[Mastoid pneumatization after blocking the aeration route through the eustachian tube]

In the mastoid air cell system, air has been thought to be supplied only through the eustachian tube and tympanic cavity to the cells, and to be absorbed continuously in one direction through the lining mucosa of the mastoid air cells. In the ear with a blocked air supply route to the mastoid air cell system, gas in the blocked mastoid air cells has been thought to be absorbed and to be replaced by exudate. Recently, several observations have supported the existence of gas exchange not only through the eustachian tube but through the lining mucosa in the mastoid. To clarify gas exchange in mastoid air cells, tympanic cavities of the infant piglet, the tympanic bullae of which is similar to the human mastoid air cell system, were filled with jellied adhesive, an alpha-cyanoacrylate monomer, to block the aeration route to the air cells, and tympanic bullae were examined histopathologically. Group 1: Injection of adhesive into the tympanic cavity 1 month after birth following glycerin injection at 1 week after birth. Group 2: Injection of adhesive 1 month after birth without any prior injection into the tympanic cavity. Group 3: Injection of adhesive 3 months after birth without prior injection. In group 1, remarkable inflammation was subsequently observed in the tympanic bullae, development of the air cell system was markedly inhibited and very few air cells remained intact. In groups 2 and 3, however, inflammatory reactions were relatively mild normal air cells remained on the periphery and development of the air cell system was not interrupted.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between the degree of chronic middle ear inflammation and tympanic bulla pneumatization in the pig as animal model

The relationship between the degree of chronic middle ear inflammation and pneumatization was investigated in the pig as an animal model, since its tympanic bulla closely resembles the human mastoid air cell system. Ten piglets (sire: Landrace-Hampshire crossbreed; dam: Duroc) were used for this experiment. Four ears of two animals served as the normal control group and 16 ears of eight animals were the experimental group. In this latter group, otitis media was induced by injecting glycerin into the middle ear clefts 1 months after birth, and the degree of inflammation was varied by administering or withholding antibiotics (cefamandole and dibekacin) and adjusting the dosage regimen. The animals were sacrificed 6 months after birth and examined for the relationship between the degree of chronic middle ear inflammation present and tympanic bulla pneumatization. Various degrees of inflammation were successfully induced by injecting the antibiotics: the more severe the inflammation found, the greater was the inhibition of pneumatization. Findings demonstrated that the degree of inhibition of pneumatization produced was directly proportional to the severity of chronic middle ear inflammation.

A case of central diabetes insipidus with spontaneous remission after 8 years of the disease

A 55-year-old male smoker developed polyuria and polydipsia in November 1983. A water deprivation study revealed a defect in the urine concentrating function, which was corrected by vasopressin. Plasma antidiuretic hormone (ADH) was not increased by smoking. His condition was well controlled by deamino-D-arginine vasopressin. However, since February 1992 he has become completely free from the need for medication to control his urine volume. Re-evaluation studies with water deprivation and smoking revealed dramatic improvements in the urine concentrating function and ADH response. A patient with idiopathic diabetes insipidus with spontaneous remission after 8 years is reported.

Restriction fragment length polymorphisms of the human renin gene: association study with a family history of essential hypertension

The aim of this study was to elucidate whether human renin gene restriction fragment length polymorphism (RFLP) is associated with essential hypertension. We sampled randomly 45 inpatients at our hospital and divided them into two groups according to a family history of essential hypertension, FH(-) and FH(+) groups. The FH(+) group was further divided into two subgroups based on the level of BP, FH(+) x HT(-) and FH(+) x HT(+) groups. The frequencies of renin gene RFLP patterns were compared among three groups: FH(-), FH(+) x HT(-) and FH(+) x HT(-). Among 18 restriction endonucleases tested, renin gene RFLPs were detected by three restriction endonucleases, Mbo I, Bg I and Hind III, digestion. There was a significant difference in the distribution of renin gene Mbo I genotypes among the three groups (chi 2 = 13.284, P < 0.01). The distribution of Mbo I genotypes in the FH(-) group was different from FH(+) x HT(-) group (chi 2 = 5.990, P < 0.05) and FH(+) x HT(+) group (chi = 9.210, P < 0.01), but there was no significant difference between the FH(+) x HT(-) and FH(+) x HT(+) groups. The distribution of renin gene Bgl I and Hind III genotypes were similar in the three groups, FH(-), FH(+) x HT(-) and FH(+) x HT(+). These results indicate that human renin gene Mbo I RFLP is significantly associated with a family history of essential hypertension.

Differential gene expression and regulation of type-1 angiotensin II receptor subtypes in the rat

A simplified and sensitive method for measuring expression levels of type-1 angiotensin II (AT1) receptor subtypes, AT1A and AT1B, was established. The two receptor cDNAs were co-amplified and measured by polymerase chain reaction using primers based on the corresponding receptor subtype genes. Both AT1A and AT1B mRNAs were widely expressed in the rat tissues including adrenal gland, kidney, heart, aorta, lung, liver, testis, pituitary gland, cerebrum and cerebellum. AT1A mRNA was predominantly expressed in the rat tissues examined except adrenal gland and pituitary gland where AT1B mRNA was predominantly expressed. Sodium depletion did not change mRNA levels of AT1A and AT1B in the all tissues. However, both AT1A and AT1B mRNA levels in the heart and aorta were down-regulated by treatment with AT1 specific antagonist, TCV 116. In contrast, AT1B mRNA in the adrenal gland was mainly reduced by the treatment. These results suggest that the expression level of AT1B mRNA in the adrenal gland depends on the activity of the renin-angiotensin-aldosterone system (RAAS) and both receptor subtypes mediate contraction and hypertrophy of the smooth and cardiac muscles via the RAAS.

[A case of "pure" progressive autonomic failure in an elderly male]

A 68-year-old man was admitted to our hospital because of postural hypotension in July 1991. He was also suffering from anhydrosis, urinary disturbances, constipation and impotence. He had not developed signs of Parkinsonism, cerebellar or peripheral neuropathy four years from the onset. Various autonomic function tests showed sympathetic and parasympathetic dysfunction of mainly postganglionic origins. Thus we diagnosed this patient as "pure" progressive autonomic failure ("pure" PAF). "Pure" PAF is a new entity described by Bannister and Oppenheimer in 1982. It shows symptoms of autonomic failure without other neurological disturbances which manifest as Shy-Drager syndrome. Treatment with L-DOPS increased his blood pressure level and attenuated his symptoms due to orthostatic hypotension.

Adult T-cell leukemia with a solitary lung mass

A 49-year-old woman was admitted to the hospital with supraclavicular lymph node swelling. On a chest x-ray film, a 4 x 4-cm nodular shadow was observed in the right middle lung field. The white blood cell count was 10,100/cu mm, showing 44 percent abnormal lymphocytes with lobulated nuclei. Since HTLV-I antibodies were markedly positive, she was diagnosed as having ATL. Transbronchial tumor biopsy revealed accumulation of ATL cells. Our patient is the first case with only a large nodular accumulation of ATL cells without diffuse infiltration of the cells in the lung.

Renin gene restriction fragment length polymorphisms in a Japanese family with a high incidence of essential hypertension

1. Human renin gene restriction fragment length polymorphisms (RFLP) were compared in a Japanese family which has a high incidence of essential hypertension. 2. RFLP of human renin gene were observed in three restriction enzymes, Mbo I, Bgl I and Hind III; 1.4 kb and 1.0 kb [Mbo I], 5.0 kb and 9.0 kb [Bgl I] and 9.0 and 6.2 kb [Hind III]. 3. Plasma renin activity was not associated with blood pressure. 4. Renin gene RFLP were not cosegregated with essential hypertension in this Japanese family.

Effect of renal denervation on the development of hypertension in Dahl-Iwai salt-sensitive rats

Renal denervation has been shown to delay the onset of hypertension in spontaneously hypertensive rats and DOCA-salt sensitive rats. We investigated the contribution of the renal nerves to the development of hypertension in Dahl-Iwai salt-sensitive (DS) rats. Bilateral renal denervation or sham-operation was carried out in DS rats, and animals were then kept on a high salt diet (study I) or on a normal salt diet (study II). DS rats became severely hypertensive (207 +/- 8 mmHg) after 4 weeks on a high salt diet. They became mildly hypertensive (156 +/- 3 mmHg) after 4 weeks on a normal salt diet. In both studies, renal denervation exerted no effect on the development of hypertension in the DS rats. The urinary sodium excretion, urinary volume, heart rate and body weight were unaltered by renal denervation. These results indicate that the renal nerves do not make a major contribution to the development of hypertension in DS rats.

Quantitative measurement of extra-renal renin mRNA by polymerase chain reaction

We established a simplified method of the quantitative measurement of extra-renal renin messenger RNA using polymerase chain reaction system. We could detect the renin messenger RNA in the kidney, heart, aorta and adrenal gland from a single RNA sample obtained from a Wistar-Kyoto rat. In the kidney, heart, aorta and adrenal gland, the contents of renin messenger RNA were found to be 55.8 +/- 17.8, 0.15 +/- 0.05, 0.11 +/- 0.03 and 0.16 +/- 0.07 pg/micrograms of total RNA (n = 5, mean +/- s.d.), respectively. The present method is very useful to study the extra-renal renin-angiotensin system.

Quantitative analysis of serum IL-6 and its correlation with increased levels of serum IL-2R in HIV-induced diseases

We have devised a luminescence sandwich ELISA for the quantification of IL-6 in both sera and cell culture supernatants, which had a detection limit of 100 fg/ml of test sample. By using the luminescence sandwich-ELISA, low but measurable levels of IL-6 (9.5 pg/ml on average) were found in the sera from normal individuals. The serum levels of IL-6 were elevated in HIV-seropositive asymptomatic carriers (55.5 pg/ml on average), and the IL-6 levels were correlated with the degree of HIV-induced disease progression (AIDS-related complex 106.8 pg/ml on average and (AIDS 283 pg/ml). IL-6 immunoreactivity in the sera of AIDS patients eluted at a 25,000 m.w. major peak, which was biologically active and heat-stable, and a 500,000 m.w. minor peak in size-exclusion HPLC. Interestingly, a significant correlation was observed between the serum IL-6 levels and soluble IL-2R levels. In vitro, HIV infection of PHA-activated PBMC led to enhanced release of IL-6 into the culture supernatants. Moreover, soluble IL-2R release was markedly increased by adding exogenous IL-6, whereas it was decreased by adding the neutralizing anti-IL-6 mAb to the cultures. These results demonstrate that increased IL-6 levels are significantly associated with sIL-2R levels, and suggest a cause of the increased levels of this receptor in patients with HIV infection. Furthermore, both serum IL-6 and serum IL-2R levels in HIV infection reflect the stage of the HIV-induced disease.

Quantitative analysis of serum IL-6 and its correlation with increased levels of serum IL-2R in HIV-induced diseases

We have devised a luminescence sandwich ELISA for the quantification of IL-6 in both sera and cell culture supernatants, which had a detection limit of 100 fg/ml of test sample. By using the luminescence sandwich-ELISA, low but measurable levels of IL-6 (9.5 pg/ml on average) were found in the sera from normal individuals. The serum levels of IL-6 were elevated in HIV-seropositive asymptomatic carriers (55.5 pg/ml on average), and the IL-6 levels were correlated with the degree of HIV-induced disease progression (AIDS-related complex 106.8 pg/ml on average and (AIDS 283 pg/ml). IL-6 immunoreactivity in the sera of AIDS patients eluted at a 25,000 m.w. major peak, which was biologically active and heat-stable, and a 500,000 m.w. minor peak in size-exclusion HPLC. Interestingly, a significant correlation was observed between the serum IL-6 levels and soluble IL-2R levels. In vitro, HIV infection of PHA-activated PBMC led to enhanced release of IL-6 into the culture supernatants. Moreover, soluble IL-2R release was markedly increased by adding exogenous IL-6, whereas it was decreased by adding the neutralizing anti-IL-6 mAb to the cultures. These results demonstrate that increased IL-6 levels are significantly associated with sIL-2R levels, and suggest a cause of the increased levels of this receptor in patients with HIV infection. Furthermore, both serum IL-6 and serum IL-2R levels in HIV infection reflect the stage of the HIV-induced disease.

[A case of peripheral adenoid cystic carcinoma]

A case of peripheral adenoid cystic carcinoma in a 70-year-old woman is presented. She had a coin lesion in the left upper lung field on chest X-ray film. Before one month on admission to our hospital, she noticed a tumor in the left thigh and underwent simple resection. Histological diagnosis was liposarcoma. Lung metastasis of the liposarcoma or primary lung cancer were suspected. Lung wedge resection was performed and adenoid cystic carcinoma was diagnosed. Generally adenoid cystic carcinoma originates from bronchial gland, arising in the trachea or main bronchus. In this case, the tumor originated from the peripheral lung field.

Anomalous aortic origin of the left anterior descending coronary artery with dilated cardiomyopathy

Serious complications such as angina pectoris and myocardial infarction in patients with anomalous origin of a coronary artery have been documented. However, this anomaly with dilated cardiomyopathy is very rare. We present the first case of anomalous origin of the left anterior descending coronary artery with dilated cardiomyopathy.

Heparan sulfate proteoglycan of murine glomerular basement membrane: relationship between localization of the core protein and localization of fixed negative charges

Antibodies to a 250,000 molecular weight heparan sulfate proteoglycan (HSPG) core protein purified from PYS-2 cells were prepared in the rabbit. After absorption with laminin, the anti-HSPG serum (AHSPGS) was specific for HSPG by enzyme-linked immunoabsorbent assay (ELISA). Immunoelectron microscopy showed that AHSPGS reacted with the mouse glomerular basement membrane (GBM) or, more precisely, with three HSPG rich layers, i.e., (i) the lamina rara interna in a discrete or interrupted-linear pattern, (ii) the interface between the GBM and the soles of the foot processes, and (iii) the lamina rara externa in a finely discrete pattern. The localization of HSPG in the GBM was very similar to that of the fixed negative charges detected with polyethyleneimine (PEI). When mice were treated with heparitinase, binding of PEI was seen only on the cell surface including the foot process soles (ii) but not in the GBM (i and iii), while the localization of HSPG core protein was unaltered. These results suggest that the localization of the HSPG core protein was correlated with that of the fixed negative charges in the GBM (i and iii). The foot process base (ii) seems to be a complicated zone since the PEI binding in this area was less affected by heparitinase treatment, while this area has been reported to have a lower sialic acid content than the foot process surface facing the urinary space.