Non-machinery-based system for cell-free, concentrated autogenous ascitic fluid reinfusion

A non-machinery-based system for the reinfusion of ascitic fluid was developed and assessed. In fundamental studies utilizing bovine serum, this procedure proved economical, quick and useful. The most suitable filter was PS-R (#405-2). Bovine serum with a protein concentration below 3.0 g/dl was treated using this system. Samples containing blood (prepared to 0.5% hematocrit) were also treated, but the treatment time required was double that of serum with the same protein concentration. In both cases the protein recovery ratios were about 90%. We conducted clinical studies on 62 occasions (machinery-based system; 31 times, non-machinery-based system; 31 times) on 19 cases of ascites refractory to treatment with various drugs including diuretics. Clarification of the differences between the non-machinery-based system, indicated the former to be superior. This new procedure is easier because of its use of no machinery, and the high protein recovery ratio proved its usefulness.

Lumbar spondylolysis in children and adolescents

We investigated 185 adolescents under the age of 19 years with spondylolysis. All but five were active in sport. The pars defect was classified into early, progressive and terminal stages. Of the 346 pars defects in 185 patients, 39.6% were early, 29.5% progressive and 30.9% in the terminal stages. Conservative management produced healing in 73.0% of the early, 38.5% of the progressive and none of the terminal defects. These results suggest that spondylolysis is caused by repetitive microtrauma during growth and can be successfully treated conservatively if treatment is started in the early stage. There was elongation of the pars interarticularis as the pars defect progressed, and this is likely to be a consequence of the defect rather than a contributing cause.

Lumbar spondylolysis in children and adolescents

We investigated 185 adolescents under the age of 19 years with spondylolysis. All but five were active in sport. The pars defect was classified into early, progressive and terminal stages. Of the 346 pars defects in 185 patients, 39.6% were early, 29.5% progressive and 30.9% in the terminal stages. Conservative management produced healing in 73.0% of the early, 38.5% of the progressive and none of the terminal defects. These results suggest that spondylolysis is caused by repetitive microtrauma during growth and can be successfully treated conservatively if treatment is started in the early stage. There was elongation of the pars interarticularis as the pars defect progressed, and this is likely to be a consequence of the defect rather than a contributing cause.

FK506 treatment of graft-versus-host disease developing or exacerbating during prophylaxis and therapy with cyclosporin and/or other immunosuppressants. Japanese FK506 BMT Study Group

A phase II study of the efficacy and safety of FK506, a new potent immunosuppressant, has been conducted in 49 patients with GVHD after allogeneic BMT. Eighteen patients with acute GVHD and 31 with chronic GVHD entered the study. FK506 was administered at an initial dose of 0.05 mg/kg i.v. or 0.15 mg/kg orally twice a day to those whose GVHD had become uncontrollable with cyclosporin and/or other immunosuppressants. The response to FK506 was evaluated in 13 patients with acute and 26 with chronic GVHD. A marked response was observed in 5 and a good response in 2 of 13 patients with acute GVHD. For those with chronic GVHD, the response was marked in 2 patients, good in 10 and poor in 8. The most common adverse effects were renal toxicity (53.1%), followed by nausea and vomiting (30.6%) and a feeding of warmth (18.4%). There was a correlation between renal toxicity and whole blood levels of FK506. The dose should be adjusted to keep a trough level between 15 and 25 ng/ml. FK506 is promising in the treatment of both acute and chronic GVHD, even if it is intractable with other immunosuppressants, and may be most effective if administered early in the course of GVHD.

[Perioperative management of patients with Meigs syndrome]

We report our perioperative management of three cases of Meigs syndrome. The major pre-operative problems in Meigs syndrome are physical trouble caused by giant mass in peritoneal space, respiratory distress, and poor nutrition. These problems must be settled before the operation. The important points in the pre-operative management are 1) respiratory care employing the intermittent positive pressure breathing (IPPB) and the pleural effusion drainage, and 2) the correction of intravascular volume and the concentration of albumin and hemoglobin by transfusion of massive lactated Ringer solution and albumin solution and/or whole blood when they are necessary. During the operation, the epidural anesthesia under spontaneous breathing is the best method of anesthesia. According to circumstances, we adopt the intra-tracheal intubation with continuous positive airway pressure breathing (CPAP). We can generally deal with excessive bleeding by transfusion of lactated Ringer solution and plasma expander, during the first half of operation. By the end of the operation, however, the correction of the concentration of albumin and hemoglobin must be made by the fresh frozen plasma and blood transfusion. After the operation, we use epidural analgesia to control the postoperative pain. We have succeeded in the treatment of three cases of Meigs syndrome owing to our perioperative management as described above.

Influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine

The influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine was evaluated retrospectively. Out of 118 patients treated in our clinic for cervical OPLL between 1976 and 1992, 27 had sustained minor trauma to the cervical spine. Of these 27 patients, 13 developed myelopathy, seven showed deterioration of preexisting myelopathy, and no neurological change was observed in seven patients. Regarding the relationship between the diameter of the residual spinal canal and the neurological outcome in these 27 patients, 18 out of the 19 patients with a narrow residual spinal canal (< 10 mm) developed neurological deterioration, whereas that occurred in only two of the eight patients with a wider spinal canal (> or = 10 mm). Although the severity of myelopathy and the transverse area of the spinal cord measured from T1-weighted magnetic resonance images, in patients who had sustained minor trauma was not statistically different from patients without trauma, neurological recovery after surgical treatment was poorer in the former group than in the latter. These results indicate that even indirect minor trauma to the neck can cause irreversible changes in the spinal cord if there is marked stenosis of the cervical spinal canal; such patients who are at risk, must be educated, and should be told to avoid even minor injuries at any cost.

A nationwide epidemiological survey of spinal cord injuries in Japan from January 1990 to December 1992

This survey of traumatic spinal cord injuries in Japan from January 1990 to December 1992 was carried out by a statistical method of the nationwide epidemiological study. The number of the registered patients during these 3 years was 9752 and the mean response rate of every of the 47 prefectures was 51.4%. The registered patients with neurological deficits (Frankel A-D) were 7471 and the annual spinal cord injury incidence was 40.2 per million. The ratio of cervical cord injuries to more caudal SCI was 3:1. The age distribution and the causes of spinal cord injuries are presented in detail. From the results of this study, the prevention campaign should be focused mainly on the following topics: sports and motorcycle accidents involving young people; traffic accidents involving adults; falling accidents involving aged people.

The discovery and function of plastocyanin: A personal account

A brief autobiographical account is presented of the early research that led to the discovery of the copper protein plastocyanin and the identification of its function as an electron carrier in plant photosynthesis. A discussion follows of different approaches employed for the determination of the functional site of plastocyanin in relation to cytochrome f. A summary is provided of a heated controversy about the involvement of two or three light reactions in photosynthesis and an experiment is described that has contributed to resolution of the controversy through the identification of the functional site of plastocyanin. An early history of photosynthesis research in Japan is also discussed.

The efficacy of indomethacin in the treatment of uremic pericarditis

Uremic pericarditis is common in patients undergoing chronic hemodialysis and has been difficult to cure using conservative medical and surgical methods of treatment. Indomethacin therapy for uremic pericarditis has been reported infrequently. We present a case of uremic pericarditis in which indomethacin was particularly effective. The patient was a 45-year-old woman with thrombocytopenia due to Banti's syndrome and congestive heart failure with pericardial effusion. She had been undergoing hemodialysis for 3 years for chronic renal failure due to chronic glomerulonephritis. Uremic pericarditis was diagnosed based on serological laboratory results, aspirated pericardial fluid, and an echocardiogram. She was treated with oral doses of 25 mg t.i.d. indomethacin in addition to hemodialysis and extracorporeal ultrafiltration method. Pericardial effusion and left ventricular dysfunction disappeared after indomethacin therapy for 38 days. There are conflicting reports on the efficacy of indomethacin therapy in patients with uremic pericarditis. While indomethacin therapy was very effective in our case, there may be many causes of uremic pericarditis for which indomethacin may not be efficacious. Further investigations of indomethacin therapy for patients with uremic pericarditis are necessary to elucidate the therapeutic mechanism by which indomethacin acts.

[Clinical study of a new injectable cephem, FK037, for acute bacterial prostatitis]

FK037, a new injectable cephem antibiotic, was administered in the treatment of 13 acute bacterial prostatitis (mean age 53.5, range 30-79), and its effectiveness and safety were evaluated. The human prostatic fluid (PF) concentration of FK037 on 7 specimens 1 hour after 1 g i.v.d., was in the range of 0.87-7.47 micrograms/ml (mean +/- SD, 3.43 +/- 2.23 micrograms/ml), whereas, the serum concentration averaged 45.3 +/- 2.88 micrograms/ml, the ratio of PF/serum consequently being 0.08 +/- 0.05. In the clinical study, 1g of FK037 was administered to 13 patients by i.v.d. twice a day for 7-9 days. Bacteriological eradication on expressed prostatic secretion (EPS) was obtained for all clinical isolates which included 11 strains of Escherichia coli (MIC < or = 0.05 microgram/ml), 2 of Enterococcus faecalis, and each one of Staphylococcus aureus and Morganella morganii. Symptomatical cure was 100% in all cases. As for safety profile, no side effects were noted. In laboratory values, slight elevation of transaminase were detected in 3 cases, but they were transient and returned to normal 1-2 weeks after completion of the therapy. We conclude that FK037 is highly effective in the treatment of acute bacterial prostatitis, and is well tolerated in comparison with other relative antimicrobials.

The roles of the N-linked carbohydrate chain of rice alpha-amylase in thermostability and enzyme kinetics

The thermostability and kinetics of starch hydrolysis were compared between a rice alpha-amylase isozyme Amy1A and its mutant enzyme that lacks an N-linked carbohydrate chain. Elimination of the N-glycosylation site in Amy1A reduced the thermostability of the enzyme. The temperature dependence of the kinetic parameters (Vm and Km) and substrate recognition of the enzymes were also affected by elimination of the N-glycosylation site. These results suggest that the N-linked carbohydrate chain of Amy1A has important roles in the thermostability and reaction kinetics of the enzyme.

Homogeneous immunoassay of antibody by use of liposomes made of a model lipid of archaebacteria

Liposomes made of 1,2-di(3RS,7R,11R-phytanyl)-sn-glycero-3-phosphocholine (DPhyPC), which was synthesized as one of the model lipids existing in archaebacterial halophiles, showed excellent stability. Because of this high stability, DPhyPC liposomes could be constituted high ratios (50%) of N-[4-(p-maleimidophenyl) butyryl] dipalmitoyl phosphatidylethanolamine (MPB-DPPE), and consequently could bind large amounts of antigen (alpha-chymotrypsinogen A) on the liposome surface in comparison with those made of ordinary lipids, such as dipalmitoylphosphatidylcholine (DPPC). Though the characteristics of the DPhyPC liposomal membranes in lysis by the classical complement pathway were similar to those of DPPC liposomes, a high sensitivity and a low detection limit in the liposome immune lysis assay (LILA) of antibodies were attained by binding large amounts of the antigen. Further, by coupling sufficient amounts of antigen, almost all the DPhyPC liposome surface was covered with the antigen, and such liposomes showed higher resistance against non-specific lysis caused by complement activity in serum samples, which may be effective in reducing positive-false errors in LILA.

[A case of pulmonary tuberculosis with HIV infection--review of 5 cases in Japan]

Recently we encountered a case of pulmonary tuberculosis with HIV infection. The patient was 54-years old male. His chief complaints were anemia, emaciation and severe diarrhea. He was admitted to our hospital on September 18, 1992. He had been diagnosed in another clinic as having pulmonary tuberculosis before the admission to our hospital. His chest films taken on admission revealed homogeneous infiltrates with cavitation in right upper lobe. Serial chest X-rays consisted with the findings of post-primary tuberculosis. Sputum smear for acid fast bacilli was positive. From his clinical manifestations and life-history, we had a suspicion that he had infected with HIV. Laboratory findings were as follows: serum albumin level was 1.9 g/dl, CRP was 10.2 mg/dl, serological tests for HIV were positive by EIA, IFA and western blott method, total lymphocyte count was 819/microliters, CD4+ T lymphocyte count was 120/microliter CD4+/CD8+ ratio was 0.2. He was treated with AZT, isoniazid, streptomycin and rifampicin. The disease progressed rapidly and interstitial pneumonia, jaundice and clouding of consciousness appeared at the terminal stage. He expired on October 14, 1992. In this paper, the authors reported a case of pulmonary tuberculosis with HIV infection and also reviewed 5 cases of pulmonary tuberculosis associated with HIV in Japan.

Characterization of soluble CD44 in the circulation of mice. Levels are affected by immune activity and tumor growth

ELISA determinations revealed substantial concentrations (0.49 to 2.10 micrograms/ml) of soluble CD44 in murine serum, with some variation among normal mouse strains. At least three species of CD44 were identified by immunoprecipitation and SDS-PAGE analysis of serum. The most prominent was indistinguishable in mobility from that extracted from normal and transformed lymphocytes and was estimated in this way to be approximately 90 kDa. A similar estimate resulted from gel filtration under nondenaturing conditions, followed by ELISA. However, lymphocyte membrane-extracted and soluble CD44 had different mobilities after treatment with neuraminidase plus O-glycosidase, and the core protein of soluble CD44 might be 17 to 20 kDa smaller than that of CD44 on lymphocyte membranes. Furthermore, an Ab to cytoplasmic residues of CD44 failed to recognize soluble CD44 recovered from the circulation or in lymphoma culture supernatants. These observations would be consistent with cleavage of CD44 from cell surfaces; and protease inhibitors slowed the loss of CD44 from cultured lymphomas. Serum CD44 levels were significantly reduced in immunodeficient CD17.SCID and BALB/c.Xid mice, and elevated in tumor-bearing mice. Mild graft-vs-host (GVH) reactions also resulted in increased concentrations of CD44, as did autoimmune disease in BXSB and MRL/lpr strains of mice. Serum with high concentrations of CD44 partially blocked the binding of one ligand, hyaluronate, to CD44-bearing hybridoma cells. The degree of inhibition was positively correlated with CD44 concentration. These findings indicate that substantial quantities of CD44 can be released into the circulation by cleavage from cell surfaces and that this process is markedly influenced by immune system activity and tumor growth. The material seemed to be intact and potentially functional.

Characterization of soluble CD44 in the circulation of mice. Levels are affected by immune activity and tumor growth

ELISA determinations revealed substantial concentrations (0.49 to 2.10 micrograms/ml) of soluble CD44 in murine serum, with some variation among normal mouse strains. At least three species of CD44 were identified by immunoprecipitation and SDS-PAGE analysis of serum. The most prominent was indistinguishable in mobility from that extracted from normal and transformed lymphocytes and was estimated in this way to be approximately 90 kDa. A similar estimate resulted from gel filtration under nondenaturing conditions, followed by ELISA. However, lymphocyte membrane-extracted and soluble CD44 had different mobilities after treatment with neuraminidase plus O-glycosidase, and the core protein of soluble CD44 might be 17 to 20 kDa smaller than that of CD44 on lymphocyte membranes. Furthermore, an Ab to cytoplasmic residues of CD44 failed to recognize soluble CD44 recovered from the circulation or in lymphoma culture supernatants. These observations would be consistent with cleavage of CD44 from cell surfaces; and protease inhibitors slowed the loss of CD44 from cultured lymphomas. Serum CD44 levels were significantly reduced in immunodeficient CD17.SCID and BALB/c.Xid mice, and elevated in tumor-bearing mice. Mild graft-vs-host (GVH) reactions also resulted in increased concentrations of CD44, as did autoimmune disease in BXSB and MRL/lpr strains of mice. Serum with high concentrations of CD44 partially blocked the binding of one ligand, hyaluronate, to CD44-bearing hybridoma cells. The degree of inhibition was positively correlated with CD44 concentration. These findings indicate that substantial quantities of CD44 can be released into the circulation by cleavage from cell surfaces and that this process is markedly influenced by immune system activity and tumor growth. The material seemed to be intact and potentially functional.

Morphologic analysis of the cervical spinal cord, dural tube, and spinal canal by magnetic resonance imaging in normal adults and patients with cervical spondylotic myelopathy

STUDY DESIGN

Transverse areas of the spinal canal, the dural tube and the spinal cord of the cervical spine of normal adults and patients with cervical spondylotic myelopathy (CSM) were analyzed by magnetic resonance imaging (MRI).

OBJECTIVES

Correlations of the results of MRI to clarify the pathogenesis of CSM.

SUMMARY OF BACKGROUND DATA

Relationships between the area of the spinal cord and that of the dural tube or the spinal canal have been reported, but there is no report to compare the relationships among the three in patients with CSM and normal adults.

METHODS

T1-weighted MR images of the cervical spine of 96 normal adults and 74 patients with CSM were evaluated by measuring the transverse areas of the three structures mentioned above in the axial plane.

RESULTS

In normal adults, the maximal transverse area of the spinal cord was 85.8 mm2 at C4/5 and the minimal transverse areas of the dural tube and the spinal canal were 186.0 mm2 at C5/6 and 236.1 mm2 at C4, respectively. At the unaffected level of C3, the ratio of the canal to the spinal cord was significantly higher in CSM patients than in age-matched normal adults. The transverse area of the spinal cord and the ratio at the maximal compression level showed significant correlations with the severity of neurological symptoms.

CONCLUSION

These results suggest that the narrow area and high ratio of the spinal canal to the spinal cord are responsible for a static factor in CSM.

Purification of secreted alpha-amylases by immunoaffinity chromatography with cross-reactive antibody

Two isozymes of rice alpha-amylases expressed and secreted by recombinant yeast were purified by immunoaffinity chromatography by using cross-reactive antibody. Antibodies raised against partially purified barley alpha-amylase adsorbed rice alpha-amylases in fermentation broth by a cross-reaction. By use of these antibodies as ligands, rice alpha-amylases were concentrated and purified to a high degree in one-step immunoaffinity chromatography. Because of the differences in the contaminating impurities between the barley alpha-amylase (antigen) from barley malt and rice alpha-amylases (target protein) secreted from yeast, the high purity of eluted alpha-amylases was attained without the use of highly purified antigen for immunization. Utilization of cross-reactive antibodies in immunoaffinity chromatography is useful for the purification of recombinant proteins in the absence of a sufficient amount and high enough purity of the target proteins to be purified.

Malignant T cell lymphoma associated with sarcoidosis

We report an unusual case of non-Hodgkin T cell lymphoma associated with sarcoidosis. A 44-year-old woman was histologically diagnosed as having sarcoidosis in 1966. Diffuse interstitial lung disease and erythematous skin nodules disappeared following steroid therapy. Twenty years after sarcoidosis onset erythematous nodosum recurred and biopsy specimens revealed non caseating epithelioid granuloma. Thirty-seven months later a malignant T cell lymphoma developed in the skin portion where sarcoid lesions recurred. We discuss the possible relationship between the sarcoid inflammatory process and the development of a malignant T cell clone as origin of the T cell lymphoma.

Human parvovirus B19-induced aplastic crisis in iron deficiency anemia

Human parvovirus B19 (HPVB19) infects and replicates in erythroid progenitor cells. Its specific cytotoxic effect on these cells results in aplastic crises in patients with congenital hemolytic anemias. Aplastic crisis due to HPVB19 infection in a healthy girl revealed occult iron deficiency anemia. The condition is characterized by a high serum iron level in the aplastic phase and rapid recovery after administration of iron. Temporary HPVB19-induced red blood cell aplasia could occur in patients with other anemias, particularly those with non-inherited form of hemolysis.

Involvement of membrane-bound transglutaminase in the invagination of transferrin into rat reticulocyte plasma membrane

We demonstrated the invagination of transferrin into reticulocyte plasma membrane to learn whether membrane-bound transglutaminase (TGase, a Ca(2+)-dependent enzyme) is involved in this invagination. The invagination was assessed by acid-resistance assay and antibody-inaccessibility assay. The invagination was blocked in the absence of ATP. [14C]Putrescine, a substrate for TGase, was incorporated into the membrane during the invagination. This incorporation was decreased in the absence of ATP or transferrin and was completely blocked in the presence of monodansylcadaverine or EGTA. The TGase inhibitor and EGTA also decreased the invagination. In the sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis, the labeling of 43 kDa membrane protein with [14C]putrescine and the increase in aggregation of proteins were observed in a transferrin-, ATP- and Ca(2+)-dependent manner. These results provide the first evidence for modification of protein by TGase accompanying the invagination of transferrin into the membrane, and suggest that membrane-bound TGase is involved in the invagination step of endocytosis.

Increased production of eicosanoids, TXA2, PGI2 and LTC4 in experimental spinal cord injuries

Arachidonate metabolites have many kinds of bioactivities. Thromboxane A2 (TXA2) stimulates platelet aggregation and vasoconstriction, whereas prostaglandin I2 (PGI2) antagonises its activities. Thromboxane B2 (TXB2) and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) are determined in biological materials. Production of TXB2, 6-keto-PGF1 alpha and leukotriene C4 (LTC4), which have potent vascular permeability, was measured by radioimmunoassay in experimental spinal cord injured animals. TXB2 level in the rat spinal cord reached a peak concentration of 133.6 +/- 3.8 pmol/g cord, and 6-keto-PGF1 alpha increased to 26.2 +/- 11.7 pmol/g cord 5 minutes after the injury. There was good correlation between TXB2 production and vascular damage as monitored by fluorescein uptake. When OKY-046 ((E)-3-[4-(1-imidazolylmethyl) phenyl]-2-propenoic acid), which selectively inhibits TXA2 synthetase activity, was administered 10 minutes before injury, the increase in TXB2 production was inhibited by more than 80%, but the degree of vascular damage was reduced by only 40%. In the guinea pig spinal cord, LTC4 levels reached a peak concentration of 2.2 +/- 0.4 pmol/g cord 10 minutes after compression, while that of TXB2 reached 146.8 +/- 6.2 pmol/g cord. The increased production of TXB2 was correlated with the degree of compression injury while that of LTC4 production did not. These findings suggest that vasoactive eicosanoids, TXA2, PGI2 and LTC4, play important roles in secondary damage following spinal cord injury, although their roles may be different among species of animals.

Diagnostic usefulness of MR imaging for pedunculated hepatocellular carcinoma

Pedunculated hepatocellular carcinoma (HC) is an uncommon tumor of the liver. We present the case of a 56-year-old man with pedunculated HC arising from the lower surface of the liver. We recommend sagittal magnetic resonance imaging, which offers a superior choice of scanning planes, in the diagnosis of pedunculated HC.

Phosphorylation by Ca2+/calmodulin-dependent protein kinase II and protein kinase C of sepiapterin reductase, the terminal enzyme in the biosynthetic pathway of tetrahydrobiopterin

Sepiapterin reductase, the terminal enzyme in the biosynthetic pathway of tetrahydrobiopterin, was stoichiometrically phosphorylated by Ca2+/calmodulin-dependent protein kinase II and protein kinase C (Ca2+/phospholipid-dependent protein kinase) in vitro. Maximal incorporation of phosphate into the enzyme subunit by these was 3.05 +/- 0.05 (n = 4) and 0.74 +/- 0.03 (n = 5) 32P mol per mol enzyme subunit, respectively. The enzyme was not phosphorylated by cyclic nucleotide-dependent protein kinase of either the cAMP-dependent or cGMP-dependent type in this study. Dihydropteridine reductase, another enzyme working in direct supply of tetrahydrobiopterin, was also a good substrate for Ca2+/calmodulin-dependent protein kinase II. Phosphorylation of sepiapterin reductase by these protein kinases modified the kinetic properties of the enzyme. It is likely that these multifunctional Ca(2+)-activated protein kinases may play a role in the regulation of the physiological function of the BH4-generating enzymes in vivo, as was previously found in the case of BH4-requiring enzymes.

Neurological recovery after conservative treatment of cervical cord injuries

We reviewed a series of 53 patients with closed traumatic complete injuries of the cervical spinal cord. They were admitted within two days to a spinal injuries centre, treated conservatively by six weeks of bedrest and skull traction, then mobilised in a neck support for six weeks. Eight patients had temporary neurological deterioration, four spontaneously and four after cervical manipulation; seven of these recovered to the initial neurological level without surgery. Of 40 patients followed for more than 12 months, 19 recovered useful motor power in local muscles which were initially paralysed (zonal recovery); one patient showed distal motor recovery. Zonal recovery did not correlate with the mechanism of skeletal injury or with the degree of residual canal stenosis. Sensory sparing and an initial neurological level higher than the level of skeletal injury were both good prognostic signs for zonal recovery.

Neurological recovery after conservative treatment of cervical cord injuries

We reviewed a series of 53 patients with closed traumatic complete injuries of the cervical spinal cord. They were admitted within two days to a spinal injuries centre, treated conservatively by six weeks of bedrest and skull traction, then mobilised in a neck support for six weeks. Eight patients had temporary neurological deterioration, four spontaneously and four after cervical manipulation; seven of these recovered to the initial neurological level without surgery. Of 40 patients followed for more than 12 months, 19 recovered useful motor power in local muscles which were initially paralysed (zonal recovery); one patient showed distal motor recovery. Zonal recovery did not correlate with the mechanism of skeletal injury or with the degree of residual canal stenosis. Sensory sparing and an initial neurological level higher than the level of skeletal injury were both good prognostic signs for zonal recovery.

Oblique odontoid fracture. Case report and review of the literature

The case of a 89 year old patient with an oblique odontoid fracture is reported. The fracture was oblique extending from the middle of the anterior aspect of the dens to the posterior junction with the body. There was also posterior displacement. This fracture was different from the previously reported two vertical fractures of the odontoid. The possible mechanism of the lesion, and the management of this patient are discussed.

Experimental approaches for the reconstitution of hair in vitro

When plucked follicles were cultured together with isolated dermal papillae in a collagen gel matrix, outer root sheath cells (ORSCs) grew more rapidly and actively than without the papillae. Cultured dermal papilla cells also activated the colony growth of ORSCs in vitro. These results may suggest the existence of some papilla-derived factor(s) activating the growth of ORSCs. In cultures of excised whole follicles whose dermal papilla had been removed, epithelial cells of bulb matrix origin grew out from the bulbous portion, and formed spikes. When a dermal papilla was implanted close to the follicle, the spikes elongated toward the papilla, and finally reached and surrounded it. This finding suggests that dermal papillae may produce some factor(s) attracting epithelial cells of hair bulb origin. In cultures of excised whole follicles, when the dermal papilla remained originally positioned in contact with the hair bulb matrix, the hair and follicle elongated for more than 1 week. But when the dermal papilla was detached from the bulb matrix, the matrix cells proliferated into the gel and formed a hair-follicle-like structure (folliculoid). In cultures of excised whole follicles whose papilla-matrix junction had been damaged by dispase, elongation of the hair and follicle was almost completely suppressed. Thus, the attachment of the dermal papilla to the bulb matrix appears to be necessary for normal hair and follicle growth.

Spinal cord injuries in Japan: a nationwide epidemiological survey in 1990

To survey the situation of traumatic spinal cord injuries (SCI) in Japan, the SCI Prevention Committee of the Japanese Medical Society of Paraplegia sent out by mail study charts in the form of questionnaires to institutions nationwide. Using the statistical method of the nationwide epidemiological survey described by Hashimoto et al,1 the annual estimated incidence was obtained from the number of patients registered, and from the questionnaire reply rate at each prefecture. The number of registered patients in 1990 was 3465 and the mean reply rate was 56.6%. There were 2665 registered patients with a neurological deficit (Frankel A-D) and the annual SCI incidence was 39.4 per million. The male:female ratio was 4.3:1 and the ratio of cervical cord injures to those caudal to the cervical cord was 2.9:1. The mean age at the time of injury was 48.5 years. The cause most frequently seen was traffic accidents, the second most frequent being falls from a height. Besides those two, sports injuries and falls on level ground were the third most frequent causes of SCI in the young generation and in elderly people respectively.

Pleural multicystic mesothelial proliferation

We report a rare case of pleural multicystic mesothelial proliferation occurring in a 62-year-old Japanese woman. Macroscopically, the lesion consisted of multiple thin wall cysts containing clear serous fluid. Histologic studies, including hematoxin-eosin stain, as well as the immunohistochemical method, revealed that the lesion was mesothelial in origin and consistent with a reactive change.

Dephosphorylation on tyrosine of epidermal growth factor receptor is inhibited by Ca2+ pretreatment in isolated liver membrane

The autophosphorylation of epidermal growth factor receptor of the liver membrane was enhanced by pretreatment with 1 mM Ca2+. This enhancement was blocked by 30 microM genistein, but not by 30 microM H-7. In immunoblotting analysis, the amount of phosphotyrosine increased in the Ca(2+)-pretreated membrane. When dephosphorylation processes were studied, receptor dephosphorylation occurred in a time-dependent manner in the untreated membrane, but not in the Ca(2+)-pretreated membrane. In the presence of sodium vanadate, receptor phosphorylation increased in the untreated membrane, but not in the Ca(2+)-pretreated membrane. Inhibition of dephosphorylation did not occur in the membrane pretreated with Ca2+ in the presence of monodansylcadaverine, a transglutaminase (TGase) inhibitor. These results suggest that Ca2+ pretreatment causes the inhibition of some protein tyrosine phosphatase via a Ca(2+)-involved mechanism such as activation of TGase and results in the enhancement of receptor phosphorylation.

(R)-1,2,3,4-tetrahydro[1]benzothieno[2,3-c]pyridines: novel optically active compounds with strong 5-HT1A receptor binding ability exhibiting anticonflict activity and lessening of memory impairment

(R)-1,2,3,4-Tetrahydro[1]benzothieno[2,3-c]pyridine derivatives (60-114) were synthesized. The (R)-isomers have affinity for the 5-HT1A receptor while the (S)-isomers have no such ability. The affinity of the (R)-isomers was discussed on the basis of structure-activity relationships between the affinity and hydrophobicity of the (R)-isomers. Compounds 71 and 107, which are representative derivative compounds, have anticonflict activity and lessening of memory impairment. In particular, compound 107 cannot bind to receptors other than the 5-HT1A receptor, demonstrating that it is a unique compound with a different mechanism of action from that of conventional anxiolytics.

[Atresia of the right coronary ostium associated with annulo-aortic ectasia--a case of successful surgical repair]

A case of a 51-year-old male with atresia of the right coronary artery and annulo-aortic ectasia is described. He presented with heart failure and underwent open-heart surgery. Preoperative aortography did not show the ostium of the right coronary artery. At surgery the right coronary ostium was not found on the intimal surface of the aneurismal aortic wall. A fine cord was attached to the adventitial surface of the anterior aortic root. A modified Bentall's procedure was performed to reconstruct the left coronary artery alone. The post-operative course was uneventful. It is speculated that the hypoplastic ostium of the right coronary artery was pulled up and formed a flap-like closure with increased expansion of the aorta.

Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy

The morphologic changes and signal intensity of the spinal cord on preoperative magnetic resonance images were correlated with postoperative outcomes in 74 patients undergoing decompressive cervical surgery for compressive myelopathy. The transverse area of the spinal cord on T1-weighted images at the level of maximum compression was closely correlated with the severity of myelopathy, duration of disease, and recovery rate as determined by the Japanese Orthopaedic Association score. In patients with ossification of the posterior longitudinal ligament or cervical spondylotic myelopathy, the increased intramedullary T2-weighted magnetic resonance imaging signal at the site of maximal cord compression and duration of disease significantly influenced the rate of recovery. A multiple regression equation was then developed with these three variables to predict surgical outcomes.

Experimental model of carotid artery thrombosis in rats and the thrombolytic activity of YM866, a novel modified tissue-type plasminogen activator

We compared the thrombolytic activity of a novel modified t-PA, YM866, with that of t-PA in a rat model of electrically-induced thrombosis. Histological examination revealed the thrombus to be composed mainly of platelet clumps. Measurement of the decrease in carotid blood flow showed that complete occlusion occurred within 14 min. At 10 min after the induction of thrombus, a test drug (YM866, t-PA, or saline) was administered by i.v. bolus injection under heparinization (300 IU/kg, i.v.). Both YM866 and t-PA exhibited dose-dependent thrombolytic activity; the reperfusion rate of YM866 was twice that of t-PA. There was no significant difference in time to reperfusion between the agents, but YM866 showed a greater improvement in patency status after successful thrombolysis than t-PA. Plasma fibrinogen fell slightly but significantly (14% of baseline value) in animals given 1 mg/kg of YM866. All groups of rats showed a significant decrease in carotid artery blood flow at 1 hr after successful reperfusion or injection of the drug, but this decrease showed significant recovery in animals given 1 mg/kg of YM866. These results suggest that YM866 by single bolus injection is a superior thrombolytic agent to t-PA, and that YM866 can improve the patency status after successful thrombolysis. Furthermore, this platelet-rich thrombosis model permits continuous observation of the process of thrombus formation and subsequent thrombolysis and provides a useful tool for the screening and evaluation of efficacy of new antithrombotic agents.

Role of platelet activating factor in ischaemia-reperfusion injury of isolated rabbit hearts: protective effect of a specific platelet activating factor antagonist, TCV-309

OBJECTIVES

The aims were to confirm that platelet activating factor is released during reperfusion after global ischaemia in isolated blood perfused rabbit hearts, and to examine the protective action of TCV-309, a platelet activating factor antagonist, against reperfusion injury of cardiac muscle.

METHODS

The hearts were mounted on a Langendorff apparatus and perfused with diluted blood perfusate. After cardiac arrest with St Thomas's cardioplegic solution, the hearts were subjected to global ischaemia for 120 minutes at 25 degrees C, and then reperfused for 60 minutes at 37 degrees C. Release of platelet activating factor into the coronary effluent was quantified by radioimmunoassay. The effect of TCV-309 on left ventricular function and release of creatine kinase was measured.

RESULTS

A pronounced release of platelet activating factor occurred after the commencement of reperfusion, although it was not detectable before induction of ischaemia. Release of platelet activating factor occurred over 60 minutes of the reperfusion period. In the control, left ventricular developed pressure after 60 minutes of reperfusion recovered to 54.3(SEM 1.7)% (n = 5) of the preischaemic value. In the hearts treated with TCV-309 at concentrations above 0.3 microM, recovery of left ventricular developed pressure was significantly improved (77.6(2.0)% at 1 microM, p < 0.01 v control). Leakage of creatine kinase during the initial five minutes of reperfusion was significantly less in the hearts treated with 1 microM TCV-309 than in the controls (5.2(0.4) v 12.2(1.4) IU.g-1 wet weight, p < 0.01).

CONCLUSIONS

Release of platelet activating factor occurred during the reperfusion period in Langendorff perfused hearts. Treatment with the platelet activating factor antagonist TCV-309 significantly improved postischaemic left ventricular function and decreased creatine kinase release. These results suggest that platelet activating factor is involved in myocardial injury during ischaemia-reperfusion.

Maintenance of CD5+ B cells at an early developmental stage by interleukin-5: evidence from immunoglobulin gene usage in interleukin-5 transgenic mice

We have characterized the development and expansion of CD5+ B cells in interleukin-5 (IL-5) transgenic mice in terms of autoantibody production and immunoglobulin gene usage. CD5+IL-5R alpha+ B cells maintained in the presence of IL-5 secreted fewer autoantibodies and had fewer N nucleotides at the 3' end of the D elements compared with CD5- B cells. The reduction in nucleotides, along with the finding that CD5+IL-5R alpha+ B cells in IL-5 transgenic mice use Q52 families more frequently than age-matched control B cells, also suggests that these cells have the characteristics of fetus-type B cells and represent an early stage of B-cell development. All of the VH11 families were expressed with JH1 and the Q52 families were frequently expressed with JH1. Furthermore, JH proximal DQ52 was frequently used in IL-5 transgenic mice. All of these characteristics in terms of immunoglobulin gene usage have been described for CD5+ B cells. These results suggest that IL-5 maintains CD5+ B cells that have a fetus-type of immunoglobulin gene usage. This cytokine could be responsible for prolonging the life span of immature CD5+ B cells, which subsequently mature to CD5- B cells that secrete polyreactive natural antibodies.

Use of cultured human epidermal allografts for the treatment of extensive partial thickness scald burn in children

In spite of recent progress in burn treatment, the early surgical therapy of partial thickness scald burns in children is still controversial. Early tangential excisions is not easily applicable for these patients because of difficulties in determination of the burn depth and probable physiological derangement after surgery. Hypertrophic scar formation and wound contraction after meshed autografts are other limitations. For these reasons, conservative treatment, not early excision therapy, has been chosen initially for these injuries. We used cultured epidermal allografts for extensive, partial thickness scald burns, during the early post-burn period without escharectomy. Fifty to 100% of the engrafted superficial dermal burns were epithelialized within 7 days. In contrast, untreated identical wounds remained open. Repeated grafting of cultured allografts on unexcised wound granulations of dermal burns also enhanced epithelialization. Long term results showed that hypertrophic scar formation in the mixed superficial and deep dermal burns was reduced when cultured allografts were used. Allografting of the cultured epidermis without surgical excision apparently promoted the rapid regeneration of the partial thickness burns. Procedural complications did not occur. Cultured allografts should be used as an effective and safe biological dressing for partial thickness scald burns in children.

Calcium pretreatment induces the decrease in epidermal growth factor binding through the activation of transglutaminase in isolated liver membrane

Pretreatment of hepatocytes with Ca2+ and A23187 resulted in the decrease in epidermal growth factor (EGF) binding to the receptor. This decrease could be induced by only the pretreatment of the isolated liver membrane with Ca2+. By the pretreatment with 1 mM Ca2+ for 30 min, EGF binding was decreased to 40% of control. Scatchard plot analyses indicated that high affinity binding sites of EGF receptor disappeared after Ca2+ pretreatment. No effect of Ca2+ pretreatment on the degradation of receptor occurred. The Ca2+ effect was prevented by monodansylcadaverine or iodoacetamide, transglutaminase (TGase) inhibitors. After membrane-bound TGase was inactivated, the Ca2+ effect did not occur, except in the presence of purified TGase. Labeled putrescine was incorporated into some proteins of membrane with Ca2+ treatment. These results suggest that Ca(2+)-activated TGase induces the decrease in EGF binding to the receptor via modification of some membrane protein.

Thrombocytopenia induced by human parvovirus B19 infections

Human parvovirus B19 (B19) has a remarkable tissue-tropism for erythroid elements--from erythroid precursors (BFU-E, CFU-E) to erythroblasts. B19 is thought to be incapable of propagating in cells other than erythroid progenitors. Leukocytopenia and thrombocytopenia sometimes occur in addition to erythrocytopenia in patients with B19 infection. We retrospectively investigated the possible cause of thrombocytopenia by B19 infection in 23 patients with thrombocytopenia admitted to our hospital in the past 5 years. Two patients were found to be infected by B19. Mild thrombocytopenia in both cases was thought to be an early event in B19 infection.

Deferoxamine reduces the reperfusion injury in isolated neonatal rabbit hearts after hypothermic preservation

The protective action of deferoxamine, an iron chelator, against reperfusion injury following hypothermic preservation was investigated in the Langendorff-perfused hearts of neonatal rabbits. Left ventricular function and radical generation were used as parameters to evaluate functional and metabolic changes. The free radicals in coronary effluents were measured with an electron spin resonance spectroscope using a spin trapping agent, 5,5-dimethyl-1-pyrroline-N-oxide (DMPO). The hearts were preserved in cold St. Thomas solution at 4 degrees C for 6 h following cardiac arrest, then reperfused with oxygenated Krebs-Henseleit solution in a control. Deferoxamine (100 microM) was added to the perfusate just prior to reperfusion in group I, and 3 min after the start of reperfusion in group II. In the control group, the left ventricular developed pressure (LVDP) after 30-min reperfusion recovered up to 43.5 +/- 3.1% (mean +/- SD, n = 5) the preischemic value. Group I showed a significant improvement in LVDP recovery after 30-min reperfusion at 57.1 +/- 3.1% (P < 0.01 vs control), but group II did not (47.5 +/- 2.3%). When a burst of DMPO-OH signals was detected during the initial 5 min of reperfusion, the signal intensity in group I was significantly reduced to about 35-40% of the control value. Group II showed a similar intensity to the control group. Thus, we conclude that deferoxamine may exert a protective action against the dysfunction of neonatal mammalian hearts induced by preservation-reperfusion through an inhibition of iron-catalyzed radical formation.

Evaluation of intravascular hemolysis by haptoglobin administration after prosthetic valve replacement

Although the measurement of serum haptoglobin (S-Hp) is of great use for evaluation of intravascular hemolysis, it is not applicable in patients with mechanical prosthetic valves because S-Hp is virtually absent. We administered haptoglobin preparation to 10 patients with Björk-Shiley mitral prosthetic valves and 10 patients with the same aortic prosthetic valves. Serum haptoglobin levels were measured periodically afterwards. The maximum haptoglobin levels (Hp (max)), serum, haptoglobin reducing rate ((Hp-delta Hp)/delta t) and expected haptoglobin disappearing time (hours) were obtained from the subsequent samples. The screening studies which were performed at the same time were not predictors of difference in the 2 groups. On the other hand, serum haptoglobin reducing rate and expected haptoglobin disappearing time indicated that hemolysis is higher in patients with an aortic prosthetic valve than with a mitral prosthetic valve. This haptoglobin administration test seems to be useful for the comparative examination of the intravascular hemolysis caused by the difference in the position of the prosthetic valve.

Hypersensitivity to heparin; a case report

Hypersensitivity reactions to heparin are very rare. A generalized hypersensitivity reaction including as fever and skin rash to a porcine- and bovine-derived heparin preparation was observed in a hemodialysis patient due to the nephrotic syndrome. The patient revealed peripheral eosinophilia and normal serum IgE. The results of a drug lymphocyte stimulating test on heparin were positive. Following prednisolone administration and infusion of nafamostat mesilate as anticoagulant therapy during hemodialysis, the high fever and generalized urticaria disappeared. Caution is required when conducting heparin therapy on hemodialysis patients.

Nucleotide sequence of the Mn-stabilizing protein gene of the thermophilic cyanobacterium Synechococcus elongatus

The nucleotide sequence of the psbO gene encoding the extrinsic 33 kDa protein (the Mn-stabilizing protein) from the thermophilic cyanobacterium Synechococcus elongatus was determined. The deduced amino acid sequence consisted of 272 residues; 26 for the signal peptide and 246 for the mature protein. The amino acid sequences of nine proteolytic peptides from the isolated protein completely agreed with the deduced amino acid sequence. Several unique variations of amino acids were found in the primary structure, of which some may be related to the high thermostability of the protein.

Case report: left ventricular apical hypertrophy in progressive limb-girdle muscular dystrophy

Cardiac involvement is uncommon in patients with limb-girdle muscular dystrophy. This report describes a patient in whom concentric hypertrophy localized to the apical left ventricle was revealed during a long clinical course of skeletal muscular dystrophy, with evolving electrocardiographic changes also compatible with apical hypertrophic cardiomyopathy. Endomyocardial biopsy revealed similar histologic changes in the skeletal muscle biopsy specimen, characterized by muscle fiber atrophy and hypertrophy with a mild degree of interstitial fibrosis. The pathogenesis of cardiac hypertrophy in this case is unclear. However, the pathologic findings suggest that the myocardium may be involved in the same dystrophic process as the skeletal muscles.

Recognition of liposome-bound antigens by antipeptide antibody

In order to clarify the effects of the differences in physical states of antigens on recognition by antibodies in immunoassays, the binding characteristics of an antipeptide polyclonal antibody to the peptide and the corresponding protein were studied. The reactivity in the immunoliposome assay (ILA), as well as in the double-antibody sandwich ELISA, was identical to that in the solution. These results indicate that the conformation of liposome-bound antigen is changed little by coupling to liposomes and is almost the same as that of the native antigen in the liquid phase. It is desirable to assay by double-antibody sandwich ELISA or ILA to detect native proteins, and the latter is very easily performed.