin and HSP47 share another common feature, stress-inducibility, as well as collagen-binding capacity and inducibility through differentiation, although they are quite distinct in their amino acid sequence and distribution.

Giant metastatic malignant melanoma with an unknown primary site

We report a case of malignant melanoma of unknown primary origin which presented with a giant metastatic tumor in his right inguinal region. A 94-year-old man noticed a small subcutaneous tumor in the right inguinal region 3 years earlier, which eventually became as larger as 9 cm in diameter without treatment. Although a histological examination of the lesion showed malignant melanoma, extensive examination did not reveal its primary lesion or any metastasis other than that to the right inguinal area. Our case took an interesting course in that this well-growing metastatic tumor was localized in only one region and supported a previous report indicating that malignant melanoma with unknown primary origin has a low tendency to metastasize and a relatively good prognosis.

The role of CD4+ and CD8+ cells in normal F1 hybrid host in the resistance to lethal graft-versus-host disease induction by transfer of parent spleen cells

Transfer of a certain number of C57BL/6 (B6) spleen cells into (BALB/cxB6)F1 (CB6F1) nu/nu mice, which are deficient in T cells, causes lethal graft-versus-host disease (GVHD) in the recipients. However, when normal CB6F1 mice are used as recipients, lethal GVHD does not occur. Using this lethal GVHD system, we investigated which roles CD4+ and CD8+ T cells play in the resistance to lethal GVHD induction by parent cell transfer in the normal F1 hybrid host. Lethal GVHD induction by B6 spleen cells in CB6F1 nu/nu mice was blocked by prior reconstitution of the recipients with normal syngeneic spleen cells. In addition, all nu/nu mice reconstituted with syngeneic CD8+ spleen cells developed lethal GVHD, whereas none of the nu/nu mice reconstituted with CD4+ cells did. Both spleen weight and number of spleen cells in the former prominently decreased in contrast to the slight increase (peak at 15 weeks) seen in the latter after transfer of donor spleen cells. H-2Dd- Thy1.2+ cells, which are considered to derive from donor B6 T cells, existed in the spleen from the CD4+ spleen cell-reconstituted GVHD mice, peaking at 5 weeks then gradually decreasing after transfer of donor cells. However, they disappeared in the normal spleen cell-reconstituted GVHD mice 5 weeks later. These findings suggest that CD4+ cells in the normal F1 hybrid host play a critical role in the resistance to lethal GVHD induction by parent spleen cell transfer, although CD8+ cells are required for the prompt elimination of donor cells.

Immunological characterization of tumor-rejection antigens on ultraviolet-light-induced tumors originating in the CB6F1 mouse

Six ultraviolet-light(UV)-induced tumors of (BALB/c x C57BL/6)F1 (H-2d/b) mouse origin were analyzed for the effector T cell subsets involved in tumor rejection, the MHC class I to which cytolytic T lymphocytes (CTL) are restricted, and the effect of UV radiation on tumor rejection, to characterize their tumor-rejection antigens (TRA) recognized by CTL. All tumors were rejected in syngeneic normal mice but grew progressively in nude mice. CD8+ T cells mediated the antitumor responses for all tumors and CD4+ T cells could also do so for one tumor 6.1B. Each tumor induced potent CTL that recognized the specific TRA in preferential association with MHC class I haplotypes not from H-2b but from H-2d; that is, Kd, Dd or Ld. Profiles of TRA expression on two tumors were obtained by the analyses of their antigen-loss variants. Female 1A codominantly expressed at least four distinct TRA associated with Kd, all of which induced CTL. On the other hand, UV male 1 had at least two distinct TRA, one of which, associated with Kd, exclusively induced CTL. However, in the absence of the dominant TRA, another TRA associated with Ld on R95C, a variant of UV male, 1, induced CTL. Unlike other tumors, R95C grew progressively in short-term-UV-irradiated syngeneic mice. Nude mice reconstituted with a combination of CD4+ T cells from short-term-UV-irradiated mice and CD8+ T cells from normal mice did not reject R95C. An increase in the former T cell population led the reconstituted mice to reject the tumor. These findings suggest some functional defects of CD4+ T cells rather than the generation of suppressor cells in short-term-UV-irradiated mice. The UV-induced tumors used in the present study provide a unique system for analyzing the preferential sorting of TRA as well as for elucidation of the TRA itself.

[A case of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with acute bilateral optic neuritis with normal findings on pattern-reversal visual evoked potential study]

A 35-year-old man with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with acute bilateral optic neuritis is described. At age 33, he noticed a tingling sensation in his toes followed by weakness in the lower limbs. He was admitted to our hospital because he became unable to walk without support. His motor and sensory symptoms gradually resolved during 7 months admission only with physical rehabilitation. At age 35, in July 1988, he noticed a tingling sensation in his toes and fingers, which reached to the knees and elbows in October 1988, when he developed weakness in the lower limbs. Motor and sensory symptoms were almost stationary thereafter and in March 1989, he experienced bilateral blurred vision of acute onset without ocular pain. He was readmitted to our hospital in April 1989. The neurological examination revealed decreased visual acuity of both eyes without any abnormality of the optic disks, mild weakness on flexion and extension of toes, an absence of Achilles reflex, and distal impairment of pain and touch sensations in the upper limbs, and of pain, touch and vibration sensations in the lower limbs. After laboratory examinations, CSF protein was elevated (122 mg/dl), and sensory nerve conduction velocity of the right median nerve was decreased (37.1 m/sec). The sural nerve action potential was not elicited on electrical stimulation. Central scotoma was found in both eyes by the visual field examination. P100 latency was seen to be normal by repeated pattern-reversal visual evoked potential (VEP) studies. CT and MRI of the brain were unremarkable.(ABSTRACT TRUNCATED AT 250 WORDS)

Reactivation of phototoxicity test for psoralens plus ultraviolet A by low-dose methotrexate

Reactivation of a solar burn has been reported after administration of methotrexate for cancer and psoriasis patients. We report a case of psoriasis with a similar but delayed elicitation of phototoxic reaction by administration of low-dose methotrexate one month after psoralen and long-wave ultraviolet light (PUVA) treatment. The reactivation was seen in an already receding phototoxicity test area but not in a less phototoxic, noninterval PUVA treated area, suggesting that the reactivation by methotrexate is related with the severity of light-induced skin inflammation.

Epitope mapping for epidermolysis bullosa acquisita autoantibody by molecularly cloned cDNA for type VII collagen

Epidermolysis bullosa acquisita is a subepidermal blistering disease in which patients have autoantibodies against the non-collagenous domain of type VII collagen. Starting with previously isolated 1-kilobase pair (Kb) cDNA for this autoantigen, we isolated overlapping cDNAs with a combined open reading frame of approximately 3.2 Kb, encoding most (approximately 115 kilodaltons [KDa]) of the N-terminal non-collagenous domain of type VII collagen. To localize immunogenic domains, we produced maltose-binding fusion proteins with cDNA encoding different portions of this autoantigen. These cDNA fragments scan from 5' to 3' of this non-collagenous domain and overlap each other. An immunoblot analysis of these fusion proteins with eight epidermolysis bullosa acquisita patient sera demonstrated that each patient serum binds to different regions of this molecule and that epitopes for these patient sera locate throughout this autoantigen. These data suggest that multiple epitopes on the N-terminal non-collagenous domain of type VII collagen are recognized by circulating autoantibodies in patients with epidermolysis bullosa acquisita.

Elevated serum levels of IgE-binding factor/soluble CD23 in bullous pemphigoid

IgE-related abnormalities and impaired B cell function have been reported in patients with bullous pemphigoid (BP). CD23 is a low affinity Fc epsilon RII on haematopoietic cells and its soluble form (sCD23) is involved in B cell growth and differentiation. In order to determine the role of CD23 in the pathomechanisms of BP, the present study assayed the level of sCD23 in sera of BP patients using an ELISA method. Levels of sCD23 were elevated in BP patients compared with mean levels in the sera of normal control. Furthermore, the increase in sCD23 levels correlated with the degree of disease activity. A significant correlation was found between sCD23 and serum IgE levels in BP sera, but not in normal control sera. These results suggest that sCD23 is an important index for monitoring BP with respect to IgE-related abnormalities and impaired B cell function.

Electrophysiologic interaction between class I antiarrhythmic drugs and volatile anesthetics in depressant effects on ventricular activation in a canine myocardial infarction model

Previous studies showed that volatile anesthetics depressed ventricular delayed activation in a canine myocardial infarction model. It is well known that class I antiarrhythmic drugs depress the ventricular activation in the infarcted myocardium. In the present study, we examined the electrophysiologic interaction between volatile anesthetics (sevoflurane, isoflurane) and class I antiarrhythmic drugs (lidocaine, procainamide) in effects on the ventricular delayed activation in a canine myocardial infarction model. The conduction time of the premature stimulation-induced ventricular excitation was measured in both normal and infarcted zones of the ventricle. An interval from the premature stimulus artifact to the epicardial activation was measured on bipolar electrograms as an index of conduction time, i.e., activation time. In the infarcted zone, the volatile anesthetics and class I antiarrhythmic drugs prolonged the activation time in the infarcted zone, and the combination of the volatile anesthetics and the class I antiarrhythmic drugs markedly prolonged the activation time or blocked the delayed activation. In the normal zone, a similar synergistic interaction was observed, but the effect of these drugs was less compared with that in the infarcted zone. From these results, possible mechanisms to explain the synergistic interaction were discussed.

Photodynamic therapy and/or external beam radiation therapy for roentgenologically occult lung cancer

BACKGROUND AND METHODS

Thirty-nine roentgenologically occult lung cancers in 29 patients were treated using photodynamic therapy (PDT) and/or thoracic radiotherapy (TRT) from January 1986 to March 1992. With the exception of one mixed-tumor case, all were squamous cell carcinomas.

RESULTS

Initial PDT achieved complete responses in 25 of 39 (64%) of the cancers. Of the remaining 14 cancers that showed less than complete response (CR), 10 of the 14 (71.4%) showed a CR when subsequently treated with TRT, yielding an overall CR rate of 89.7% for cancers treated. Although nine patients experienced recurrences, six of these had CR when treated with PDT and/or TRT. To date, 22 patients are alive. Causes of death in the patients enrolled in this study are as follows: pyothorax (2); heart failure due to pulmonary hypertension (1); chronic respiratory insufficiency (1); subsequent primary brain cancer (1); and subsequent primary lung cancer (1). Only one died of primary lung cancer.

CONCLUSIONS

These findings suggest that PDT and/or TRT may be used as an alternative to surgery in the treatment of selected patients with roentgenologically occult lung cancer.

Synergistic interaction between class I antiarrhythmic drugs and halothane in depressant effects on ventricular activation in a canine myocardial infarction model

Previous studies have showed that halothane has depressed ventricular activation in a canine myocardial infarction model. It is also well known that class I antiarrhythmic drugs depress ventricular activation in the infarcted myocardium. In the present study, we examined whether some electrophysiologic interactions between halothane and two class I antiarrhythmic drugs, lidocaine and procainamide, occur in a canine myocardial infarction model. Halothane, lidocaine and procainamide prolonged the activation time in the infarcted zone, and the combination of halothane and either lidocaine or procainamide markedly prolonged the activation time or blocked the delayed activation in the infarcted zone. Although the mechanism of the interaction is not clear, the present results suggest a synergistic interaction between halothane and class I antiarrhythmic drugs. Therefore, care should be taken that doses of class I antiarrhythmic drugs during halothane anesthesia will not be an overdose.

Gene alterations and clinical characteristics of xeroderma pigmentosum group A patients in Japan

BACKGROUND AND DESIGN

The responsible gene for xeroderma pigmentosum group A was recently identified. This study was performed to detect the gene alteration of xeroderma pigmentosum group A complementing gene in 29 xeroderma pigmentosum group A patients in Japan and to analyze whether genetic alterations in the xeroderma pigmentosum group A complementing gene are related to the clinical features.

RESULTS

Of 29 patients, 25 (86%) had a mutation at the splicing junction of intron 3 and exon 4 in the homozygous state that was detected by the polymerase chain reaction and the AlwN I-restriction fragment length polymorphism. Patients having a splicing mutation at intron 3 in the homozygous state develop severe skin manifestations from early infancy and severe progressive neurologic abnormalities, including sensorineural hearing impairment, brain atrophy, mental retardation, areflexia, and ataxia. Four patients were heterozygous for splicing mutation in intron 3. Among them, at least three patients showed milder skin symptoms and milder neurologic abnormalities than patients with the homozygous splicing mutation. Two patients (single-ovum twins) revealed a compound heterozygote of splicing mutation of intron 3 and a nonsense mutation of exon 6. One patient had the splicing mutation and another mutation at the last codon of exon 5, a type of mutation that has never been reported.

CONCLUSION

These data indicate that different genetic alterations in the xeroderma pigmentosum group A complementing gene may induce different clinical features.

Effects of volatile anesthetics, enflurane, isoflurane, and halothane on ventricular delayed activation in a canine myocardial infarction model

The authors examined the effects of volatile anesthetics (enflurane, isoflurane, and halothane) on ventricular activation in a canine myocardial infarction model. Enflurane at 1 minimum aveolar concentration further delayed or blocked delayed activation in the infarcted zones with only slight effects on activation of the normal zones. Halothane showed similar and comparable effects on ventricular activation to those of enflurane. Although isoflurane also showed similar effects, they were of a lesser extent. Enflurane and halothane, but not isoflurane, inhibited ventricular stimulation-induced arrhythmias. Thus, enflurane and halothane produced marked depression of delayed activation in myocardial infarction, which may affect, that is, inhibit or provoke, ventricular arrhythmias in myocardial infarction.

Susceptibility to UVB light in cultured keratinocytes of cutaneous lupus erythematosus

In this study, we investigated UVB-light-induced cytotoxicity and the binding of antibodies to extractable nuclear antigens on cultured keratinocytes from patients with cutaneous lupus erythematosus (LE). Keratinocytes from cutaneous LE patients showed a higher susceptibility to single-dose UVB light irradiation compared to keratinocytes from normal controls. The binding of antibodies to U1RNP and Ro/SS-A antigens on cultured keratinocytes was induced by UVB light and more up-regulated when cultured keratinocytes were reacted with autologous sera. Antibody-dependent cellular cytotoxicity (ADCC) was induced when cultured keratinocytes irradiated with UVB light were combined with autologous sera, using peripheral mononuclear cells of normal controls. Immunohistochemical studies of skin biopsy specimens from patients with systemic LE revealed an increased number of epidermal Langerhans cells at the peripheral sites of skin lesions and a relative dominance of infiltrative CD8-positive lymphocytes in the central area of skin lesions. Based on these findings we suggested that ADCC mechanisms were involved in the development of skin lesions, and the distribution of Langerhans cells and infiltrated CD8 cells were responsible for the expansion and persistence of lesions.

Production of monoclonal antibodies against the N-terminal noncollagenous domain of type VII collagen encoded by epidermolysis bullosa acquisita antigen cDNA

Eleven monoclonal antibodies were produced against the human N-terminal noncollagenous domain of type VII collagen. All antibodies were specifically bound to the epidermal basement membrane zone and did not cross-react with other dermal collagens. A binding of these antibodies was investigated with various species and revealed that the reactivities of each monoclonal antibody against rat, mouse, human and guinea pig skin differ from each other. These data may suggest that type VII collagen is antigenic to immunized small animals, i.e. the rat and mouse, and that there are multiple antigenic determinants on type VII collagen.

[Further study of Schellong testing in 152 young females]

Orthostatic dysregulation (OD) generally implies a systemic condition indicating poor circulatory function resulting from autonomic imbalance, which usually appears in a rather young population at or around puberty, predominantly in females. This condition can be recognized from the results of a questionnaire which has been proposed and prepared by the Pediatric OD Study Group of Japan as diagnostic criteria for OD. Schellong testing has also been developed as a screening method to determine OD or orthostatic hypotension. We carried out a survey and analyzed data collected with the questionnaire and Schellong test results among 152 young normal females ranging in age from 18 to 21 years in order to obtain the actual prevalence of OD in these subjects. Among 152 young normal females, 39 (25.7%) were confirmed to have OD based on the questionnaire. Although orthostatic dizziness was relatively common in this series of young females, regardless of the presence or absence of OD (90/152, 59.2%), this symptom, which is listed as one of the 5 major items on the questionnaire, was much more prevalent in subjects with OD (37/39, 94.9%). Similar prevalence patterns for fatigability or unexplained tiredness were also found in subjects with OD (28/39, 71.8%) when compared with total subjects (55/152, 36.2%). As for the positive rate of the Schellong test, subjects with and without OD showed 33.3% and 31.3%, respectively, and this difference was not statistically significant. There was, however, a highly significant difference in the fall in systolic pressure during the Schellong test procedure between subjects without OD and 10 subjects with OD in whom orthostatic dizziness frequently occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of intravenous anesthetics, thiopental, fentanyl, and morphine on ventricular delayed activation in a canine myocardial infarction model

We examined the effects of intravenous anesthetics (thiopental, fentanyl and morphine) on the ventricular activation in a canine myocardial infarction model. Thiopental at 5 and 10 mg/kg delayed or abolished the delayed activation in the infarcted zones with slight delay of activation of the normal zones. Fentanyl at 30 micrograms/kg slightly but significantly prolonged the activation time in both normal and infarcted zones. Morphine at 1 mg/kg did not produce any significant effect. Thiopental, but neither fentanyl nor morphine, inhibited ventricular stimulation-induced arrhythmias. Thus, thiopental, but not fentanyl nor morphine, markedly depressed the delayed activation in myocardial infarction, which may affect and probably inhibits the ventricular arrhythmias in myocardial infarction. It also should be kept in mind that thiopental may have arrhythmogenic effects in myocardial infarction.

High prevalence of the point mutation in exon 6 of the xeroderma pigmentosum group A-complementing (XPAC) gene in xeroderma pigmentosum group A patients in Tunisia

Xeroderma pigmentosum (XP) patients in Tunisia who belong to the genetic complementation group A (XPA) have milder skin symptoms than do Japanese XPA patients. Such difference in the clinical features might be caused by the difference in the site of mutation in the XP A-complementing (XPAC) gene. The purpose of this study is to identify the genetic alterations in the XPAC gene in the Tunisian XPA patients and to investigate the relationship between the clinical symptoms and the genetic alterations. Three sites of mutation in the XPAC gene have been identified in the Japanese XPA patients, and about 85% of them have a G-->C point mutation at the splicing acceptor site of intron 3. We found that six (86%) of seven Tunisian XPA patients had a nonsense mutation in codon 228 in exon 6, because of a CGA-->TGA point mutation, which can be detected by the HphI RFLP. This type of mutation is the same as those found in two Japanese XPA patients with mild clinical symptoms. Milder skin symptoms in the XPA patients in Tunisia than in those in Japan, despite mostly sunny weather and the unsatisfactory sun protection in Tunisia, should be due to the difference in the mutation site.

Induction of neonatal immunologic tolerance to heart transplantation by intrathymic myocardial cell inoculation in rats

To induce immunologic tolerance, intrathymic inoculation of myocardial cells in rats was performed during the neonatal period. Isolated myocardial cells from Wistar-Lewis (LEW/Crj) rat hearts were inoculated into the thymi of incompatible neonatal Wistar-King (WKAH/HKm) rats without use of immunosuppressants. Ten weeks later the heart from the LEW donor was transplanted heterotropically to the pretreated male WKAH rat (group 1, n = 14). As controls (groups 2 through 4), heart transplantation was performed in each of 10-week-old rats as follows: (1) The syngeneic heart was transplanted (group 2, n = 4); (2) the allogeneic heart was transplanted without use of immunosuppressants (group 2, n = 12); and (3) the allogeneic heart was transplanted with use of immunosuppressants (cyclosporine, 20 mg/kg/day, for 10 days after transplantation, (group 4, n = 5). In groups 1 through 3, four rats with heart transplants in each group were killed on the seventh day after transplantation and were histopathologically examined. No early rejection was seen in group 1. Hematoxylin-eosin staining of the thymus from the inoculated recipient revealed that donor myocardial cells continued to survive in the thymic tissue. The remaining rats in groups 1, 3, and 4 were saved for study of graft survival time. The longest proven graft survival in group 1 was 390 days, whereas it was only 7 days in group 3. These results indicated that intrathymic inoculation of donor myocardial cells in rats into incompatible neonatal recipients induced donor-specific tolerance for subsequent heart transplantation.

Direct effects of cutaneous neuropeptides on adenylyl cyclase activity and proliferation in a keratinocyte cell line: stimulation of cyclic AMP formation by CGRP and VIP/PHM, and inhibition by NPY through G protein-coupled receptors

Many neuropeptides are present in the peripheral nerves of human skin and are distributed from the intraepidermis to subcutaneous appendages, and those peptides are considered to be involved in the pathogenesis of various inflammatory dermatoses. In this investigation, we determined the effects of various neuropeptides on intracellular cyclic adenosine-5'-monophosphate (AMP) formation in cultured human keratinocytes. Among the many peptides tested, calcitonin gene-related peptide (CGRP), vasoactive intestinal polypeptide (VIP), peptide histidine-methionine (PHM), and growth hormone releasing factor (GRF) stimulated a rapid and marked formation of intracellular cyclic AMP in keratinocytes in a dose-dependent manner. The direct association of the receptors for CGRP and VIP with adenylyl cyclase in keratinocytes was confirmed by the findings that CGRP and VIP stimulated the enzyme activity in membrane preparations derived from cultured keratinocytes in the presence of guanosine triphosphate (GTP). On the other hand, neuropeptide Y (NPY) showed an inhibitory effect on forskolin-induced cyclic AMP accumulation in keratinocytes. This inhibitory effect of NPY was completely eliminated by glucocorticoid pretreatment of cultured keratinocytes. Furthermore, the presence of peptides that substantially increase intracellular cyclic AMP accumulation also stimulated DNA synthesis and proliferation in a human keratinocyte cell line in a dose-dependent manner. These results suggest that neuropeptides work directly as biologic modulators of keratinocytes through the cyclic AMP cascade.

Histamine-releasing factor(s) in sera of uraemic pruritus patients in a possible mechanism of UVB therapy

Uraemic pruritus is poorly understood despite the high incidence among chronic renal failure (CRF) patients undergoing haemodialysis. Serum histamine levels have been shown to be elevated in CRF patients with itching, and ultraviolet B (UVB) therapy, even if applied to only part of the body surface, has been reported to be beneficial for the generalized relief of the pruritus. A local mechanism of UVB action is suggested by evidence that UVB radiation is able to suppress histamine release from mast cells. However, detailed systemic mechanism(s) remain obscure. Sera from patients with or without uraemic pruritus were incubated with purified rat peritoneal mast cells and the resulting histamine release was compared. A higher histamine release was obtained with sera from uraemic pruritus patients (44.60 +/- 6.32%, n = 9, P < 0.005) than with sera from patients without itching (19.71 +/- 3.14%, n = 5, P > 0.25) and with normal control sera (23.62 +/- 7.14%, n = 6). This increased histamine release was dose-dependently restored to spontaneous release levels in five of seven patients by pre-exposure of the sera to UVB in vitro. From these results, sera of CRF patients with uraemic pruritus were considered to contain some histamine releasing factor(s) which was depleted or diminished by UVB irradiation, suggesting a possible systemic mechanism of UVB action.

Gene screening of 23 Japanese families with complete thyroxine-binding globulin deficiency: identification of a nucleotide deletion at codon 352 as a common cause

Thyroxine-binding globulin (TBG) is a major thyroid hormone transport protein in human serum. Its complete deficiency (TBG-CD) is one of inherited TBG abnormalities that transmit on X-chromosome. We previously reported a nucleotide deletion at codon 352 of the TBG gene (TBG-CDJ) in Japanese families with TBG-CD. To determine the prevalence of this mutation in Japanese with TBG-CD, 23 affected subjects (19 males and 4 females) belonging to unrelated families living in 4 major islands of Japan were analyzed with regard to the mutation at codon 352. Their genomic DNAs were amplified by the polymerase chain reaction with allele specific primers. Nineteen male and four female subjects were shown to have the mutation as hemizygotes and heterozygotes, respectively. It is concluded that TBG-CDJ may be a common cause of TBG-CD in Japanese and might have appeared in the ancestors of the Japanese after the human race divergence.

gamma delta T-cell receptor-positive cells of human skin. II. Appearance in delayed-type hypersensitivity reaction

In order to investigate the distribution and involvement of human gamma delta T-cell receptor-positive (TCR+) cells in delayed-type hypersensitivity reactions of the skin, we examined the occurrence and kinetics of gamma delta TCR+ cells during skin reactions of allergic contact dermatitis. In normal human skin sections, gamma delta TCR+ cells were scarce. In allergic contact dermatitis from DNCB, increased gamma delta TCR+ cells were observed both in the epidermis and in the dermis from 48 h after the challenge. Most of the gamma delta TCR+ cells were TCR delta 1+ delta TCS1- BB3+ Ti gamma A+ (V delta 1- V delta 2+ V gamma 9+). The percentage of gamma delta TCR+ cells in the peripheral blood remained unchanged and a few gamma delta TCR+ cells in the skin lesions proliferated in situ. It is suggested that the gamma delta TCR+ cells in skin lesions of allergic contact dermatitis may not be involved in initiation of delayed-type hypersensitivity but may have some other roles responding to factors induced in the reaction.

Anti-inflammatory effects of eicosapentaenoic acid on experimental skin inflammation models

Anti-inflammatory effects of eicosapentaenoic (EPA) and docosahexaenoic acids (DHA) were examined on three models of skin inflammation induced in mice by topical application of an arachidonic acid (AA) solution, ultraviolet-B (UVB) irradiation, and contact sensitization with dinitrofluorobenzene. Ear oedema reactions induced by AA and UVB irradiation were significantly suppressed in mice fed a daily dose of 300 mg/kg EPA for 2 weeks. The contact hypersensitivity reaction was not impaired by EPA. None of the skin reactions was significantly inhibited in mice fed DHA or safflower oil. The results suggest that EPA, but not DHA, has anti-inflammatory effects on AA- and UVB-induced acute inflammation reactions.

Dominantly inherited early-onset non-progressive cerebellar ataxia syndrome

A mother and daughter with suspected dominantly inherited, early-onset, non-progressive cerebellar ataxia syndrome have been reported. A review of the literature and the clinical features of the present cases revealed the nosologic features of this rare disorder, possibly dominant inheritance, floppiness and delayed milestones preceding early-onset mild cerebellar ataxia, non-progressive clinical course, retained or even brisk tendon reflexes without pyramidal tract involvement, normal or slightly delayed intelligence, and occasional nystagmus. Neuroimaging reveals selective involvement of the cerebellum, which is prominent in the vermis and the anterior part of the hemispheres.

Cloning and expression of a Pseudomonas 3 alpha-hydroxysteroid dehydrogenase-encoding gene in Escherichia coli

A bacterial strain, B-0831, which produced 3 alpha-hydroxysteroid dehydrogenase (3 alpha HSD) was isolated and identified as belonging to the genus, Pseudomonas. Molecular weights of the purified 3 alpha HSD, determined by SDS-PAGE and by chromatography on Sephacryl S-200, were about 25 and 50 kDa, respectively. A genomic library of Pseudomonas sp. B-0831, prepared in the plasmid vector pACYC184, was screened with probes based on the amino acid (aa) sequence of the protein to obtain the plasmid, p3 alpha HSD1, identified by hybridization with the probes, that contained a 2.4-kb insert from Pseudomonas DNA. When the 1.4-kb SphI fragment of p3 alpha HSD1 was inserted into the vector, pUC118, and introduced into Escherichia coli DH1 under the control of lacZ promoter in the vector, the transformants produced 200-fold more 3 alpha HSD intracellularly than Pseudomonas sp. B-0831. Sequence analysis of the 3 alpha HSD gene revealed that an ORF encoding 3 alpha HSD consists of 254 aa, with a calculated M(r) of 25,761, suggesting that the enzyme consists of homodimer subunits.

Relationship between heat shock protein induction and the binding of antibodies to the extractable nuclear antigens on cultured human keratinocytes

The importance of environmental factors such as ultraviolet light and temperature in the pathogenesis of cutaneous lupus erythematosus is well recognized. Recent evidence suggests the presence of autoantibodies to heat shock proteins (HSP) in the sera and enhanced expression of the HSP70 gene in peripheral blood mononuclear cells of patients with systemic lupus erythematosus. We designed experiments to determine how HSP or stress protein inducers affect the cell surface binding of IgG antibodies from sera containing anti-SS-A/Ro and anti-ribonuclear protein (RNP) antibodies to keratinocytes because these antibodies are considered to be one of the immunologic triggers of cutaneous lupus erythematosus. Immunofluorescence and immunoblot analysis using a monoclonal antibody to the 72 kDa of HSP revealed that an 18-h incubation with 10 micrograms/ml of delta 12-PGJ2, one of cytotoxic prostaglandins, induced HSP72 formation in cultured human keratinocytes. delta 12-PGJ2 augmented the binding of IgG antibodies from sera containing anti-U1RNP and anti-SS-A/Ro antibodies to cultured keratinocytes, but produced no enhancement of the binding of IgG antibodies from sera containing anti-Sm or anti-DNA antibodies. Similar results were also obtained by using flow cytometry analysis. HSP was also induced by ultraviolet B irradiation. These results suggest that exposure of keratinocytes to stressors such as delta 12-PGJ2 and ultraviolet light increases the binding sites for U1RNP,SS-A/Ro, and SS-B/La antibodies. The association between HSP induction and the appearance of extractable nuclear antigens may provide a better understanding of why environmental stimuli can promote the development of erythematous lesions in the skin.